Archive for the ‘photography’ Category

This looks like a bird, don’t you think? That’s interesting because in fact it is a stone on a beach with a little sea creature clinging to its undersurface, looking for all the world like a bright orange beak, and a tiny shell attached to the side just where you might expect to find an eye if this was a bird.

So, my mind has taken a combination of a stone and two completely different sea creatures and created a image for me which makes me think “This looks like a bird”.

We do that all the time. All the time. When we look at clouds we see patterns which make us think they look like faces, creatures, or other familiar shapes. We see people who look like people we know. We see likenesses in babies features which remind us of parents or grandparents.

This “looks like” ability isn’t unique to human beings of course. Flowers, insects and many other creatures are brilliant at developing shapes and forms of other life forms….either to attract what they want to attract, or to repel what they want to repel.

But we humans take this “looks like” ability to a completely different level. We use “representation” to become aware of, or to create, connections between things which we would otherwise miss. We use it to know, quickly, what we are looking at, or at least, to make a preliminary, perhaps “good enough” assessment.

But we also use it to connect to others. We look for similarities, symmetries echoes and reflections, to form bonds, attachments, relationships. We look for some aspect of a person or their life and say “I identify with that”, or “me too”, or “I sympathise with that”, “I understand that”.

Even in the circumstances where we look closer and realise that what we perceived at first wasn’t really what we thought it was…..this is not a bird….that ability of do the “looks like” thing turns something mundane into something just a bit more magical. It’s a way of “re-enchanting” the world.

I think we take this power to a whole new level when we start to employ symbols, art and language. I’ll say more about that tomorrow.

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I took this photo of an office block in Malmo about three years ago. I liked the green colour of the office reflected in front of this one, and the green exit sign in the bottom left hand corner just seemed so right for the whole image.

When I look at it again now, in the light of the pandemic, it’s got a whole other level of meaning.

One of the things which happened in many countries as authorities tried to control the spread of the virus was not simply asking people to stay at home as much as possible, but to work from home if they could. Millions did so. Possibly millions are still doing so as I write this at the beginning of September. In the UK the Tory government, is applying an increasing amount of pressure on people to stop working from home and get back to the office. They are concerned about the economic impacts of less workers travelling, buying their lunch in the city and town centres, using taxis and so on. In other words, it’s not just offices which are pretty empty, it’s the streets and businesses in the environments of those offices. Turns out everything is connected after all!

But a lot of workers are finding they are much happier without a couple of hours of commuting on overcrowded Public transport, or sitting in long queues of traffic on the roads. They are happier sharing their meals with their families and they are discovering that the localities around their homes have lots of small businesses, shops, cafes and so on where they can spend their time and money instead of in the big city. They are enjoying cleaner air to breathe, enjoying the sound of birds which have replaced the sounds of traffic and building works. In other words, they are finding that their quality of life is just better.

Many are now thinking of moving out of cities altogether and finding somewhere to live in smaller towns a little further away, looking for homes with some outside space or a small garden, and a fast internet connection so they can continue to tele-work.

The world is changing. Funny how we don’t control as much as we think we do. Funny how life will get on and adapt even without any central planning from politicians and managers.

Well, folks, you know my favourite phrase “And not or” …….. At one point in this pandemic it looked like the big new thing would be “blended education” with some delivered face to face as before, but more delivered online. That’s faded a bit since schools started to re-open but I think we are a long way from seeing the full changes in that area. Maybe what there wasn’t so much talk about was “blended working” but that seems to be what a lot of businesses are moving towards – having their staff work from home as much as possible, and getting them together for face to face meetings, or events which are better face to face, only as they need to. There are more and more stories of companies reassessing their need for large amounts of expensive city centre office spaces.

Change is happening already.

It seems the question of “to office or not to office” is already being answered with “and not or”!

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When I discovered complexity theory and science suddenly everything started to make sense. It gave me an entirely new, consistent, clear lens through which to view and interpret life.

Sadly though, I think the word “complexity” puts people off. They think “complex = difficult” and that’s not quite true. They also confuse “complicated” with “complex”. They aren’t the same thing.

So I thought I’d just share one way into this beautiful way of understanding reality – by focusing on lines. Look at the lines on this stone. You can look at this as a drawing made up of lines and junctions. In network and complexity theory these junctions, those meeting points, are known as “nodes”. Seriously, that’s a good place to start.

