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Hi, everyone. I just started this a bit early just to make sure it's working and make sure the live function is working. Ok? I'm gonna leave it probably 34 minutes just to let people get in and then I'll start recording the teaching session. I'll turn my camera off. So I'm just not staring at the screen the whole time. Turn off. OK, I'm back, I'm gonna give it one more minute and then I'm gonna start the recording part of it and I'm going on to basically go through the powerpoint. I imagine most of the people who watch this are going to be people who are watching after the fact that's what I've been told. So we may end up skipping it over the quiz that I've made at the end. But there is a QR code to scan the end, which may be useful. And of course, if anyone's here and wants to get feedback, of course, it would be very useful. I'm fairly new to teaching and anything you can use to get constructive criticism would be highly beneficial. So I'll just leave it just a bit longer. All right. So I'm gonna share my screen now and let's begin. OK? There we go. So I'm just check. This is, yeah, that's working. OK? I'm gonna put it on to presenter mode. So I'm gonna press this here. I put it, I'll present a mode cos that enables you to see the notes I have. It makes it better for you and it makes it better for me. So moving this. So it's less. Yeah, this over here. OK? So I'm William. I basically did a internship, an internship on health inequality. I looked at a very hefty document called the Emar review which basically looks at health inequality and I'm sure we all agree that inequality is bad. But the one that is particularly pervasive and deeply entrenched and the most evil of all would of course be health inequity if I don't have an Aston Martin or a Tesla. Well, that's not great, but I can live with that if you tell me that I'm gonna spend a much larger sizeable chunk of my life disabled, largely because of factors that are outside of my control. That's gonna probably make me quite angry. And if you tell me there's a huge cost to this inequality and if we're intelligent and find ways to combat it, we could save ourselves a lot of money, particularly when the NHS desperately needs more money, then I would be particularly interested. Why aren't you changing? The slight? There we go. OK. So in the part one of this series, which was basically last week I talked about the ma review. Now I'm going to talk about research I did around that and build on that. So I've gone with some pretty good research. I've gone with stuff from who you can see all the various articles they have here. And one thing you learn about politics very quickly is they love giving themselves broad overreaching statements which everyone could agree with from all different cultures. But it dilutes it to the point where they don't really mean anything and it means no matter what, you can always claim victory, for instance, article 24 kids deserve the best possible health. I mean, II don't know anyone. I II, I'm not even sure if Adolf Hitler would disagree with that one. So it's a bit like, you know, they haven't really said anything of any particular magnitude. It's one of those things where you can see these things where it's about giving people good help in life, giving people the ability to state their opinion, develop their personality, play and interact. All, all these things sound very, very lovely. That's there, there's an element of how vague these things are and that's one of the things that's really irritated me about this. So I'm going to try and find research that is specific, but there's just no getting around it. Some of these statements are going to be very vague. So early childhood development matters and by this. We're talking about numeracy, obesity, risk of heart disease, crime, mental health. And of course it affects the economy. The recommended goal is to spend 2 to 2% of GDP on early childhood development. And that is from who if we can get it right. It will be a powerful equalizer because damage is done when you're younger can often become greater as you go on for life. Because to quote the Matthew principle, those who have more shall have more given to them, those who have nothing shall have more taken from. That's not verbatim, but I'm paraphrasing it. And essentially there's an element of, that's one of the problems with the world we live in. But the problem is if you start in the wrong place, then it's not really even something you have any control of whatsoever. Ok. So these are some general recommendations for who and you can see that they're recommending pretty basic things, vaccines, education, good sleep, discouraging, smoking, nutrition, mental health, sexual health, giving help to teen mums and helping people with extra learning needs. When it comes to some of the basics like vaccines and cleaning water and breasting. These are pretty basic things, but you'd be amazed how hard it is to implement them and you can spend an awful lot of money trying to get these things done. But at the same time, you can, how do I put this? Just because you throw money out of a window doesn't mean that money's going to do good. You have to spend the money on something intelligent, which shows an ability to actually make a change otherwise it just feels good and doesn't actually achieve anything in the long term. So there's this lovely book I read called Social Mobility And Its Enemies. It basically looks at how deeply entrenched a class system is and how bad the difference is between say the income of the bottom 10% and the top 10%. And as a positive correlation, basically, it's gotten worse over the last 40 years that the differential between the top and the bottom has increased by several magnets in the UK. So that was the ratio previously, that is the ratio now and the stronger this correlation, the stronger the genie coefficient, the higher crime is which makes sense because if you're seeing all these people who are basically seem to be winning and you can't see any way of climbing the ladder, you are going to be very irritated by that. And it's particularly high en neighborhood where there's higher inequality because you can see it all the time, people who have more the haves and the haves nots. And frankly, it has a real effect on people that is measurable and you see it all the time in Crime London is a great example of that. So these are some of the other pages. So a good way to make Harrison is to compare us to other countries because we can all talk about some utopia that sounds like sort of best capital or something. But in reality, you think in the here and now today countries that are of a similar development to us economically, what is achievable? Generally speaking, you find we do better than America, but we have a funny habit of not being far off. I like to think we should be somewhere between Germany and France. Generally speaking, in terms of what is pragmatic for us. You can see you've got the inequality much higher and you see that the intergenerational elasticity is also higher. It's much harder to climb the ladder. We can see a similar factor here of it getting worse over