For more than a century, type 1 diabetes has meant one thing: a lifetime administering insulin. But for the first time, science is breaking that paradigm – not by managing the disease, but by intercepting it before symptoms even appear.
As the first patients in the UK begin receiving the groundbreaking new therapy, teplizumab, we are developing ways to identify who might benefit from a drug that only works if given before any symptoms appear. At the Royal Devon NHS, we are currently treating the first UK adult, Hannah Robinson, who was found to have early type 1 diabetes by chance during routine pregnancy screening.
About 10% of people with diabetes have type 1, while the remaining 90% have type 2, a condition linked to lifestyle factors where insulin is still produced but does not work properly. Type 1 diabetes is an autoimmune condition that leads to complete loss of insulin production from the pancreas. Without insulin, blood sugar levels rise dangerously, increasing the risk of blindness, kidney failure and early death.
Although type 1 is often thought of as a disease of childhood, research from the University of Exeter has highlighted that more than half of all new cases occur in adults.
For millions around the world living with type 1 diabetes, treatment to keep blood sugar in check means lifelong daily insulin. However, using insulin comes with its own risks.
If blood sugar drops too low, it can cause hypoglycaemia, or “hypos”, which in severe cases may lead to seizures or even death. It is no surprise that constantly balancing between high and low blood sugars takes a heavy toll on both physical and mental health. During her pregnancy, Robinson needed insulin and saw firsthand how “life completely revolves around balancing your blood glucose”.
Teplizumab offers a completely different approach. Instead of simply replacing insulin, it targets the immune attack that causes type 1 diabetes.
Our immune system is usually remarkably good at telling friend from foe, protecting us from infections and cancer while leaving our own organs alone. But sometimes, for reasons still not fully understood, this balance breaks down in a process known as autoimmunity. In type 1 diabetes, the immune system mistakenly attacks the pancreas, destroying insulin-producing cells.
Diabetes symptoms.
Teplizumab works by retraining the immune system and dialling down the specific cells that target the pancreas. Studies show it can delay the disease and the need for insulin therapy by two to three years, with generally mild side-effects. For Robinson, who knows all too well from pregnancy and the full-time job that is living with type 1 diabetes, the possibility of a few extra years without insulin really mattered.
The drug is already approved in the US and is under review for routine NHS use, although a few children and teenagers in the UK have also received it through special access programmes.
Finding people early
There is a catch. By the time people develop symptoms of type 1 diabetes, such as thirst, weight loss and fatigue, more than three-quarters of their insulin-producing capacity is already destroyed.
For teplizumab and similar therapies to work, they need to be given before symptoms appear, while blood sugar levels are still normal. This means these treatments are not an option for people who already have established type 1 diabetes.
So how do we find people at this early stage? Fortunately, it is possible to detect the beginnings of the autoimmune attack many years before symptoms show using simple blood tests that measure immune markers called pancreatic autoantibodies.
Just a few drops from a finger prick can reveal whether the immune system has started to target the pancreas. Finding people early not only offers the chance to delay disease progression, it can also help avoid the life-threatening emergencies that sometimes come with a first diagnosis – such as diabetic ketoacidosis.
With type 1 diabetes affecting roughly one in 200 people, there is still the question of who to test. Not everyone’s risk is the same. When we think of inherited diseases, we often imagine conditions caused by a single gene change, such as cystic fibrosis.
Type 1 diabetes does have a genetic component, but it involves many different genes, each nudging a person’s risk up or down. Having genetic risk alone is not enough, with unknown environmental factors also needed to tip the balance.
Nine in ten people who develop type 1 diabetes have no family history. While testing relatives of people with type 1 is a logical first step, research at the University of Exeter suggests that combining all these genetic factors into a single risk score could help predict who might develop the disease and identify babies who should be monitored more closely. This could become an important tool as we move towards wider genomic screening.
It is still early days, but we are seeing a fundamental shift in how we approach type 1 diabetes. For more than a century, treatment has meant patients taking on the daily burden of replacing the insulin their bodies can no longer make. Now, the focus is turning to therapies that tackle the immune problem at its source, with the hope of stopping the disease before it fully develops and opening the door to an insulin-free future.
Richard Oram has received research grants or contracts from Randox and Sanofi. He has also received royalties and license from Randox, consulting fees from Sanofi, Provention Bio, and Janssen and payment or honoraria from Sanofi and Novo Nordisk. He has served on data safety monitory board or advisory board for Sanofi.
Nicholas Thomas serves on an advisory boards for Sanof (manafacturer of Teplizumab) guiding the technical delivery of therapy within the NHS. He is currently employed by Exeter University as an NIHR Academic Clinical Fellow.
Exhausted from a long campaign but buoyed by an extraordinary victory, Keir Starmer stood on the steps of Downing Street just over one year ago to deliver his victory speech. “Your government,” the new prime minister said, “should treat every single person in this country with respect.”
This message of respect resonated strongly in the year leading up to the campaign, coming as close as anything to providing a central argument to Labour’s case for government. And, according to polling and focus groups that my team at UCL Policy Lab designed along with polling company More in Common, it seemed to work.
As our research at the time showed, voters felt that “respecting ordinary people” was the most important attribute that any politician could have, more important than having ideas for the future, managing effectively or having real experience. And they thought Starmer was the leader who displayed that respect most.
