Focus Group 6 Me What is the biggest health problem facing everyone today? FG65 Obesity. Me Can I ask why? Well I will ask why. FG65 It would seem to me that a lot of the younger people are certainly not taking part in active sports as much as they used to do in the past and this is leading to problems both here and in America with the possibility of obesity in children as they go through life. Me Has anybody got any more to say on that or a different problem completely? FG62 I can say to a point it is a problem but not as public health. I thought public health is to put in clean sanitation, clean water, sanitation, control of infectious diseases basically. Me I’ll say then health problems, any health problems. FG62 Health problems, well obesity and sexually transmitted diseases. FG63 Drugs under health. Me Drug abuse yeah, I’ll include that in as well. FG64 I think the eradication of cancer, I mean that, get it out by it’s roots. Me OK any others? FG61 Childhood asthma, which usually leads to long-term asthma. I was lucky that my children haven’t got any ailment at all ?I feel very lucky with? children, but their cousins do have for various reasons, whether they’ve lived in cities or for other reasons, Inexplicable allergies that just develop and seem to be turning into long term problems. Me Any other problems or what I would ask is then for those propositions that have been mentioned why do you think they are so important? Is it the type of illness, the scale of the illness or…? FG61 Think you have to look at the causes before you look at the actual treatment, the problems themselves, lets look at what the causes are. Start from the bottom up and find out what cause is rather than treat it once its become a problem and then you won’t have the problems to deal with FG62 The other thing I suppose is poverty in general, because poor people are sicker than the more wealthy. FG61 Might be that the more wealthy might go to the doctor more often __ can’t take time off work. 1 FG62 It’s lifestyle really. Something to do with that the poor people tend not to look after themselves, whether it’s out of ignorance or just because they don’t care, I don’t know. FG64 I find the term public health a little confusing because when I was young and it meant things like sanitation, or a public health or sanitary inspector and in this context I take it means the health of individual members of the public? Me Yes, for the sake of the general discussion about health issues and why you think they’re important. Different people think different things are important for different reasons. For example you mentioned cancer as a big health problem. Why do you think that’s a big problem, just numbers? FG64 Well I think it is manifest isn’t it? The numbers are so great, I think it kills more than…, it’s the greatest killer of all. People, the, tobacco, the last cigarette you had 30 years ago causes it now. Me OK that leads me on to our next question. When we think about health problems, whether the ones you’ve mentioned or others: what do you think the government should do to improve health? FG61 They should bring it back into schools, they should bring it back into the issues in biology and home economics, I think it is, and stuff like that. All these were covered when I was at school, a while ago, but they don’t seem to cover it in school at all now, regards nutrition and health, lifestyle, it’s not actually part of the curriculum, it’s sort of covered fleetingly. Oh well we’ve done that, and then that’s it, it’s left, it’s not ongoing development of the individual as they go through school, taking them through the stages and the other learning that they should have in order to cope with life outside. There’s a lot of things that aren’t covered in schools. FG62 The other thing they could do is ban smoking in all public places. __+ I’m very anti-authoritarian, as much as people can do what they want, but I think that smoking is something that should be done by consenting adults in private. They can kill themselves if they want, but in a public places I think it ought to be banned. FG61 I think for the Government that’s why the income costs, what they get from the income and what it’s costing them at the moment in healthcare. Because they are going to have an ongoing problem to, if people start dramatically ?chopping up? smoking, two of my children smoke and I keep telling them not to. ?Course? I told them about the extra additives that have been put into cigarettes to make them even more addictive than they were thirty years ago. But it would be very difficult for the government to, if they were to lose 50% smokers they’ve lost that income and they’ve still got the people to treat now without having a wedge of money to… FG63 Hypocrisy is the word. FG61 If they don’t all give up smoking all at once, they should do it gradually over the next thirty/forty years. 