All complex systems can be seen as a number of nodes joined together – lines and junctions – or in the case of the human brain, long spindly nerve cells and synapses. If you were to pick a starting point somewhere on this stone and mark a finish point, you could trace an enormous number of ways between those two points, just by following the lines with your finger.

All complex systems are so massively interconnected this way that there are a countless number of alternative ways to trace the relationships and pathways between the nodes. There are always a massive number of alternatives available. And you can never know exactly which of the alternatives is going to be taken.

Complex systems are NOT predictable in detail. That applies more in human beings than perhaps anywhere else because human beings are probably the most complex systems in the universe. The paths a living creature takes are highly unlikely to be straight. Creatures meander and wander and change direction all the time. Have you ever watched a butterfly flying from flower to flower? Have you ever tried predicting which flower it will go to next, and how it will get there? Good luck with that!

Complex systems are not only massively interconnected on the inside, they are massively connected to everything else as well. Complex systems adapt and change according to the environment. They cannot be understood outside of their unique and particular contexts – by the way, I read yesterday that the word “context” has Latin roots in the words for “connection” and “weaving” – nice, huh?

One more thing about complex systems…..see all those lines that indicate the connections and bonds between the nodes and parts? Well they carry influence – in the form or molecules, energy or information – and as they carry whatever it is they are carrying they might multiply them or diminish them. Connections in complex systems make feedback loops of influence – “positive feedback loops” which increase a signal, or “negative feedback loops” which put the brakes on.

All this adds up to “non-linear” function – perhaps the absolute key to understanding a complex system. There is no simple A + B = C. There are a host of factors and influences in play, there are multiple routes through the connections, and there are accelerators and brakes. And all of this is “adaptive” – it responds to, and changes according to, the contexts.

Machines can be complicated. But they aren’t complex. They are made of individual isolated parts which have direct one to one effects on only the parts they are connected to. They are not non-linear. They don’t learn to adapt and grow.

For many years I was a fan of the word “holistic” and would say I practised Medicine holistically. But in the latter part of my career I changed that to saying I practiced the Medicine of “Complex Adaptive Systems” – I know, maybe it isn’t as catchy but I maintain it’s more understandable – after all, just what is “holistic” anyway? Dealing with “everything” at the same time? Seeing “everything there is to see”? I understand the aspiration but…….well, what do you think? I’m not out to attack “Holistic Medicine” here, I’m just sharing with you how I think about human beings, Nature, Life, the Universe, health, healing and disease now – it’s through this lens of the “complexity”.

I know, some of you will be thinking there is more to this “complexity science” than this, and, yes, of course, you are right. There are whole books on the subject, whole multidisciplinary research projects, there is always more. Maybe this will whet your appetite.

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When I looked up at the sky and saw these clouds I thought of Hokusai’s famous work of art, “The Wave” …….

Of course, now that it’s 2020 and we’re still in the midst of this COVID-19 pandemic, that image has taken on a new significance I think.

There was always something both awe-inspiring and a bit frightening about “The Wave” (or is it called “The Great Wave”?). When I look at it I’m immediately struck by its beauty. What a fabulous form! And with Mount Fuji on the far horizon you get the impression that the wave is actually bigger than the mountain! Then you notice the people in the boats, and they are looking, to say the least, precarious! I mean if a wave the size of a mountain is about to come crashing down on you with its foam forming giant claws above your head, then, how could you be anything other than terrified? Well, maybe exhilarated too, responding to the challenge, the way a surfer would, but surely you’d be afraid?

This pandemic is a bit like this. I can’t help but feel awe in the face of the power of this tiny virus to spread over such enormous distances and affect so much of our tiny human lives. And I can’t help but feel a bit afraid of it too. Sure, we now seem to have reached a phase of frustration and don’t we all just wish the bloody thing would go away? But wishing isn’t going to get us there, is it? We have to face up to it, paddle like fury and try to ride it out.

What we’ll find on the other side of the Wave/Pandemic none of us know, but, one thing is for sure, we’ll be changed. This world will be different. Maybe we’d better face up to that too, and start to make the personal and collective changes which make sense in the light of what we’re learning from this experience……

Maybe that’s the big wave coming, actually…..not so much the tiny virus, but CHANGE…….change which washes away old and ingrained habits, routines, methods and ways of organising things. Change which inspires us to invent new ones.

