Talk 200: lecture and podcast series

Hi everybody. Thanks so much for coming. And apologies for the slightly combative first slide.

It's not the end, but it is an end. And when we think about the challenges that our world faces, this is a lecture really about sustainability in its grandest sense.

We have to first understand that there is a deep interconnection between these different challenges, because climate change is not just about carbon or just about fuel.

It's also about all of those other challenges that we face. So the challenges of pollution, the challenges of the circular economy, the challenges of social justice, the challenges of war, all of these things are interconnected with each other.

And so this may seem like a pretty bad picture, but really the question that we have at 51�� is: what way do we want this Earth to turn.

Do we want to turn towards our left side here and try and get the world which is genuinely, authentically sustainable?

Or do we want to just give up? And actually really what we need to do is to work together to collaborate and to build these relationships.

And today I'll talk a little bit about our work and our vision, but also how that connects so many different things that are happening around the world.

So the unmaking of everything, that sounds equally bad at the end.

But really what we have to do is to think more critically about how complex these materials are and how we can go and create value out of these systems.

So the first thing is that this is all unfortunately your fault because when you make decisions, those decisions have consequences.

So you might need a beverage, right? Early in the day that might be coffee. Late in the evening, it might be something else.

But you'll have a choice to make in the receptacle you're going to drink out of.

So you can choose this styrofoam cup here, or you could choose a ceramic mug.

So just checking with the in-personalities, how many people would choose the styrofoam
cup?

One, okay? That's good.

I mean who would choose the ceramic mug?

Lots of people. And by the way, the people that didn't raise their hand at either of those times, those are the robots, right?

They don't drink at all.

When did I raise my hand, though?

I raised my hand for the styrofoam cup.

Well that seems illogical, right?

But when we actually think about the energy embedded in these materials, we realise that we can make transport used and disposed of over 500 of these styrofoam cups for the energetic cost of a single ceramic mug.

Right? And when we think about that, that's because we have to dig up some clay from the ground.

We have to fire a kiln up to a high temperature. We have to make that mug.

We've got to transport it to, we're in London, so I'll say, Waitrose. You're on Waitrose crowd.

And then you've got to pick it up from Waitrose. You've got to then bring it back home, right?

And all of those steps have an energetic cost.

Now you may be saying: "Well, but there's a difference here. I would throw away my styrofoam cup and I would reuse my ceramic mug."

And the question really is: "Well, are you going to wash it afterwards?"

Because if we need to make some detergent, we need to heat some water up and we need to clean the detergent under that water afterwards.

That's the energetic cost of two styrofoam cups.

And so what is the sustainable solution? Well, actually, if you were to go into any professor's office at 51��, you would see an unwashed, gross mug that has had about 500 coffees in it, right?

And that is because we really care about sustainability.

But the reality is that these materials are so important to minimising our footprint.

When we think about packaging waste, packaging waste would quadruple if we don't have plastics.

Foods to spoilage would double if we don't have plastics.

Vehicles would be heavier and our petrol consumption would double if we don't have plastics light-mating these vehicles.

And of course, the insulation we used to previously keep our houses warm and now increasingly keep our houses cool.

It would increase energy costs by 1.5 times.

So this has been estimated to be 583 million giga-joules of energy per year.

That's a relatively meaningless number. But if we convert that into the barrel of oil, which we do have a concept of, it's 100 million barrels of oil each year, which are saved by plastics.

So why do we have this dependency on plastics? Why is this addiction so clear?

Well, the first thing we have to do is to recognise that in any system these materials are playing essential roles.

And so if we think about where plastics are most demonised, right, the grocery store, we go in, we're like, oh my gosh, waste conundrum.

But that material has absolutely transformed our system for food provision.

It increases food shelf life, therefore decreasing food waste, it improves food safety.

So any time we think about an alternative material, we must ensure that whatever provision we're doing, whatever we're packaging this in, has to keep that same function.

So plastics are these diverse materials that have these important functions.

But of course, many of the things that we have done with plastic are not good.

So we might want to keep all of those things recycling, right? So you're going to go home and you're going to try and have a package which is recyclable.

But at some point in time, a marketing person, and apologies if there is a marketing person in the audience. But that tray up at the top left, that meat is demonstrably sexier.

And a marketing person figured out that when you take meat and you put it on a black background, well, you can actually sell it for more money.

But that has a consequence because that black package is less recyclable than the white package, right?

And we have a consequence both in terms of sorting in the system and in terms of keeping that material in its highest value condition.

And so that's something we need to stop doing.

But the challenge with that is that these materials, which might look like a plastic package, are exceptionally complex.

And we think of them as simple, but actually they're exceptionally well tuned.

Because this is not just one thing. This is a plastic tray, a plastic reinforced paper tray, perhaps, if you're looking at a modern material.

A plastic laminated film, which looks like just a plastic sheet, but actually it's five microns in layers of different materials with different functions.

We have adhesives and heat seals that are keeping that all together.

And then maybe that paper label, which actually to keep it waterproof, has a bit of plastic on it as well.

And of course underneath that meat is that adsorbent plastic mesh, right?

And so what do we want?

Well we want these things to be kept in our highest value condition.

We want these materials to be recycled.

And of course we can get someone in their home to rinse out that tray and put it into the recycling bin.

No one is rinsing meat juice.

That's about an adsorbent mesh.

And so when we as scientists, as academics, but also in industry, think about how these materials need to be designed.

We have to design them around social papers, not around wishful thinking.

And that is the key to unlocking change within that system.

And so we might go and step back and say, well okay, sure, that's all fine and good.

Well why don't we just start using different materials?

And so maybe instead of that styrofoam cup, we wanted to use a paper cup instead.

And actually that paper cup has a higher carbon footprint than that styrofoam cup.

But when we think about carbon footprint, we actually have to think about the whole use case scenario.

So let's say I wanted to run a lemonade stand.

And if you're at one of our events in 51��, then you can actually maybe come to a lemonade stand that we run.

