Millions of people in the UK are suffering poor health because they miss out on vital rehabilitation after strokes, heart attacks and cancer, which in turn is also heaping further pressure on the NHS, a damning report warns.

Physiotherapists say some groups of patients are particularly badly affected. Without access to these services, many patients desperately trying to recover from illness became “stuck in a downward spiral”, they said, with some developing other health conditions as a result.

The Chartered Society of Physiotherapy (CSP) says millions of people in marginalised communities, including those from ethnic minorities, are not only more likely to live shorter lives, but also spend a greater proportion of their lives struggling with health difficulties.

Vital services that could tackle those inequities are either unavailable or poorly equipped to meet their needs, the report warns, adding that “some communities face particular barriers”. People who face “systemic discrimination and marginalisation” and those who live in poor communities are more likely to miss out on rehab, the report says. The CSP said access to high-quality rehabilitation services must be improved to avoid “further entrenching health inequalities faced by millions”.

Prof Karen Middleton, the chief executive of the CSP, said: “Rehabilitation services have been under-resourced for decades and were not designed coherently in the first place. This has exacerbated poor health outcomes, particularly for people from marginalised groups. It’s not only the individual who suffers. Without adequate access to rehabilitation, health conditions worsen to the point where more and more pressure is eventually piled on struggling local health systems and other public services. We desperately need a modernised recovery and rehabilitation service that adequately supports patients following a health crisis and prevents other conditions developing.”

People are living longer with long-term conditions and after cancer, stroke or heart disease. When people are dealing with a long-term condition, their future health and wellbeing “makes a significant difference”, according to the report. However, the authors warned: “It should be universally available as an unmissable part of treatment. But currently millions miss out.

“Without rehabilitation people can be stuck in a downward spiral where having one long-term condition leads to other health conditions, including further long-term conditions, with loss of mobility and poor mental health and multiple medication regimes. Ensuring everyone who needs rehabilitation can access it can reverse this downward spiral.”

Thousands of physiotherapy staff in England and Wales would vote on industrial action after overwhelmingly rejecting this year’s NHS pay award. The CSP said almost 80% of those voting in England said they were prepared to take industrial action, with 83% in Wales. The CSP council recommended members voted in support of action. A decision has already been taken to ballot in Scotland.

Millions in poor health due to lack of rehab after illness, warns UK report | Health | The Guardian

 Industries such as retail, health care and logistics are reverting to an old tactic and trapping people in miserable jobs by threatening to saddle them with debt if they quit. Workers across the United States in fields ranging from nursing to trucking have been discouraged from leaving jobs because employers charge them for training costs if they quit before an arbitrary deadline.

It is the  Training Repayment Agreement Provisions (TRAPs) clauses in employment contracts. A practice likened by critics to indentured servitude, peonage and modern slavery, a form of debt bondage. Bosses are primarily using TRAPs to obstruct workers from leaving jobs.

TRAPs have been commonly used by employers since the 1990s, but they were almost exclusively reserved then for highly specialized workers such as engineers or airline pilots. As markets became increasingly concentrated and union power was diminished by policymakers into the 21st century, bosses used their growing dominance to impose TRAPs on rank-and-file workers, such as truckers, nurses, mechanics, electricians, salespeople, paramedics, flight attendants, bank workers, repairmen, and social workers. 

Registered nurse Cassie Pennings testified about being stuck with $7,500, “more than six months’ rent,” after leaving one hospital job because she was appalled by staffing ratios during the COVID-19 pandemic and didn’t want to be complicit in neglecting patients.

“Despite being one of the most profitable health care systems in the nation, my former employer responded to cries for help from the front line with breakfast burritos and free water bottles,” Pennings said.

Pennings also told lawmakers that she doubted the $7,500 price tag placed on the cost of her training. “I didn’t get any kind of license or accreditation or anything, and my actual training was only a few weeks.”