time. Now, of course, I'm generalizing a bit. You can see how in this map of England, how it varies in a lot of different places. And in this place here, I don't know what you call this place, London or something I think. But you can see how there's a much greater difference in terms of lack of social mobility in terms of things like private tuition. And of course, this book precedes COVID, but it's only going to have gotten worse since COVID. You can see how it's become a much bigger thing. Are people who have extra money giving their kids extra education, which also gives an advantage. But these are basically window dressing. No, nothing here is gonna surprise you much. This one I suspect might surprise you a bit. You have essentially had the black line. This is people of high ability and high socioeconomic status. So we're talking about age. So in terms of school, they're doing the best. The thing that's funny is you start off in a situation where the people are of low socioeconomic status and high ability, they start off doing well as well. But then for some reason, they dip below. So even if you're someone of high ability, deemed high ability and low socioeconomic status, you'll start higher than the people who you're smarter than from a more privileged background. But in time, you'll dip below. So I just want to illustrate that clearly. So we see here, if you're basically from a rich family, I'm simplifying from a rich family and know ability, you find that you start to improve with time. Whereas if you're with someone who's gifted, but there isn't the opportunities in the family to be able to help you do. Well, you tend to find that you actually decline, which is a real sign of people not living up to the potential in a sense of I'm sorry to make it sound pedantic, but it is really quite true that we're kind of crushing people and feeling well. There's, there's no hope to me doing this. So what, what's the point of me trying hard if I'm not gonna do as well as someone else? Ok. So when we talk about private education and the pro principle, the idea that 20% of something tends to get 80% of the award. If you think of a singer, it'll be the top 20% of singers will probably make 80% of the money. And for those top singers, it will be the top 20% of the songs which make 80% of their money. People like to go to success. It's the Matthew principle basically. So basically, according to the B BCI heard a statement that around 80% of doctors come from top 20% of schools. If we talk about private schools here, medicine, we find that despite a small minority of people, I believe less than 10% of people send their kids to private schools, they make over 40% of doctors and even something like acting, which isn't really that academic because of the connections you make. It also has an impact when it comes to public service. No surprise there, the amount of premises who have gone to eating is nothing short of crazy. And you can see this here all the way all the important jobs because of the book. So sorry, the address book, someone has to connect people to navigate the system. It becomes a lot easier. All our systems are basically made up of people. And the simple reality is if you know how to play people, well, then you're basically a king of the world. If you're at the bottom, then you're in trouble. OK. So this is a similar situation here. This is basically a measure of if you're born in the bottom 20% what is the chance of you getting to the top 20%? Ideally in an ideal world? We'd want it to be 20 because quintile is sets a five and we'd want someone's background to have no impact on where someone ends up, Like in reality, that's not realistic. But we can see Britain is here and comparing to say, Canada, Canada is here, so you can see there's sizeable room for improvement. It's not as bad as it could be. It's not zero, it's not a cast system, but it's definitely a steep hill and it is definitely steepest at the bottom. So you can see a similar pattern here in terms of intergenerational elasticity. So we have low social mobility compared to countries with similar economies is the long story short and there's definite room for improvement. So in terms of giving help to teen mothers giving advice, there was something called shortstop. So I'm just gonna read out some of the things they helped with parenting. Antenatal services, basically help for teenage mothers, family support, help with benefits, training and employment, child development, breastfeeding, getting activities, nutrition, all these things that sound lovely and from a moralistic perspective, th th this sounds fantastic. How could you be against this? But then you start looking at cost. And if you look at a lot of these policies, the same way, we look at medicines and surgeries in the NHS. We have to look at it as by giving someone this vaccine, we pay X many million and it saves this many million in future because it provides this many years of healthy life, which is good trade off. The problem is here. The total averted cost that this has helped with is quite a lot. But you can see the total cost it has borne us. The two aren't even in the same ballpark to go off. Something slightly different, something like Weight Watchers, which sounds like a nice idea. We have all these branded foods which help people lose weight. But what we tend to find is that people's habits are quite ingrained and losing weight in some ways is like trying to give up a drug. It's incredibly difficult and people quite often put on more weight afterwards. It either shows no effect or in some cases it causes a rebound effect. So that's one of the problems how you can spend a lot of money on something, but actually find it doesn't do as much good as you want it to. And that's led to things like sure start basically being well crippled in terms of funding. So that's just something for perspective. It may feel good. It may be a good thing that doesn't necessarily mean that it's going to come across as cost effective. And that is a real concern of how do we actually impact people's lives while at the same time spending our money intelligently because all this money that's been spent here is money that wasn't being spent in, say the NHS. It's someone who didn't get their cancer treated as well as it perhaps could have been someone who didn't have that scan they needed. It's not a case of just keeping the money in a pot so someone can go on a holiday. It's a case of we chose one good thing instead of another good thing. And that good thing we chose turned out not to be as great as we hoped it was ok. It's a chronic illness and this is where I really tie it back to health. So for perspective, over 10 billion of the N HSS money. So over 10% of the budget is spent on things basically affected by lifestyle type two diabetes, smoke induced bronchitis, things like that. And these are affected by things like smoking, lack of sleep drinking and poor diet. Of course, I'm sure you've heard all the general advice. So I'm not going to patronize you by telling you these things though. I do have some les here. If any of you want to read them, there is a document I believe it was Matt Hancock who was going for it