How Amsterdam is reducing child obesity

Childhood obesity rates are rising in many parts of the world – but in Amsterdam they are falling. The city’s healthy-weight programme has seen a 12% drop in overweight and obese children.

“Go!” shouts the instructor. Tyrell van der Wees throws himself forward to do sit-ups, then jumps up and runs to the end of the gym and back again. He is breathing fast, his heart pumping.

The nine-year-old is smiling, working hard and having fun. He is also part of Amsterdam’s efforts to improve the health of its children.

At the back of the gym Tyrell’s mother, Janice, is sitting with other parents watching the fitness class.

“He’s really happy. He is doing something to improve his health. He knows the consequences and he is trying to do something about it,” she says.

Child and teen obesity spreading across the globe

UK: ‘Stark’ increase in overweight youngsters

A year ago Tyrell’s school told Janice he was overweight. Children in Amsterdam are now regularly weighed and tested for agility and balance.

Tyrell was referred to a child health nurse, Kristel de Lijster.

She offered them a package of help including dietary advice, joining a gym class and a volunteer to make home visits – all for free.

In a health centre in south-east Amsterdam, Kristel de Lijster explains how she helps families such as Tyrell’s.

“The most important thing is not to communicate in a standard way, because everybody already knows eating sugar and eating fast food is unhealthy,” she says.

“You really want to communicate the message on the level the parent and the child understands.

“So, when the child is overweight it is more important for them to tell you what they think is going wrong.”

In Tyrell’s case, Janice thinks he was snacking on unhealthy food and playing computer games after school before she returned home from work.

At Tyrell’s flat, Daniphra Millerson has come to pay a visit. She is Tyrell’s “buddy”, part of a volunteer network helping families towards healthier lifestyles.

She makes weekly visits. She has also taken Tyrell to the supermarket to look at healthier food choices and introduced him to some after-school activities.

He now plays tennis, goes to gym class and is much more active.

“It’s working. It’s really working,” says Janice. She is delighted with the range of help available for her son.

“I am really happy that all that support is there from the city so we can make use of it. I wish I had known this before,” she says.

Immigrant communities

Amsterdam’s childhood obesity problem is concentrated in the poorer parts of the city, among immigrant communities from Surinam, North Africa and Turkey.

It is here the city’s healthy-weight programme targets its resources. And it is here the fall in obesity has been greatest.

Between 2012 and 2015 the percentage of children who were overweight fell from 21% to 18.5%, resulting in a 12% drop in the total number of overweight children.

The city authorities are cautious about the findings, but the trend is encouraging.

At a community centre in north Amsterdam, women are chopping vegetables and cooking chicken soup. Most are from Morocco, Syria or West Africa. A dietician is with them giving advice on healthier cooking.

“Obesity is a problem in Amsterdam so it is urgent to work on this,” says Fatima Ouahou, a community organiser.

“The women are the ones who buy and cook the food, so we want them to be the example and spread the message on healthy eating.”

Amsterdam’s healthy-weight programme’s budget is less than €6m (£5.3m) a year.

Rather than hiring new staff, it works with existing professionals including teachers, nurses, social workers and community leaders to get across a consistent healthy lifestyle message.

“We have managed to build a whole systems approach in Amsterdam,” says Karen den Hertog, deputy programme manager.

“In the everyday life of children and their parents, we manage to get the healthy message across and help people have a healthier lifestyle.

“Once we decided what the message was, we were surprised by the enthusiasm from all our partners – youth workers, schools, teachers, doctors and nurses.

“All are using the same message. We hear back from children that it’s good they get the same message.”

Much of the budget goes into supporting Jump-In primary schools, which allow only fruit, water and healthy food in school and encourage exercise.

It was here they faced some early obstacles from parental opposition. However, complaints soon faded, says Pascal Reit, head teacher of Pro Rege School.

“There has been some protest from some parents who think we should not be telling them how to raise their children. Now everyone accepts it. There is no problem any more,” she says.

To keep its healthy message consistent, the city has banned junk food companies from advertising on the subway or sponsoring sporting events. It is also working with shops and supermarkets to promote fresh food.

All political parties back the programme, and this consensus helps the programme take a long-term approach towards healthier lifestyles.

Sugar tax: Will paying more for fizzy drinks and alcohol make us healthier?

An anti-obesity drive is about to see a tax introduced on sugary drinks across the UK, while Scotland is set to impose a minimum price on alcohol to target problem drinking.

But does making unhealthy products more expensive persuade people to make “better” choices? And what are the trade-offs associated with doing so?

Everybody will pay more

The price increases being introduced could lead to significant health improvements, but they will be felt by everybody, not just those with the unhealthiest lifestyles.