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I’ve had a couple of days thinking about beginnings, so it seemed kind of obvious to have one about endings!

This photo shows a number of berries, all part of the same plant, even the same part of the same plant, but each in a different stage of maturation. Some are still green, some have turned yellow, some red, and some are even beginning to get wrinkled (like me, ha! ha!) and so appear the most mature.

When I think about beginnings, I realise that they are all pretty arbitrary – a beginning is where we begin – if you pick a thread or two you’ll always find your way back to an earlier beginning.

I don’t think that means there are no beginnings. I think there are. All the time. Every day. Every moment of every day. There are beginnings. There are phenomena and experiences which have only this moment come into being for the first time ever. It’s pretty great to notice that.

Endings have exactly the same quality. It’s not that there aren’t any. There are endings all the time. Every day. Every moment of every day. There are endings. There are phenomena and experiences which have only this moment slipped into the past. You’ll never have them again. It’s pretty great to notice that.

Outcomes, targets and goals

In Medicine, there is a lot of focus on “outcomes”, sometimes called “clinical outcomes”, which, somehow are a bit different from “patient reported outcomes” (“PROMS”). These are all endings. They are points to be reached. Measurements to be attained, or ratings to be completed. But when your working life is that of a family doctor, (a “GP”), then you’re never done with outcomes. The patients don’t reach the intended outcomes then go away. Life, it turns out, goes on. What was an ending today, turns out to be just another chapter in an ongoing story, just another time and place sensitive reading in the midst of a flow of a whole life.

Oh, yes, you’ll say, but there is one outcome which isn’t like that isn’t there? Death. The final outcome. The ultimate ending. Except it’s not really, is it? Well, it is for the physical body of the person who has died, but we are more than physical bodies aren’t we? We are experiences, stories, events and memories, aren’t we? And those continue long after the physical body has gone. Are the people you loved who are no longer alive completely gone from your life? I don’t think so. Their life continues to influence our lives. The experiences we shared, the memories we made, whatever we created together, the stories told, the photographs taken, the objects held…….

Have you ever seen a BBC TV programme called “The Repair Shop”? I love it. People bring old objects to a workshop of artisans. The old objects are usually in a poor state of repair, but they mean something to the person who has them. Once restored by the craftsmen and women, the person comes back to reclaim the object, and time and time again, it is an immensely emotional experience. They are put in touch, deeply, and significantly with a loved one, long gone. It’s lovely to watch and it shows how a person, an individual, continues to influence others long after they’ve gone. How their “presence” I suppose you could say, is made more real through what they’ve touched, what they’ve handled, what they played with, or made.

Targets are a kind of outcome. They are useful as ways of getting you to somewhere you want to get. For example if you want to save up a certain amount of money then setting a target of that amount is a good aid to getting there. The trouble is that targets are used inappropriately. Whose targets are they? And are they the same, most important targets, which others want to achieve? Because the selection of targets is an individual, value-based, subjective, exercise of choice. But if they are set for others then they direct the efforts and lives of others towards those targets instead of others. I’m not a fan of targets. At least, not ones I don’t have a say in the creation of!

Goals are a bit like targets. I’d say the same about them. They can be helpful to get us to places we want to get to. But they are aspirations, not predictions. And they are not endings. Or at least, they are not final endings. Are they?

I think this unique and unpredicted pandemic is forcing us to face up to the reality of beginnings and endings. It’s making us more aware of connections, of webs of influence, of the non-linear, multifactorial, dynamic, ever flowing, ever changing nature of reality.

This morning I read an article in Le Monde about how management methods are already starting to change in the light of this experience. Here’s the main point I got in that article – management is having to move away from “control” to “coaching”. Three things have come to the fore – the need for individual autonomy, the need for good team working and relationships between workers, and the need for transparency.

Well that all seems pretty good to me! I look forward to seeing the end of de-humanising “Taylorism” and “command and control”, and the beginning of an emphasis of autonomy, relationships and transparency. Imagine if we governed countries according to those principles?!

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I took this photo the same day as the one of bubbles in the surf which I shared yesterday. I think it is beautiful. It’s one of those images which is lovely to spend some time with. I can lose myself in it.