though. Obviously, he's departed for going on all manner of reality TV shows. But the idea was we need to set a target of let's try and give everyone an extra five years of healthy life. And I say healthy life because I believe the bottom 10% of people, I believe it's about ii could be misquoting myself if it's around 40% of a shorter life, not free of disability. So a much larger part of their shorter life is spent with disability. So you could argue that's the thing called proportionate universalism, which is a thing preached by the Moment review, which is the idea. It's basically health equity. It's a fantasy socialist way of saying we need to get everyone to the same place. If someone's living to 90 they don't need to live to 95. The person who is living till 60 doesn't need another five years, they need another 20. So that's one of the weaknesses of this though. You could argue if it's the case, if everyone's living an extra five years, that's still a very, very good thing. This doesn't focus as much on health inequality as one would perhaps hope but still many, many cases, a a step in the right direction. Now you could say to yourself, well, health inequality is just one of those things, you know, people who are very hedonistic, they're gonna smoke more, they're gonna drink more. And that's just one of those things that happens. Uh Health inequality is inevitable. So what we do there is we make a comparison to other countries. And we find comparing to other countries, the difference here in terms of being in good health is here comparing with just the poor 24% difference, comparing to Greece, France and New Zealand where it's only a 5 to 10% difference. So the point is compared to our competitors. If you like appears, there are a lot of other countries that are doing better. A lot of these countries have, I don't know, in France, they do a lot more cycling in Greece, they'll have a more Mediterranean diet. These aren't general comments and of course it's not. They love of olive oil, which is gonna make the whole difference. It's gonna be a whole host of things. But you can see how there is a great potential here to adopt other strategies that have worked elsewhere. And if we can choose the right ones, we can actually save ourselves a lot of money and do a lot of good. I have to put it very cynically about 50% of health inequality costs is down to smoking. So if we could just get rid of that, that would basically fix the problem. That's one of the reasons why it's been so clever and important to focus on smoking as a negative. The actual cost of inequality from P DFL I was looking at which I didn't put a link to which I should have is put at around this. Now. I don't know if that's the whole difference and you'll never be able to get rid of the whole difference between rich and poor. But the point being that it is not a small thing and consuming, we always need more money in the NHS. If we can find a way of investing intelligently, you've heard me say it once, you've heard me say it 1000 times. It's good for everyone at the moment. The NHS only spends around 5% of its budget on prevention. The plan with this new document. That's well old document I should say. Now that's that old guy who got fired for whatever reason I was talking about was to increase the spending on prevention by about 1% a year until by 2030 it's about 15%. And the idea is that we can use that as a way of saving money in the long term. So I can see all these II, I'm sure you've all heard these before. So I wanna focus on these. Ok. So here are some solutions and potential hurdles. So I'm gonna touch on sleep. A lot of this comes from a book I read called Why We Sleep by a guy called Matthew Walker. To give you an example. If you don't sleep for two days, you'll find your natural killer cells drop to 37%. So basically, roughly a third, a bit more than a third, these cells are important because they basically kill the beginnings of tumor cells. Now, when I was in biomed doing biomedical science at the University of Sheffield, I remember being told that it was hypothesized that well, could a lack of sleep be tied to cancel them because there's an intuitive reason. And there are a lot of good stories that make sense. But the problem is finding hard data that backs them up. And at pre as far as I'm aware, there is no data saying a lack of sleep definitely causes cancer. It's a hypothesis which I believe has been pushed. I don't think it's been rebuttal, but it's not something that is accepted though. It is something that is in the sort of maybe category like it, it, it's in contention if you like. It's also true that sleeping burns more calories than just sitting around doing nothing. And it also believed with things like the compla theory for Alzheimer's disease. Basically, you have your neurons in your head, you have the supporting cells which go around them when you sleep. It's believed the support cells get smaller, which makes it easier to drain the fluid from your brain. The CSF, which means draining all the toxins, which means there's less damage to neurons, which is believed to be a reason. Of course, this isn't a 100% perfect thing. It's merely hypothesis at this point that you end up with less amyloid oligomers around because you've basically got rid of all the bad stuff. So put you like this and of course, this is a bit of a cherry pick, Ronald Reagan and Margaret Thatcher both hated sleeping. They like working all the time and both of them so far as I'm aware, ended up with Alzheimer's. Now, of course, that's definitely cherry picking, but it's a potential example of is sleep. Something that can make the difference. If someone has a predisposition to Alzheimer's, could it be that someone is more likely to be healthier and not get it or not get it as early if they have a better sleep hygiene. But again, saying that you should sleep more. I've said all this to you. I've said it multiple times in various forums. But guess what? I still have a terrible sleep habit. One of the reasons I'm glad I'm presenting this to you. So you can't see the bags under my eyes right now. So it's all good while saying these things, it doesn't mean it's gonna stick. And some of these habits despite being very important, they just don't end up happening cos people are people. So another factor is leptin. When you sleep, you have higher amounts of leptin, which come from fat cells. And basically this makes you feel full, more fat, you feel full, you don't want to eat. So if you're tired, you're more likely to snack more, which makes a certain degree of sense. You feel you don't have enough energy, you need some quick energy because you want to outrun the tiger. So it makes perfect sense that lack of sleep is also tied to things like diabetes. There's also a risk to things like heart problems and infertility. So you can see how something simple, if you can encourage a better culture for sleeping, we can make things better. An interesting thing in our culture is because we evolved when we were basically like amoeba in the ocean, we had our circa circadian rhythm regulated by blue light from the sun. Cos it went through the water and was filing, became basically blue light. So