From 6 April, the UK’s tax on sugary drinks will see shoppers asked to pay 18p or 24p more a litre, depending on just how much has been added to their drinks. The price of a 1.75-litre bottle of cola bought from a supermarket could increase by about 25%.

In Scotland, from May, alcohol will not be allowed to be sold for less than 50p per unit, which could see a four-pack of cider cost 10% more, while a pack of 20 cans could double in price. Wales is looking at similar measures.

This is happening because sugar and alcohol are associated with problems that impose a substantial cost on society.

For example, problem drinking can lead to anti-social behaviour, crime, pressure on A&Es and increased liver disease. Excessive sugar consumption is linked to rising obesity rates, some cancers, diabetes and heart disease.

But alcohol consumption is concentrated among a relatively small number of people: 5% of households buy more than 30% of all alcohol.

And the government is particularly concerned about obesity among children and young people: teenagers consume more than three times the recommended amount of free sugars – those which are not naturally present in food.

The government has to consider the trade-off between potentially large improvements to public health and making everybody pay more.

Will shoppers make healthier choices?

Price increases will be most effective if the people who consume too much sugar and alcohol significantly reduce their intake.

But people respond differently to higher prices, depending on how much they like the product. And, in the case of alcohol, addiction can also be a factor.

Research by the Institute for Fiscal Studies suggests that heavy drinkers respond less strongly to price increases.

For example, if the price of alcohol increases by 1%, the percentage fall in consumption among households which buy more than 40 units per adult each week is only half as large as among those which buy fewer than eight units.

What people choose to buy instead also matters.

In the case of sugary drinks, increasing the price of a bottle of cola might work if people choose water instead.

But only some drinks, and no foods are being taxed. So, if people choose to buy a milkshake, a chocolate bar, a cake, or ice cream instead of the cola, then the impact of the tax on sugar consumption will be reduced.

It can also be difficult to know how great the impact of a price rise has been, compared with other measures.

The proportion of adults smoking halved between 1974 and 2013 – at the same time as the real rate of excise duties on tobacco more than doubled.

But higher taxes are not the only thing that affected behaviour, as awareness about the dangers of smoking also increased significantly.

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    What will shops and manufacturers do?

    The food and drink industry will react to the taxes – but not necessarily in the intended way.

    The simplest response is for firms to pass on price changes to their customers. But they could choose to change prices by more or less than the tax, which will affect how much consumption falls.

    They may also change their products – a move which could make the policy more effective.

    There are examples of this happening – several soft drinks companies have already reduced the sugar content of their products to avoid the tax. The sugar content of Fanta has been reduced by 30%, for example.

    If people are happy to buy the reduced sugar varieties, this could be a relatively effective way of reducing the nation’s sugar intake.

    And new recipes can work – voluntary targets led to a 5% reduction in the salt content of groceries between 2005 and 2011.

    Money from the sugar tax will go to the government, which could use some of the tax revenue it receives to improve public health, for example by increasing funding for school sports.

    However, minimum pricing per unit of alcohol is likely to create windfall profits for the manufacturers and retailers.

    If the alcohol industry uses the money to increase promotions, or advertising, this could undo some of the potential benefits of the policy.

    The sugar tax and minimum pricing

    • The UK-wide sugar tax takes effect 6 April
    • 18p per litre if the drink has 5g of sugar or more per 100ml
    • 24p per litre if the drink has 8g of sugar or more per 100ml
    • A sugary drink is exempt if it contains at least 75% milk
    • The Scottish Alcohol Minimum Pricing Bill takes effect 1 May
    • Minimum pricing for alcohol to be fixed at 50p a unit

      Other ways of suggesting healthier choices

      Introducing taxes is only one of many options available to the government.

      A lot of attention has been paid to differences in the quality of diet between different people. But there are also big differences in the same person over time.

      Research by the IFS suggests that the share of calories people get from healthy food increases sharply in January and falls by 15% by the end of the year. Similarly, searches for “diet” on Google spike at the start of the year.

      This suggests that if the government could persuade people to behave as they do in January for the whole year, then there could be substantial improvements in nutrition.

      And “nudge” policies that encourage people to make better decisions – such as not allowing sweets and chocolates to be sold next to tills – could be used more widely.

      Such policies could be effective at reducing impulse buys that people later regret.

      A related idea would be adding information about the dangers of excess sugar and alcohol to food labelling, just as health warnings are placed on cigarette packets.

      • Sugar tax is already producing results
      • What happens to sugar tax money?
      • Minimum price ‘will affect 70% of alcohol’

        No easy solution

        The challenges posed by obesity, poor nutrition and alcohol consumption are substantial.

        All the options involve trade-offs.

        The government needs to balance the potential improvements to public health against the costs to consumers.