I love how this shows water in the process of changing into several of its forms. We can see the water which forms clouds, and if you sit or stand and watch clouds for even a few seconds you notice how each cloudy constantly changes. It changes position, it changes shape, and it changes size.

We can also see the water which has reached the beach, turning the sand into a kind of mirror because in this thin surface of water we can see the reflections of the clouds up above. I think that’s quite unusual….. it was the main thing which caught my attention and led me to take this photo. The thin layer of water on the sand has been left by breaking waves which have stretched up to a certain point on the beach, then receded back into the ocean. Some of those waves have turned to bubbles and foam. Waves don’t stand still. They are constantly on the move. They sound like the ocean breathing, breathing the water out onto the sand, and then breathing it back into itself again.

We can see the ocean which is a huge volume and expanse of water constantly changing from flatness to swells, individual waves, and white foam, under the influence of energy waves and tides in the sea interacting with the wind blowing over surface.

The ocean, the waves, the foam, the bubbles, the mirror like surface, the clouds up above……all manifestations of the one phenomenon – water. Water, that ubiquitous, mysterious, substance without which there would be no Life on Earth. A constant source of wonder and amazement.

It’s beautiful to gaze on such ever changing mystery, to remember how essential this is to us, and to feel humble in the face of all we don’t know, and don’t understand about this most important element on Planet Earth.

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Here in Europe the school year is starting and for most children they haven’t been to school since about March or April because of this pandemic. Although we know now that children under the age of 14 seem to be almost unaffected by COVID-19 there is a lot of anxiety about children spreading the virus through the community, and, perhaps more specifically, to the adults who work in the schools. So each country has been making cautious preparations for the re-opening of its schools, looking at everything from cleaning regimes, the use of hand gels and masks, and the way children spend their time in the school buildings.

Out of all this, at least in the UK, has emerged a concept of “bubbles”. The idea is to have children spend most of their school day with a small group of other children and teachers…..often much smaller than a regular class size. The same concept of “bubbles” has also been used for the wider community in the UK, with lockdown rules easing gradually to allow slightly more people to interact on a daily basis – two households meeting up, then three perhaps; limitations to the number of people who can gather in any one place but allowing particular groups or families to meet up and spend regular time together.

I think it’s an interesting idea. And, as this photo shows, a potentially beautiful one. This photo is of breaking waves on a beach in Western France where the land meets the Atlantic. The bubbles forming in the surf are just gorgeous, aren’t they?

It strikes me that this bubbles idea highlights a major issue for our societies and the way we organise our daily lives. It’s the issue of size. Mass gatherings, mass transport, mass tourism, have been shown to be amongst the most vulnerable points for us…..the circumstances which lead to most infections. The social distancing measures that each country has brought in have been based on the understanding that the more you keep people together in closed spaces the more the disease spreads.

So now we are seeing a huge increase in “home working”, and, it would seem, a large number of people find they actually prefer that to spending time every day packed onto buses or trains with hundreds of strangers, then working all day in the shared spaces of offices. People are learning to live locally, enjoying their local parks, shops, cafes etc now, instead of traveling long distances to share time with masses of strangers in huge workplaces, shopping centres and so on.

I’ve decided to re-read a book which made a huge impact on me when I young – “Small is Beautiful” by E F Schumacher. It’ll be interesting to revisit it in the light of what we’ve learned since it was written in 1974, and in the light of our experience of this pandemic. What I remember of the book is the key point that big is not best…..that we should try to create societies at human scales instead of around mass production and mass consumption.

Maybe the “new normal” will involve a lot less “mass” anything – maybe we will move towards a more human scale everywhere, overturning the industrialised principles of the last century to abandon so called “efficiencies of scale” (which have probably only ever been useful in the manufacture and delivery of products). Maybe we will start to create smaller schools, smaller classes, smaller hospitals, smaller communities. Maybe we will move towards more diversity and less uniformity.

We are more able to do that now. We now understand that complex systems are like vast interconnected networks of nodes and links. We know that the most robust and most resilient systems are diverse and adaptable. We know that distributed power and responsibility produces more sustainable systems and organisations than hierarchical, command and control, massively scaled ones.

Integration is the creation of mutually beneficial bonds between well differentiated parts. It’s how the body works. Not with a command centre, but with interconnected, responsive, open networks. It’s how Nature works, through inter-dependent, diverse elements within ecosystems.