we used that to figure out when it was that time of day because the other predators would change their hunting cycles accordingly. We were all on the same clock, so to speak. The problem is we now have our smartphones and computers and these are the funny habit of omitting that blue light. So if we're working till nine o'clock or 10 o'clock, then it's gonna be a lot harder to get the melatonin we need because it needs about, I think it's around, this isn't verbatim here. It needs around three hours without blue light to get to acceptable levels where you can easily fall asleep. If you're watching TV, then you need to go to bed. Kind of like I do, you're gonna struggle to get to sleep and guess what? I do struggle to get to sleep. But if I'm working on research or you're working on stuff for your exams? Well, what can you do? So, it's a bit of a cultural thing. Where, how do you do different? There's very much a hustle culture which doesn't promote healthy lifestyles. Ok. And I believe I've touched on most of the things there. So, vaccines. So a vast majority of people see vaccines as important to health. Nine out of 10. That's quite a lot though. Frankly, it will probably be more like 99%. I'm gonna touch briefly on mmr in a bit. But basically, some of the ideas are little things to help people get more vaccines. It basically be a case of following people up if they don't attend a point to get some of the vaccines quite often. It's one of those things where someone's sort of on the fence if you just chase them up about it politely, those things, those little human things where people see, feel seen as an individual where you feel where they feel you're chasing them up because you care as opposed to just ticking a box. Those are things which really make the difference, which paradoxically is a problem because we're trying to fix these problems with health inequality by making people feel seen and listened to. When in reality, there's a real problem of we're effectively under great time pressure being forced to basically take people off, which runs a risk of it. Not really having good rapport and it feeling very procedural. So moving on to the next page, I am going to have a look at this. I'm sure you've all heard of Andrew Wakefield. Just to give a brief summary. He was this guy who basically decided I'm gonna take these 12 kids and I've decided that this small sample size is enough for me to say there's a link between autism bowel disease and the Mmr vaccine. This was the bump, the paper was refracted and he had his medical degree revoked. And this guy has probably killed quite a few people by reducing the amount of vaccinations globally in terms of quality evidence. If you're ever with a patient who wants to see quality evidence, but of course, they're a patient and they'll struggle to read papers. And if they tell you otherwise, unless they're a research, they're probably lying because the truth is I've done biomedical science. I've done a medical degree and I can tell you whether it's a piece of research that I'm not intimately aware of that. I've not done myself that I've not read a lot of, I have no idea what it's on about when I start it off. So the stuff that's simple, generally speaking is lies. But there is something called Cochrane systematic reviews. They basically take all the high quality research they can find on an issue and they bring it together. Now they had a look at this and they found that looking at all, the high quality research that there was no link between them at all, which is interesting. It's even better because Cochrane's reviews, they write the conclusion in a paragraph which is in layman's terms. So if you're ever confused or you want to signpost a patient to somewhere, tell them about Cochrane reviews, cos if they are independent in mind, that's a good thing. Increasingly with A I that's gonna become an even bigger thing, but it's important that you signpost them to the correct place. So that's something you can do to help fight this problem with Antivaxx in a way that isn't aggressive and you can empower the patient to come to a conclusion from the highest possible source communicated in a good way. Ok. So this research I looked at basically looks, let me find it comparing uptake. If you live further away from the GP, you're less likely to go to the GP and by extension, less likely to have a vaccination, there's no surprise there. So having better coverage with a way of increasing uptake, we're also finding that in places with higher socioeconomic status, we find that they have high uptake in places of low socioeconomic status, it's not massive, but it is noticeable. And when it's a few percentage points to make the difference between having herd immunity and not, then that makes a big difference. And that is one of the things to be aware of the further you are away from something from source, the less like you are to get it, it, it, that's fairly intuitive. It's now meant how there is a correlation of people who maybe go to university have more faith in universities. Whereas people who are told they're not smart to go to university or don't go to university because they want to do other things. They, they could have a completely different mindset about a fairly alien thing which they're probably quite skeptical of when it comes to universities. So that's a little bit of an aunt that OK, so nes are breastfeeding. Now, I put the World Health Organization logo at the top left because I figured it would seem a little odd if I keep going on breastfeeding for about 10 minutes now. And you're wondering why on earth is this guy talking about this? I'm talking about it because it is quite a good way right up there with clean water and vaccines to improve people's health. Quite often, the things we do to drastically improve people's health, to fight health inequality. It's not a case of introducing something new. It's basically reintroduce something that we kind of made the mistake of getting rid of. I remember reading a science book when I was in primary school, it used to be believed that we're so clever. We can basically build robots and uh basically devices that we implant in the body that will take over the role of the heart we, we, we can improve on this biology basically. But generally speaking, what we found is in research, it's more a case that we understand something about nature and then we work with nature, but we very rarely succeed when we go against it. We have to sort of ectopically deploy nature in a way to get it to restart. We, we basically, we're like the coach of a boxer called nature. We're trying to get it to do its job better. As a doctor, you generally fail when you try and do the opposite to nature. But I, I'm simplifying things a bit there obviously. But to put it very simply, the recommendation is for the first six months to breastfeed exclusively and then partially breastfeed for two years at the moment, about 40% of people breastfeed their kids between 0 to 6 months, let alone up to six months. So that's a bit of a problem there. Now, this matters because it's associated with a lot of different things. It's associated with health. It's associated with a lot of things which