        It is likely that a whole range of policies will be needed to tackle these major public health challenges.

        Unfortunately, there is no silver bullet.

        About this piece

        This analysis piece was commissioned by the BBC from an expert working for an outside organisation.

        Kate Smith is a senior research economist at the Institute for Fiscal Studies, which describes itself as an independent research institute which aims to inform public debate on economics.

        More details about its work and its funding can be found here.

        Charts produced by Daniel Dunford

        Edited by Duncan Walker

Buying Viagra: What you should know

Men can now buy the impotence pill Viagra Connect without a prescription at some UK pharmacies.

Health experts hope it will mean more men get help for erectile dysfunction – a condition thought to affect up to one in five adult men, 4.3 million in the UK.

Like any medication though, the drug can cause side-effects and should not be misused or abused.

What should men consider before buying and trying the little blue pills?

Who can have it?

Viagra Connect is only for men who have impotence.

No-one under the age of 18 can buy it, although women might be able to buy it on behalf of their partner if the pharmacist is satisfied it is appropriate to dispense it.

And it will not be sold to men who are not medically fit enough to have sex. This includes men with severe heart or blood vessel problems.

As a rule of thumb, men who become very breathless or experience chest pain when doing light exercise, such as climbing two flights of stairs, should not take these pills.

Can it be bought off the shelf?

No. You will need to ask the pharmacist for it, who will then check it is safe for you to take.

A packet of four pills will cost £19.99.

Do men wanting to buy have to talk to someone and be examined?

You can ask at the pharmacy counter for a quiet word or to have a conversation in a private room if they prefer – most pharmacies now have private consultation facilities.

The pharmacist will ask about symptoms, general health, and any other medications you might be taking. They should not ask personal questions about your sex life or sexual preferences.

You should not need a physical examination.

Will it work?

In many cases yes, but it is not effective for everyone.

The drug relaxes the blood vessels in the penis to help blood flow and will help achieve an erection in response to sexual stimulation.

It can be taken with or without food, although it may take a little longer to start working if you have just had a big meal.

You should take it about an hour before you plan to have sex.

Do not take it with grapefruit or grapefruit juice, because this can affect how the medicine works.

And do not take more than one 50mg tablet per day.

If it has been some time since you were able to get or keep an erection, it may take a couple of attempts before you are able to achieve one.

Drinking lots of alcohol can also make it more difficult to get an erection.

What if it is too strong?

Talk to your pharmacist or doctor if you think it is too strong – the drug’s effects last too long or are too powerful.

Prolonged and sometimes painful erections lasting longer than four hours have been occasionally reported by men taking the drug.

Although unlikely, if this does happen, seek immediate medical assistance.

What other side-effects might there be?

Very common (may affect more than one in 10 people):

  • headache

    Common (may affect up to one in 10):

    • dizziness
    • colour tinge to vision or blurred vision – some people start seeing a blue hue
    • hot flushes
    • blocked nose
    • nausea

      Stop taking the pills and seek immediate medical attention if you have a serious side-effect such as:

      • chest pain
      • sudden decrease or loss of vision
      • an allergic reaction (eg difficulty breathing, wheeze and swelling of the lips, eyelids or face)
      • a seizure or fit

        Drug clashes

        People on nitrate pills for angina should not take Viagra Connect. That also goes for people taking recreational poppers (amyl nitrite).

        There is also a clash with a medicine called riociguat and an HIV medication called ritonavir.

        Make sure you tell the pharmacists about any treatments you are taking so they can check it will be safe for you to also have Viagra Connect.

        Pharmacists should advise men to book a follow-up appointment with their doctor within six months of starting on Viagra Connect because erectile dysfunction can sometimes be a sign of other underlying conditions, including heart disease, high cholesterol and diabetes.

        Can I get it anywhere else?

        GPs can prescribe it. And some pharmacies will be selling it online, after a virtual consultation.

        Always check that the seller is reputable. Drugs from unregulated sellers may be fake, ineffective and unsafe.

Teenagers urged to take part in meningitis B vaccine trial

Teenagers in Great Britain are being asked to take part in a study to learn if immunising them against meningitis B could protect them and other people.

The NHS wants 24,000 to take part in the Oxford Vaccine Group’s Be On The Team trial, which is helped by National Institute for Health Research funding.

Bacteria at the back of the throat can cause meningitis and the study will see if vaccination can stop this happening.

The trial will take place in four waves of recruitment over the next two years.

Control group

Each of the teenagers who chooses to participate, in Year 12 in England or the equivalent in Scotland and Wales, will be put into one of three groups of 8,000 participants and will receive two doses of one of two vaccines.

Two of these groups will be in the programme for a year, with the third, which will act as a control group, taking part for 18 months.