You can see that we've got 100, 1.84 kilograms of CO2 per kilogram of lemonade compared to about 6.2 kilograms of CO2 per kilogram of paper cups.

Which is about three times higher than the styrofoam cups.

Okay, so that all seems like we really have to get the packaging right.

But none of us drink lemonade.

I know what I'm addicted to and that's this.

And if I think about coffee instead, actually I have 17.5 kilograms of CO2 in a similar espresso shop.

And I have 85.4 kilograms of CO2 in the latte.

If carbon is everything, then we really have to understand how that integrates with the system that it exists in.

Integrate with those materials instead of treating those things in a solution.

And when we think beyond the grocery store, we suddenly realise that we have a huge challenge on our hands.

So this is a group called Extinction Rebellion.

I talked to the Mavo plastic and not these guys, they were busy.

But one of the things of this group is that in the past they were sort of a zero plastic group.

An advocacy group that wanted us to have zero plastic in the world.

But of course what they didn't realise is that these plastics were in their textiles and their PPE and their footwear and their electronics and even in the adhesive that is attaching this gentleman's hand to the London Stock Exchange.

And the complexity of our plastic world and these polymers that we depend upon go much further than our addiction to plastic packaging.

So our integration of these and the things that we value, well that doesn't mean that these are materials sent from heaven and we need to keep this addiction.

I'm not a plastic apologist.

We actually have huge problems with this plastic system, but we have to equally recognise the importance of it.

And so when we think about where these are really challenging, well we have large objects which are littered.

We have the breakdown of these materials forming micro and nano plastics in our environment.

We have plastic producers often deflecting criticism and not taking ownership of their part of the problem.

All of these things coming together in a situation where we really have inadequate waste management facilities for these materials.

And that's because we often have this priority of economy over environment.

And so what does this actually mean for the broader system?

Well the reality is that this view that we need a more sustainable material or we need something which is going to be a penisé or a silver bullet.

Well that simply is not true. There is no such thing as a sustainable material.

When we think about the future, what we have to first recognise is that these plastics hold massive societal benefit.

And if we don't recognise that societal benefit, we're going to have severe unintended consequences.

We also have to recognise that alternatives often have a higher carbon footprint.

And we can't try and address a waste problem by introducing a problem in another bit of our sustainable system.

We have to recognise that plastics are diverse and this problem goes well beyond grocery stores.

And that we need solutions which are integrated together that are tuned towards those different states of material.

So we need to reuse things, we need to recycle things, we need to deconstruct things.

And if we can't do anything else then we might be able to pyrolyse those things.

But the thing we must not do is to release that material into the environment.

And so when we think about our plastic free world, it's actually that there are grave consequences about trying to imagine a future without this material.

But if we don't deal with the problems that we have with its environmental consequences, we have equally grave consequences in terms of this extraction and pollution.

So what do we do?

Well the reality is what we need is some sort of a sustainable system.

So a sustainable material only exists in a sustainable system which can recover its value, which can control its release and where we can recover that value from all plastic to go through the system.

And of course our work, my research is focused on plastics, but the same concept could be and should be applied to all materials with flow throughout lives.

And that is the concept of the unmaking of everything.

If you're going to remember one thing from this chat, it's this.

It does not matter if something is reusable or recyclable or compostable, if it is not reused, recycled or composted.

So the first thing we have to do is think about that system using past tense terminology and stop wishfully thinking about what might happen to a material and assuring that that faith is realised.

So what are we going to do about this? It's a really hard problem.

But luckily, you know, six years ago I joined 51�� and lots of brilliant colleagues and together we're trying to address some of these challenges.

And so I'm going to pick up just a few of the things that we're doing to try and pick up solutions to subsets of these challenges just to give you a bit of a story about how we're working on this.

So the first project of I just go back. So this is this central thing, which is a project which we started four years ago called 'one bid to rule them all'.

And so this that started as a Lord of the Rings joke is now going to be something which ends up on my grave stuff.

But really what this is is an integration of social science and economics and material science is looking at what happens in household waste management.

During the pandemic, we got the fun task of actually getting outside our homes and going to sort through other people's waste.

So when I say our team is garbage, this is actually a positive view.

But really this is a remarkable community of people who are working together to try and solve these challenges.

And what's great about the people we get to work with, the students at 51��, is they literally fight with each other for the privilege to go to advance to sort through other people's waste.

It's quite a remarkable thing.

But what was really important about this is the ability to integrate on understanding of material flows.

So quantify all of the different materials which were in the homes of the bins in the homes of the people who were part of this trial.

But also the fascinating decisions which were being made about these materials, right?

This picture in the bottom right here where someone has chopped off the top of a tetra- pack curtain because obviously that bit is plastic for the rest of the time.

And what we have is a deep and detailed map on both social practice and material flow.

So what does that actually allow us to do?

Well, it actually allows us to look at the supply chain at these materials in a very different way.

And so in the past when we think about plastic waste management, we demonise three groups, right?

We say, okay, I put this in my bin, it goes to a waste management company, and that waste management company probably does something dumb with it.

And they send it to landfill, they send it to a recycler, and that's the bit of the system.

But actually the things that are happening are a result of decisions which are made across the supply chain.

And so by looking across the supply chain, we suddenly see lots of different opportunities to make design decisions which are improving sustainability.

And one of the simplest that I just walked through is in the bottom right-hand corner here.

So what if you don't mandate sort of all of these systems being the same, but you mandate material segregation?

And so one of the thought experiments I guess we did was on looking at segregating food grade bottles to being either made of PET or HDPE.

So that's C or no.

Non-food bottles are only PP or other, but we don't put PET or HDPE in those systems.

Food grade pots, tubs, and trays are only PET or PP, and the non-food pots, tubs, and trays are only HDPE.

The decisions that a waste management company can now make increases that value dramatically.

So the waste management company instead of losing money by recycling can make money by recycling.

You tie an environmental outcome to an economic outcome, and then you incite change across the system.

