I don’t celebrate Christmas.

I got lost twice on the way to a festive lights show in Hyde Park with my college friends and whizzed through the din without stopping for a hot chocolate. I stood in a packed chapel in high school while dramatic renditions of the nativity were performed and watched as only an interested observer. My most treasured occasion on the 24th is my first-half-of-high-school bestie’s birthday (and even she celebrates Christmas).

Because I am free from the onus of decorating and wrapping and gifting and baking and making sure the turkey doesn’t go past a mildly charred colour, I make the cards.

I make them for my friends and my teachers and my parents’ colleagues whose names I can’t remember. This year I’m making them for the people I volunteer with and sending them to their homes. I’m also making them for key workers I’ve never met before.

Let’s say it started from the post office. I liked to go when the sky was a magical colour and I was the only one there. That was lucky because I often had a pile of six cards to deliver, each needing scanning, sealing, and labelling by the employees at my local branch. No one ever saw me twice, or they might’ve gotten sick of me.

So I said I would surprise someone by including their own piece of A6 paper next time. It would have “Happy Holidays” typography, as neat as I could do with a ballpoint pen, and a reindeer or a snowman or a Christmas tree with googly eyes. You would turn it over and find a short message, something appreciative and not too sappy. I would keep them in my backpack and give them out whenever I felt like it.

The first one went to the motorcyclist who delivered a weekend treat to my front gate two weeks ago. In the darkness no one could have seen what I’d written on that tiny, teared-out piece of paper, but he thanked me anyway. I dashed away with my keys and my dinner and silently pumped my fist climbing up the stairs.

Next was a customer service assistant at my closest Waitrose, and then a waitress at LEON who I caught when she was posting a sign outside the restaurant. Then a cashier at M&S who thought I was buying the groceries of the person behind me (their haul seemed enough for five Christmas dinners) instead of just one bag of red onions (I didn’t want to stand in line with nothing in my hands). Then came the supermarket staff at the Brunswick Centre, a popular student spot whose used bookstore was the place I most liked to show London newcomers.

Last week I paced outside the entrance of UCLH, our university’s affiliated hospital, and pondered whether I should go past the rotating doors to find an NHS worker. Then I realised someone might shout at me about visitor policy so I dropped off my wares with the kindly security guard and exited as quickly as I could.

Yesterday I stopped at a cluster of grocery destinations near a shopping complex in Islington. The Waitrose here was running out of party platters and Brussels sprouts – I approached an employee who whispered happily to himself as he restocked jam and peanut butter. I realised that it was hard to catch people alone and even harder to not look suspicious circling a store multiple times and staring aimlessly at loaves of bread without taking any, waiting for the perfect moment. This man got the card with a Westminster Abbey sketch on it and made me smile with what he said in response.

The Sainsbury’s had a queue so long that it was no longer linear, but instead winding through a neighbourhood I hadn’t been to before. The ponytailed store assistant who held out a tin of sparkly chocolates to each customer who entered gasped in surprise when I handed her something of my own.

Then I was ready to go home. Some stores were too difficult to reach, their employees always working in pairs, and though the artistic quality of these cards were nothing to be jealous of, I didn’t have that many of them. So I walked back along the road where open-air vendors displayed their dried saucisson and seafood and squash and noticed an empty McDonald’s (empty compared to the usual, at least) – maybe this was an opportunity!

I approached a young woman with a nametag who seemed engrossed in sweeping the floor. Other people had retained a puzzled look on their faces even after I left them with a card, but not her; she exclaimed – no, squealed – with gradually increasing volume until I became a little embarrassed and left her with a thumbs up and an invisible blush behind my mask. I needed to work on my delivery, I realised.

I’m not done yet. This mundane work has brought some hope amidst this country’s ever-changing announcements and rules, and on days when I needed something tangible to jump out of bed or didn’t have the drive to create anything sophisticated or publishable, this was the gift I found under the Christmas tree.

Disclaimer: I can argue that the subject matter of this post relates to the name of this blog and cannot therefore be berated for failing (yet again) to stick to my degree topic.

This year, and this day, have shown me how lucky I am. Here are 18 reasons why, excluding the ultimate gifts of sustenance, shelter, education, and good health.

I am grateful for:

Original Tabasco sauce. It’s a culinary staple in any household I occupy, and variations of the classic don’t come close. These tiny bottles can keep for five years, but I never know how to store them. A reasonable person would put theirs in the fridge, but mine sit in front of my desk lamp. The lamp gathers more dust.

This miraculous two-ingredient hot sauce will be my crutch until I learn to properly season my cooking.

Grey’s Anatomy. This medical drama set in Seattle has been running for more than 15 years. Its creator, Shonda Rhimes, pioneered a “blind casting” approach that saw a talented troupe of actors diverse in gender, sexuality, race, and ability take the screen. Though my medic colleagues will attest to the show’s numerous inaccuracies, I think it captures well the spirit of being a health practitioner and the struggle to juggle personal and professional responsibilities in the quest to do the “right” thing. Having just started Grey’s 17th season (set in April 2020), I am once again amazed by the showrunners’ ability to capture the humanity of patients and staff alike in a divisive and terrifying environment. It’s worth the hype!

Regent’s Canal. The narrow paths that line this London waterway are occupied by hurried businesspeople carrying their Waitrose hauls, fluent cyclists of every description, and toddlers in hooded parkas. It’s just quiet enough for an afternoon walk, and a special treat when it’s raining so softly you can’t hear the splashes.

The Canal’s colour-splashed moored boats and its green meandering water, which reminds me of the time I tried catching tadpoles in a nature reserve outside the city as a kid, make me smile so much I’m glad I wear a mask everywhere.

R (the programming language). It would’ve been unimaginable to think that my desire to destroy my laptop over a linear regression coding error a year ago would turn into a real appreciation for R. I’ve been using it for my Data Science courses, and it’s a language with a steep learning curve that doesn’t allow a single misplaced punctuation mark. I have to forgive it, though, because it can produce maps like this using its free, open-source software:

Epigenetics. This recent development in human biology is defined as the study of changes in gene expression rather than in genetic code. Its existence means that we can no longer dismiss the theory that the effects of harmful environmental exposures (e.g. smoking) during one person’s lifetime can be passed down to their grandchildren and adversely affect their health. Rather than being cause for dismay, this can motivate policy change and put pressure on public servants to take responsibility for future generations, too.