The recruitment started this week and is planned to work around school holidays and exams, taking place in March-April and September-October this year and in 2019.

Meningitis B facts

  • Meningitis B is a bacterial infection that most often affects children below the age of one
  • It is the most common form of the condition in the UK
  • Since 2015, children under 12 months have been offered the vaccination
  • There are about 1,200 meningitis B cases each year in the UK
  • With early diagnosis and antibiotic treatment, most people will make a full recovery
  • It is fatal in one in 10 cases
  • About one in four of those who survive is left with long-term problems, such as amputation, deafness, epilepsy and learning difficulties

    Dr Matthew Snape, a consultant paediatrician at the Oxford Vaccine Group, told the BBC: “We’ve had great enthusiasm from the schools we have approached, with the majority of Year 12 students interested in taking part.

    “The peak of carriage for the bacteria is from the teenage years through to young adulthood – there is a lot of carriage with university students.

    “We are doing the study to help us understand whether an immunisation campaign in teenagers would help us to protect the whole community.”

    Dr Snape said the study’s findings would be passed on to policymakers “to inform any future decisions about adolescent meningococcal immunisation”. And there have already been calls for a wider meningitis B immunisation programme.

    Following the death of two-year-old Faye Burdett in 2016, a petition set up to ask for all children to be routinely vaccinated attracted 820,000 signatures.

    As a result, the government published a report last month explaining how it made decisions about which vaccines to fund.

    • Meningitis survivor beats odds to ski
    • Girl, six, died after doctor ‘failed to spot meningitis’
    • Jeremy Hunt ‘apologises’ for meningitis care failures
    • Family’s call to highlight meningitis B symptoms

      One of the report’s recommendations was to lower the cost-effectiveness threshold for immunisation – widescale vaccination against meningitis B had been rejected as being “not cost effective”.

      A consultation on the report is running until 21 May.

      What are the symptoms of meningitis?

      Georgie Hall, whose six-year-old son died from the condition last October, told the BBC: “The government, I know, are saying that it’s not cost effective to vaccinate more children against this disease. We really need the government to listen to the families.”

      And Health Secretary Jeremy Hunt apologised for “system failures” that led to the deaths of two teenagers from the disease in Bristol in 2016.

      Claire Donovan, head of research and information at Meningitis Now, told the BBC: “We support the trial, and it’s something we’ve been waiting to happen for a number of years – we are very keen that it goes ahead.”

      Ms Donovan added that if the trial was successful, “then potentially vaccinating that age group will help protect the rest of the nation”.

      Dr Tom Nutt, the charity’s chief executive, said: “This important study is a chance for young people to make a real difference to not only their own health but that of their wider community.”

Vauxhall to build new Vivaro van at Luton

Vauxhall’s French parent company PSA has announced an investment in its Luton van-making plant which could eventually see Peugeot and Citroen-branded vans made in the UK.

PSA said Vauxhall’s next Vivaro van would be built at the Luton plant.

The investment, which PSA said it made “despite Brexit uncertainties”, secures 1,400 jobs beyond 2030.

However, the Unite union said there was still “a cloud hanging over” Vauxhall’s Ellesmere Port plant.

The government said the investment is worth more than £100m in total. The Unite union estimates that figure to be up to £170m.

It was secured after a negotiation with the Unite union and a financial contribution from the government thought to be about £9m.

Business Secretary Greg Clark said: “Today’s decision is a vote of confidence in Vauxhall’s high-skilled workforce and the UK’s world leading automotive sector.”

In 2017, the Luton plant produced 70,000 Vauxhall Vivaro-branded vans.

The next-generation model will be based on PSA’s Citroen and Peugeot technology, and the company hopes to produce up to 100,000 vans a year, which could include some under the Peugeot and Citroen brands. The life-cycle of commercial vehicles is between 10 and 15 years.

If demand for the vehicles means that target is hit, then additional jobs will be created in Luton.

PSA bought General Motors’ European business last year, and there has been intense speculation about the future of both Luton and Ellesmere port, where the Vauxhall Astra is made.

Group chief executive Carlos Tavares said: “This is a major milestone for the future of the Luton plant and a key enabler to serve our ambitions in the commercial vehicle market.”

Unite general secretary Len McCluskey said: “The investment into Luton is very welcome, but we do expect to hear of similar plans for Ellesmere Port, where the workforce has been just as loyal and is just as deserving of a secure future but continues to live with a cloud hanging over it.”

Peugeot and Citroen have made inroads into the light commercial vehicle market, and accounted for half the increase in the total van market in Europe, which is why the company is looking to increase production capacity.

Company officials said it had the choice of Germany or Poland to base the new plant, but neither of those plants are equipped with a paint facility suitable for vans, and installing one would come at enormous cost.