The second thing that I wanted to look at was instead of thinking about those packages to think about another material flow.

So some years ago now we were approached by MasterCard, and their CEO had got up on stage and announced the world's first biodegradable credit card.

When it biodegraded it released the barium from the magnetic strip and the 18 metals in the chip set into the environment causing grave toxicological damage.

It was an atrocious idea.

They figured this out after the CEO had got up on stage and then approached us to say, "Well, what would a sustainable card actually look like?"

And actually the key is they were degrading something and they were releasing metals into the environment.

Because if we switch the resin from something which is called PVCs, since it's the same material that would be in your windows at home, and switch it to a material which is called TechGee, well that actually unlocks a new fate.

We can now do a deconstruction of that card. We call that process depolymerisation.

And that depolymerisation actually allows us to create a circular card.

And so this is just an example of one of our scale up processes.

So we did about 300 credit cards in a single batch here.

And you get all of these different materials.

And what's really interesting is I can go and create a bunch of monomers and these are materials which I can use to make a brand new credit card that has the exact same properties as the first credit card.

But this is not driven by the economics of doing that polymer recycling.

It's actually all the bits on the right.

So if we don't actually do anything in that reactor, we can recover a full chip.

We can actually reuse that chip, or if we want to just do that really quickly, we can recover all of those different materials and reuse those materials.

And by thinking about that card as a system, we suddenly can unlock economic value which goes well beyond the plastic recycling.

And so by considering not only just the plastic recycling system and extending that to a multi-material, we unlock economic value and we drive that forward.

So what's next? Well, next really, we have to go to an even more complex system.

And by a more complex system, we're really looking at a sense of scale.

And so in terms of bottles, there's 580 billion plastic bottles which are put on the market each year.

That's about 8.2 million tons.

And each one of those is going through tiny roots.

So if you put your, if you want some good news, right, if you put your bottle in the recycling bin in the UK, it will be recycled.

Have confidence in it.

Okay?

If we look at the credit cards, well, we actually have 6 billion credit cards, not just credit cards, but also hotel cards or any of those limited cards put on the market each year.

That's 30,000 tons.

So actually, even though that's a more complex material flow, it's actually not that much material compared to the box.

And then we look at cars.

Cars have 92 million vehicles put on the market each year.

That's 173 million tons of material, and that's 15% polymers by weight.

So we actually have more plastic material in the cars than we do with the bottles.

And so I was fortunate enough to get awarded a Royal Academy of Engineering Chair to work with an ambitious electric vehicle company called PULSE there.

And if we think about, you know, I pitched to them, oh, okay, we can do this for a credit card.

Oh, cars are really hard, right?

So if we think about this car as a multi-material, we suddenly realise that we have a huge range of different materials.

We need to be able to separate those out.

Each of them is going to have a different fate.

And I have co-mingled with that glass and metal and so many different components that it becomes exceptionally difficult to recover value.

Not only that, this is a company because, you know, if we want to go and recycle a milk bottle and put it into a milk bottle, well, that's a technical challenge, but to recycle a milk bottle and to put it into a car, well, I have a higher spec.

I need to make sure that that is safe. I need to ensure that that still maintains the integrity of that car and that's still going to be good to use for the entire lifetime of that vehicle.

And so this is an exceptional challenge that we're working on now to try and make this as low-carbon footprint and as circular a vehicle as possible.

Now, I presented this as we are developing solutions. But what's really important to remember is that we are constrained by the laws of physics.

And the laws of physics say that we always will have lots.

And so the reduction of consumption is still going to be very important for a sustainable future. But we have to recognise that the limitation in infinite recycling, infinite reuse, infinite composting, and those things which simply will not happen, that breaks the laws of physics.

And so we have to have a solution where we think about those transitions in as sustainable a way possible.

So I talked about that sustainable system. But in fact, what we need to unmake everything is interconnected systems which work together with each other.

And so we imagine this circular economy as an ideal. We want to be able to take that bottle and turn it into another bottle.

But actually what we need to be thinking about is what we're calling a spiral economy.

And so how does that bottle turn into our car? And how does that car turn into a chair? And how does that chair turn into, let's say, ID 51��?

So if we want to go to that point, we basically can have different intersectional transitions which allow us to keep those materials in their highest value condition.

And when we get to the built environment, when we go and sequester that carbon in something like ID 51��, which is going to be a harbinger for innovation for the next 200 years, we can then take those materials and deep memorise those, take those back to a molecular form so that we can go and put those back into new systems.

That spiral economy is about transitioning in the most sustainable way possible. Those materials flow across those systems.

Now, that means we have new words, right? And so I talked about the importance of past tense terminology.

And so what do we need? Well, we need to ensure that all materials which come through our lives are valued.

We need to ensure that all materials that come through our lives can be unmade. And that's so important from a design perspective.

And the key out of both of those is we reduce, if not remove, our addiction to extracting urgent resources from our planet. And that is the key.

And that's the key to unmaking of everything is when walking that economic value and preventing extraction.

So the next 200 years, where are we going? Well, so many of you in the audience will have come and travelled here today.

You probably were like, this is going to be a cool lecture, so I want to wear my best jeans. I did that.

And then you're looking for your best jeans and you realise that they're dirty, right? And so you've got to put them in the washing machine and then maybe the dryer or maybe you've hung them outside.

And you realise that you don't even know where this place is. So you grab your phone and you're saying, well, I need to look on Google Maps where I'm going.

And so you contact the server farm where the information is stored and you connect and try and figure out what's going to go on at the server farm so you know where you're going.

And of course, because it's a sustainability event, you're taking public transportation. Yeah, maybe.

And so you're taking that public transportation all to come to this place here that we're sitting in.

If we think about the complexity of the car and that we look at the complexity of the multi materials which are on the screen here, we realise how grand a challenge that we have.

But that is the vision for the next 200 years. We remove our addiction to extraction. We recover value from all of these material flows.