Hope for ending the human immunodeficiency virus (HIV) epidemic. Though known primarily as a sexually transmitted disease, HIV significantly challenges global health through mother-to-child, or vertical, transmission. In 2019, 1.5 million pregnant women around the world were living with HIV, and vertical transmission occurred in 15-30% of those cases. However, drugs have been developed targeting this process in utero, during birth, and post-birth. This meant that for the first time last year, there were more averted childhood HIV infections than new ones. Despite our current circumstances, progress in global health is happening every day.

Cohort studies. My first year as a Population Health student introduced me to the 1946, 1958, 1970, and 2000 British birth cohorts, composed of several thousand people who were selected to take part in studies tracing their entire life trajectories. This kind of research has saved lives by evidencing maternal health, lifestyle, and early years interventions, as well as producing large-scale data that is just fascinating (one cohort was asked to write essays about their career plans at age 11). And yes, cohorts like these have faced issues such as survey non-response and a lack of diversity, but recent advances have seen researchers account for both problems. Read more about the progress that continues, especially following COVID-19: source.

Progress on accessibility. More than two decades have passed since landmark disability equal rights legislation was passed in both the UK and US. Though positive change has been gradual and uneven, I notice it in my surroundings. I went to the supermarket last week and saw an employee using sign language with a customer, something so exciting that I struggled to focus on my groceries. I attended a webinar hosted by my university’s Disabled Students’ Network where I learned that school accommodation residents can now request a room with modifications (for example, an accessible bathroom or an en-suite where one was not allocated originally) at no extra cost. This fight was championed by a few dedicated activists whose work will change thousands of lives. This summer gave me a chance to learn more about disability studies, and I am looking forward to furthering my interest this term.

Steadfast leadership and innovation in the fight against COVID-19. Excellence in infectious disease response has been seen everywhere this year, but I am especially grateful for the examples I read about in sub-Saharan Africa. Western media, as it often does, underestimated the ability of low-income countries to control a pandemic that had ravaged richer states. In the meantime, Rwanda employed robots in treatment centres to monitor patient temperatures (source) and Senegal’s ministers pledged one hospital for every coronavirus patient, no matter how symptomatic they were (source).

A world that is examining itself. Though I can’t name all the movements that the turmoil of the past several months have ignited, I am energised and humbled by the spirit of revolution that is changing our lives for the better. I see it in the classroom and on social media feeds that stayed quiet in the past and in private discussions between my peers and in the cardboard-sign-clutching teenagers that walked past my university accommodation a while ago.

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The chance to make things easier. This year, mostly through good fortune, I have taken on a variety of roles that involve welcoming new people to my community. I joined two other volunteers on Zoom in October to introduce UCL newcomers to the city of London using slides prepared ten minutes before (I hope at least the sentiment was there). I stood in my flat’s kitchen as freshers moved in and asked how to operate the washing machine, feeling like a sage on the topic of surviving university accommodation. And I am mentoring a handful of first-year students in our department as they go through the same exhilarating process we did last September. My favourite moment so far: when they reciprocate after I ask them how they’re doing.

The arts and the way they lighten the load. I watched my first workshopping of a new musical recently, one written by the director of my school’s spring term “Legally Blonde” production and his good friend (both of them pursuing postgraduate degrees in theatre). Though shown online, the singing was perfectly synced, and the plot, set in 20th century China, was rendered alive by phenomenal (and occasionally bilingual) actors. The experience made me even more glad that I had gone to school with people who were determined to show that the arts are essential.

The capacity to feel completely. I have noticed, in an out-of-character way, that being isolated for several months on end has heightened all the emotions I could have. The sight of a building I had only read about a few feet away, hearing good news about people I had never met, even compiling this disorganised list – these things that inexplicably move me make me a better writer, artist, and friend.

Nairobi vegetable gardens and table tennis tournaments and national park game drives. These are the staples of life back home that I wish I could experience. I am lucky, though, that they exist to occupy my family while we wait for the chance to reunite.

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Finally, not mutually exclusive:

The people who have asked if they could help me, served me food, held doors one second longer than needed, or told me my backpack was open (as it always seems to be).

The people who have said “yes” to me, welcomed me as a volunteer or leader or researcher or performer, listened carefully to my ideas, and made me strive for greater excellence.

The people who tell me when I’m being ridiculous, laugh at my jokes because they’re so bad, complain to me about their workload, and show their care without a word.

Health and social care workers. I love following their fictional lives when I’m procrastinating about university work, but I now know some real-life amazing doctors and medical students who have fought for the protection of staff, patients, and the general public. Their work inspired me to publicise an art project I started in March, which you can now find here.

Thank you so much for reading, and I promise to stay more on topic next time. 🙂

I have been so delayed in updating this blog that many of you are likely unaware of the significance I ascribe to March 23rd, 2020. Or maybe that date’s significance is the reason for my delay.

Either way, I apologise. The very representation of a key epidemiological concept is playing out across the globe right now and there have been many chances to startle and galvanise us to continue the fight for population health. I’m also apologising to myself because writing through uncertainty always lightens the load.

The fourth stage of the “epidemiological transition”, a standard concept in human geography, is characterised by globalisation, increasing life expectancy, rapid population ageing, and a considerable non-communicable disease burden. At first glance, this may look like progress – the eradication of transmissible diseases that once killed babies and young children, as well as their mothers, would surely mean that more individuals could be healthy into old age. But the growing threats of cardiovascular disease, obesity, and other chronic conditions have the potential to lessen individual dignity in spite of revolutionary medical advances, and the dizzying movement of people and goods, especially coupled with rising socioeconomic inequality and antibiotic resistance, has created an optimum environment for emerging infectious diseases. Most of the world’s medium- and high-income countries, with some notable exceptions (life expectancy high-achievers without staggering inequality), are reaching this stage.

This virus may hardly be alive in the biomedical sense, but our globe’s daily activities and priorities keep it content.

This may already be obvious to you, and I will get to my chosen date’s relevance soon. Just one important point first, though – I pulled up the latest statistics on the pandemic recently, something I hadn’t done in a while, to illustrate its severity in writing, and found that the numbers, or at least their proportions, were not the most shocking. I will not equate them to the “Spanish” flu of 1918, for example, whose estimated death toll made up more than 3 percent of the world population that year.

Of course, our current global figure of 974,000 deaths is no small number, and it’s hardly one that can be counted on your hands and feet. Because data can seem far away and theoretical to the most experienced scientists among us, I will instead highlight a different facet of COVID’s impact.