Lawyer, David Seligman, told the Senate Banking Committee that TRAPs are used by managers to leave workers “stuck with low pay, dangerous conditions, abusive treatment, or work that does not allow them to advance professionally.” He continued, “The law does not permit employers or others to provide a work opportunity in exchange for a worker’s promise to indenture themselves to their employer through debt,” Seligman said. “These sorts of work arrangements harken back to nineteenth century peonage used to subjugate former slaves, and they are precisely the kind of exploitation that our anti-trafficking and peonage laws were designed to prohibit.”

The chair of the committee, Sherrod Brown, commented, “Last I checked, indentured servitude was illegal in the United States. But it looks like some enterprising companies are rebranding it, with these new employment contracts.”

“For every TRAP that is the subject of a court opinion, tens of thousands remain unchallenged.”

More US Employers Are Trapping Workers in a New Form of Indentured Servitude (truthout.org)

 One person is estimated to be dying of hunger every four seconds. 19,700 people are estimated to be dying of hunger every day, which translates to one person dying of hunger every four seconds.

238 organisations from 75 countries – including Oxfam and Save the Children have warned that urging decisive international action is required to “end the spiralling global hunger crisis”.

In an open letter addressing world leaders gathering in New York for the United Nations General Assembly on Tuesday, they expressed outrage at skyrocketing hunger levels.

“A staggering 345 million people are now experiencing acute hunger, a number that has more than doubled since 2019,” they said.

 “Despite promises from world leaders to never allow famine again in the 21st century, famine is once more imminent in Somalia. Around the world, 50 million people are on the brink of starvation in 45 countries,” they said.

“It is abysmal that with all the technology in agriculture and harvesting techniques today we are still talking about famine in the 21st century,” Mohanna Ahmed Ali Eljabaly from the Yemen Family Care Association said. “This is not about one country or one continent and hunger never only has one cause. This is about the injustice of the whole of humanity.”

According to the organisations, the global hunger crisis has been fuelled by a “deadly mix of poverty, social injustice, gender inequality, conflict, climate change, and economic shocks”, along with the lingering impacts of the coronavirus pandemic and the war in Ukraine, which further increased food prices.

Hunger now killing one person every four seconds, NGOs say | Russia-Ukraine war News | Al Jazeera

 They have fought to deny sick days and other vital benefits to workers in the rail freight industry and the safety of workers and communities, meanwhile, has been put in jeopardy by executives who have fired workers and increased hours, train operator executives have been rewarding shareholders with billions of dollars in stock buybacks and dividend bumps.

According to Railroad Operators: Bad for Workers, Good for Investors, a collection of data compiled by the Groundwork Collaborative, a handful of major rail companies reported more than $10 billion in buybacks and dividends over the first six months of 2022.

“Our research shows just how far railroad executives will go to funnel record profits to their shareholders—even if that means stagnant wages, inhumane attendance policies, and throwing our supply chain into further turmoil,” Mike Mitchell, director of policy and research at Groundwork Collaborative, explained.

Groundwork found that Union Pacific is leading the pack in 2022. Rather than using billions of dollars in revenue to improve pay and job conditions, Union Pacific gave $5 billion to shareholders through buybacks and dividends in the first six months of this year alone. CSX, for instance, funneled nearly $3 billion in buybacks and dividends to investors from January through June, while Canadian National Railway reported $2.3 billion in stock buybacks during the same time period.

Norfolk Southern’s chief financial officer Mark George said on a July call that “shareholder distributions are up and you’ll observe here the 19% higher dividend payments through six months on top of continued strong share repurchase activity.”

Railroads have been enjoying record profits after decades of deregulation, consolidation, and “just-in-time” practices known as “precision railroad scheduling” transformed the industry into what Sarah Miller, executive director of the American Economic Liberties Project, describes as “another monopolized cash cow for Wall Street.”

Union Pacific chief executive officer Lance Fritz told investors on a July call that the company had cut staff by a third since 2018 and said, “We’ve got to do some other unique and creative things with our labor unions in order to make our crews more available and more productive.”