And we retain value in some of these objects, some of them as components, some of them as materials, and some of them as molecules, by unmaking the things that create our world.

Thank you.

Thank you so much for all of you attending and also those of you watching online, who include Thalia's family in Montego Bay, Jamaica.

You can rest assured that's where most of us would like to be tonight, but nonetheless welcome to you as well. It's a real pleasure to be able to share a few of my thoughts on this. My thoughts have germinated, I think, in the last decade or so.

I left prosecuting in 2015 and one of the reasons I left prosecuting was I felt that every prosecution was a failure because somebody had been harmed to get to me and I wanted to move more into the sphere of prevention and ultimately trying to see whether we could actually improve the system that I was part of.

That in itself is the problem, that we call the criminal justice a system rather than a service because when you have a system you're only focused on process, how things are done, you know, arrest, charge, conviction, sentence… that kind of thing.

Rather than the people in it, the humanity which I think is missing and we're going to hear undoubtedly from people I've taught this afternoon around when it goes wrong and it does go wrong more frequently than perhaps we appreciate. When I first became a lawyer a long time ago, 1989, one of my first cases, or first group of cases I was dealing with was the West Midlands Serious Crime Squad, which is police officers that were, there's no other way of putting it, they were fitting up suspects.

They were writing confessions for them on statements and then submitting it and I worked for a firm of solicitors called Glaziers who back then were doing some great work in miscarriages of justice and I learned my trade working with my partners and others in that field and recognised then that there was more needed to be done, but again I focused entirely on prosecution when I moved into prosecution and I didn't realise what it was that was happening in our system.

Additionally, you know, I worked in central London for 20-odd years, pretty much early on in my career as a prosecutor we had Stephen Lawrence's terrible murder and the immediate aftermath of that or the lack of an aftermath, namely no prosecution for 15 years. That I think in itself again was a steep learning curve for all of us around it, perhaps justice doesn't follow automatically. It needs some actual, you know, something being done about it rather than expecting somebody to do their job and I think we, I can't have this conversation without, I'm not going to be party political because we're in a general election but to try and describe where we are now as a country when it comes to our justice system, we have a broken justice system. It is broken in every respect.

We have lost half a million years of police experience. That’s 20,000 police officers times 25 years. We've lost 600 courtrooms, we've lost 800 police stations, we've lost thousands of probation officers and victim support workers, there is poor morale throughout the system, the lowest public confidence I think in my 30 years in working in the justice system, the conviction rate for sexual offences you know is 1.8%, turn it around, that means 98.2% of those accused of sex offending will not be charged with a crime. There have been increases in domestic abuse, increases in violence against women and girls, low police detection rates, online fraud is going unpunished, hate crime is going up, knife crime is going up, prisoners failing to rehabilitate, the longest time, now, ever, from offence to charge in all of my years, the highest delays in trials being finalised, the highest backlogs in trials being heard and NGOs are suffering because they just don't have the resources.

That's where we are right now. So when we're discussing, as we are discussing what's wrong with our system, we have to recognise where we are right now is not going to make it any better because if anything it's going to make things worse.

And I tried to understand or try to appreciate, I have the good fortune Thalia, I know worked with the Grenfell families, so did I. I carried out the review of London Fire Brigade culture about 18 months ago and I had the privilege of meeting the Grenfell families and I saw in them, 72 people, 72 families, quite frankly, who felt that the country had let them down and there was nothing that would come from that, and we've, what, seven years in now and to date there has not been one person arrested, never mind charged. And so they wonder about accountability.

And that's the question that I keep asking myself is whether or not there really is accountability in our system. And of course the experience of people like the Grenfell families, like the Hillsborough families, like the infected blood families, you know, you can go on and list them.

You know, the disproportionate or unfortunate use of joint enterprise, there are so many different ways in which miscarriages of justice occur, where people are brought into the system and the system just follows the process without anybody saying stop, let's have a look. And of course, then it links into something I know others will touch on this afternoon, is that the accountability must come from a legal duty to tell people what's going on.

You know, we often use the firm, why aren't there any whistleblowers? You know, why should there be whistleblowers? The system itself should call itself up to scrutiny. There should be, as we, undoubtedly we'll discuss, a duty of candour, where people are mandated to speak up about what's going wrong in their systems. Right now, as I speak to you, I'm now carrying out the independent review of the Nursing and Midwifery Council, and my report is due on the 9th of July, would have been a couple of weeks earlier, but there was something happening on July the 4th, which has delayed that.

But again, you've got, and that is the world's largest regulator, 808,000 nurses and midwives, and you will hear, unfortunately, I can't give you more detail, that had there been a duty of candour, had whistleblowers been protected, we wouldn't be where we are today, and where the NMC is today.

So what's wrong? What's wrong with our system? There's so much wrong.

There is an inequality of arms. So there are those who, you know, we talk about legal costs being really expensive, we're then reliant upon people working pro bono, people working for nothing.

Legal costs are expensive, the high legal fees that we have are preventing low income individuals from obtaining representation. That can't be right. At the same time, the state or these large institutions, such as the Post Office, have all the resources.

I'm assisting somebody, I can't talk about, against somebody in power right now, and that person in power has said in no uncertain terms to this person, I have all the means at my disposal to keep this going forever, and you haven't.

And that shouldn't be right. There should be an equality, an equality of arms to enable people to be able to represent themselves, or be represented through that. Before that, there's the access to legal aid itself, the access to legal aid has been struck down over the last few years.

It's now, there are so many unrepresented defendants appearing in our courtrooms, and they are what they're doing, they're often pleading guilty because that's the easiest thing to do. You'll hear more about that later from Tom.

Race and ethnicity is another challenge when it comes to inequality.

You are nine times more likely if you're a black person to be stopped and searched by police than a white person. You are as a black person, more likely to be arrested, more likely to be charged, more likely to be convicted, more likely sentenced to prison than a white person on the same evidence in this country. Well, that surely can't be right.