A nuclear family visiting someone they love in the intensive care unit today will see more wires and flashing lights than the same family would have in 1918. They will receive more breaking news notifications on their devices than they would have in 1957, the year of another devastating influenza pandemic in Asia. They will be shielded behind more layers of plastic and disposable fabric than ever before.

No amount of suffering can be minimised. I need to keep that in mind, like we all do.

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March 23rd marked the first full day of the UK’s lockdown. The previous week had seen me say my quickest goodbyes, accompany my last musical theatre choir rehearsal of Dear Evan Hansen’s “You Will Be Found”, and stuff my recital dresses into a navy blue suitcase before hanging them back in my closet an hour later.

The weather became unremarkable and the air itself seemed to hold its breath. Every insignificant noise outside was amplified. The kitchen utensils and cheers around the block each week at 8 p.m. sounded like they came from an empty concert hall. Because of evolving restrictions, I was moved to a new student accommodation, and then another. I needed to learn how to cook properly, and my flatmates and my neighbourhood changed in rapid succession …

I was lucky that many crucial aspects of my life remained the same, like my health, my loved ones’ presence, and my stash of non-perishable Chinese delights. The one most pertinent to this anniversary, however, was the existence of the charity Medical Supply Drive UK.

Six months before today, a handful of doctors in London took inspiration from a Georgetown-University-student-led project to deliver donated personal protective equipment (PPE) to healthcare workers in need and set up a similar network in the UK after hearing about supply shortages from their own NHS colleagues. Local businesses alerted them with news that their labs or studios had hundreds of unused surgical masks, and the team directed the items to the hospitals or GP surgeries that had requested them most urgently.

I joined the charity (which was not a certified nonprofit at the time) as a Twitter volunteer, given that I had neither the driver’s license nor the guts to deliver PPE myself. I had little relevant experience, but was keen enough to do something with my suddenly cleared schedule. Many of my fellow UCL students joined for the same reason, only with an added sense of obligation to their future colleagues as medics.

No matter my surroundings, there was always MSDUK work to do. Every post was spontaneous, based on changing regulations and circumstances. Our three-hour-long meetings at the beginning of this journey made us feel like we had met in class or at work, even though most of us were strangers beforehand. We have grown to celebrate our treasured anniversaries and offer a virtual shoulder to each other when tragedy strikes.

I used to think that my current role, social media management, couldn’t be a “real job” because I wasn’t the one approving donations or putting them in doctors’ hands. I still believe that sometimes, but I’ve expanded my repertoire since March to include designing infographics that will be disseminated to over a thousand people, and I’ve got our team organised with plans for the future. I promise to keep going, and I know that everything will be worth the effort.

If you want to find hope, consider volunteering.

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Med Supply Drive UK has delivered over 200,000 pieces of PPE to the health and social care frontline to date and hopes to give even more to the individuals who deserve the safest working conditions possible. We continue to fundraise via GoFundMe to research new ways of manufacturing sustainable PPE, cover logistical costs of future donations, and advocate for evidence-based infection control policy in the UK.

I’m writing about all this because I want to thank you. I couldn’t have invested so much time into this charity without your support. Also, if you are reading this, you have probably told me off at least once for staying up until 3 a.m. because I felt like doing so, and I thank you, too, for that insistent kindness.

Let’s wish for a better world in the next six months. Maybe something like this:

Illustrations by @portraitsforppe (www.instagram.com/portraitsforppe)

March 22nd, a Sunday, celebrates mothers around the world. Our lives are likely in tumult as you read this, and our fears and uncertainties cannot be minimised. But today, I’ll be honouring the women who hold the world together, in this time as in any other. In one of my heavier posts on this blog, I’ll tell you about what stops us from achieving health equity in motherhood and why health policy must serve mothers with the greatest attention and dignity.

140 million babies are born globally each year. That is hundreds of millions of mothers who need timely prenatal, perinatal, and neonatal care to allow their children, and themselves, to flourish. Today, we center our discussion on gestation, the period after conception and until birth when maternal and foetus health hang in a precarious balance. What groups are most at risk for a difficult pregnancy, and who have healthcare systems prioritised?*

1 Health outcomes

Childbearing can be complicated by a variety of clinical and biological factors. Medical conditions that can lead to a risky pregnancy include high blood pressure, polycystic ovary syndrome, diabetes, kidney, thyroid, and autoimmune diseases, obesity, and HIV/AIDS. The biggest biological risk factor for pregnancy is age at first birth. Many of these risk factors are socially patterned, meaning that socioeconomic position (SEP) significantly contributes to their unequal distribution in the population. I will give examples of each and present evidence for this inequality.

Clinical

First, high blood pressure during pregnancy causes preeclampsia, which restricts blood flow to the placenta and is the leading cause of maternal and infant death right before, during, and after birth. Researchers studied a group of nearly 10,000 mothers in the Netherlands and found that the least-educated among them had five times the risk for preeclampsia as the most well-educated. You argue that this could have been due to other factors related to developing high blood pressure, like diabetes or a woman’s previous pregnancies, but this relationship remained strong after “controlling” (statistically manipulating the data) for those factors that could modify the association. This is no coincidence.

Next, looking at obesity, which the World Health Organisation (WHO) defines as having a BMI above 30, we can also find a series of adverse outcomes. Women who carry extra weight during pregnancy are at higher risk for miscarriages, cardiovascular conditions, anaesthetic complications, and gestational diabetes (insulin resistance that specifically develops during, you guessed it, gestation). Here, we see a socioeconomic gap measured by a variety of factors in addition to the education level classification used above. In one Australian study of pregnant women where 18% of the participants were diagnosed with obesity, researchers found that the condition was associated with having a partner who was less educated and out of the workforce, being unmarried, and not owning one’s own house. Every one of these, and other “proxy measures” of socioeconomic position, had a statistically significant relationship with obesity. In short, this was no chance association, but an explainable one.

Our final clinical spotlight is on polycystic ovary syndrome, or PCOS. Even though this condition affects up to 10% of all reproductive-age women, you might have never heard of it before. PCOS is difficult to diagnose because it manifests in a variety of ways, such as excess body hair, irregular menstruation, and enlarged ovaries (contrary to what the name suggests, the syndrome does not involve ovarian cysts). Women with this diagnosis are at higher risk for miscarriage, gestational diabetes, and preterm birth. Studies suggest that low socioeconomic status, especially in childhood and adolescence, is associated with developing PCOS. This can be partially explained by the metabolic risk factors often coexisting with the syndrome such as insulin resistance, obesity, and high cholesterol, but we are unsure about how these two characteristics are linked otherwise.