Vauxhall UK manufacturing

  • Vauxhall employs 1,400 people at its Luton plant, which produces Vivaro vans
  • There has been a plant at Luton building vehicles since 1905
  • The firm has 1,300 employees at its Ellesmere Port plant, where the Vauxhall Astra is built
  • The Ellesmere Port plant has been running since 1962
  • Vauxhall has 3,400 employees overall

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Could non-alcoholic gin ever be as good as the real thing?

It’s 13:00 on a Wednesday lunchtime and in the Palace of Westminster, a very lively drinks party is in full swing.

In the gracious surroundings of the wood-panelled Jubilee Room, corks are popped, beer is guzzled and lemons fizz in free-flowing G&Ts.

But despite the prodigious volume of liquid being consumed, there aren’t any slurred words or collisions with furniture. That’s because, contrary to appearances, no alcohol is actually being drunk.

The event is co-organised by Club Soda, a “mindful drinking movement”, and is being held to showcase low and alcohol-free drinks.

The group, which has about 15,000 members, was co-founded by Jussi Tolvi and Laura Willoughby. Jussi still enjoys the odd alcoholic tipple, but Laura is teetotal.

“I gave up drinking six years ago and was stuck with a tonic or a really bad non-alcohol beer,” says Laura.

“There is demand for good products, but industry is taking time to catch up. Having said that, big companies like Heineken are spending money on creating a beer that tastes like their full-strength product and to me, this shows that it isn’t a fad, it’s a market shift.”

The demand appears to be borne out in the figures. The Office for National Statistics found that in 2016, 20.9% of Brits drank no alcohol, up two percentage points from 2005.

At the same time, CGA, a food and drink data firm, found that for the on-trade – that’s restaurants, bars and festivals etc – sales of no and lower alcohol beers, ciders, wines, spirits and mocktails were £232m in 2017. That’s up about 3% on the year before.

Among the MPs ploughing their way through booze-free tipples at the drinks event is Fiona Bruce MP, chair of the all-party Parliamentary Group on Alcohol Harm.

“There are some lovely options: prosecco, G&T, ale and lager,” she says. “Later, I’m going to be able to go into the chamber of the House of Commons this afternoon and not be in the least bit woozy.”

Botanical buzz

Intrigued, I try a “teetotal G&T” from the Temperance Spirit Company. It’s sold 500,000 bottles in the last year and is one of a new breed of adult-focused soft drinks.

Served over ice and with a slice of cucumber, it looks the part. But after the first sip, I’m not convinced; it lacks that deliciously dry bite of the real thing.

Company director Gillian Venning encourages me to persevere: “It takes a while for the flavour to come through, but you’ll soon start to taste the botanicals.”

The juniper does indeed creep up on me and although that warm ginny buzz is missing, it’s far more interesting than the lemonades and colas normally on offer for non-drinkers.

So why are people drinking less? Jane Peyton, founder of the School of Booze, says there are several reasons: “I recently went to a mindful drinking festival and some people said they weren’t drinking because they were pregnant, for others it was religion, but for many it was for health reasons.”

Jane’s last point chimes with the revelation that during this year’s Winter Olympics, German athletes drank gallons of imported non-alcoholic beer.

According to skier Linus Strasser, “It tastes good and it’s good for the body. Alcohol-free wheat beer is extremely healthy. It’s isotonic. That’s why it’s good for us sports guys.”

‘Good karma’

This is music to the ears of Steve Dass, co-founder of Nirvana Brewery. “We’re the UK’s only alcohol-free brewery,” he says.

“It’s a holistic movement, we’re all vegetarian, we hardly drink, it’s about good vibes, good karma and we also have yoga sessions in the brewery.”

But do they have good beer? Steve pours me a pint of Karma, a pale ale with an ABV (alcohol by volume) of 0.5%.

It’s billed as “light, refreshing, with classic citrus and floral hop aromas leading to a dry bitter finish”.

As a fan of big, flavourful beers, I like the taste, but it doesn’t have the all-important body.

Next up is Chakra, “a hopped pale ale with fresh notes of passion fruit, pine & a light bitter finish”.

This is more like it. At 1% ABV it drinks more like something akin to 3.5% and I reckon I’d be hard pressed to tell the difference in a blind tasting.

“Not being able to tell the difference” is something The Big Drop Brewing Co’s Chocolate Milk Stout has arguably managed to achieve; it won a silver medal in the 2017 World Beer Awards in competition against full-strength rivals.

Delicate and refined

Although beer is one of the most visible parts of the low and no-alcohol market, the sector in general can be hugely innovative.

Zoe Burgess is head of research and development at the Drink Factory, a bar group and consultancy. At a laboratory in East London, she creates both regular and alcohol-free products.