Then we've got the more general things around language barriers. You know, we've had a massive impact on the availability of interpreting services. So many cases fail now because the interpreter is not there, or on many occasions I've seen judges and district judges and magistrates say to the defendant "we can adjourn this case to get you an interpreter, but let's go ahead anyway".

And that person doesn't understand a word that's been said to them. I could talk about gender bias. Again, I don't have enough time, but you have to recognise it.

We do recognise it, I mentioned the 1.8% figure when it comes to victims of sexual violence. That there is a bias in the system when it comes to women and the way that they're treated, and a lack of understanding from legal professionals really about what's happening within the family, what's happening when it comes to sexual violence, what's happening when it comes to domestic abuse.

One in four women in this country suffer domestic abuse, one in five women in this country suffer sexual assault, two women every week are killed by their partners and ex-partners, ten women every week take their own lives because of the abuse they're suffering.

But I can assure you that judges, magistrates, professionals in the system don't routinely consistently know what they're dealing with. And they don't seek expert advice and guidance and support when they should do. And where they look for it, the NGOs aren't there anymore, or the NGOs aren't properly funded. I'm the patron of nine women-led NGOs all working in this field, and they spend probably half their time trying to fundraise. I'd rather they spend 100% of their time trying to help the victims that they are meant to be supporting or they are supporting.

Then there is the geographic inequality, the rural versus urban. If you're living in a rural environment, say in Cumbria, I remember when I was Chief Prosecutor for Northwest England, in Cumbria we, as in the Ministry of Justice, closed lots of magistrates' courts. It made it a 50-mile journey for some people to travel to a magistrates' court for a hearing, with no transport, nothing like they could have on the tube in London. So you have those kinds of issues which undoubtedly will impact upon them. And of course when you're in a close- knit community in a village somewhere in whatever part, the reality is if you make an allegation against your partner, for example, this is a real case, everybody in the village tries to dissuade you from going ahead. And that's another issue that we just don't have any research on or we have any understanding of. Infrastructure, I've touched on it, there isn't any infrastructure in remote court when it comes to access to justice in certain large parts of our country.

There's the other inequality around educational awareness. There's legal literacy in this country, I'm afraid is really low. That's why you see people on social media saying the law says this, when it doesn't.

And they go to social media when they don't have the means themselves to know what the law should be or they wait for Martin Lewis to tell them on his programme or something. You know, what we need to have is access to information. You should have access to information. It should be legal literacy in your curriculum, enables you to understand from a very early age what your rights are, potentially what you could do differently, where you can seek guidance and seek support. We thought we solved disability access. You go to any courtroom in the country and think about how difficult it is for somebody who's disabled to be able to access either the courts or the legal offices.

The accommodation itself outdated. So many of our courtrooms in this country, they've got roofs leaking. They're falling apart. And the idea that somebody who's got disability can come in and do so without being impeded is absolute nonsense. So we've got significant issues there around simply the way we treat disabled people in our system. Never mind how the prisons deal with them. Immigration status, I can't go without mentioning immigration status. We still have no recourse to public funding for so many people, particularly women who are suffering abuse.

They don't have the ability to access legal services for free. And that means that, again, the perpetrator can abuse them knowing that's the case. And there are fair repercussions because of immigration status. If you are the victim of modern slavery, technically, you are the victim. Therefore, you should be treated as a victim and you be provided with support. But they're frightened and undoubtedly should be frightened given the public discourse that if they come forward, they will simply be deported from the country and the perpetrator who's put them in that position will undoubtedly walk free.

And of course, immigration law itself is complex. I thank God I'm not doing immigration law but that changes like every other week. Criminal justice bills every year, literally. There's tinker. There's tinker with the criminal law like nobody's business. And the promise of a Rural Commission that was given in a 2019 manifesto, by the way, never came off.

And so we're still tinkering with the legal system. But all that does is make it even more complicated for the average citizen, never mind the average citizen, for the average lawyer.

The youth and elderly, young people, not only are they subjected to potential national service, they're also being told to literally suffer. They undoubtedly are treated poorly by the services that were there for them aren't there anymore. Children's services, youth services are struggling to provide all manner of support both to the victims and to those accused.

And the system has a lack of understanding, really, of particularly youth issues. But also, elderly, the elderly themselves have additional barriers which are not being faced. And there's technological, technological barriers. The digital world, now these days, more and more post-COVID, you know, will do the hearing on Zoom. What the hell is Zoom? I don't have Wi-Fi. You know, all those kinds of things that we seem to think that we've taken for granted. Digital technology is not there. The infrastructure is not there. The system, you know, when I tried to bring in digital printing 12 years ago in the CPS, I did. I said, what we would do is we'll send our file digitally to the court. The police said, no, no, we can't do it. We'll have to send you a paper copy. The judge said, we need a paper copy too. The whole idea, just, no, but the system wasn't working as a system. And I'm afraid that's still the case. Every element of digital technology seems to take forever when it comes to the criminal justice system or the justice system more generally.

And of course, I mentioned internet access or lack of it. And we need to expand all of these services. You know, I'm a very strong believer whether you like it or not in live streaming of all court cases. But for those there were clearly there were vulnerable victims or or vulnerable victims or witnesses. I think unless you shine a light on what happens in our courtrooms, you don't know what's happening in our courtrooms. I think that would be the game-changer to my mind about, you know, when we talked about, when Tom talks about his experience in the Post Office scandal is one way of putting it, the hard words, harder words I would use, in many of you, it was a television series that suddenly got the government to take this seriously because they saw a visual representation of what happens.

Yet others have been writing about it, talking about it for months and years and years and years yet it didn't seem to have the same traction. I think that by shining a light, literally a visual light, on what happens in courts is the answer. When I talked about, I wrote about it in the Times a few months ago, a lawyer contacted me and said, "Nazir, if I want to be an actor, I'd have gone to RADA".