This is the observational evidence. In describing the socioeconomic inequalities of these medical conditions, I have touched upon three common pathways that population health scientists use to explain the connection between SEP and health outcomes: respectively, the psychosocial, behavioural, and material mechanisms.

Why does the association between maternal education level and preeclampsia diagnosis remain after we control for known clinical (measurable) risk factors? It must be the inequality that sickens. This defines the psychosocial pathway, which combines the chronic stress of living with little means with the unavoidable notion that you are on lower down on the socioeconomic ladder than others. These psychological processes lead to body system changes that damage health.

How about the link between obesity and house ownership, among other measures? This is a little more straightforward. Because a high BMI results from an imbalance in the number of calories taken in and used up, a mother’s diet during gestation contributes to obesity. Just because individual behaviour is implicated in this instance, however, does not mean that we fail to consider the myriad societal factors that contribute to an unbalanced diet. Just like many smokers continue their behaviour even as they are aware of how devastating lung cancer is, pregnant women of a low socioeconomic position may not have the resources or time to obtain healthful foods (this is well-evidenced), which are less accessible and more expensive than their processed alternatives in the first place.

We can say much the same about the socioeconomic gradient in polycystic ovary syndrome incidence as we can about similar inequalities in high blood pressure, gestational diabetes, and other modifiable risk factors. But I consider the material pathway, specifically healthcare access, especially important with a lesser-known disorder like PCOS. Without concrete data to back up my claim, I imagine that an expectant mother with little disposable income and a demanding blue-collar job would be unwilling, nigh unable, to attend multiple doctor’s appointments to piece together a complex and misunderstood condition and finally obtain a diagnosis. The costs of transport and time could be difficult to handle. Therefore, I argue that the socioeconomic inequality in PCOS incidence is not entirely driven by true disease rates, but underdiagnosis in the most vulnerable mothers.

Biological

Teenage , or under-20, pregnancy poses health risks such as possible hypertension, anaemia, premature labour, and sexually-transmitted infections (STIs). In addition, having a child at young age limits educational and workforce opportunities, adding a financial and psychological burden to the lives of young women who may not have the resources to adequately handle parenthood. Teenage pregnancy can also be passed down generationally. In a literature review of 15 studies conducted in the U.S. that encompassed tens of thousands of subjects, researchers found an undeniable association between teen childbearing and disadvantaged scores on a variety of socioeconomic indicators, including income, employment status, and neighbourhood disorder.

Why is this? Studies suggest that more disadvantaged teens have higher discount rates, meaning that they place less consideration on future prospects and instead consider the present more important. Also considerable is the real or perceived lack of opportunity in a young woman’s community which can lead her to pursue the alternative route of childbearing. These processes are complex, and no one factor can elucidate the differing prevalences of teen pregnancy across socioeconomic strata. However, we can be optimistic here: at least in the United States, the number of teens who have children is decreasing every year.

2 Healthcare access

Now that we have identified the groups most at risk for pregnancy complications, we must look at who can access adequate healthcare. The ideal pathway through antenatal, or pre-birth care, involves appointments at 12 and 20 weeks to screen the foetus for anomalies. Further appointments at 30 weeks and beyond measure the health and development of the foetus. These are crucial to mitigate the risk of illness and death for the mother and baby. After all, the period in one’s life from birth until the age of one is often the most mortality-sensitive timeframe until middle age.

So who books these appointments on time? And to whom are they less accessible? Data from the UK shows that women who book appointments late are likely to live in a more deprived area (deprivation is a summary measure that includes an area’s education, housing, and health outcomes, crime rate, and employment), come from an ethnic minority group, have lower educational attainment, be obese, be very young, have a disability, and struggle with substance misuse, among myriad other factors. The actual barriers to access can stem from poor communication of information to patients, long waiting times, transportation costs, confidentiality concerns, difficulties with GP registration, and the attitudes and cultural backgrounds of healthcare staff.

And the question is not only about access. When healthcare, even clinically competent healthcare, is available, is it dignified? Does it treat all mothers fairly?

In a qualitative (as opposed to quantitative, or numbers-based) study in the U.S. about women’s experiences of maternity care, researchers discovered that one in six women in a racially and socioeconomically diverse sample had been victims of clinical mistreatment. These were no minor slights; they included such occurrences as violations of patient confidentiality and physical privacy, feeling forced to accept or withdraw a certain treatment by their healthcare provider, and being shouted at or scolded by their doctor. Aside from the unacceptable care given to these women in general, we can see that their mistreatment is unequally distributed. Women of low SEP were twice as likely to report being threatened by their doctor as women of middle or high SEP. Moreover, women in vulnerable groups such as survivors of intimate partner violence, those who had been incarcerated, and those with a history of substance use were even more likely to be mistreated, with one-third of these groups reporting violations of protocol. These underprivileged populations likely intersect.

Notice anything familiar? These underserved populations coincide with the groups described in Section 1, who, rarely by personal choice, will likely face a difficult pregnancy. This reminds me of the “inverse care law”, a principle asserting that those in the greatest need for healthcare seldom get the quality or quantity of care they warrant. Our maternity care systems are broken.

3 So What?

In studying the social determinants of health, researchers must make a careful contrast between inequalities and inequities. A clear distinction has not been set out, but many think of inequalities as differences between groups that can exist without seeming unjust. If genetics, an inevitable factor, leads to worse health outcomes for one mother than another, this disparity is unfortunate but not inequitable. If, on the other hand, modifiable risk factors such as social class, health behaviours, or age at first birth bring about massive differences in maternal health outcomes, this may well be inequitable. Something can be done about these differences. To put it better, we can do something.

If we cannot construct equitable, actionable health policy for our societies’ most important members, we should be ashamed. There is so much I have not mentioned: the ethnic and racial disparities in maternity services access and health, the physical and practical accessibility of health services for mothers with disabilities, the unique challenges single mothers face in pregnancy, and the list goes on. For each of the groups that are negatively impacted by our current healthcare systems, there will be individuals who are unable to reach their own or their children’s potential through no fault of their own.

We owe our greatest thanks to our birthgivers. Without them, we would be nothing.

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As for mine?

She has braved earthquakes and hurricanes, the bitter winters of Moscow and the gritty deserts of Upper Egypt. She has slammed a garage door on her index finger and dialled the ambulance with the same hand, blood oozing onto every surface.

She was once a fantastic high jumper. She has taken American doctors around China, improving her English as she commented on every historical site. And she had good enough taste to be enamoured by a skinny bespectacled guy studying education and journalism who always got the best grades.