A year later, the picture looks quite different. In new polling, we asked a representative sample of over 7,000 people to evaluate the government one year on. On respect, the judgement has not been good.
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During the general election campaign, 41% of the electorate said that they believed that Starmer “respected people like them”. One year on, that stands at only 24%. At the same time, the number who say that he does not respect them has risen from 32% to 63%. Starmer is now outstripped on that question by Nigel Farage – 33% say the Reform UK leader respects people like them.
Losing support
This view has had crucial political consequences. Of those who voted for Labour in the general election, only 60% of our respondents say they would vote for the party in an election held tomorrow.
And that is not because some other political party is suddenly swooping in for their supporters. Labour’s voters are defecting in a host of different directions: 11% say they would vote Reform; 8% would vote Liberal Democrat; 4% would vote Green and 4% would vote Conservative. A further one in ten say they simply don’t know how they would vote.
Labour’s losses have been most dramatic among their first-time voters. Of those who voted for Labour in 2024 but not in any other general election since 2010, barely a third still support the party, while a fifth would vote for Reform UK.
These political failures, our report contends, are directly related to the declining sense of respect. The top reason voters gave for turning away from Labour are the broken promises and U-turns made by Labour in government, followed by the party’s failure to reduce the cost of living and changes to the winter fuel payment.
The idea of “respect” being key to the public’s sense of whether a government is on their side or not has been growing for many years now, both in academia and in politics itself. Since at least the 2007/8 financial crisis there has been a sense that large swathes of the public feel neglected, overlooked and even disdained by those who govern them.
When people talk about wanting to see “change” in Britain, this is often what they mean. It was a theme I touched on recently in two books, Out of the Ordinary and, with my co-author Tom Baldwin, England.
Just over a year ago, a happier Starmer delivers his victory speech. Shutterstock
But respect is not just an abstract idea. People appear to judge whether they are respected by those who govern them or not primarily on the basis of whether the government stands up for them against powerful vested interests.
Our earlier research demonstrated that there is a widespread sense among the British public that certain groups have had it too easy for too long. This is either because they have been able to intimidate the government, or because government ministers and advisers have themselves been recruited from among these groups.
In our new report, therefore, we see that the new government’s most popular act was their willingness to raise the minimum wage by £1,400 in April, against the objections of some in business who suggested that such a move was too burdensome on them.
Changes to the winter fuel allowance and proposed changes to the disability benefits system, on the other hand, registered poorly. They suggest that the interests of ordinary and vulnerable people count for too little in decision-making.
These judgements currently shape the mood of the country and probably top the list of issues that the government now needs to address. There is still time for the government to rebuild its appeal, of course. Indeed, our respondents who said they would vote for Labour said they would do so because the party needs more time to fix the problems they inherited.
But as it seeks to do so, voters will want to know who this government stands for. Whose interests does it put first? What kind of people does it respect?
Much of the electorate thought they knew the answer to these questions one year ago. Now they’re not so sure.
Marc Stears directs the UCL Policy Lab, a non-partisan think tank based at University College London. He was previously chief speechwriter to the UK Labour Party.
During his recent public spat with Donald Trump, Elon Musk tweeted a poll asking if a new political party would better represent the 80% of voters in the middle. Hundreds of thousands of people responded and more than 80% answered “yes”.
Many think that polarisation is fuelled by echo chambers created on social media platforms. These only expose people to beliefs similar to their own.
However, I study how narratives emerge on social media, and ways to investigate them. My work has two aims: first, to identify political issues that are likely to cross party lines, and a wider goal of exploring the role of social media in mitigating, rather than exacerbating, levels of polarisation.
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Earlier this year, for example, I sorted through 12,000 posts from Republican and Democrat voters on subreddits (online forums discussing specific topics). Using a technique I developed in my PhD research, I analysed attitudes to contested political issues around the time of Trump’s inauguration. Like other researchers, I am finding that there are things both sides often agree on, and that not every issue splits neatly across party lines.
Pew Research shows what Democrats and Republicans agree on.
People on both sides of the political divide can be distrustful of tech companies and big businesses, where billionaires have power regardless of who’s in charge. Divisions of “up v down” could be alternatives to seeing divisions as “left v right”.
Both Republicans and Democrats want “the best” leaders who could get things done fast and efficiently. But it would appear that people on both sides are concerned about the “slash-and-burn” way that Doge (the Department for Government Efficiency, the new agency tasked with cutting federal spending) is working.
Emma Connolly does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
“In the real world, I’m a coward. When I’m online, I’m a hero.”
These words, paraphrased from a conversation with a young man with autism, have stayed with us throughout the years of research that underpin our recently published book exploring the relationship between children with special educational needs and disabilities and digital technology.
We’re constantly bombarded with warnings about the potential dangers of digital technology, especially for children. But this quote captures something we might miss. The digital world can be a vital space of empowerment and connection.
In our work, we’ve found that digital technology offers more than just access to learning for young people with special educational needs and disabilities. It opens doors to social lives, creative outlets and even employment opportunities that might be closed to them in the offline world. And yet, this potential is too often overshadowed by fears about the risks and harms they might encounter online.