And he totally misunderstood. It's not about him, it's about you, the citizen, the public gallery, which is where you're meant to go, you don't go. They're empty. You don't know what happens in your name and my personal view is that you should have the access to do so. Now, two minutes, I will finish in two minutes by giving you some of the answers. Expanding legal aid, pro bono work needs to be celebrated. I would say it should be mandated for legal firms. Some of them do it, some of them pick and choose where they do it. Daugherty Street don't, they do the good ones.

Most of them simply pick and choose the sexy stuff and the other stuff that needs to be done. Anti-discrimination programs, I've held so many judges to account. I've got judges struck off because of their abuse and their racism in a courtroom, but that's handful. There is hardly any accountability for judges and lawyers and those in law enforcement when it comes to implicit and cultural competency. The diverse representation is not there. I, 20 judges approached me five years, four or five years ago. They can't speak. I had to speak on their behalf. They said that they're being bullied within the judicial profession, that there's nobody speaking for them and they, and they, it's quite simply because the system itself isn't diverse enough. Simplified legal processes, more alternative dispute resolution, more mobile courts, more legal clinics, greater usage of technology, more accessible facilities, more community education, more school programmes, more multilingual resources, more interpreter services, greater support for NGOs, please.

They are the backbone of our legal system, of our representation and our citizens' experience, more community legal clinics, more integration of services rather than working in silos, better data collection so that you know where you are and how bad things are and whether improvements are happening. I will assure you that there will be another miscarriage of justice in five minutes time. There will be another tomorrow and there will be another day of tomorrow and maybe Sunday is a day off but no, Monday they'll be one. The point is the system is broken. The point is I have no confidence that the people that are meant to be running it are running it for your benefit, the citizen, and that's why we have to hold their, well, hold their feet to the fire.

We've got to present them with the answers but also ensure that they respond to our questions and we've got to shine a light on what's going on and not allow the terrible scandals and the thousands and tens of thousands of people that are suffering day in, day out because of the misuse of our system. We need to ensure that they are listened to and the system works for all of us.

Thank you.

It's a great honour to be here, and when the President invited me to discuss inequalities, I was very keen to do so because this really is what drives a huge amount of public health.

I'd like just to start off, because this is a global university, with one slide about the global situation because I think it is stark, and it makes the point very clearly. This is a famous update of a famous slide. Every country in the world is lined up with its income on the bottom axis and the lifespan / life expectancy on the left axis.

Two things really worth highlighting with this, and then one additional encouraging point...

The first is that the line is extremely predictable. Poverty drives poor health outcomes in every country in the world. But, more positively, the great majority of countries in the world not actively at war are moving steadily from the bottom left of this graph to the top right, and the graph scale is not clear on this, but it starts at around 50.

At the point this University started, the lifespan in this city was in the 20s and when the NHS was formed, the lifespan in the UK was roughly where it is in most countries in Africa today.

So, things have improved in every part of the world, but there is a very long way to go.

Now I'm now going to move over to the UK, and specifically England, and again this map I think tells a story that does not need laying out too heavily. The darker on the right the colour, the greater the level of deprivation, this is The Ten Deciles of Deprivation, and on the left, is under 75 mortality in the country. Those maps are essentially identical.

Poverty and deprivation drives premature mortality with extraordinary predictability.

Now this is true in whichever kinds of infection or non-communicable disease you look at for different reasons, but I also want to highlight another reality of this. And on the left here, I’ve put a map of child mortality under five in the 1850s, and on the right, a map of Covid in its initial period in the UK in this century.

And I think two things, there's a good point and there's a bad point. The good point is child mortality, of course, has massively improved over that time, but the bad point is the areas of deprivation, where premature mortality occurs, are incredibly deep-rooted and have remained the same in this country in many areas, including around 51��. So, this is something which I think we have to tackle as a matter of national priority.

Some of the reasons for this are relatively easy to explain, and, with will and determination, possible to tackle.

I'm of course going to highlight smoking.

And I’m delighted that the government is aiming for a smoke-free generation. People being addicted to smoking in their childhood, and then suffering for the rest of their lives, something they do not wish to do, a great majority of smokers wish they'd never started and are forced to carry on by addiction, is one of the most appalling situations that leads to avoidable mortality in this country.

On the left, we have deaths from respiratory diseases, particularly chronic obstructive pulmonary disease, but others, and on the right, lung cancer deaths. Smoking drives a very large proportion of the difference that we see here. So, this is a relatively straightforward relationship because the companies that promote smoking essentially do so among the most vulnerable.

But there are also more complex relationships. This, for example, is on the right, liver cancer in the UK. And people often, rather I think simplistically, say well, that's because there's more drinking in people who are living in more deprived socioeconomic areas. That is not true.

In fact, the amount of alcohol and the number of people drinking it is higher in some of the higher socioeconomic groups, but the patterns of drinking are more harmful, so this is a bit more complicated.

The more granular you look at the data for all of these diseases, the starker the differences become, and this has two implications. The negative one is we have an enormous gradient when you look at a granular level between the wealthiest and the least wealthy parts of our society. But on the positive side, from the point of view of what we can do, this tells us where we should go.

There is a very clear concentration of poverty and deprivation related in illness and disability and short lives, and those are the areas we should be concentrating much of our effort.

And this is true at however micro level you go. This is a classic presentation, in this case of 51��. You can do this for almost any city in the world where there is a ten-year gap in very short distances between more deprived and less deprived parts of the city. And the same would be true in London, Glasgow, or indeed Paris and New York.

Now, the reason the deprivation drives this premature mortality is multifactorial.

Some of the factors are relatively clear, straightforward, and should be addressed through public health. Many of them are much more complex and based on issues around diet, housing, working environment, education, for example education is highly protective against dementia and many other conditions, smoking, as we talked about.

But also importantly, there is something called the inverse care law. Those who need most medical help tend to be those who get it least. And this is a very important mission of the University, in training doctors, nurses, and other health professions, to ensure that we have people to serve those who are in the greatest need.

So, that's one huge driver of inequalities in this country but I want to highlight another one which I think is less discussed.

And that is age.