2 FG63 They want it both ways. FG62 I don’t know, you see all sorts of different figures, but I must admit that a lot of the health care budget is spent on the treatment of smoking-related diseases. If we didn’t have any of these – it’s a none answer really, because people will always want more health care but if you’re doing things, as accountants do, saying “we get this amount of income from smoking, it costs this much to treat smoke related diseases”, they probably equal up to an extent. Am I right? Me I wouldn’t like to say, I don’t know, I really don’t know. Any other ideas about how the government should help improve the health of the public? FG64 I think it has become too much of a political football, the National Health Service in particular and the government should take a much longer view of things than four years. I wonder whether the present system is as good as the old when you have national headquarters, regional headquarters, district headquarters and then down to the bottom in a nice, tidy system. I should think financing it would have been easier then than it is now. You hear of primary care health trusts virtually going bankrupt, should not be so. Me Any other ways the government can tackle health problems? FG65 Yes, more control over food and food additives in particular, __ Me So for processed foods? FG65 Yes. We’ve got to buy, we need food, but it’s imperative that it’s as wholesome and as unadulterated as it can be. Me Does that mean regulation? FG65 Of the food industry? Yes more regulation, tighter regulation, better regulation, whatever you wish to call it. Me Any other ideas? FG65 I think the water is OK, something you need, you have to have. FG62 Fluoridate the water to stop people getting caries. Me Would you be happy with that? FG Yeah, I’m happy with that. Me I’ve got a couple, you’ve mentioned a couple of potential policies that could be done. I’ve got one here that I’ve prepared earlier. I will help with the potential solution, I’ll just hand them around then when I’m sat down I’ll read it out and I’d just like you to think, what do you think of this policy really? 3 Speed Limits policy…. FG63 I don’t think many people would disagree with it as a figure and reading that. It’s just a case of how you’re going to apply it that’s allimportant. If you’re going to go on to residential estates with lots of kids, fine, going into the middle of towns, fine. But you all know while driving round the country, I mean in Derbyshire, apply 50 miles an hour all down the A6, now there’s some areas on that, there’s no reason why it shouldn’t be 60. The County Councils are just throwing in figures, signs, there doesn’t appear to be any reason for some of them at all, maybe there trying to get rid of their March budget on signs, but as such I don’t think any sensible person could disagree with 20 miles an hour in proper residential areas. FG65 Would this be 24 hours a day, necessarily? Me I think the idea is yes. FG61 They have in Australia, I moved out there, have 20 mile an hour, equivalent of 20 mile an hour as it’s kilometres out there, 20 mile an hour speed limits outside schools and playground areas. Outside schools they do it at certain times and it is in term time. Outside play areas and some play areas are actually attached to schools, so they are public fields that the school uses during term-term, those are done by certain hours of the day, so in other words it would be from 8 o’clock in the morning until 8 o’clock at night, and that is the equivalent of 20 mile an hour speed limit and they have speed cameras at the beginning and at the end. And they are a huge signs, huge signs saying these are the hours it operates. Me So you would be happier when it is certain hours rather than just? FG61 Probably yes because then it makes sense because, with they’ve found it works out there because they have had it out there for quite some time, there’s markings on the road, a different colour strip that you drive across so you can’t say you haven’t seen the signs or the signs up on the street were obscured or something. There is no excuse. And because it’s across the board everywhere, the same times, then anywhere you drive in New South Wales it’s all the same. If it ‘s a school day, and it’s a school day, you know what the times are, you know what speed you should be going at. People do do it, they do slow right down, they really do. They are far better at doing it in those areas than we are, I think overall their deaths on roads, per head of population, has halved now. FG62 This is fairly convincing on the figures, but this doesn’t mean weight of numbers, a significant number of injuries in urban areas, if you compare us to the rest of the world. Is it really worth doing in terms of… Me So a sixty per cent reduction if it’s one person a year, is maybe not worth it, three hundred people a year it might be worth doing? FG62 Yeah, that sort of thing. 4 Me I don’t know the answer I’m afraid, apologies for not giving you all the facts there. Any other comments on that, any views on that? Whether it’s a good thing, bad thing? FG61 Think it’s a good thing. FG64 It’s speed that kills. I remember learning when I was a boy the force of impact is ½ m v squared, half the mass of the car times the square of the speed thus if you had an accident at 30 miles an hour it’s 900, as opposed to 20, becomes 400, and then of course we had the demon drink. FG62 A point of interest on this sort of thing, somebody has had a scheme somewhere in England where they’re, can’t remember the details, but they’re mixing pedestrians and traffic and not trying to separate them and the article I saw said it seems to be working because people make eye contact and walk and drive very carefully. FG61 Taken away all the signs haven’t they, all the signs have been moved. All the street furniture, signs, have all been removed. Taken away pavement, __ and the whole lot, Cambridge was it. FG62 Thought it was somewhere like Durham, I