I'll cover in the, for other slides. Ok. So there are things here. I think generally speaking, the slide is fairly simple. So I won't go over it. I'll just leave it here, you can pause it if you want to. Ok. We have this hip just basically making sure that it's given to the right amount. This is more of a caveat. It's not directly that important for the UK. But of course, if someone's living in a country where they have HIV, and there's maybe not good sanitation, good water, it's probably a case that it's better to breastfeed with HIV, than not breastfeed at all because breast milk is so positive for a baby's development that it's actually more positive than HIV. Risk is negative. So that's something to just put it in perspective. It's, it's more of a caveat just to make sure that this doesn't take enough context. A lot of what I'm saying here is more for the UK, but I'm just putting this in because it just feels important to provide a bit of context. Ok. So of course, a child's premature, the composition of breast milk changes to help baby to give them the best chance it actually changes in color. It's also important when you have a baby who was born through trauma or you have a low birth weight or an adolescent mother, all these things are affected and the breastfeed basically tailors itself to the individual, which is, you know, that's actually kind of cool in some ways storage. A lot of people like to store it. But of course, storage isn't as ideal. There's loss of Vitamin C. So that's something to be aware of when it comes to diet to make sure the baby gets, I don't know, e enough orange juice, I suppose when they start drinking normally. So you're probably wondering why is this strange? I'm talking about breast milk so much. So, I'm going to read through this and hopefully that will make me seem a bit less. Well, so if we can find a way of supporting mothers to breastfeed until four months, it will reduce the incidence of childhood infection diseases, which will reduce the cost of the NHS and the UK in general by 11 million annually. So that's basically the way we can find a way of having conversations. If midwives can find a way of being given the time to basically talk to mothers and build that report to basically convince mothers to breastfeed. It, it has to be done in a way where it's obviously it's their choice a way where it's an informed discussion where it's they're respected if they choose not to, but also informed of the positives if they do. And of course, getting that balance right is definitely a skill. That's not something you can put on a bullet point of a slide. If you to double the proportion of mothers currently breastfeeding for 7 to 18 months, you could reduce the incidence of maternal breast cancer and save at least over 30 million. That's because while you're breastfeeding, your chance of getting breast cancer greatly decreases. Breastfeeding is also associated with lower amounts of respiratory tract infections, acute otitis media, necrotizing interior colitis and gi infections. One of the reasons it's believed to be superior to substitutes is because of Arachidonic acid, though, that is something that's hypothesized and not accepted universally. To put it very crudely. It's something that has evolved over many, many thousands of years, if not longer to give nutrition to babies so they can survive. It's very likely that in a few decades, a company that's prioritizing making profit is going to do as well. So cultural shift, this is a slide which I have to be sensitive about effectively these substitutes make up a huge industry and a lot of money gets spent on promoting these substitutes. It doesn't necessarily get spent promoting breastfeeding. If I were to channel my inner socialist, I'd say put a tax on these companies that for every dollar or pound they spend promoting themselves, they have to spend that money basically promoting breastfeeding. And that would be a fantastic way of promoting better health to tell you a bit of a colonial story if you like because in Victorian Times, we had wet nurses who basically breastfeed babies. So mother wouldn't have to a lot of the other cultures that were colonized by Britain and other European countries adopted these mortalities wanting to emulate what was seen as higher status. And in these countries today, you have a situation where some people don't want to breastfeed. Basically because there's still that emulation of that colonial legacy, which in some ways is a bit of a weird one how breastfeeding is part of the colonial collateral damage even decades after the fact. And we can see data here. I won't touch on this too long. Cos I'm mindful of time. OK. So here's the data I was referring to earlier. So we can see by six months it's less than 40% who are breastfeeding and we can see that it's gotten better. It's going up because attitudes are changing. Definitely in the UK though, we find that people of lower 30 economic status are less likely defeat. And of course, that's likely as I said to do with things like university and people have been more skeptical of what we might call experts and their opinions, I suppose. Ok, I believe most of that we've covered already. Now, once again, I'm gonna mention the World Health Organization because I'm talking about IQ and IQ is a very important area of health because it's tied to a manner of things to put it to you very simply. If you are not given good nutrition, your body will not develop as it should. When we think of someone getting rickets, when think of someone getting all matter of conditions, cos they were starved as a child or not given what they need to grow, take that feeling you have inside you and imagine that's the brain. If a child isn't given good nutrition, is their brain going to grow to its full potential? Probably not. If they are poisoned, whether it's in the air or in the water, there's also research, which I'm gonna touch on briefly, which shows the impact of that and how that's bad for everyone. So there is a belief that maybe, well, I'm getting ahead of myself. So generally speaking, breastfeeding is associated with higher IQ. There was a belief, could it be down to mothers who go to university who probably have a hierarchy anyway, are more likely to breastfeed it that has been looked into in a systematic review funded by the Gates Foundation. And it has been found even after taking that into consideration roughly around 3.5. Well, technically 3.44 points of IQ are associated with breastfeeding. So it is a positive correlation, we can be fairly certain of that. So it does like you the matter. So for the economy, you tend to find if you're in the area where you're on the brink of what we might call is difficulties or disability, you find that it becomes more restrictive as you become more intelligent, develop a higher general intelligence. Perhaps I should say you find that it becomes a bit more dispersive. It's not as restrictive but to succeed. You need a lot of things. You need people to give you the opportunities. You need luck, you need drive, you need a sense of emptiness inside you that you need some sort of external validation to fill the gaping hole inside you, you you need