She is obsessed with the darkest of chocolate that nobody else likes. She is terrible at cake decorating, though no worse than yours truly. She read ancient poetry to my toddler self in the hope that I would memorise it, which I never did. She took more notes than me when I went to Chinese harp lessons, and knew my pieces better than I. She has attended every concert, even when I’ve been on stage for only five minutes, and once sat on the balcony for three nights of a musical to get a better view of me in the orchestra.

妈妈，you terrify me when I don’t listen. But you make me feel like the luckiest thing alive with your encouragement, humour, and love. Love not expressed extravagantly, or spoken about often, but declared through immaculately sliced watermelon and second grade tears-and-tantrums homeschooling and strange medicinal concoctions that I question. All I will have done through my university career will make a better world for you, because you deserve it the most. 您是最伟大的。**

Happy Mother’s Day to you and yours! May you be reminded of your loved ones’ embraces even as you are physically apart. Please take care of yourselves during this time, physically and mentally, and remember that we are all doing the best we can. Monitor official sources of information such as the World Health Organisation and your country’s respective health departments, such as the UK’s Department of Health and Social Care. If you need help, do not hesitate to reach out to family, friends (my own ears and arms are wide open!), and support services available through your school, university, employer, or charitable organisations. I hope you all stay well and in good spirits.

Here are a variety of sources I consulted:

https://www.nichd.nih.gov/health/topics/high-risk/conditioninfo/factors

https://ourworldindata.org/births-and-deaths

Preeclampsia:

https://insights.ovid.com/crossref?an=00004872-200806000-00020

Obesity:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989730/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4165994/

PCOS:

https://www.fertstert.org/article/S0015-0282(16)61278-5/pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115419/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4433074/

Teen pregnancy:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3562742/#!po=23.6842

Maternity care mistreatment:

https://reproductive-health-journal.biomedcentral.com/track/pdf/10.1186/s12978-019-0729-2

And the most important source of all: my phenomenal lectures in modules such as “Social Determinants of Health”, which you will need to join the BSc in Population Health to experience!

*This post is unedited and akin to a stream of consciousness. I apologise about this.

I had unexpected inspiration for my writing today. Ginormous story short, I am in the nearly-empty triage room of a paediatric emergency ward, waiting for my name to be called. I’m okay. Everything’s intact. It could be worse, at least I have something to post about.

On my left are two young people who look like they’re in secondary school.
The teenage guy has just come back from a blood and vitals test, moaning about his painful arm but looking spirited otherwise. He is dressed in Lakers merch and sporting a wavy short haircut. His trainers are greyed and worn from use.
The girl on the left, who I can only assume is his one and only, has a buzz cut that is growing out. Her eyeliner is thick and draws my attention immediately. Her jacket, the same colours as his, reaches to her knees and is made of a loose fabric.
I try not to eavesdrop, but their conversation is loud and lively. The boy was attending a protest while on a hunger strike and fainted. They are both in their early teens, full of idealism and a desire for Parliament to listen to their demands. The girl pledges to stay by the guy’s side, but he insists that she go home soon. Her sister won’t be happy picking her up from the hospital so late, he argues. In the end, they go home together, test results clear. I wish them, and their activism, the best.

This waiting room only has nine seats. The walls are adorned with poppies, simple but elegant on a white background. A TV is mounted above the chairs, looking barely used. There are posters all over; one says that being different isn’t a bad thing and that it means you are brave enough to be yourself. Another, perhaps posted in December and forgotten about, gives options for mental health support during Christmas. My favourite decoration is a crude cardboard tree with tissue paper leaves and a hastily glued black-and-white wren. The Arial font indicates the tree’s life advice: stand tall, remember your roots, be content with your natural beauty, and enjoy the view.

Wouldn’t we all be happier as trees?

A mother and her daughter, the latter still in her school uniform, are sitting in front of me. They speak a language I can’t identify: possibly a Slavic tongue? The mother takes a colouring page and works at it with a pink pen. She doesn’t seem concerned at first glance, but her hair is frazzled and she watches the doctors’ every move. Her daughter is only able to speak softly and clutches her hip every time she stands.

Another school-aged girl is here too, accompanied by an older boy: her friend or her brother? They are exuberant, though clearly exasperated at the waiting time. Her outfit looks like she could go to the gym at any moment if it weren’t for the A&E. When her companion leaves, she is at first talkative, calling a school friend to complain about the urine samples she had to provide for pregnancy testing (“I’m like the Virgin Mary, what the ****!?”) and mourning peers who were soon to graduate. Then, she asks for a prayer for her health and says goodbye. But now, she is sitting quietly, occasionally letting out a deep breath.

As I grow restless, unable to find a comfortable position for all my limbs, a nurse shouts, “How you feeling, Elijah? Have the minions helped?”

I hear sobbing moments later.

__________________________________________________________________

I’ve been seen now. I should go home soon. What a long wait for such a minor problem! But I’m glad I could experience the bowels of this hospital and the heroes that run it.

A Chinese family sat down while I was being examined. They brought two howling children in a stroller, one complaining of a fever and a sore throat. The family is bilingual; their Mandarin is spoken with an accent I don’t recognise and their English is almost completely British. An old man, his English heavily accented, is also sitting here with his adult daughters. He teases the children gently, asks the parents whether they have seen a doctor, and gives up his seat for another patient. People like him are more common than we realise in the emergency department.

I am still here, waiting for the painkillers to set in. I have a friend with me. She has several deadlines and still volunteered to give me company. Another dear friend texted me the whole way, asking about my state at every turn. Others have shown through numerous means that I am cared for. I hope you get the same treatment when something, however minor, happens to you.

I want to thank you all for your well-wishes. What a gift you are.

Note: this post contains language that some readers may find distressing. Please take care.

I’ve done it. I’ve jumped on the bandwagon.

At the beginning of this decade, I was a third grader in a New York City public school. My art and PE classes were becoming sporadic due to underfunding. I exchanged germs and junk food (but mainly germs) in the cafeteria with my Bangladeshi, Mexican, Chinese, and Greek classmates. My friends and I had gotten a basketball and perfected the free throw technique literally translated as “lifting a bowl of pee” in our backyard.

Where were you?

And where was our world?

World Bank and United Nations data tells us that global life expectancy has risen from 70.5 to 72.6 years in the last decade. If you don’t think that’s a lot, consider what you’ve been through in the last two years. Remember that life expectancy is not the average age people live to, but also reflects a decline in infant mortality that allows those who may not have survived until their first birthday to contribute more years of life.