 He also said that Union Pacific is prepared to make further staffing cuts during an economic downturn, asserting that conductor-less trains would be “better for the conductors’ quality of life.”

While Fighting Workers, Railroads Made Over $10 Billion in Stock Buybacks (commondreams.org)

 Save the Children is urgently calling on the international community to ramp up its support to Haiti, to meet the growing needs of vulnerable children and families.

More than 4.9 million people—including 2.2 million children—need assistance, many of them suffering from hunger and malnutrition. 

Widespread poverty, a rising cost of living, extreme levels of violence, low agricultural production, expensive food imports and growing political instability have worsened existing food insecurity in the country.

Chantal Imbeault, Save the Children’s Country Director in Haiti, said, “The situation in the country is increasingly precarious, violence has reached extreme levels. It is very difficult to access water and food, with children being the most affected, suffering from hunger and at risk of losing their lives. There is lack of health services for mothers who are blocked behind barricades. We urge the international community to continue the efforts to assist children and families in Haiti.”

Haiti: More than 2.2 million children in need as violence surges across the country – Haiti | ReliefWeb

 Female protesters have been at the forefront of escalating protests in Iran and have been burning headscarves, after the death in custody of a woman detained for breaking hijab laws. Mahsa Amini died in hospital on Friday after spending three days in a coma. Ms Amini was arrested in the capital last week by Iran’s morality police, accused of breaking the law requiring women to cover their hair with a hijab, or headscarf, and their arms and legs with loose clothing. There were reports that morality police beat Ms Amini’s head with a baton and banged her head against one of their vehicles,

 An estimated 20% of UK adults, or 10.9 million people, are behind on one or more household bill – up by 3 million since March – according to the Money Advice Trust report. This figure was much higher, at 45%, for households that received a means-tested benefit, the debt charity said. High energy price rises had already become unaffordable for millions of people, the charity said. About 10.7 million had seen their energy bills rise by £100 or more a month since April.

 5.6 million have gone without food in the past three months according to new research that reveals Britons are skipping meals “just to keep the lights on”. This included skipping meals, eating once a day or not eating at all on some days.

Joanna Elson, the charity’s chief executive, said, “Many households are already facing impossible choices, such as which meal to skip just to keep the lights on.” 

The charity found that many households had little or no wriggle room left in their budgets to cope with rising prices. It said 41% had already cut all nonessential spending, a figure which was up seven percentage points on its March poll.

The jump in energy costs meant more people were borrowing money to try to make ends meet. The charity estimates that more than 15 million people have had to use credit to pay for essentials – an increase of 2.1 million since March 2022 – while one in 10 have had to borrow money from family or friends.

Britons skipping meals ‘just to keep the lights on’, research reveals | UK cost of living crisis | The Guardian

Less than 10% of U.S. plastic waste is recycled annually.

 The American Chemistry Council (ACC), an industry group is seeking to “change existing law so that plastics incinerators can operate without meeting the environmental and health protections of the Clean Air Act.”

“Removing existing Clean Air Act limitations on burning plastic will allow chemical manufacturers to produce and release these toxic chemicals into our communities without limitation.”

“Under the guise of offering a solution to the global plastic waste crisis, the American Chemistry Council has invented an Orwellian new name for decades-old incineration technologies,” the signers stated. “It seeks to rebrand pyrolysis and gasification incinerators as ‘advanced recycling,’ even though there is nothing advanced about them and nothing gets recycled.” 

“In reality, the plastic trash that enters pyrolysis and gasification incinerators gets burned, creating dioxins and other harmful air pollution. What’s left is toxic chemical waste that gets burned again later at hazardous waste disposal facilities or as a dirty fuel. Far from ‘recycling’ the plastic waste they get paid to accept, gasification and pyrolysis incinerators are turning plastic into highly toxic air pollutants and generating hundreds of thousands of pounds of hazardous waste.”