“The key to making good non-alcoholic drinks is to pay as much attention to them as alcoholic drinks, keeping them delicate, refined, using beautiful glasses,” she says. “There’s no reason they should be treated any differently.”

Zoe takes a bag of yellowish liquid from the fridge.

“This is pear shrub syrup. We take whole pears which we slice and cover in caster sugar for a day, add verjus, which is a very delicate vinegar, blend and strain.

“This creates a fine syrup which captures the balance of the pear. We top it up with soda to get that lovely sparkle.”

Zoe and her team work with some of the world’s most exclusive bars, but non-alcoholic alternatives are also becoming more popular in mainstream outlets. Bar chain Be At One offers nine alcohol-free cocktails.

“In the last 12 to 18 months, we’ve seen a growth in demand for drinks which are more like cocktails,” says area manager Tim Sparrow.

“Customers are coming out with friends or work colleagues, so we’re dealing with social experiences as much as the drinks themselves. People don’t want to feel as though they’re being left out just because they’re not drinking.”

‘More fun’

As a designated driver, TV and radio presenter, Susannah Streeter is often left drinking Virgin Marys and she’s keen to try something different, so she joins me in a tasting at the chain’s Soho branch. Her verdict is mixed.

First up is the Botanical: Seedlip Garden 108 non-alcoholic spirit plus egg white, apple juice and sugar syrup.

“It’s made my eyebrows stand on end! It’s got a kick to it and it looks like a champagne cocktail. I also like the glass it’s served in.”

The Passionate Pomme is up next, a blend of passion fruit, manuka honey, pomegranate and coconut water.

“I’m not keen, it’s sweet and syrupy, a bit like Ribena.”

We finish with a Bean: coffee, cream and almond syrup.

“It’s quite substantial and I’d get one as a treat, it’s more fun than a lime and soda.”

So would Susannah order a non-alcoholic cocktail in a bar?

“Yes, if I’d had enough to drink already or I was driving. The choice is usually really boring, so it’s nice to have some options.”

A pair of glasses to see a better future

The turning point might be that moment when you’re struggling to read the small print of the cooking instructions.

Or else it might be when you’re straining to read messages on your mobile phone or decipher a map – and have to hold them further and further away, screwing up your eyes to see.

It’s the moment when you realise you need to do something about your sight, which might mean a trip to the opticians or buying a pair of reading glasses in the chemist’s or supermarket.

But what would happen if there was no way of getting help? What would the consequences be if there were no opticians or affordable glasses and you simply had to accept not being able to read?

The chances of keeping a job or staying in education would begin to diminish, even if it was only a minor problem that could be corrected by glasses.

Narrowing opportunities

A report this week from the Overseas Development Institute shows how much can be lost by something as simple as the absence of a pair of spectacles.

There are an estimated 2.5 billion people worldwide who need glasses but do not have access to them. About 80% of these are concentrated in 20 developing countries, mostly in Africa and Asia.

The report says that the most acute lack of access to eye care and glasses is in the most disadvantaged communities, marginalising even further those with vision problems.

Poor sight in poor countries, says the report, is a barrier to education and employment. It traps families in poverty.

And the ODI think tank warns that while aid budgets are given to urgent, life-threatening illnesses, relatively little international attention is paid to the slow-motion disaster of someone struggling to see clearly.

Locked in disadvantage

But not being able to see well enough to read, and not having glasses, “can lock children into a life of disadvantages”, says the ODI report.

They can be seen as low achievers and fail to get qualifications, rather than be seen as having a simple problem that could be rectified.

Among adults, researchers say, vision problems can mean loss of opportunities in work and loss of income – and for the local economy a lowering of productivity.

The report was commissioned by Hong Kong businessman and philanthropist James Chen, who has made improving eye care something of a personal mission.

He founded a charity in Rwanda, Vision for a Nation, that has tested ways of delivering eye care to large numbers of people.

Taking the long view

Nurses have been trained to give eye tests, glasses have been provided at low cost or for free and there have been treatments for some eye problems, such as eye drops for conjunctivitis.

The Rwandan project has reached two million people and has delivered 160,000 pairs of glasses.

Mr Chen’s charity, Clearly, is lobbying for more attention to be paid to eye problems and to make glasses more readily available.

“Glasses have been manufactured in different parts of the world for at least 700 years, but at least a third of the world’s population still do not have access to them,” says Mr Chen.

“Most of these people have easily correctable problems such as short- and long-sight. The cost to their quality of life is huge and the total economic cost throughout the world runs into the trillions each year.”

Economic gains

He wants the Commonwealth heads of government, gathering in April, to make sight problems and access to glasses a priority in development projects.

Mr Chen says this is a deceptively simple way of improving individual lives and benefiting national economies by making people more productive.