In 2010, 18% of the world’s population lived in extreme poverty (defined as an income under $1.90 a day). Now, less than 8% of people have to experience the deprivation, hunger, and poor health that come from being poor. That’s a reduction of more than 700 million, and we know we can do even better.

In the last ten years, the number of people living on our blue planet has increased from 6.9 to 7.8 billion. Much of this population growth has occurred in low- and middle-income countries in Asia and sub-Saharan Africa, some of whose governments now struggle to support the burgeoning numbers of youth who need jobs, healthcare, and a quality education. On the other hand, countries like China have felt the impacts of antinatalist laws such as the One-Child Policy of the ’70s and now seek to grow their population for the future.

In 2010, 6.7% of the world’s children were overweight or obese. It is predicted that this statistic will reach more than 9% next year. Have parents suddenly forgotten about the health risks of a high body mass index (BMI)? In reality, the disease burden of overweight children again falls on the shoulders of the world’s most impoverished communities, which lack the resources, time, and circumstances to make the most nutritious choices. This includes developing countries who face the “double burden” of a simultaneously obese and undernourished population (both of these extremes fall under the “malnourishment” umbrella), as well as those lower down the social ladder in wealthy European and North American countries whose heart disease, stroke, and cancer risk are already magnified by their socioeconomic position. There is, too, something to be said about the commercial determinants of health; you can find unhealthy products being colourfully advertised to children around the world, and supermarkets are designed to make shoppers browse through aisles of processed food in order to reach the checkout.

These numbers have been inching up or down for the last ten years without making headlines. But with the human impact they have, shouldn’t they?

I think more people should know about them.

In 2012, Dr. James Cheshire, a UCL (!) researcher, developed a map showing the life expectancies of the people living within a 200 meter radius of each of Greater London’s Tube stations. Borough Station, right next to its tourist-flooded namesake market that serves artisanal cheese and bread, has an abysmal 79 years. Oxford Circus Station, located on the same street as the latest in high fashion and a six-story toy store, isn’t faring much better at 82. Green Park Station, just one stop away from the latter, is thriving at 89 years. These places are all in the same city, so how can they be so different?

My field has a term called “neighbourhood effects” to describe how your surroundings influence your behaviours, opportunities, and health. The people you live with, the green spaces you can visit, the state of your housing, the amount of people seen smoking in your area, the prices of fresh produce in your nearest supermarket, whether there is even a supermarket near you … the list continues. Researchers theorise that a combination of psychologic, social, environmental, and material factors impact health on this level. And these impacts are seen from birth to death, otherwise known as — my favourite term — the life-course.

Dr. Cheshire’s visualisation can be found here: https://tubecreature.com/#/livesontheline/current/same/U/940GZZLUGDG/FFTFTF/11.95406366809641/-0.3325/51.4638/

So if you live in the city, think of yourself ageing as you ride the Tube one way and becoming younger as you ride it the other way. And if you don’t live here, these effects are seen elsewhere too. Please find out about them.

2

On September 2nd, 2015, you might’ve woken up to a photo taken by journalist Nilüfer Demir plastered all over your feed. I will not show it here. In it, 3-year-old Syrian refugee Aylan Kurdi, navy blue shorts and a red t-shirt sticking to his soaked body, lies face-down on a Turkish beach. Lifeless.

You can read statistics about the rate of drowning among migrants trying to reach Europe or North America. You can listen to politicians espouse border policies that drive vulnerable people away. You can even comb through a technical manual about malfunctioning life jackets like those that Aylan and his family were given. But nothing prepares you for this sight; a child who can’t possibly be dead, who must be sleeping, who could be on a vacation to the seaside, who is well-dressed, whose little trainers could belong to your brother or your son or your cousin.

In the next week, donations to some refugee aid organisations increase 55-fold. This impact lasts for months. This is no longer an issue for “them”. This is for everyone to fix.

Migration is a key component of demographic change, along with mortality and fertility. When waves of people are forced to emigrate, they lose their financial security, their safety, their access to healthcare, their guaranteed education, and perhaps most devastatingly, their sense of belonging. Their material losses may be significant, but psychosocial factors are an oft-overlooked aspect of the refugee experience. Trauma, depression, anxiety, and loneliness contribute to the stress of learning a new language by necessity, having new neighbours who cannot understand you, and missing that simple plate of food that reminds you of home.

And that’s if you survive the journey.

3

Marjory Stoneman Douglas High School isn’t known for its football team or its college admissions record. It hadn’t won any national awards. Instead, it’s become a household name in a way it never wanted to: when a former student opened fire in its hallways in February 2018, killing 17 and injuring just as many.

Gunshots sound like distant firecrackers. I can’t tell the difference myself. And I likely won’t need to; at least not in the classroom, where Floridian teenagers getting educated for a better future had that future cut short.

But for each light extinguished, hundreds have been lit in the name of political activism. A month after tragedy struck, Stoneman Douglas survivors marched out of their classrooms to honour the 17 lives lost and to join thousands around the world in a “March for Our Lives”. This was no activism from a distance, no activism for faraway issues; this kind of politics meant the difference between life and death. Between spending your lunch break gushing about that new school musical and spending it hidden behind filing cabinets, crossing your fingers and quieting your tears. Between full attendance at graduation and flowers being placed on 17 seats.

In March, Florida governor Rick Scott signed legislation tightening gun control laws and raising the minimum age for firearm purchase from 18 to 21. Hotels and insurance companies cut ties with the National Rifle Association (NRA). President Trump signed a bill improving the quality of national background checks.

We are reminded by the students of Stoneman Douglas that young people, some of them not even old enough to drive, can make a difference. We are a crucial demographic that is set to increase in size, and it is the issues of life and death, those that I have described above, that will affect us the most. Let us ring in the new decade empowering this generation to act.

A year after the shooting, Stoneman Douglas lost two more lights. Calvin Desir and Sydney Aiello, both survivors, took their own lives less than a week apart in March 2019. Their deaths are less well known but no less sobering. We remember them.

P. S. We all know that negative news makes headlines. If some of the events I have described today sadden you, I apologise. But if tragedy drives us to act, so can positivity. If you need a pick-me-up, be sure to subscribe to my friend Divya Manocha’s weekly positive news newsletter, Happinewss, and be inspired to make the world a kinder, healthier, and more inclusive place. She, too, stays up until unholy hours of the night to bring her writing to those who might need it. I would know, I’ve seen it happen. Besides, don’t we all need that little something on a dreary Monday ;)?