“Plastic contains hundreds of toxic chemicals, including heavy metals, phthalates, flame retardants, bisphenol A, and PFAS. The process of burning plastic via pyrolysis and gasification generates even more toxic pollution, including chemicals known to cause cancer, birth defects, and other serious health harms. Emissions include dioxins, benzene, cadmium, arsenic, lead, polycyclic aromatic hydrocarbons (PAHs), and mercury.”

“Changing the legal definition of incineration or waste so that chemical companies can burn plastic in poor and minority communities without controlling the toxic pollution they emit is environmental injustice at its worst.” 

200+ Groups Decry ‘Orwellian’ Industry-Backed Plastic Burning Push (commondreams.org)

 India is seeing an increase in suicides among daily wage workers, according to the latest report by the National Crime Records Bureau. The report released in August revealed that the share of daily wage workers is the largest among those who die by suicide in India.

Out of 164,033 suicide cases reported in 2021, just over 42,000 suicides, or one in four, were among wage workers.

“Suicide numbers and attempts have risen significantly. The data is reflective of the trend but the numbers are likely to be even more,” Delhi-based psychiatrist Achal Bhagat told DW. “Poverty contributes to mental health problems in multiple ways.” Bhagat, who has studied the issue closely, said many wage workers are uncertain if they will be able to support themselves, and have feelings of feelings of guilt for not living up to the role of being a young man in a patriarchal society. 

Mental health professionals attribute the climb in suicides to factors including joblessness, poverty, debt and inability to cope with cuts in wages.

 “The two most important policies that could make a difference are sustainable livelihoods with social security, and access to mental health and suicide prevention services,” Bhagat said. 

About 450 million of India’s 1.3 billion plus population work in the informal economy. These include wage workers, construction workers, street vendors and landless laborers. Over half of India’s daily wager workers earn just 200-400 rupees a day (€2.5- €5, $2-$5), far below the prescribed minimum wage for unskilled workers. Many workers become indebted and are left vulnerable to exploitation.

The pandemic “led to a severe decline in earnings for the majority of workers resulting in a sudden increase in poverty. Women and younger workers have been disproportionately affected,” a recent study by the Azim Premji University in collaboration with various civil society organizations found. Most daily workers experienced an acute drop in employment, including after November 2020 and in much of early 2021. Sectors such as real estate, construction, infrastructure and urban development took time to restart projects.

“Because of the uncertainty about work and income, they [daily wage workers] had to frequently migrate, have lost safety nets, possess zero savings and are debt-ridden,” Nelson Vinod Moses, founder of the Suicide Prevention India Foundation, explained. “Many have high alcoholism rates, no health insurance, get ill-treated and work in hazardous conditions with injuries,” he added.

Tina Gupta, a psychotherapist who has studied behavioral patterns, cited a study published in the Journal of Epidemiology and Community Health showing that a $1 increase in the minimum wage is linked to a fall in the suicide rate of between 3.5 and 6% among people with high school education or less. 

“This study points out how low wages are linked to high suicide risk among the vulnerable. Daily wage workers are among the poorest,” she said. “There would be a complex pattern of vulnerabilities like financial stress, lack of social and economic stability, and debt,” she added.

Daily wage workers are most often the primary breadwinners of the family, stated Anjali Nagpal, another psychiatrist in New Delhi.

“Because of their limited academic or vocational skills, if they are terminated or face financial difficulties, they’re not in a condition to adapt by changing their trade or ask for help from their friends, as they are in similar position,” she said. “On top of their work and financial woes, they often struggle with their personal life as being aware of one’s mental health issues isn’t a priority in this stratum,” she pointed out.

But without social and economic safety nets or access to mental health care, many daily wage workers continue to feel trapped.

The key to suicide prevention is “health insurance, debt assistance, social security, access to health care and a public health campaign that shows that civil society cares,” stressed Nelson Vinod Moses of the Suicide Prevention India Foundation.

India sees spike in suicides among wage workers | Asia | An in-depth look at news from across the continent | DW | 18.09.2022