can’t remember. It hasn’t been going for very long but it seems to be working, I think. FG61 Was it something to do with the confusion of road signs for drivers it said it’s overloading drivers and the pedestrians haven’t got enough room. FG62 I think the theory is that if you put up a speed limit, people drive at it. If you’ve got your bit of road, you can drive at 20 miles an hour, 30 miles an hour, but if you’ve got to share it with pedestrians and cyclists you take more care. And they __ find people were making eye contact and slowing down, people being altogether more courteous than otherwise. FG? Don’t think it will work in Bakewell. FG So we’ve got no reservations about that policy then? Right, we’ve got another one, same drill I’ll just hand it out. The policy which is being discussed is the fortification of food with folic acid. Folic Acid FG63 What’s neural tube defects? BL Spina bifida is the common one and anencephaly, which is a bit similar but in the head, is the other. So it’s when the spine doesn’t close properly and so the spinal cord is exposed, so it’s sometimes fatal and sometimes not, or can lead to disability. FG63 How many babies are born in the United Kingdom in a year? Me In total? 5 BL About 60 000 isn’t it, no 600,000. FG62 So statistically it’s not a high proportion of children born with neural tube defects anyway. Me No BL Well __ in the past because often they’d be picked up on a scan. FG62 To treat a whole population there must always be side effects to avoid a very small proportion, a small number. BL It might mask the fact that a number of people will abort foetuses with, will be picked up and then aborted. So that’s probably in addition to the number of babies born. FG62 And why does it say if it goes ahead the treatment of B12 deficiencies will be made more difficult? Me It’s a fairly technical argument which I don’t fully understand but vitamin B12 deficiency is mainly seen in the elderly and folic acid gets in the way of the screening test they do for vitamin B12 deficiency. So it means you can’t identify it as quickly and therefore the signs and symptoms are not picked up until later, therefore these problems, which is called peripheral neuropathy, this feeling of numbness, sometimes can’t be avoided. That’s the problem with it. FG62 But in order to make the judgement you need to know how many cases of B12 deficiency there are, it’s obviously a balance I would have said. I don’t think you can say anything, you can’t comment on this. FG63 Are we saying at the end of the day that in rough terms the number of spina bifida babies or others in that group will be cut by half by the addition of adding folic acid to the whole of the food chain. Me Give or take, yes. FG61 What would it be added to? What foodstuffs? Me Essentially it’s added to flour, so anything made with flour would have it in, although you may be able to buy non folic acid foods, so maybe organic foodstuffs, but your flour, your cornflakes. FG61 What else do we have in flour, because they did something in the war didn’t they where they added something to flour, for the health of the nation, so that in your daily bread you got, whatever it was they did at the time. FG65 I think there is one vitamin added to it already. FG61 I just think at what point do you stop forcing things on people, you’ve got fluoride put in the water. My first child had fluoride drops because I was told __+ fluoride drops and guess what, it was already in the water. They just put it in and they hadn’t told anybody, they 6 hadn’t even told the dentist that they had put it in. FG62 The other thing about this is, you’ve got a population to be taught, you’ve got pregnant women, surely ?pregnant women? advised to take “folic acid”. Why should the rest of society have additives put in when you know who to give it to? Me I know the answer to that one. They reason why it’s suggested is that to get the effect of folic acid it’s got to be taken pre-conceptually, so before the baby’s conceived. Only 10% of women will do that when they’re planning a child, even if the majority are told about it and 50% of pregnancies are unplanned, so it’s impossible to take it pre-conceptually, so those are the two general reasons to do with that. Have you got an opinion about whether those are good things or bad things? FG63 If we’re looking at the whole thing dispassionately, 180 babies out of 600,000 - it’s not a very high priority in my view. Me That’s fine. Your view is quite good for me. Any other views? FG61 Presumably 50% of those are planned then 50% of those will not be affected because the mother will have taken folic acid to start with, so you’re only talking about 50% of the mothers anyway. Me May have taken it, most don’t. FG61 May, more likely to. I would agree with you there, yeah. FG65 There’s not enough information to make the judgement because the statement “this could lead some elderly people” - some - “getting feelings of numbness” - what is that? - “in the arms and legs”. What is happening to these people? How many elderly people percentagewise? What feelings of numbness do they get, how often does it occur, is it there all the time, etc etc? There’s a whole host of problems there. Can that be quantified at all? Me Not as accurately as maybe it should. I couldn’t tell you off the top of my head. The evidence for that is not firm, because they know it will happen but they don’t know whether it can be