all of these things. So it's not a simple case of it, it, it's like a chain. If you don't have the intelligence to be one of the best, then you won't be able to get it. But if you do have it, that doesn't mean you're going to get there. Cos that's just one of 100 things you need. That's how I describe this graph now to put it very simply. And of course, it's not perfect data, but it shows that for each IQ point, it roughly correlates with 200 to $600 of incoming in. That's not a lot for an individual. But if I told you throughout your life and if I told you for a nation, you can make them a couple of IQ points smarter that would be very good for the economy. OK. Here we go. This is just a fun little factoid from a guy called Malcolm Gladwell. He wrote a book called Outliers. Looking at all the people like Bill Gates who are really successful. What he did find is that of the people who won the Nobel Prize, which isn't really, it's, it's not, it's not without fault, but generally speaking, that's about as prestigious as a prize as it gets. And you tend to find that when we got to 100 and 20. So the top 10% of the population past that point, it didn't seem to matter. But up until that point getting an increase in IQ, it did matter. And if the average is 100 there's nothing we lose by increasing it. A few points. I want to be sensitive cos I appreciate it's a subject with a very dark history. But I'm just basically trying to convey the point that whatever we can do to help people reach their full potential, fully nourished, that is better, not just for them but for their families and for society as a whole. OK. So I just want to have this point home. This is basically some other research basically saying the same thing showing correlation between IQ and income. And I just basically repeat it here. I feel like I've already iterated points. So I don't know much else to say here. I just want to make sure I didn't just make that point once with one piece of data, an interesting factor is that poverty impedes cognitive function. If you think of it like this, I I'm quite privileged. You're quite privileged if you're watching this cos you went to medical school and you'll probably find that you can plan your life out years or even decades in advance. If you're on the street or you're living in a council house or you don't know if you're going to have a house by the end of the week, then you're gonna be quite stressed and you're gonna have the privilege of planning realistically in the future and you're gonna probably have a scarcity mindset. It's gonna be more short term thinking as much gains over the short term. That's probably one of the situations where you get a arguably slightly more hedonistic culture of, I'll smoke now. I'll enjoy now because, you know, I don't have no control of the future. That's one of the reasons why, where there's greater poverty, people are more short term minded because frankly, they can't afford to a lot, a lot of people with very little money going off on a bit of a tangent. Yeah. They don't care as much about the environment. Cos frankly they can't afford to, they've got a million different things they can't afford. That's just another thing which frankly, they don't need to, they can't afford to prioritize having an electric car. So that's one of the things that I think a lot of middle class people like myself and a lot of other people in this sort of situation tend to forget. It's nice to be in a situation where you can afford to care about all the other things. But the people who don't care, it's not even that they don't care. It's that they don't have the privilege of being able to care. Now, I'm going to bring this back here. There was some research done. I can't remember which book it was in. I heard about, but basically it looked at Indian farmers who were basically paid, it was either once or twice a year and they did IQ tests on them. Some of them, they did an IQ tests on them before they were paid. So when they were running out of money, when they were probably a little bit hungry and some of them after they've been paid, oh, it found, it was night and day, they found a 13 point difference in the fluid parts of the assessment. So, just put it very simply. I mean, this will probably sound quite intuitive to a lot of people, but it shows that it can be affected by a lot of things. If someone's hungry and stressed and starving, they're not gonna be as smart as if they're not stressing in a stable position. And you can say all sorts of things about mental health and nutrition in the short term and the long term here. But it just shows that it's not an absolute thing. Now, if you've seen this here, you're probably thinking of the U cat because the U cat is, of course, an IQ test, they dress it up as something different. But that's, that's what it is. That, that is basically what it is. So there's two points here. Let me just make sure I get this right. There's a Stroop test which is basically where you say what is written without saying it. So I'm supposed to say this is blue and not red and that's distracting. And this part, this is the Ravens test which you recognize pattern finding. Basically these are the parts which are harder to improve. You found a 13 point difference in IQ for the parts that you generally speaking can't change. So that's something to be aware of that. A lot of the ideas we have about IQ are a little bit maybe out of date. Another part of this paper. It was in the USS A in New Jersey. I think it was at, I think more and they basically spoke to some people who were of higher income or lower income and they basically had them do the Ravens test, the abstract reasoning test. And they found that and this is very interesting. The word hard here just means they told them the higher figure. So they said you have a car that needs fixing, it's gonna cost you 100 and $50. And for the hard group, they said $1500 for the people who are quote unquote rich, they found no difference in the performance in the IQ test whether or not they said it was 100 and 50 or 1000 500 in the poorer group. What they found is the people who were told it was gonna be more expensive to fix the car did worsen the test because they were too busy, presumably worried about that than the high, high in the sky. Abstract reasoning side of things, which makes a certain level of intuitive sense. So it basically shows that things like IQ are tied to the economy which is tied to taxes, which is tied to healthcare and this is tied to all manner of other things. So it's a vicious cycle and you can see how it's quite intrinsic tied to all manner of other things which we need to consider. But what we just need to look into basically, mm, the other thing to be aware of is IQ isn't static. People tend to peak around the age of 25 and then it's all downhill from there. I'm sorry to say it's a bit like a rubber band. If you think of it like this, we don't all necessarily start off the same length. We don't necessarily all have the same elasticity, but we can all stretch and become better. But if we stop doing those things that stretch us, we'll go right back to where we were before and I'll talk about that in a second in the