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Adolescence, the Netflix drama that delves into the hidden dangers of growing up in a digital world, has taken up a lot of the national conversation around social media, cyberbullying and online exploitation. But there is another show on Netflix that has received far less attention.
The Remarkable Life of Ibelin is a powerful documentary that tells the story of Mats Steen, a young Norwegian man with a severe disability who found freedom, friendship and purpose in the online world of gaming. Though physically limited by Duchenne muscular dystrophy, Mats, known as “Ibelin” in World of Warcraft, built a rich life online.
After his passing at 25, his gaming friends revealed just how much he had meant to them. Some travelled to his funeral. The film challenges stereotypes about online gaming. It shows it as a source of connection, compassion, and real human bonds.
We’ve spoken to many young people with special educational needs and disabilities who echo the same themes. Online spaces offer a sense of identity and capability they don’t always feel offline.
We found that the benefits of digital engagement for children with special educational needs and disabilities are extensive. It enhances communication: tools such as voice interfaces and text-to-speech software help those with speech or language difficulties express themselves confidently. Online platforms create spaces for friendships, especially for those who find face-to-face interaction challenging.
Digital tools can also foster independence. Calendar apps can be useful for those with ADHD, or assistive technology for learners with dyslexia. And for education, tailored online content can bridge the gap between mainstream and specialist learning environments.
But the digital world isn’t an equal playing field. Children with special educational needs and disabilities face disproportionate levels of online harm, including grooming, cyberbullying and exposure to inappropriate content. Crucially, they often lack the tools or support to report harm or seek help.
This, of course, raises concerns for the parents, carers and teachers of young people with special educational needs and disabilities. We’ve found that parents, carers and teachers we’ve spoken to often reach for a “prohibition first” approach – feeling young people will be safer if they do not have the access to the internet and social media that a young person without their needs might enjoy.
Safeguarding and empowerment
We’ve been asked questions such as “What apps should I ban?” or “How do I stop my child going on the dark web?” These questions reflect a risk-averse mindset that fails to appreciate the value of digital engagement. Risk cannot be eliminated, but it can be managed. And, more importantly, opportunity must be protected.
Too often, safeguarding strategies are done to children, not with them. It’s a good idea for parents and teachers of all children to talk to them about their digital life: what brings them joy, what worries them, where they feel confident or confused. Children are more likely to talk about fears or bad experiences if they feel believed, respected and understood. Make yourself a safe adult to talk to: one who listens without panic.
While banning apps or limiting access might be useful in some cases, it should not be the starting point for safeguarding. It’s worth considering whether there are skills that a child could learn that would allow them to use technology safely.
What’s more, online safety lessons are best when adapted to the communication style, cognitive ability and emotional maturity of an individual child. Visual aids, social stories, or interactive games may work better than text-heavy advice.
Fear can limit what technology can offer the children who may need it most. For young people with special educational needs and disabilities, digital spaces are not simply entertainment, they are platforms for agency, creativity, relationships and voice.
The role of adults here is to ensure these spaces are not only safe, but welcoming and empowering. That means moving past automatic restrictions and toward thoughtful, inclusive strategies that support children who might gain the most from using these technologies. We don’t need more bans. We need more belief.
The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
During his recent public spat with Donald Trump, Elon Musk tweeted a poll asking if a new political party would better represent the 80% of voters in the middle. Hundreds of thousands of people responded and more than 80% answered “yes”.
Many think that polarisation is fuelled by echo chambers created on social media platforms. These only expose people to beliefs similar to their own.
However, I study how narratives emerge on social media, and ways to investigate them. My work has two aims: first, to identify political issues that are likely to cross party lines, and a wider goal of exploring the role of social media in mitigating, rather than exacerbating, levels of polarisation.
Get your news from actual experts, straight to your inbox.Sign up to our daily newsletter to receive all The Conversation UK’s latest coverage of news and research, from politics and business to the arts and sciences.
Earlier this year, for example, I sorted through 12,000 posts from Republican and Democrat voters on subreddits (online forums discussing specific topics). Using a technique I developed in my PhD research, I analysed attitudes to contested political issues around the time of Trump’s inauguration. Like other researchers, I am finding that there are things both sides often agree on, and that not every issue splits neatly across party lines.
Pew Research shows what Democrats and Republicans agree on.
People on both sides of the political divide can be distrustful of tech companies and big businesses, where billionaires have power regardless of who’s in charge. Divisions of “up v down” could be alternatives to seeing divisions as “left v right”.
Both Republicans and Democrats want “the best” leaders who could get things done fast and efficiently. But it would appear that people on both sides are concerned about the “slash-and-burn” way that Doge (the Department for Government Efficiency, the new agency tasked with cutting federal spending) is working.
Emma Connolly does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
When COVID arrived early in 2020, pandemic restrictions made in-person mental health care difficult or impossible. Both therapists and patients had to adapt almost overnight. For many in the field, it felt like a gamble: could this screen-based format offer the same level of support for people struggling with depression, anxiety or trauma?
Evidence has been growing, but until now few studies have compared treatment outcomes before and during the pandemic. Research my colleagues and I conducted offers new insights into this period.
We followed 2,300 patients treated in Sweden’s public mental health system over six years – three years before and three years during the pandemic – and tracked outcomes for common conditions including depression, anxiety, post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD).