avoided. FG61 In that case you shouldn’t do it. You could have people say using sharp knives and cutting themselves and having to be hospitalised. Elderly people are bound to take longer to recover from injuries. Another factor is that injuries are more likely to be of a severe nature rather than a mild trauma. If they getting numbness in their feet they could slip down steps, break a hip and I would say overall in that case it shouldn’t be done. FG64 I think it’s a question of proportion, it seems an awful lot for some 60 million all together for the sake of… course if you were a mother of one of those children I’d think that… but the proportion seems wrong 7 to me, and then the risk to the elderly. FG62 It is the proportion thing which is a bit out of kilter isn’t it, because most pregnant women have their foetuses scanned and you pick up these things, pregnancies, presumably __ ?terminated foetuses? are picked up, are they? And if they’re counselled properly, that’s another way of dealing with it, but as you say peripheral neuropathy in elderly can lead to a lot of morbidity Me I think vitamin B12 deficiency is probably a relatively less common cause. I can’t quantify it at all. The numbers are probably also very small. It’s not a major cause like diabetes for example. FG62 Yeah, I know, but it’s symptomatic of the way governments seems to think, pick up one thing and they don’t really look into the details of it. For these small numbers, it seems a bit excessive to make everybody have another additive in their food. Me Can I pick up something you mentioned about scans picking up abnormalities? The other thing to mention is that first of all some people think see the policy as important because it avoids terminations of pregnancies, they see that as a plus, but the other thing is that some miscarriages take place because the body realises there’s something wrong with the foetus, so miscarriages will be reduced to a certain degree, but that certain degree, people don’t know what it is yet. It would be slightly larger in effect than 180 babies, but again I wouldn’t be able to quantify that. FG61 Again it would be a case really of those who are presenting themselves as miscarriage cases, who would be advised by the doctor in future, “it may be to prevent a miscarriage in the future, that you should be taking this, that and the other. Presumably if a woman suffered a miscarriage they are going to go to surgery anyway whereas it may well be that other women don’t attend surgery until they are 13/14 weeks, which by that time it will be too late. FG65 Are the long-term effects of folic acid in food known, other than numbness in legs and arms? Are there any other? BL It’s a natural, it’s in foliage and leaves or a leaf, it’s in vegetables, it’s basically one of the vitamins like selenium. I think it doesn’t cause the numbness, I think it masks the tests. So in fairness there’s no, in any dose that you would give, there’s no negative, like vitamin C, a little extra isn’t going to do you any harm. Me I’ve sort of condensed a 200 page report into 3 paragraphs, so I apologise for that, but it was worse for me reading the 200 page report. There is evidence of some other long-term effects, but as with vitamins they’re all positive. If there is a long-term effect, it’s actually on heart disease, it will reduce the incidence of heart disease, but it’s so “if”, “but”, “when”, “however” that I didn’t think it worth putting it in here, but potentially there are other positive spin-offs. I’ll leave it at that. FG61 Can you get enough folic acid in a normal varied diet to make up for any shortfall? 8 Me As far as I understand it, it’s almost impossible. You’d be eating a lot of broccoli, so even with a natural diet women are still recommended to take iron supplements because you’re not going to overdose on it. Strangely, if you look at regional variations, the rates of neural tube defects do vary by region and they think that is due to diet and the way in which people cook vegetables in particular. FG61 Does it vary through the world as well, are vegetarian countries and people more inclined to be vegetarianism less likely to have it than large meat eaters in New York? Me I would suspect so, but I don’t know the answer. The strange one that I do know is there’s a slightly higher rate in the Republic of Ireland and I think it’s down to the fact that they boil their vegetables more. It’s one of the explanations I heard. So diet does play a part, but people are still recommended to take the tablet once a day. BL The causes of all these sorts of conditions are quite complex, so you won’t easily pick out one cause leading a variation. Sometimes there will be lots of factors involved, so what happens in one country isn’t that easy to compare with what happens in another. Me So in general people are reasonably happy with urban speed limits, potentially with a few alterations? FG61 If it doesn’t harm anybody, to reduce the speed limit, because you’re not actually having an effect on anybody at all including probably the person going to work, is probably still going to arrive at work within 2 minutes of when he was going to arrive anyway when he was going 50, but fairly, completely different issue, because nobody actually has to lose there. Whereas if you start putting in folic acid then you are doing things in an underhand way that doesn’t have great big signs or whatever, buy your bread and it’s folic acid in it, should have bread that people want to buy that has got folic acid in it __ so it shouldn’t just added because the government __+ BL So just the fact that of the government telling you to slow down isn’t ?such? an issue for anyone (Shakes of heads) Me But you’re generally sceptical of the second one? If you look at those side by side, do you actually see anything in common between them or are they completely separate issues? FG61 Separate. Me Why do you think they are separate? FG65 As the lady said, there’s no detrimental effect to a speed limit, there’s only advantages and in the second case there’s both pros and cons, and the cons don’t seem to be too well known and that would be my concern. Me Any other opinions? Can you see any common links there? 