He says that within Commonwealth countries, making glasses available would mean an economic boost worth $44bn (£31bn) per year.

Former UK Prime Minister and UN education envoy Gordon Brown has backed calls to do more to tackle “the cost, in human and economic terms, of so many of our fellow citizens being unable to see”.

“If we fail to act, those left behind will never catch up,” Mr Brown says.

The ODI report suggests the economic return can be 30 times greater than the cost of glasses and the eye-care screening.

Elizabeth Stuart, of the development think tank, said: “If a third of the world cannot see clearly, and fixing it requires only limited investment, and delivers excellent returns, then this would seem to be a no-brainer.”

She said giving people better vision would help to improve education and eliminate poverty – for people who would otherwise be left behind.

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UK/EU trade deal? Boy, it’s going to be a complicated year

When considering any difficult conundrum, it is often worth stating the obvious first.

Both sides in the negotiations between Britain and the European Union say they want a deal on trade once Brexit has happened.

Both have said they want that deal to be comprehensive – “deep and special” according to the UK.

Both have signalled they are willing to give ground to achieve their desired outcome.

Britain – for example – has moved on the issue of financial services’ access to the European Union once we have departed.

No “passporting rights” as Theresa May admitted in her Mansion House speech in London earlier this month.


Just one of the “costs” of Brexit the Government is now admitting are attached to the decision to depart.

Alongside the “benefits” on sovereignty and the freedom to sign free trade deals with non-EU countries.

The EU – for example – has agreed that Britain will be able to negotiate and sign (if not implement) free trade deals with non-EU countries whilst still effectively a member of the single market during the implementation period.

And despite many protestations that there would be no such thing as a “bespoke” free trade deal for the UK, Donald Tusk, the president of the European Council, has made it clear that a different type of deal is exactly what is on offer.

As David Cameron’s former advisor, Mats Persson, now of EY, points out, the offer of no tariffs and no quotas on goods trade between Britain and the EU already puts the deal in a better position than the EU’s agreements with Canada, Norway and Switzerland.

The two sides do differ on sticking points and red lines.


Such as how on earth do you solve the Irish border issue without resorting to “technological solutions” that even the most optimistic of trade negotiators admit don’t actually exist yet?

Or what does “equivalence” look like when it comes to regulating the insurance or banking industries for example?

And can that equivalence be too easily withdrawn by either side, leaving a great deal of regulatory risk on the post-Brexit table?

But, here are two sides in a difficult negotiation whose expressed will is to get a deal.

And, when it comes to negotiations, that is not a bad starting point.

Lower growth?

That is not to say for a moment that whatever Britain’s deal with the EU, there are not likely to be costs.

Nearly all the economic modelling done on any future free trade arrangements – including by the government – have said comparative economic growth is likely to be lower for the UK.

And growth since the referendum has softened as Brexit uncertainty has weighed on business confidence and the inflation spike linked to the fall in the value of sterling has re-introduced the incomes squeeze.

That’s when prices go up more quickly than peoples’ wages.

That effect is only now starting to unwind as the pound strengthens once again.

The timetable is tight for the “political agreement” planned for later this year on a future trade deal.

The government insists it is doable as there is already a great deal of regulatory trust between the two sides, bound as they have been for more than 40 years in a trading union.

And sources indicate that Britain will show the correct degree of humility in asking the “club” to rewrite the rules of an organisation we have just quit.

Heroic assumptions, critics will say.

No deal has been done and Parliament has not voted on leaving the customs union or the single market.

“A shambles” according to the Labour MP, Ben Bradshaw, will remain just that until the government either falls or a different deal is put in place.

For the two protagonists, though, at least in this negotiation both sides want an outcome whose similarities possibly outweigh the contradictions.

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UK car registrations plunge in March

Car registrations plunged in March, according to figures from industry body the Society of Motor Manufacturers and Traders (SMMT).

Preliminary data shows the UK new car market shrank by 15.7% last month compared with 2017.

Demand for diesel vehicles fell 37%, but demand for petrol was flat and that for alternative fuel models rose 5.7%.

March 2017 was a record month as customers bought new vehicles ahead of a change in Vehicle Excise Duty.

New car sales fell for the first time in six years in 2017, with a 5.7% decrease to about 2.5 million vehicles.

Demand for diesel cars plunged by 17% last year, meaning the pace of decline for such vehicles in March has more than doubled.

Analysis: Theo Leggett, BBC business correspondent

At first glance, this looks like deeply worrying news for the automotive industry. But it it’s worth remembering that in March 2017, new car registrations hit a record high. Buyers were rushing to get hold of new vehicles ahead of big changes to the vehicle excise duty regime, which sharply increased the rates payable on some cars.