We found that nearly half of visits shifted online during the pandemic (up from just 4% pre-COVID), yet treatment outcomes did not decline – they remained stable, despite the rapid transition.
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Patients filled out regular questionnaires during treatment to track their progress, using standard mental health assessments that measured depression and anxiety symptoms. We examined the degree of symptom improvement and the number of patients who transitioned from severe to manageable symptoms.
Fully 38% of depressed patients recovered, along with 56% of those with generalised anxiety disorder, 46% with OCD and 59% with PTSD. These recovery rates were almost identical before and during the pandemic.
We aren’t certain why remote care works, but one reason might be that the most important aspects of good therapy – things like building trust between patient and therapist, using evidence-based treatments and regular follow-up – can still occur online. In fact, for some people, meeting by video can make it easier to show up and feel comfortable. Our study suggests that, when care is done well, whether it’s in person or online doesn’t make much difference.
Online care also helps with everyday difficulties. It’s often easier for people who live far away, have trouble getting around or have busy schedules to get help from home. And during a health crisis like the pandemic, being able to keep up with treatment probably helped many people stay on track instead of falling behind.
Still, the findings come with limits. The study did not include children, people in acute psychiatric crisis or those with severe psychotic disorders — groups for whom in-person care may still be essential. And while online therapy offers flexibility, it also requires access to a private space, stable internet and the ability to engage through a screen — conditions that aren’t guaranteed for all patients.
Just turning on a webcam isn’t enough. The clinics in this study followed proven treatment methods and kept a close eye on how patients were doing. These steps probably made a big difference and are important for making remote care work.
Rather than being a temporary fix, online mental health care has become a core part of the system. Our study offers strong evidence that remote care, when well implemented, can match in-person treatment in effectiveness, even during something as challenging as a pandemic.
There is no one-size-fits-all model – and not all patients will benefit equally from internet-based treatments. But giving people the choice – and maintaining high standards of care regardless of delivery method – appears to be a key to success.
Because in the end, what matters most isn’t where care happens. It’s that it happens and that it works.
Fabian Lenhard works as the Head of Data & Analytics for WeMind Psychiatry and is affiliated as a researcher at Karolinska Institutet, Stockholm, Sweden.
Source: The Conversation – UK – By Christian van Nieuwerburgh, Professor of Coaching and Positive Psychology, RCSI University of Medicine and Health Sciences
Want to remember things better as you get older? The secret might be surprisingly simple: focus on feeling good.
Recent research involving over 10,000 people aged 50 and above has found that people with higher wellbeing perform better on memory tests as they age. The study, which followed participants for 16 years, checked their wellbeing and memory every two years.
The researchers expected that good memory might improve wellbeing, but found no evidence for that. Instead, it was wellbeing that predicted better memory performance over time.
The study also found that the link between wellbeing and memory stayed strong even after taking things like depression into account. This means wellbeing may affect memory on its own, not just through effects on mood.
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However, the study’s authors acknowledge some limitations that should be taken into account when considering the real-life application of their findings.
The study relied on people reporting their own wellbeing, which can be biased – some people might overestimate how good they feel. The research also can’t prove that wellbeing directly causes better memory – other factors like income or life experiences might play a role.
Also, the memory tests used were relatively simple and might not capture the full complexities of how memory works in real life.
Despite these limitations, the study offers a compelling reason to invest in your wellbeing now. Here are five evidence-based strategies to increase the positive emotions in your day-to-day experiences.
Being kind can boost the wellbeing of both initiators and receivers of kindness.
3. Nurture your most important relationships
Positive relationships are important for our wellbeing. These should be nurtured and maintained.
4. Be more present.
In a distracted world, being present in the moment can be difficult. Being present is the opposite of multitasking. This takes intentional practice and you can develop it through meditation or mindfulness practices.
5. Do things that lead to a “flow” state.
Being in a flow state means that we are fully engaged in an activity. It is a mental state where a person feels fully involved and enjoys a process or activity that provides just the right balance of challenge and reward. People often talk about this as “being in the zone”. Finding an engaging hobby or sport is a good way of increasing flow moments.
Ensuring that you and the people around you experience positive emotions regularly is not just about feeling good in the moment. It is also an important investment for the future, ensuring better mental health and wellbeing for yourself and others. What will you do?
Christian van Nieuwerburgh does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
Source: The Conversation – UK – By Dante McGrath, Postdoctoral Researcher, Centre for Climate Repair, Department of Engineering, University of Cambridge
Since 2019, the UK has been committed to the target of net zero greenhouse gas emissions by 2050. Legally binding net zero targets form the basis for national efforts to meet the international goals of limiting global warming to “well below 2°C above pre-industrial levels” and ideally to 1.5°C.
These goals, launched in 2015 as part of the UN’s Paris agreement, set the stage for climate action in a warming world. Much like the “reduce-reuse-recycle” sustainability initiative, various climate actions fit within three Rs — reduce, remove and reflect. These actions were the subject of a recent debate in the UK parliament.
My colleagues and I have reviewed how these three Rs differ in scope, scale and state of knowledge. Our analysis reveals that a range of climate interventions may complement intensified mitigation efforts (to reduce greenhouse gas emissions), but more research is urgently needed.