And here the maps are very different. In fact, they are to some degree almost mirror images of one another in parts of the country. In the dark blue are the percentage of the population who will be over 75 years old and, as you can see, this is because of the pattern of migration internally in the UK, going to be very heavily in rural, semi-rural and coastal areas. And that is because the pattern of migration in the UK is generally for people to move into cities and towns in their late teens, or early 20s, and to move out typically after two children.

So, this pattern means that the ageing of society is happening in the periphery and the cities are remaining forever young.

And you can see that very clearly in these demographic pyramids on the left, where 51��, on the left, because of its student population, in large part to which this University contributes, has a very young demographic. But the equation has to balance. And therefore, other parts of the country are ageing extremely rapidly.

And this is leading to a vision of certain forms of disease. So, diseases of young age are concentrating in the cities. I have picked out sexually transmitted infections, I could have chosen many others, this is a disease of youth, by large, not exclusively obviously, and on the right, I've picked out dementia, a disease principally of older age. These are in completely different parts of the country, driven by different risk factors.

So, this separation of diseases, which is actually accelerating or at least progressing very rapidly now, is going to present us with very different problems in the future to those that we face today.

And, of course, most diseases are a combination in terms of their risk factors of age and deprivation.

So, here's coronary heart disease and the two things that drive it are age and deprivation. So coronary heart disease rates are high where there is both age and deprivation around the coastal strip for example, or in any place where there is either a high level of older people or a high level of people living in deprivation. What's spared are the areas of the country that are both affluent and young.

If you superimpose most universities onto that map… I don't need to complete the sentence.

And the same is true for mental health.

For complex reasons, different parts of the lifespan, but obviously a growing concern, already a very major area where our research has been less effective than in some of our other areas of work.

When we look at individual diseases, and I will come on to my views about what we should do next but I'd wanted just to finish describing the issues, some, let's just take cancers, and I've chosen cancers because 51�� University has put…, has over many years contributed so much to our understanding of both epidemiology and the treatment of cancers. Some cancers are very heavily associated with deprivation – obviously lung cancer, head and neck cancer, liver cancer at the top on the left there for men, on the right for women lung, again, stomach cancers, vaginal cancers.

These are very strongly predicated on poverty.

And smoking plays a very major part as I'll come on to.

But many of the cancers have very little gradient. So they will not be driven by deprivation but they will be driven by age, because almost all cancers, not all, are very strongly age-related, so they will go in different directions in different parts of the country.

And to make this in a sense slightly even more concerning, what I have here this is unpublished data by the Cancer Research UK, who kindly allowed me to show it. On the left-hand of each of these bars, these are all major cancers, is where the ten-year cancer survival was in the 1970s, and on the right is where they are now.

There have been some stunning improvements.

Melanoma, breast cancer, prostate cancer, Hodgkin's lymphoma, these have improved in terms of their survivals immeasurably compared to, measurably but very highly, compared to where they were some decades ago.

At the bottom, however we have a group of cancers, oesophageal cancer, lung cancer, pancreatic cancer and these are the ones in which there is a major socioeconomic gradient, so what we have been doing, and this is not deliberate but it is a reality, is making substantial progress in those cancers where deprivation is not a major driver and making much less progress in those cancers where deprivation is a major driver.

And that is just a reality, that's a fact. You can see on the numbers, not for want of trying, but that is a reality.

And once you then put together large numbers of diseases, you then see a picture which complicates this further.

Most people actually do not, by the time they get near to the end of their life, have a single disease. They usually have multiple diseases – what's sometimes called multimorbidity.

This unsurprisingly increases with age, so age is a major driver of this, but for anyone under the age of 80, it also is very significantly accelerated by deprivation.

So people living in deprivation will typically get multimorbidity, multiple diseases in one person, making it much harder for them, their families, and for their health care, up to a decade or more earlier than those living in areas of relative affluence. So, this again, has a very major inequality component both on age and on deprivation.

Finally, before I move on to a slightly more cheery part of my talk, but I did want to lay out the problem really clearly, it is important to acknowledge that whilst many things in child health have improved, we are setting up serious problems for ourselves in the future and the biggest one, I think, to highlight at this point, is people living with overweight and obesity.

And the deprivation gradient on this in children is simply shocking. You can see the data on the left, and where this is found in the UK on the right. These people will live with problems which will cause them longer term issues, cardiovascular issues, diabetes, cancers, mechanical problems, for the rest of their lives. They were set up to fail by the system we have in place, and this is driving obesity in areas of deprivation. So, these are the problems that I think we clearly must, as a society, address.

Now, what should we do about it. Well, I think the first thing to say is, I consider this is a largely soluble problem, if we are very serious about it.

And this is both good and bad news. What this slide shows, and this is possibly the single most important slide I would show here, is that those who live in the most deprived areas live for shorter periods, but they also live for a much longer absolute number of years in ill health.

Now, what that tells you – that's a bad thing. But what that also tells you is that, if you can shorten the period of ill health, and you should be able to because biologically they're exactly the same people as the people in the bottom, they may live longer but they'll have less time feeling unwell, they'll have less time in the NHS, they'll have more time with their families, indeed, they'll have more time in economic employment, many of these people are becoming unwell early in their working lives in reality.

So, shrinking this period of illness, what's called, slightly pompously, compressing morbidity, should, in my view, be the central aim of what we should be trying to do in these groups, and I consider this as achievable because what we need to do is delay disease.

If we all live to 150, we would all get cancers, and dementia, and heart disease, and many other things. But we don't. If we can push diseases off to the right, we will shorten the period people live with them and, indeed, if we can push them off to the right beyond the point that someone naturally will die, because we will all die, then they won't have them at all. So, if you were going to die at 80 and you have your dementia at 85, it's never going be a problem. So, pushing disease off to the right will compress morbidity. It will mean people live longer. But it will also improve their lives and, indeed, reduce the amount of work the NHS has to do to support them.