Wilson effect when it comes to twin studies. But what we can see here is there's something called the fly effect. As we've increased education, they had to re standardize it. So if you start off with 100 in the average every decade, they had to re standardize it because we kept getting smarter and smarter because the education kept improving. Now, there is some argument about around the time of austerity. Has there been a decrease in the increase in IQ? It looks like there's been a decrease in increase in life expectancy. That's the question of, is a lack of funding in terms of that, saving us in the short term. But taking money out of prevention of problems, putting it into crisis effect isn't making it. So we're losing gains in the future by not putting appropriate investment into people. And we talked about that. So to put it very simple, someone like Winston Churchill was seen as an orator of his time, even if, if he was hypothetically middling of intelligence for his time, which of course, he probably wasn't by modern standards. He'd be seen as someone who was probably cognitively stable. So there's a huge difference in terms of people's IQ across time. I believe there's some research here. I have annoy, I found that if they put people into school for an extra two years, they found they increased the IQ by 3.7 points. So I'm basically trying to say we do talk about genes and genes are important. The idea of just try harder, put more work in, you'll get to the same place is actually quite cruel in some cases because the sad proofers were not all equal and uh putting it in a sensitive way. But those of us who do well in life often have gifts that we don't al always acknowledge that other people aren't as privileged to have, which is something we need to low key acknowledge. But to put it very simply if we have better education people are going to be more cognitively loaded. Think of it like a muscle, the brain, like a muscle and they're able to do better and provide, they keep fine tuning that to keep working in something cognitive or then it'll probably stay there, which is good for the economy, which is good for tax, which is good for the health of the nation. So all these things make sense. There's also the fact it's affected by things like milk, breast milk omega three. And is there anything else here to cover? Yeah, I think I've covered that back. So adoption studies. So the general dogma which I'm going to uh I'm gonna challenge it a bit. Basically, the central dogma is adoption studies. You have two people who are genetically identical. So logically, if you have them adopted, you'll find that on average, the discrepancy between the two will be environmental and degrees which they are the same will be genetic because it's randomizing, you could make the criticism that orphanages tend to be in certain areas which may not be representative of the rest of the country and that the people who adopt them are probably from certain backgrounds as well. So it sort of isn't as much as I want to say, it's believed to up to 80% of the variation in IQ is down to genetics. And what you tend to find is that IQ can be affected by things such as schooling and the parents. But when people move into their own environment where they become their own boss, if you like when, well, boss, as much as you know, when do I get up, what do am I eating today? When am I going to sleep? That type of stuff, it becomes more affected by a queue because a bit like a rubber band, people don't like being stretched too much and I'll probably choose something which is a bit more comfortable for them. So that's something to be aware of in terms of how IQ shifts and changes over time. So I I'm saying it's more as context because it's one of these areas where people talk about twin studies as been great. They talk about them also has been flawed. They talk about them as saying everything a a lot of these areas of I QW we have a sort of mindset where it's like I II think the best analogy I can think of is really that the brain is a muscle. I don't believe everyone who works out is gonna get to the same situation, even if you ignore the blatant use of anabolic steroids. But you, you have a situation where if you put work into it, people can improve. It is and good education is always a good thing. All right. So fantastic book. One of my favorites ever is by Robert Sapolsky. He basically lived with a bunch of monkeys for 10 years which was kind of cool. But his book here isn't really about that. He basically looks at research and says what we actually determine about human behavior. And he found and think of it like this, the limiting factor for IQ for people who were of higher socioeconomic status was genetic. Cos if they receive the best education, they're going to reach their full potential. The rubber band is going to stretch to maximum capacity if you like people of lower socioeconomic status, what he said is he found that it was more to do with education because people are in a more lax situation, they're not being pushed. You know, there isn't that strain to get the best out of them. So there's what you might call a lack of opportunity to put it very simply when it comes to people of lower socioeconomic status. What I'm trying to get at is it's not just a case that there's, it, it, it's basically that there's a lot of opportunity for everyone because it's a computer that we're not running to. It's extreme. It's a computer that we're not even running to a medium capacity because not giving them the proper investment in terms of education in terms of nutrition in order to get there, which basically means they're getting short changed, society gets short changed in the long run. So if you can prove all these things, it's better for absolutely everyone. Ok. So this is perhaps the most insidious thing to do with IQ. And I think this is one of the last things I can on to. Basically, there's some research saying that air pollution is something that damages the brain. So to put it very simply in terms of welfare, in terms of cancer, health protection, in terms of respiratory problems, a pollutant, a neurotoxin called polycyclic aromatic hydrocarbons, which is a whole group of chemicals. Obviously, it generally speaking, is believed to be a cause of all manner of different illnesses. And it's also believed to be a decrease in terms of IQ. So in terms of air pollution, being bad for the environment, it's also bad for kids brains and of course, where exactly do they tend to put the polluting machines, the, the factory, sorry, it tends to be poorer areas. People with lower political capital where something bad happens to them, people are less likely to care. And, and that's the same story across all of human history, which is quite sick. But you can see the sense of that there's a situation where you put something in a place where it's going to do harm and it's going to do harm to people that no one cares about. And, and that's kind of sick because if you think about it, you, you're basically, if this research is correct and it's one of those things where I think to myself, it's a big audacious claim, I'm sure there's a lot of funding from these companies basically trying to say, oh, it's not a problem. 