Reducing greenhouse gas emissions is at centre stage. This is non-negotiable. Emissions reduction must be deep, rapid and sustained if we are to limit global warming to less than 2°C. These drastic cuts demand an ensemble cast, players from all sectors, from energy to agriculture. The energy to power modern society accounts for almost 75% of our greenhouse gas emissions.
We need a prop change at centre stage: an energy transition from fossil fuels to renewables. This requires electrification and energy efficiency measures — both are central to managing the growth in energy demand sustainably.
At stage right, greenhouse gas removal offers a supporting role by removing historical emissions and offsetting residual emissions from sectors lagging behind in the energy transition (such as shipping and aviation). A number of academics have stressed that a range of removal methods is required to achieve net zero emissions and halt the rise in global temperature.
Conventional carbon removal methods, such as forestation or the restoration of peatlands and wetlands, are vital. However, due to resource constraints (such as land and water security) and ecosystem impacts of global warming, we need to scale new methods rapidly to meet Paris agreement targets. These include ways to capture and store carbon on land and at sea.
Novel methods have many challenges, however, related to their effectiveness (including storage durability and permanence), unintended environmental consequences, economic costs and demands on natural resources. The challenges constraining the scale-up of novel removal methods must be addressed if we are to achieve net zero and halt global warming.
The consequences of climate change are outpacing efforts to abate it. With each year, the likelihood of exceeding 1.5 and 2°C warming increases, posing major risks to society and Earth’s ecosystems. That’s why the third R — reflect — needs to be assessed.
Sunlight reflection methods have been in the wings on stage left. In the context of limiting global warming to 1.5°C, they have been considered feasible in theory, but fraught with challenges in practice. As the chance of exceeding 1.5°C in the coming years increases, this form of climate intervention needs further consideration. Experts brought together by the UN Environment Programme have concluded that, although this intervention is “not a substitute for mitigation”, it is “the only option that could cool the planet within years”.
The most studied methods to reflect sunlight are called stratospheric aerosol injection and marine cloud brightening. These methods mimic natural processes that cool the earth by reflecting sunlight, be it through the release of reflective aerosols into the upper atmosphere, or the addition of droplet-forming salt crystals into marine clouds in the lower atmosphere.
Sunlight reflection methods pose immense challenges with respect to research, ethics and governance. There are many scientific uncertainties about how these interventions will influence the climate. There is also no global regulatory framework in place. Any legislation needs to be based on scientific evidence and informed decisions.
Shining the spotlight
Meeting climate goals requires an ensemble cast performing actions across the warming world stage. Emissions reduction is indispensable and should remain centre stage in climate policy. Climate interventions at stage right and left — in the form of greenhouse gas removal and sunlight reflection — need responsible and responsive direction. Their risks and benefits need to be assessed.
Before curtains are drawn, let’s make sure every climate action — reduce, remove and reflect — gets a fair hearing.
Don’t have time to read about climate change as much as you’d like?
Dante McGrath does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
Across much of Europe, the engines of economic growth are sputtering. In its latest global outlook, the International Monetary Fund (IMF) sharply downgraded its forecasts for the UK and Europe, warning that the continent faces persistent economic bumps in the road.
Globally, the World Bank recently said this decade is likely to be the weakest for growth since the 1960s. “Outside of Asia, the developing world is becoming a development-free zone,” the bank’s chief economist warned.
The UK economy went into reverse in April 2025, shrinking by 0.3%. The announcement came a day after the UK chancellor, Rachel Reeves, delivered her spending review to the House of Commons with a speech that mentioned the word “growth” nine times – including promising “a Growth Mission Fund to expedite local projects that are important for growth”:
I said that we wanted growth in all parts of Britain – and, Mr Speaker, I meant it.
Across Europe, a long-term economic forecast to 2040 predicted annual growth of just 0.9% over the next 15 years – down from 1.3% in the decade before COVID. And this forecast was in December 2024, before Donald Trump’s aggressive tariff policies had reignited trade tensions between the US and Europe (and pretty much everywhere else in the world).
Even before Trump’s tariffs, the reality was clear to many economic experts. “Europe’s tragedy”, as one columnist put it, is that it is “deeply uncompetitive, with poor productivity, lagging in technology and AI, and suffering from regulatory overload”. In his 2024 report on European (un)competitiveness, Mario Draghi – former president of the European Central Bank (and then, briefly, Italy’s prime minister) – warned that without radical policy overhauls and investment, Europe faces “a slow agony” of relative decline.
To date, the typical response of electorates has been to blame the policymakers and replace their governments at the first opportunity. Meanwhile, politicians of all shades whisper sweet nothings about how they alone know how to find new sources of growth – most commonly, from the magic AI tree. Because growth, with its widely accepted power to deliver greater productivity and prosperity, remains a key pillar in European politics, upheld by all parties as the benchmark of credibility, progress and control.
But what if the sobering truth is that growth is no longer reliably attainable – across Europe at least? Not just this year or this decade but, in any meaningful sense, ever?
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For a continent like Europe – with limited land and no more empires to exploit, ageing populations, major climate concerns and electorates demanding ever-stricter barriers to immigration – the conditions that once underpinned steady economic expansion may no longer exist. And in the UK more than most European countries, these issues are compounded by high levels of long-term sickness, early retirement and economic inactivity among working-age adults.