Why do I think that this is a realistic possibility? Well, because if you look and take the long view of medicine, it has had a stunning achievement in dealing with the diseases to which we have put our minds systematically, scientifically, and politically. So, this is the second half, roughly, of 51�� University's existence. In the first half, infectious diseases disappeared very largely from public view. They were still there just at the beginning of this – they're the dotted line at the bottom.

Then we had a substantial increase in cardiovascular disease in this country, driven principally by smoking, but also by air pollution, working environments, and a variety of other factors, dietary and others, that peaked in around the 1950s. We then had a systematic attempt using primary prevention – stop smoking services and campaigns – all the things that reduced air pollution would be examples of that. Secondary prevention, which came a bit later down that path, where we started reducing blood pressure, dealing with high cholesterol and areas of that kind, and curative services, and the improvements we've seen moving from a situation where roughly one in two people in the UK died of heart disease to roughly one in four, which is where we've sort of moved to now. That has been done by a combination of primary prevention, secondary prevention, and curative services. It can be done, just as we achieved it with infection.

And if you look at the extraordinary improvements in infection over the time that this University has been in existence, we've seen the end of cholera, typhoid, diphtheria, tetanus, TB, very largely, and the bacterial diseases. And I'd just like to highlight, on the right, this sad painting by Lowry from 1935, The Fever Van.

The medical officer of health would arrive, a child who had an infectious disease would be taken from their parents, all their belongings will be destroyed, they'd be taken by the state into isolation, and their parents might never see them again.

Those kinds of pictures are now not seen because medical science has, by combination of prevention and treatment, de-risked those diseases. So I've just taken cardiovascular disease and infection in their contexts.

And in many of these areas these improvements continue. So, this is from 1970 through to just before the Covid pandemic. This is coronary heart disease in younger people. And again, a stunning improvement over that period, where the difference between men and women has significantly reduced because that was largely driven by much higher smoking rates in men, those have come down, sadly rates in women went up, coming down again now. But public health and curative medicine combined have achieved a great deal. Scientists here, as elsewhere, have contributed to this.

We could, by the single action of stopping smoking, substantially reduce the cancers which are most prevalent in areas of deprivation.

One in five deaths from cancer in this country are due to smoking, maybe going up to one in four. And a fifth of cancer deaths in the UK are due to lung cancer, the overwhelming majority of which is smoking. So, here is something we know what to do, and it is simply a matter of – do we have the political will to do it?

Then, moving on to some of the issues of older age... As I said earlier on, I think that we now need to think very seriously about what we're going to try and do to support people in older age and to improve their health in a realistic way.

And, if you talk to the average person walking up and down Oxford Road, and say to them: “I can give you two years of life in bad health, or one year of life in good health”, the overwhelming majority will say: “I want the one year of healthy life where I can see my family, see my grandchildren, enjoy my, my existence”. Not all, this should be someone's individual choice.

As a profession, we have in medicine, we have in science, concentrated for a long, long time on trying to improve longevity, and we have achieved that, to a very large degree. On the bottom of these graphs, what you can see is under-75 mortality, it's been falling for a long time, I’ll come to the caveat of that. Over-90 mortality has hardly moved at all now for a long period of time. And that we should not see as a failure, provided those people are living good lives.

Finally, I'd like to finish with a one bit of cheerfulness, and then one bit of moderately uncheerfulness, and then a summary.

This is what has happened to life expectancy in England over the period that this University has existed. I put the arrow where the University began. And I’m not claiming causality, but there is undoubtedly association, and science has done so much, as have the doctors trained and nurses trained in this University, done so much to contribute to this extraordinary turnaround in mortality.

There's a but to that. If you extend the line further to the end, all of Europe, not just the UK, it's often ascribed to an individual country, all of Europe saw an infection point roughly at the time when the big financial hit occurred. That’s not particularly surprising to anyone in public health. We all know that if you increase wealth, you reduce health. You shouldn't be surprised if the opposite is also true. It is true. You can see it on that graph. This is every country in Europe, big country in Europe. But there are two things you should see with this. The red line is the UK. The dark blue line is the rest of Europe. And we have been drifting down the leaderboard for some time, slowly. It's not one particular issue. And then, of course, Covid had a major hit for everybody in the UK, and elsewhere, and we've got to recover also from that.

So, my summary from all of those points: health inequalities due to deprivation and those due to age are both serious. We need different approaches to them and they are diverging geographically.

It's no longer going to be realistically possible to only go to areas of deprivation. I think we need to think about both.

We should have as a major aim, shrinking the period of ill health. Because if we do that, longevity will follow as night follows day. But the principle point is that people want to live a good and independent life, shrinking period of illness is the key to that. In my view, this is entirely possible if we aim to at least delay disease and start in the areas of deprivation, which you can see extremely easily if you just map them out. And we should have the same self-confidence to do that as the people who addressed infectious diseases and cardiovascular disease in the last century, where they just said: “we're just going to do this”.

Wider social interventions, non-health interventions are, of course, essential. But we, as a profession, need to target primary and secondary prevention. Primary prevention, we do it to everybody before they get disease, secondary prevention as an individual intervention, when people have got particular risk factors.

And finally, turning to 51��. 51�� has some of the best scientists, one of the largest medical schools, one of the most important areas of training for nursing. And it has also some of the greatest inequalities in the country. If you wanted to start somewhere, you couldn't start in a better place than 51��. This is a serious thing we want to tackle. And good luck.

51������

Talk 200: Lecture and podcast series

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‘The unmaking of everything’

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‘The limits to equality – access to justice and scandal’

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‘Health inequalities past, present and future’

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Talking digital and AI: An interdisciplinary approach

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Talking health innovation: 51������ as a living lab

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Talking fairness and equality: “We’re not moving fast enough”

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Talking innovation: It's in 51������’s DNA

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Talking energy and climate change: “We don’t have hundreds of years to sort this out”

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Talking creative and culture: 51��’s “anthropological soup”

Talking health innovation: 51�� as a living lab

Talking innovation: It's in 51��’s DNA