Selected bibliography:

https://www.npr.org/sections/goatsandsoda/2017/01/13/509650251/study-what-was-the-impact-of-the-iconic-photo-of-the-syrian-boy

Click to access fair-society-healthy-lives-exec-summary-pdf.pdf

https://www.brookings.edu/blog/future-development/2018/12/13/rethinking-global-poverty-reduction-in-2019/

https://academic.oup.com/eurpub/advancearticle/doi/10.1093/eurpub/ckz153/5574387

https://www.who.int/global_health_histories/seminars/presentation46b.pdf?ua=1

https://www.theguardian.com/us-news/2018/mar/26/gun-control-movement-march-for-our-lives-stoneman-douglas-parkland-builds-momentum

Yesterday, the reality of the Christmas holidays struck me.

A friend had texted the day before, asking if I was back from rehearsals. She was raring to give me something. “What is it?”, I pressed. “You really didn’t have to”, I said in Mandarin, hoping that would make an impact.

It didn’t. Of course she had to.

For the past ten weeks, I’ve come into class, jumping with energy or sleep-deprived, to see peers that I’ve grown to admire. We groan collectively when we see Dahlgren and Whitehead’s “rainbow” diagram of health determinants for the thousandth time. We puzzle over intention-to-treat analysis and start questioning why experimental integrity is important in the first place. We complete questionnaires on wellbeing and mental health and realise how invasive they can feel. We rack our brains to recall everything about antibiotics from high school biology, wanting to impress a new lecturer who challenges us like never before. We hear stories of social change that inspire us to invest in our local community’s most vulnerable residents, to teach them a new skill or to simply be present.

That sticker-sealed red envelope, passed under the table at breakfast, meant the world to me, and it came as a complete surprise. So I knew I had to do something.

These past few months, I’ve learned that data is important. In the UK, we take census availability for granted, but you only realise how crucial vital statistics are when you are researching for your paper and find next to nothing on Sierra Leonean population change over the centuries. When I participated in the 2019 Kenyan census, I thought little of the questions, giggling incredulously with my parents at our interviewer when he inquired about my marital status. But this information is invaluable for policymakers, who need to learn about their constituencies before making decisions about them. Improved data collection is one step on the road to lessening global health inequities.

9:20 AM. My breath fogged up in the air as I headed towards the stationer’s. Had I budgeted enough time to get to class? If not, what would be my excuse? A sudden desire to make people smile?

I’ve learned that it’s hard to do the right things. In my field, there is often a discussion of “upstream” and “downstream” influences on health, where upstream influences include the wider socioeconomic and cultural structures that cause disease and downstream influences include individual health behaviours and health education. It can be politically suicidal to suggest extensive upstream strategies, especially if those changes seem unappealing to a great proportion of a constituency. On the other hand, campaigning on the issue of smoking cessation is an idea that most people can get behind. We examined a Guardian article where the author, who had been in poverty, sharply criticised celebrity chef Jamie Oliver’s mocking of the unhealthy food choices made by low-income families. One line stood out: “[…] poor people’s bread does not go stale, Jamie. It goes mouldy. And if you had ever been poor, you would know that.”

I make preliminary sketches during a lecture break, hoping that my pencil marks are invisible to everyone else. I don’t have any other time that day. But I flash my work by accident. Too late, my cover’d been blown!

I tell the recipient to leave the room. For five minutes, then ten. When she comes back, the envelope is closed, labelled, and ready. This is an accomplishment I can be proud of.

I’ve learned that my friends are brave. I gush about working on the musical directing team of my university’s production of “Legally Blonde” every day. I tell them that we have auditions next week, and they step up without needing much convincing. They prepare and practice their pieces. They stand in front of a panel that is 2/3rds strangers and blow us away. Their nerves don’t deter them. On the other hand, my heart is beating out of my chest the whole time. I am proud of them, no matter the outcome.

On my way back from rehearsals, I buy candy bars that I can’t identify. I work feverishly into the evening, putting carrot noses on piano-playing snowmen and drawing talking Christmas trees. I forget about first drafts and final drafts and make it all into one. A pile of envelopes builds next to me.

I’ve learned that I can give people the wrong directions and bust my lungs chasing them down afterwards. I’ve learned that I can pretend to know what I’m doing when someone gives me music to read ten minutes before an audition. I’ve learned that I’m a good campus tour guide and could even earn something on the job (@UCLcareers?). I’ve learned that my supply of hugs is nearly inexhaustible.

I knock on doors at midnight and hope that disgruntled zombie-like figures with half-open eyes don’t appear. I’m lucky; other people have stayed up too.

They see the envelope and I ask them to open it. They tear up the edges like little children and their faces light up. I ask them to read what’s been written, and they don’t know how to react. That is the day that my hug supply is nearly exhausted. But I’m not complaining.

I am grateful that this first term has given me enough free time to start this blog. I hope to keep writing regularly next year, even as university life places extra demands on my time.

I thank you, dear reader, for taking an interest in me and my words. You are the reason I write. I am taking a short hiatus to properly celebrate loved ones at home and to focus on academic work.

See you soon! ❤

Warning: the following article contains brief graphic descriptions of medical symptoms.

What do you envision when you hear the word ‘experiment’? Bespectacled researchers with white coats and pristine microscope slides working into the wee hours of the night? Lab mice injected with this, that, and the other, scurrying around a maze?

What if I told you that the first documented clinical experiment occurred on the HMS Salisbury, a British 50-gun warship navigating the Bay of Biscay in 1746? The subjects: around-the-clock-drunk male sailors afflicted by scurvy, causing a “lazy inactive disposition”, “extremely putrid and fungous” gums, “black and livid spots” on the skin, and ulcers caked with “coagulated gore”. The researcher: one James Lind, the ship’s Scottish surgeon, who rose up Navy ranks after only an apprenticeship and no medical degree. The background: only a handful of military personnel were dying from battle wounds, but hordes were falling victim to scurvy. The research question: whether a change in diet would cure the sailors of their horrific symptoms.

Lind selected 12 sailors from the 30-40 on the ship that were already scorbutic (suffering from scurvy), making sure that his subjects had similar symptom severities, living quarters, and diets (featuring delicacies such as “water-gruel sweetened with sugar” and “fresh mutton-broth”). He assigned two sailors each to six daily treatments over two weeks: a quart of cider, twenty-five drops of dilute sulphuric acid, two spoonfuls of vinegar, half a pint of sea-water, a medicinal paste containing herbs and myrrh, and two oranges and a lemon (this last treatment was discontinued after six days because the citrus fruits ran out). All these were to be taken on an empty stomach.