As the European Parliament suggested back in 2023, the time may be coming when we are forced to look “beyond growth” – not because we want to, but because there is no other realistic option for many European nations.
But will the public ever accept this new reality? As an expert in how public policy can be used to transform economies and societies, my question is not whether a world without growth is morally superior or more sustainable (though it may be both). Rather, I’m exploring if it’s ever possible for political parties to be honest about a “post-growth world” and still get elected – or will voters simply turn to the next leader who promises they know the secret of perpetual growth, however sketchy the evidence?
To understand why Europe in particular is having such a hard time generating economic growth, first we need to understand what drives it – and why some countries are better placed than others in terms of productivity (the ability to keep their economy growing).
Economists have a relatively straightforward answer. At its core, growth comes from two factors: labour and capital (machinery, technology and the like). So, for your economy to grow, you either need more people working (to make more stuff), or the same amount of workers need to become more productive – by using better machines, tools and technologies.
Historically, population growth has gone hand-in-hand with economic expansion. In the postwar years, countries such as France, Germany and the UK experienced booming birth rates and major waves of immigration. That expanding labour force fuelled industrial production, consumer demand and economic growth.
Why does economic growth matter? Video: Bank of England.
Ageing populations not only reduce the size of the active labour force, they place more pressure on health and other public services, as well as pension systems. Some regions have attempted to compensate with more liberal migration policies, but public resistance to immigration is strong – reflected in increased support for rightwing and populist parties that advocate for stricter immigration controls.
While the UK’s median age is now over 40, it has a birthrate advantage over countries such as Germany and Italy, thanks largely to the influx of immigrants from its former colonies in the second half of the 20th century. But whether this translates into meaningful and sustainable growth depends heavily on labour market participation and the quality of investment – particularly in productivity-enhancing sectors like green technology, infrastructure and education – all of which remain uncertain.
If Europe can’t rely on more workers, then to achieve growth, its existing workers must become more productive. And here, we arrive at the second half of the equation: capital. The usual hope is that investments in new technologies – particularly AI as it drives a new wave of automation – will make up the difference.
In January, the UK’s prime minister, Keir Starmer, called AI “the defining opportunity of our generation” while announcing he had agreed to take forward all 50 recommendations set out in an independent AI action plan. Not to be outdone, the European Commission unveiled its AI continent action plan in April.
Keir Starmer announces the UK’s AI action plan. Video: BBC.
Despite the EU’s concerted efforts to enhance its digital competitiveness, a 2024 McKinsey report found that US corporations invested around €700 billion more in capital expenditure and R&D, in 2022 alone than their European counterparts, underscoring the continent’s investment gap. And where AI is adopted, it tends to concentrate gains in a few superstar companies or cities.
In fact, this disconnect between firm-level innovation and national growth is one of the defining features of the current era. Tech clusters in cities like Paris, Amsterdam and Stockholm may generate unicorn startups and record-breaking valuations, but they’re not enough to move the needle on GDP growth across Europe as a whole. The gains are often too narrow, the spillovers too weak and the social returns too uneven.
Yet admitting this publicly remains politically taboo. Can any European leader look their citizens in the eye and say: “We’re living in a post-growth world”? Or rather, can they say it and still hope to win another election?
The human need for growth
To be human is to grow – physically, psychologically, financially; in the richness of our relationships, imagination and ambitions. Few people would be happy with the prospect of being consigned to do the same job for the same money for the rest of their lives – as the collapse of the Soviet Union demonstrated. Which makes the prospect of selling a post-growth future to people sound almost inhuman.
Even those who care little about money and success usually strive to create better futures for themselves, their families and communities. When that sense of opportunity and forward motion is absent or frustrated, it can lead to malaise, disillusionment and in extreme cases, despair.
The health consequences of long-term economic decline are increasingly described as “diseases of despair” – rising rates of suicide, substance abuse and alcohol-related deaths concentrated in struggling communities. Recessions reliably fuel psychological distress and demand for mental healthcare, as seen during the eurozone crisis when Greece experienced surging levels of depression and declining self-rated health, particularly among the unemployed – with job loss, insecurity and austerity all contributing to emotional suffering and social fragmentation.
These trends don’t just affect the vulnerable; even those who appear relatively secure often experience “anticipatory anxiety” – a persistent fear of losing their foothold and slipping into instability. In communities, both rural and urban, that are wrestling with long-term decline, “left-behind” residents often describe a deep sense of abandonment by governments and society more generally – prompting calls for recovery strategies that address despair not merely as a mental health issue, but as a wider economic and social condition.
The belief in opportunity and upward mobility – long embodied in US culture by “the American dream” – has historically served as a powerful psychological buffer, fostering resilience and purpose even amid systemic barriers. However, as inequality widens and while career opportunities for many appear to narrow, research shows the gap between aspiration and reality can lead to disillusionment, chronic stress and increased psychological distress – particularly among marginalised groups. These feelings are only intensified in the age of social media, where constant exposure to curated success stories fuels social comparison and deepens the sense of falling behind.
For younger people in the UK and many parts of Europe, the fact that so much capital is tied up in housing means opportunity depends less on effort or merit and more on whether their parents own property – meaning they could pass some of its value down to their children.
‘Deaths of Despair and the Future of Capitalism’, a discussion hosted by LSE Online.