But we can say with certainty that registrations have now been falling steadily for a whole calendar year. The SMMT has consistently blamed economic uncertainty, which it links to Brexit and the collapse in diesel sales.

The latest figures show that the move away from diesel seems to have accelerated. That suggests that the industry’s attempts to convince consumers and politicians that modern diesels are clean and have a future are failing badly.

By historical standards, new car registrations are still at pretty high levels. The steep fall in March might be a glitch. However, the overall trend cannot be ignored – and that is what the industry will be worried about.

Reaping the wind with the biggest turbines ever made

When engineer Lukasz Cejrowski finally saw the world’s largest wind turbine blades installed on a prototype tower in 2016, he stood in front of it and took a selfie. Obviously.

“It was amazing,” he says, recalling the moment with a laugh. “The feeling of happiness – ‘Yes, it works, it’s mounted.'”

Those blades, made by Danish firm LM Wind Power, were a record-breaking 88.4m (290ft) long – bigger than the wingspan of an Airbus A380, or nearly the length of two Olympic-sized swimming pools. The swept area of such a mammoth rotor blade would cover Rome’s Colosseum.

But things move quickly in the wind turbine industry.

In just a few years, those blades could be surpassed by the company’s next project – 107m-long blades.

LM Wind Power is owned by global engineering firm General Electric (GE), which announced in March that it hopes to develop a giant 12MW (megawatt) wind turbine by the year 2020.

A single turbine this size, standing 260m tall, could produce enough electricity to power 16,000 households.

The world’s current largest wind turbine is a third less powerful than that, generating 8MW. Various companies, including Siemens, are working on turbines around the 10MW mark.

When it comes to wind turbines, it seems, size matters.

This is because bigger turbines capture more wind energy and do so at greater altitudes, where wind production is more consistent.

But designing and manufacturing blades of this size is a significant feat of engineering.

Mr Cejrowski says that the firm could in theory use metal, but the blades would be extremely expensive and heavy. Instead, they use a mix of carbon and glass fibre.

First, they make a glass-fibre and polyester shell for each blade – in two halves. Then the spar cap is added. That’s a length of reinforcing material that runs down the inside of each of these halves.

For this, Mr Cejrowski’s team uses a glass-carbon composite fabric, infused with a special resin that hardens in place.

These ultra-large blades are extensively tested. Prototypes are bent, stretched, buffeted in wind tunnels and, during “fatigue tests”, flexed back and forth quickly millions of times to simulate a lifetime of use. They’re also tested against lightning strike.

The world’s biggest wind turbines are generally installed offshore rather than on land. That way, they avoid being gigantic eyesores in our midst and are able to harness the powerful winds out at sea.

On 17 March, more than a third of domestic electricity generation in Britain was achieved with wind power, the National Grid reported. This is a record.

The potential of offshore wind has prompted some to draw up plans for future windfarms on an enormous scale, in waters many miles from land.

  • Offshore wind cheaper than new nuclear

    US researchers recently showed that a huge amount of untapped energy could be harnessed by building a giant windfarm in the North Atlantic.

    Separately, Dutch firm TenneT has developed a concept for a very large windfarm that could be built at Dogger Bank, an area of shallow water in the North Sea.

    It would include a man-made island where substations could be located and, with many hundreds of turbines, supply power to countries including the UK, the Netherlands, Germany, Denmark and Sweden.

    In total, it could have a capacity of some 30GW (gigawatts), the company says.

    To put that in context, the average electricity demand for the whole of the UK is 36GW.

    Henrik Stiesdal, a former chief engineer at Siemens’ wind power division who now works at Danish Technical University, says there are numerous advantages to building supersized offshore farms like this – even cosmetic benefits.

    “If you’re more than 40km (25 miles) out, the curvature of the earth means the turbines will be below the horizon,” he says.

    Mr Stiesdal says various organisations, including his own institution and the University of Oxford, are working on ways to make offshore wind turbine foundations cheaper.

    One idea is to develop floating platforms that would be cheaper to manufacture in large quantities in factories.

    But if the cost of foundations does come down, it could then be cost-effective to install larger numbers of smaller turbines rather than fewer big ones.

    “The chasing of the big machines will continue only as long as the infrastructure costs are high,” he explains.

    For this reason, wind turbines are unlikely to exceed the 12MW models, he believes.

    One downside of building offshore windfarms with many smaller turbines, though, is that there are many more individual bits of equipment needing to be serviced and maintained out at sea, where the conditions can often be inhospitable, to say the least.

    For the more immediate future, expect to see offshore wind farms continue to multiply, especially in Europe, says Joel Meggelaars at industry association Wind Europe.

    “GE is definitely the biggest announcement that we’ve seen so far,” he says, referring to the planned 12MW turbine.

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