00, the data over a bone like they did with climate change and cigarettes. But if this is true, it basically means that we are effectively damaging people's brains just so we can pollute more. And when we were a member of the Eu London would be fined every single year for being too polluted to a into context. Fact. Just something that enrages me just a little. Ok. So this one isn't as much of a surprise. So I won't spend too long on it. But we basically have a situation where if mothers are drinking when a baby is inside them, they have a situation where their IQ is going to be effective. So that's another example of something social of someone being addicted to alcohol and people drink for a whole manner of reasons. A part of it is genetic, of course, because some people are more predisposed to disposition to that disposition. But it's also a sense, there's a great mental health side of that. People who are drinking when they're pregnant, generally speaking, they're not in a happy place. And if we had better mental health support that worked, that gave people the time to have the conversations they needed to, you'd find that it would be beneficial. And I keep coming back to this idea of IQ because it ties into all the other things, it ties into all the other things. It either runs in parallel to health problems. It also makes it easier for people to operate at the best. And for an individual, a three point difference isn't a lot for society. It's a huge amount. So it's just something that kind of enrages me because we're basically, well, ok, so ment 12. So this is something I'm going bottle. Mental health problems are three times more likely to occur up in people who are lower socioeconomic status. That makes sense in that book of behavior I told you about by Rob Sapolsky, the monkeys that are of lowest status in the group, generally speaking, it had higher cortisol, which is stressful. And cortisol is something like the sympathetic drive flight or fight. That's not something we're supposed to have all the time. We're not supposed to be in stressed out mode all the time. Some things that are supposed to be in short doses in long term doses. It makes things like diabetes more likely. It's bad for our immune system. It's bad for all manner of different things. And the problem is it really wears on you. So I'm just gonna come back to this here. There was a belief called the marshmallow test. And the idea of course, I'm sure you've heard of it is you give a child a marshmallow and say, hey, if you don't eat that marshmallow for about, I think it was five or 10 minutes, we'll give you two marshmallows and it was seen as a measure of strength of will. And it was claimed that people who showed that at that early stage could basically be put in a group of winners and they will go and succeed. And it was all very famous. But here's the problem, like a lot of psychology, like the Stanford Prison experiments, like the third experiment, it turned out to be a little bit overblown. It hasn't shown that probably because just because someone in, let's say year one doesn't have great control, it doesn't mean they won't catch people up by year three. And one of the problems is that people can get into a mentality of seeing themselves as someone who couldn't pass a marshmallow test. Or they're not one of those people who could do well at school, people develop a mentality. It could be that someone's dyslexic and they could say, oh, I'm dyslexic. I II can't do this. The one thing I heard is that when it comes to learning disabilities or learning difficulties, the difficulty, sorry, I should say that there's a greater likelihood of finding out about it in university than one would expect because they've not been carrying around the baggage of seeing themselves as restrained by deficiencies in the same way that the labels we give people in some cases can be more damaging than whatever difference or deficiencies they have to begin with. And that's something that is really quite insidious when you think about it I was gonna talk a bit about emotional intelligence, but I feel like reading the situation here, I feel like it seemed a bit more a antics. So I'll just say very simply we live in increasingly simultaneously multicultural, multireligious. But also if we put it in black and white, a much more secular society, we don't have the same sense of communities that we used to. And part of that sense of belonging has been lost, which isn't good for mental health. And people have a lack of that pastoral care where people feel they can talk about things and maybe have those conversations about their emotions to feel like they belong in the group. And for some people that can be very damaging and that loss of belonging, I think we see in politics all the time in a lot of negative ways. That's the tip of the iceberg of people respond to it poorly. We can see quite easily how those things go on to affect people's mental health. And of course, with people with less agency, particularly where historically, you know, workers comrades, what whatever you want to say, they'd have a sense of unity for having a shared profession. They do their whole lives and that would give them a certain amount of strength that has completely dissociated. Now, uh People feel like individuals, quite a lot of them without any sense of belonging. So that's just something I want to touch on. It doesn't turn immediately but you can see how it ties on to a lot of the other things as an association. Ok. So some school ideas, this is very simple stuff, more school clubs, subsidizing healthy snacks clubs, letting people talk about their feelings. And that was something that was more designed for the internship I did. I left it in cos it's no harm but you can see how these are little things that could get people into good habits. Ok. So thank you everyone for listening. I hope you have a good evening. I do have a little ment quiz. Of course you could click on. But I think given the time it wasn't supposed to take this long to go through. So I'm going to cut it short here and I'd like to thank you all for your time. Ok. Ok. Ok. I'm just reading through the comments here. Hello, Marianne Eileen Davis. Yeah, this is very interesting. If you haven't read the Pfizer papers, please do. Ok. Oh, DD. Do you have a link to the paper? Cos I would be interested in reading it. So, so, so, um sorry, I don't know if the recording can see that someone's just recommending some papers, which I think would be interesting. There, there's some papers pfizer have gone through which should be quite interesting. People become aware of the situation as they get older, the, the right attitude if I can. The. All right. So, thank you, everyone. For your time. I really appreciate it. If there's any opportunity for you to maybe give me some feedback, I'd really love that. I don't do teaching very often. And if you give me some feedback to improve, I'll definitely take that on board, but I wanna wish you all the best and thank you for the comments, Marianna. I'll definitely have a look at those Pfizer papers. Ok. Right. So I'm gonna turn off live now. Thank you for your time.