Stagnation also manifests in more subtle but no less damaging ways. Take infrastructure. In many countries, the true cost of flatlining growth has been absorbed not through dramatic collapse but quiet decay.
Across the UK, more than 1.5 million children are learning in crumbling school buildings, with some forced into makeshift classrooms for years after being evacuated due to safety concerns. In healthcare, the total NHS repair backlog has reached £13.8 billion, leading to hundreds of critical incidents – from leaking roofs to collapsing ceilings – and the loss of vital clinical time.
Meanwhile, neglected government buildings across the country are affecting everything from prison safety to courtroom access, with thousands of cases disrupted due to structural failures and fire safety risks. These are not headlines but lived realities – the hidden toll of underinvestment, quietly hollowing out the state behind a veneer of functionality.
Without economic growth, governments face a stark dilemma: to raise revenues through higher taxes, or make further rounds of spending cuts. Either path has deep social and political implications – especially for inequality. The question becomes not just how to balance the books but how to do so fairly – and whether the public might support a post-growth agenda framed explicitly around reducing inequality, even if it also means paying more taxes.
In fact, public attitudes suggest there is already widespread support for reducing inequality. According to the Equality Trust, 76% of UK adults agree that large wealth gaps give some people too much political power.
Research by the Sutton Trust finds younger people especially attuned to these disparities: only 21% of 18 to 24-year-olds believe everyone has the same chance to succeed and 57% say it’s harder for their generation to get ahead. Most believe that coming from a wealthy family (75%) and knowing the right people (84%) are key to getting on in life.
In a post-growth world, higher taxes would not only mean wealthier individuals and corporations contributing a relatively greater share, but the wider public shifting consumption patterns, spending less on private goods and more collectively through the state. But the recent example of France shows how challenging this tightope is to walk.
In September 2024, its former prime minister, Michel Barnier, signalled plans for targeted tax increases on the wealthy, arguing these were essential to stabilise the country’s strained public finances. While politically sensitive, his proposals for tax increases on wealthy individuals and large firms initially passed without widespread public unrest or protests.
However, his broader austerity package – encompassing €40 billion (£34.5 billion) in spending cuts alongside €20 billion in tax hikes – drew vocal opposition from both left‑wing lawmakers and the far right, and contributed to parliament toppling his minority government in December 2024.
Such measures surely mark the early signs of a deeper financial reckoning that post-growth realities will force into the open: how to sustain public services when traditional assumptions about economic expansion can no longer be relied upon.
For the traditional parties, the political heat is on. Regions most left behind by structural economic shifts are increasingly drawn to populist and anti-establishment movements. Electoral outcomes have shown a significant shift, with far-right parties such as France’s National Rally and Germany’s Alternative for Germany (AfD) making substantial gains in the 2024 European parliament elections, reflecting a broader trend of rising support for populist and anti-establishment parties across the continent.
Voters are expressing growing dissatisfaction not only with the economy, but democracy itself. This sentiment has manifested through declining trust in political institutions, as evidenced by a Forsa survey in Germany where only 16% of respondents expressed confidence in their government and 54% indicated they didn’t trust any party to solve the country’s problems.
This brings us to the central dilemma: can any European politician successfully lead a national conversation which admits the economic assumptions of the past no longer hold? Or is attempting such honesty in politics inevitably a path to self-destruction, no matter how urgently the conversation is needed?
Facing up to a new economic reality
For much of the postwar era, economic life in advanced democracies has rested on a set of familiar expectations: that hard work would translate into rising incomes, that home ownership would be broadly attainable and that each generation would surpass the prosperity of the one before it.
However, a growing body of evidence suggests these pillars of economic life are eroding. Younger generations are already struggling to match their parents’ earnings, with lower rates of home ownership and greater financial precarity becoming the norm in many parts of Europe.
Incomes for millennials and generation Z have largely stagnated relative to previous cohorts, even as their living costs – particularly for housing, education and healthcare – have risen sharply. Rates of intergenerational income mobility have slowed significantly across much of Europe and North America since the 1970s. Many young people now face the prospect not just of static living standards, but of downward mobility.
Effectively communicating the realities of a post-growth economy – including the need to account for future generations’ growing sense of alienation and declining faith in democracy – requires more than just sound policy. It demands a serious political effort to reframe expectations and rebuild trust.
History shows this is sometimes possible. When the National Health Service was founded in 1948, the UK government faced fierce resistance from parts of the medical profession and concerns among the public about cost and state control. Yet Clement Attlee’s Labour government persisted, linking the creation of the NHS to the shared sacrifices of the war and a compelling moral vision of universal care.
While taxes did rise to fund the service, the promise of a fairer, healthier society helped secure enduring public support – but admittedly, in the wake of the massive shock to the system that was the second world war.
In 1946, Prime Minister Clement Attlee asked the UK public to help ‘renew Britain’. Video: British Pathé.
Psychological research offers further insight into how such messages can be received. People are more receptive to change when it is framed not as loss but as contribution – to fairness, to community, to shared resilience. This underlines why the immediate postwar period was such a politically fruitful time to launch the NHS. The COVID pandemic briefly offered a sense of unifying purpose and the chance to rethink the status quo – but that window quickly closed, leaving most of the old structures intact and largely unquestioned.