As you might expect, the sailors who received oranges and lemons quickly recovered and were able to care for the other subjects within a week. Next in effectiveness were the cider and sulphuric acid, which eased dental symptoms (but may have created their own problems). The other treatments had little effect on the patients’ conditions, although one vinegar-drinker did improve after the experiment (Lind was able to attribute this to the natural course of the disease rather than the vinegar itself).

One glaring critique of Lind’s design is its sample size; how do we know that the various treatment outcomes were not due to chance if only two sailors were assigned to each one? Also, did Lind introduce his own biases in selecting sailors to participate in the study, and were the subjects he chose representative of the seafaring scorbutic population? Did the subjects always comply with the treatment assigned to them? Was there something apart from the treatment variable that caused a difference in disease outcomes of the subjects (heterogeneity)?

Nevertheless, the amount of experimental control Lind achieved is admirable, and his methods were a revelation to his contemporaries. More inspiring was the extent to which he doubted his own conclusions; unlike some headstrong scientists, he gathered that his results were almost meaningless and sought further research, even admitting defeat after the observations he made repeatedly contradicted the citrus fruit hypothesis. Given that Navy policies relied on reputation more than scientific evidence, citrus rations were only provided to sailors from 1795 onwards. Some could say that the British defeated Napoleon with lemon juice.

But was this trial ethical? Researchers use the term equipoise to describe the uncertainty that justifies a randomised control trial. Since Lind was the first to experiment on scurvy patients, he was hardly expected to recognise which treatment would be most successful. However, the treatments he enforced, such as the ingestion of sulphuric acid on an empty stomach, are hardly excusable to the modern reader. No publication, contemporary or otherwise, has mentioned Lind asking the sailors for informed consent. Such an experiment, especially one involving a potentially fatal disease, would never have been authorised today.

So this holiday season, be thankful that clinical trials have consent forms, ethics review boards, and medical professionals on hand. And be glad that attrition is due to participants who no longer want to give you their time, not those who happen to fall from your ship and drown every other week.

To read Lind’s A treatise of the scurvy : in three parts, containing an inquiry into the nature, causes, and cure, of that disease, together with a critical and chronological view of what has been published on the subject (1753), go to: https://babel.hathitrust.org/cgi/pt?id=ucm.5320216015&view=1up&seq=2

Sources:

Milne, Iain. “Who Was James Lind, and What Exactly Did He Achieve?” The James Lind Library, 2012, https://www.jameslindlibrary.org/articles/who-was-james-lind-and-what-exactly-did-he-achieve/.

Sutton, G. “Putrid Gums and Dead Mens Cloaths: James Lind Aboard the Salisbury.” Journal of the Royal Society of Medicine, vol. 96, no. 12, 1 Dec. 2003, pp. 605–608., doi:10.1258/jrsm.96.12.605.

*If you are interested in research design and using experiments and data analysis to solve our biggest challenges in the health and social sciences, consider a course in UCL’s Q-step Centre, a pioneering programme to introduce more quantitative skills to social studies degrees across the university’s diverse departments. Geography, Social Sciences, Political Science, and Population Health can all be studied with a Q-step pathway.

Disclaimer: I write only as a passionate student observer on issues of social justice and disability. I am not widely read on this topic, nor do I have direct personal experience of the pertinent issues. This is my own opinion. Correct me in the comments!

I went on a walking tour of my university campus this week and made myself suspicious to security officers by snooping around back entrances and examining emergency exits a little too carefully. After reading so much about access online, I decided to see if the spaces I visited daily were free of physical and social barriers.

But first … the technical part! Why should we care about these barriers in the first place?

If you’re in the UK, the Equality Act of 2010 makes it illegal to discriminate against nine protected characteristics, or personal attributes that should not stop you from participating in society to your full potential. As well as (dis)ability, these include age, gender, marriage/civil partnership status, pregnancy and maternity, race, religion/belief, sex, and sexual orientation. The passing of the Act means that businesses and institutions need to make reasonable adjustments to their facilities, goods, and services to accommodate users with physical, mental, sensory, and cognitive disabilities. What counts as reasonable, I’m afraid, is too legally complex a question for me to address.

Modern-day activists define disability through the social model, which states that it is not medical diagnoses themselves that disable people, but social barriers, which prevent them from engaging fully in community life. Access concerns itself with disability, but that’s not the whole picture. Physical accessibility involves improving the built environment for families with buggies, people carrying multiple pieces of luggage, and any other group, temporarily or permanently defined, that may have different access requirements.

I focus on physical accessibility in this overview, which is more conspicuous to the outsider than other types of accessibility. As I learn more about this topic, I may write about whether the buildings I visit are suitable for those with sensory and cognitive impairments.

We begin in my hall of residence, where students are assigned a room for their first year of undergraduate studies. Step-free access has not been specifically designed and is only available through a side gate that usually opens for large vehicles. Ramps are present throughout the building, but lifts (elevators) are not always working. This is a recurring theme in many structures, and is unavoidable. However, there should be alternative measures in place when infrastructure breaks down. These measures should not be demeaning or prevent any user from accessing the building.

On my tour, I was able to locate step-free access to the majority of UCL buildings, though some entrances were not clearly marked and proved difficult to reach. Many buildings lack automatic doors, which may restrict wheelchair users from entering them unassisted. I also noticed some uneven sidewalks near campus buildings, which could make the journey more difficult. Because our campus contains a handful of historical buildings from the last two centuries, renovations may be difficult to authorise. Ideally, the pieces of architecture that we take the most pride in, such as the Portico and the Medical Sciences building, would be made available to all users without fundamental changes to their design and integrity. However, contradictions are unavoidable. I can only assume that the historical eras from which these structures came, just like the structures themselves, were not made to be accessible to all.

But I hope to never give the impression that UCL’s accessibility is disappointing. The attention given to users with mobility needs is clear. Virtually all of the spaces where I attend lectures or events can be accessed through alternative means. Did you know that UCL’s Main Library has study spaces reserved for users with disabilities? I could say much more about what has been done well than what may need fixing. However, I’d welcome any changes, no matter how subtle, that would make my university more inclusive and equitable.

This is a very brief review of my campus’ accessibility, but I hope it has made you think about why this topic is worth your consideration. Take yourself on a tour of the places you visit every day. Are they designed with everyone in mind?