Is this our model for a “new normal”?

Human scale. Small. Diverse, open and healthily inter-connected? Can we see a future way to live in this beautiful image of bubbles?

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Yesterday I wrote about new beginnings, about choosing what and when to start, but I’ve been thinking about it since then and I realise beginnings are paradoxical. They are both easy to find and impossible to find. Why do I say that?

Well they are easy to find because every action, every thought, every experience is, in fact, brand new. Life moves and flows continuously. This present moment has never existed before, not for you, not for anyone you know, not for the planet, not for the universe. So every present moment is a beginning (and, yes, it’s an ending too, because no experiences are exactly repeatable)

They are also impossible to find because everything is connected. We human beings are “complex adaptive systems”. That is we are massively interconnected, both in our own being, and in our contexts, relationships and environments. We are “open systems”. That is there are no impermeable barriers between an individual and the rest of the universe. The atoms, molecules and cells which make up our bodies are changing all the time, as we breathe in, ingest and absorb new materials, and breathe out, expel and excrete other ones. Energy and information flow into and through us continuously.

So what? Well, all this means it can be very hard to trace back from now to a “start point”, or a “beginning”. For example, when a patient would come to see me and complain about a particular problem, and I diagnosed a certain disease, where did that disease start? With the first symptom? With the first symptom which was troublesome? With the pre-conditions before the first symptom began? I was taught to explore a patient’s “past history” to see how this illness might fit in the trajectory of their life. I was taught to explore their “family history” to see if there were family patterns or dispositions. I was taught to explore their “social history” to find out what was happening in their work and social life. I could go on……

A beginning is pretty much arbitrary. It’s where we choose to begin. Think how you would tell your life story to another person. What would you say first?

As I progressed in my work experience I changed my introductory question to each patient, from something like “What’s the problem?”, or “How can I help you?” to “Tell me your story”.

Yep, “tell me your story”. Sometimes a patient would be a bit taken aback with that beginning, but I’d just maintain eye contact, show I was listening and wait. Sometimes I’d have to say a little more to get things going, for example to explain that I wanted to understand what they were experiencing and how it might have come about so I’d like them to just tell me about it in their own way, but usually, people would just start to speak.

Where a person chose to start, and how they told their unique story, was always interesting and relevant. As the consultation progressed I’d often ask another question “When did you last feel completely well?” This was a particularly useful question to be followed up with “Tell me about the weeks and months leading up to that time”.

Those were beginnings. Different beginnings. All useful and all relevant.

I came across this photo of the seed head of a poppy the other day and it’s so beautiful that I just decided I’d like to share it with you. How does it fit with today’s thoughts about beginnings? Well, all plants live cyclical lives, with phases passing through seed, germination, growth, perhaps blossoming or fruiting, and scattering the new seed before dying back for the next cycle. Does the beginning of that cycle start with the seed in the ground, or the seed in the seed head waiting to be dispersed? Or somewhere else?

So, back to beginnings. Whatever you want to begin, begin today. Even if its a habit, a routine, a task you’ve experienced before and stopped, because even when you stop, you can start again. You can start today. After all, you’ve never lived this day before.

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I remember reading that Paulo Coelho, the author, had a practice of starting a new book whenever he came across a white feather. I’m not sure if he still does that, or whether or not he always started a new book every time he came across a white feather……however, this has got me reflecting on the issue of beginnings.

Here I am, sitting in my studio office, near the French town of Cognac. It’s the second last day of August 2020 and we are now….how many months? into this COVID-19 pandemic.

I’ve had some recent experiences of thinking the pandemic was easier to cope with when we were in full lockdown than it is now. It seems that life was simpler because it was so constrained. Now there are an ever-changing host of regulations, laws and guidelines depending on where you are. Different in different places in the town, different in different towns, different in different countries. And the stats seem to be changing all the time as well now, as testing numbers increase, positive cases increase, hospital admissions and COVID deaths don’t increase…..just how widespread is this virus? Just how lethal is this virus? What are the best ways to minimise its impact? The answers to all these questions and more seems to change almost by the week now.

So this feels a particularly unsettled period. And, here’s a weird thing, so is the weather! I’ve never known a summer like this here. More wind, cooler mornings and evenings, high afternoon temperatures, unexpected showers, thunderstorms, and weather forecasts that are literally different between going to bed and waking up in the morning.