9 FG61 Government can still bag all the money and you can’t do anything any thing about it. Me That is a common link, yeah, and it was deliberate. Any other common links? Do you see these as the same, similar policies or completely different? FG63 They’re different, I can’t see any commonality. Me Why do you think they’re different? FG63 I can’t see any commonality at all. Me That’s fine, you don’t have to. FG63 I’m not sure the first one will barely squeeze into public health, I would have thought, road safety __ FG61 It only becomes a public health issue when that person’s ?been injured? FG63 In terms of saving lives, then the reduction of the speed limit is going to be better value for money. Well you got to put the costs in. FG62 You save more than 74 lives a year by reducing the speed limit. FG61 Got serious injuries and minor injuries to take into consideration as well though, take time off work, because if they have been knocked over and that kind of thing, costs of insurance. Me I’ve got one more for you then, the grand finale. This one is banning smoking in public places. Smoking Ban FG64 It’s true. Me Is it true that that will happen or ? FG64 I’m sure it is yes. Me But what do you think – good idea, bad idea, crazy idea? FG65 Good idea. We’ve learnt the lesson. FG62 Think it’s the single most important thing the government could do. Excellent idea. FG63 I’m a smoker. At the end of the day it’s going to happen anyway. Why it hasn’t happened already I don’t know. Just come back from Italy and I mean if Italy can do it, for goodness sake, we’re next, and it’s working. I said it wouldn’t work in Dublin when the Irish introduced it, but it did. 10 Me What do you mean by working? That people did stop? FG63 Yes, in the bars, I never thought it stood a chance in Ireland. I was over in Dublin for a weekend last year and it’s working and I’m just back from Italy and it’s working there. So be it, it’s going to happen. Me But would you be in favour of it? Do you think it’s a good idea? FG63 Well, it’s such a minority at the end of the day that it’s not going to make any difference. I think the whole thing is, Britain’s ruled on political correctness and a load of facts, some of which are highly suspect, especially in the field of passive smoking. Me Okay. Any other views on this policy? FG65 The sooner the better. As an ex-smoker, but as a smoker, let’s go from that scenario first, why should I inflict something onto someone else just because I like smoking? I think it’s terrible, so I don’t smoke. I welcome this proposal. Me Okay. We usually get more discussion than this, people start arguing with each other, but you’re all agreeing with one another. FG62 Well, it’s obvious. FG61 People know, it’s like smoking on aeroplanes, in a very short time people say, even if it’s a long flight, even if you got an eight or nine hour flight, it becomes a mindset I think, as you probably know, that if you can’t smoke you don’t think about it. People will be sort of lighting up in the areas before they get on the plane and as soon as they get off the plane they got the packet out of their pockets and they’re flicking their lighters all ready to light up, but they know all that time they’re on the plane, they’re not sort of making do with dummies or anything like that, don’t seem to be, just accept, a friend of mine who is a smoker, you get on the plane, you don’t think about it because you can’t smoke and that’s it. Me You say it’s obvious, but we’ve had other groups where we’ve had lifetime non-smokers saying it’s a ridiculous idea, because I don’t want to stop people smoking when they want to. FG62 People can smoke in private as long as they’re not going to harm anyone else. FG61 I don’t object to it in pubs, but I do object to it in restaurants and in dining areas for the pubs where the smoke is coming across and I do, well don’t think they do it any more, but in Little Chefs and places like that where they cordon off an area, and say “you may smoke in this area” and you think what’s the point in that because it’s all drifting across anyway. Absolutely no point. They usually just stick them by the door, you just go out of the door the smoke actually comes back into the rest of the restaurant. I’ve got no problems with people if they are walking along the streets and if they get rid of their cigarette butts and dispose of them properly, instead of flicking them as you see them by the bus stops and what have you. I don’t have a problem with people smoking in my presence. The only problem I have with it is, probably explained, is that you get out of bed and you realise you 11 hair stinks and you pillows stink and