I find I can’t help wondering from time to time….”when is this all going to end?” Then, I realise, it might not end. The world might be changed by this. Life might be changed by this. We are not in a cycle of return where we will re-inhabit the past, pick up our “old ways” and carry on as if nothing had happened.

I think some people were thinking this way. Sure, a lot of people have talked about the “world after COVID” suggesting many things that could, and should, be changed. But others are more cynical and expect the predominant forces and power groups to steer things back to what suited them up till now.

The truth is none of us know. The truth is none of us can know. We haven’t lived through this particular event before and we haven’t even lived through an event which is “just like this”. We are still trying to understand what we are dealing with. And the future is never a place sitting like the next destination along the railway line just waiting for us to arrive. The future arrives as we live it. The future emerges from the present, from today’s choices and actions.

I got to thinking that maybe a bit like the “glass half full or empty” dilemma, maybe as life is lived it feels full of endings, but maybe it can also feel full of beginnings. Both are true. They are different perspectives. Isn’t there a saying somewhere about life being understood backwards but lived forwards? Something like that. How we make sense of things through reflection and memory, but how we live in a present which is constantly changing as possible futures come into being…..

So, maybe this as a good a time as any to concentrate on beginnings.

What shall I, what shall you, what shall we, start today? If the future really is like a path which emerges as we walk it, which path shall we take today? Which path will we start to create today?

This is my beginning. This is me just thinking of this. But over the next few days I’m going to devote some time and energy to this and ask myself, what shall I begin? How shall I begin to live now, in the light of this recent past, and this ongoing present?

Want to join me? Feel free. Share if you want, or just take some time this week to explore what you’d like to begin. Then begin.

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A few years ago I visited Segovia in Spain and saw all the storks which live there for part of each year. Here’s one feeding a chick….mind you that chick is looking pretty big already! The storks’ nests are huge and look pretty chaotic really. They’re built on roofs, on the tops of towers and tall trees.

If you look carefully you’ll see that each nest is constructed on a kind of wire basket. Now, I don’t know who makes the wire baskets or puts them there but I’m pretty sure it isn’t the storks! So, there’s no doubt the people of Segovia welcome these birds and help them create their homes here. Not all storks are migratory but I think these ones are. Their nests are used for many years, with each season’s storks adding to the material. In amongst a copse of trees I came across there were quite a number of large twigs and branches scattered on the ground, but I don’t know if they fell off during construction, were thrown out by some of the birds, or just fell down because the nest grew too big.

Looking at these photos again I’m reminded of some of the basic needs and drives we share with all living creatures – the need for a home and the need for food. I know there’s a lot more to human beings than that, but we are all motivated to get both food and a home….neither is optional.

Ah, you might say, but some people are nomadic. That’s true, but nomads have “homes” too, they just take them with them, or build new ones wherever they settle for a bit.

We humans are apparently the most highly developed species on the planet. Don’t you think we could manage to provide both home and food to every single human being? Is that beyond us? Or do we have the means, but not the motivation?

When I consider this pandemic I’m struck by the importance of both home and food. If we had better housing, less densely occupied and less densely clustered together, don’t you think it would be harder for an epidemic to become a pandemic? In France, it’s been striking that most of the infections have been in cities with populations greater than 100,000 people – mainly the cities of the “Grand Est” – Paris, Lyon, Marseilles. Incidentally I read a study recently which surveyed populations for life satisfaction and the highest rates were in those who lived in cities or towns of less than 100,000 people.

The second striking feature has been about food – on the one hand, the difficulties faced by many families in getting enough food, because so many people live in precarious conditions, with hardly enough money to get to the end of each normal month. When a crisis comes along, they are hit the hardest. Another aspect of food is the contribution of obesity to the incidence of severe COVID-19 disease. Obesity is a true pandemic, and unless it is tackled by addressing poverty, well-being, inequality and the industrialised agriculture and food production systems of our societies I don’t know how it’s going to be resolved – certainly not by fat-shaming and hectoring people to eat less and move more!

Is it beyond our abilities and/or our will to create more robust, healthier, happier societies by at least dealing with these two key needs…..the need for decent homes and the need for nutritious food?

Oh, and just so you don’t forget what this is all about……

Let’s do this for the babies, the children, the chicks!

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