your clothes stink and you got to have a shower before you go anywhere __+ night before you ?went to bed?. FG64 In the past, a lot of people smoked because it was the thing to do. The old Prince of Wales was never seen without a cigarette drooping from his lip. In the railway carriage, you could catch smoke, and lots of people died, I often think that galloping consumption was probably cancer of the lung, killed a tremendous number of people. FG62 You’ve got to think of the history of this because I gather, during the war, military personnel encouraged to smoke, because it kept them calm, did they get a special cigarette allowance? FG64 You got 50 free cigarettes a week. Yes. FG62 That was before the harmful effects were known and that now is… so it’s not only cancer, is it? FG61 ?Knowledge? has been there a long time because the guy who just died, Richard Donald is it, he’s always been, interviewed about three months before he died, we’ve known about this since 1943 or whatever. But the harmful effects cannot be denied, although people who are smokers, as I say I have friends who smoke, and they are in complete denial. “I have catarrh because of my next habit” or your dad smoked as well, got something to do with it. Always got a cough or I’ve got a cold, yeah well you got a cough because you smoke. Because you can’t, friend of mine, particularly when she was in hospital, she says “oh I can’t stop coughing” I said that because it’s all the tar coming off your lungs and your lungs are finally able to work properly. So a lot of people are in complete denial about that anyway, about the effect that it’s having on their health. Me Okay, now you’ve got three, this is going to get tricky with bits of paper, so my question now to you is. In general, everyone’s in agreement so you’re quite happy to say urban speed limits, no folic acid and but to ban smoking. FG63 They wouldn’t have the guts! Me No not the government, but in your own minds you’re happy that the Government can intervene to reduce speed, it can’t intervene to put folic acid in food and it can intervene to ban smoking in public places. So you’re quite happy with that? FG61 It’s not going to radically affect people by banning smoking, people aren’t going to say I need to have a cigarette. If I’m not going to smoke and all the rest of it I will have a headache for the rest of the day. That’s not going to happen because that’s just ridiculous. If I can’t have a cigarette while I’m having my drink I’ll get the shakes or my blood doesn’t circulate as sluggishly as it should do. There will be no complaints in a medical way whereas this thing on folic acid is really an unknown quantity as far as quantifying goes. FG62 In answer to your question, yes. 12 Me So yes, no, yes – there’s no problem? O.k., final question: imagine you do have to vote on these policies. What would be the two main factors that would be going through your minds when you make a decision? What would be the two factors that influence your vote? What I’m going to do now is go round you one at a time. FG63 Am I an MP now? Me Not what’s popular, not allowed to say what’s popular. What are the two factors that you think would influence you with this. FG63 We’re talking about public health here? isn’t it? FG And these policies as well. FG65 Banning smoking would be the most important of those three, because it would have the most significant effect of the three, in my opinion. Me That’s fine by me. You’re next – what two factors that would be buzzing around, if you had to vote. FG61 The only thing is the fact that this is so well documented that the costs, the savings, would be big once you had got everything in place, whether it’s cameras or speed bumps or something like that. Actually the cost because, the fact that somebody may be knocked down and not killed still means that they have costs to the health service because they would still need, they will still need to be seen by x number of people when they go to hospital, the will still need the ambulance, they will still need all those things, and then maybe the hospital stay as well. When they come home, they might need physiotherapy. If they’re a bit old they might need to be retrained because they used to be a window cleaner and they can’t do that anymore. All these sorts of things are really quite high costs and we don’t have individual insurance and therefore it’s a cost to society and I think that cost-wise makes just so much sense, so that factor is ?crucial? Me That would be one of the main factors in. FG64 I think factor number one is simplicity in putting it into effect, and factor number two getting the maximum gain for the least effort. Me Next. FG62 I’m not quite sure, what you meant by the two factors that would affect me in voting. I think what would give the maximum daily health benefits to society, but I’m also very conscious of not eroding people’s individual liberties, like making folic acid, because when all’s said and done, __+ I think saying an extra two minutes, going at 20 miles an hour instead of 50 is not significant but the folic acid thing is a bit of an unknown quantity. Me Okay, thank you. That’s the main objective, 13 FG63 Costs and practicalities, practicalities ought to include, beneficial potential. Me That’s good. Thank you for coming along. Key ?word? Uncertain about word ___ Word inaudible ___+ Several words inaudible (comment) Comment from notes for clarification 14