A society’s ability to flourish without meaningful national growth – and its citizens’ capacity to remain content or even hopeful in the absence of economic expansion – ultimately depends on whether any political party can credibly redefine success without relying on promises of ever-increasing wealth and prosperity. And instead, offer a plausible narrative about ways to satisfy our very human needs for personal development and social enrichment in this new economic reality.
The challenge will be not only to find new economic models, but to build new sources of collective meaning. This moment demands not just economic adaptation but a political and cultural reckoning.
If the idea of building this new consensus seems overly optimistic, studies of the “spiral of silence” suggest that people often underestimate how widely their views are shared. A recent report on climate action found that while most people supported stronger green policies, they wrongly assumed they were in the minority. Making shared values visible – and naming them – can be key to unlocking political momentum.
So far, no mainstream European party has dared articulate a vision of prosperity that doesn’t rely on reviving growth. But with democratic trust eroding, authoritarian populism on the rise and the climate crisis accelerating, now may be the moment to begin that long-overdue conversation – if anyone is willing to listen.
Welcome to Europe’s first ‘post-growth’ nation
I’m imagining a European country in a decade’s time. One that no longer positions itself as a global tech powerhouse or financial centre, but the first major country to declare itself a “post-growth nation”.
This shift didn’t come from idealism or ecological fervour, but from the hard reality that after years of economic stagnation, demographic change and mounting environmental stress, the pursuit of economic growth no longer offered a credible path forward.
What followed wasn’t a revolution, but a reckoning – a response to political chaos, collapsing public services and widening inequality that sparked a broad coalition of younger voters, climate activists, disillusioned centrists and exhausted frontline workers to rally around a new, pragmatic vision for the future.
At the heart of this movement was a shift in language and priorities, as the government moved away from promises of endless economic expansion and instead committed to wellbeing, resilience and equality – aligning itself with a growing international conversation about moving beyond GDP, already gaining traction in European policy circles and initiatives such as the EU-funded “post-growth deal”.
But this transformation was also the result of years of political drift and public disillusionment, ultimately catalysed by electoral reform that broke the two-party hold and enabled a new alliance, shaped by grassroots organisers, policy innovators and a generation ready to reimagine what national success could mean.
Taxes were higher, particularly on land, wealth and carbon. But in return, public services were transformed. Healthcare, education, transport, broadband and energy were guaranteed as universal rights, not privatised commodities. Work changed: the standard week was shortened to 30 hours and the state incentivised jobs in care, education, maintenance and ecological restoration. People had less disposable income – but fewer costs, too.
Consumption patterns shifted. Hyper-consumption declined. Repair shops and sharing platforms flourished. The housing market was restructured around long-term security rather than speculative returns. A large-scale public housing programme replaced buy-to-let investment as the dominant model. Wealth inequality narrowed and cities began to densify as car use fell and public space was reclaimed.
For the younger generation, post-growth life was less about climbing the income ladder and more about stability, time and relationships. For older generations, there were guarantees: pensions remained, care systems were rebuilt and housing protections were strengthened. A new sense of intergenerational reciprocity emerged – not perfectly, but more visibly than before.
Politically, the transition had its risks. There was backlash – some of the wealthy left. But many stayed. And over time, the narrative shifted. This European country began to be seen not as a laggard but as a laboratory for 21st-century governance – a place where ecological realism and social solidarity shaped policy, not just quarterly targets.
The transition was uneven and not without pain. Jobs were lost in sectors no longer considered sustainable. Supply chains were restructured. International competitiveness suffered in some areas. But the political narrative – carefully crafted and widely debated – made the case that resilience and equity were more important than temporary growth.
While some countries mocked it, others quietly began to study it. Some cities – especially in the Nordics, Iberia and Benelux – followed suit, drawing from the growing body of research on post-growth urban planning and non-GDP-based prosperity metrics.
This was not a retreat from ambition but a redefinition of it. The shift was rooted in a growing body of academic and policy work arguing that a planned, democratic transition away from growth-centric models is not only compatible with social progress but essential to preventing environmental and societal collapse.
The country’s post-growth transition helped it sidestep deeper political fragmentation by replacing austerity with heavy investment in community resilience, care infrastructure and participatory democracy – from local budgeting to citizen-led planning. A new civic culture took root: slower and more deliberative but less polarised, as politics shifted from abstract promises of growth to open debates about real-world trade-offs.
Internationally, the country traded some geopolitical power for moral authority, focusing less on economic competition and more on global cooperation around climate, tax justice and digital governance – earning new relevance among smaller nations pursuing their own post-growth paths.
So is this all just a social and economic fantasy? Arguably, the real fantasy is believing that countries in Europe – and the parties that compete to run them – can continue with their current insistence on “growth at all costs” (whether or not they actually believe it).
The alternative – embracing a post-growth reality – would offer the world something we haven’t seen in a long time: honesty in politics, a commitment to reducing inequality and a belief that a fairer, more sustainable future is still possible. Not because it was easy, but because it was the only option left.
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Peter Bloom does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment. His latest book is Capitalism Reloaded: The Rise of the Authoritarian-Financial Complex (Bristol University Press).
“Are we stopping again already?” It’s a familiar complaint on family road trips and one that’s often aimed at women. From sitcoms to stand-up routines, the idea that women have smaller bladders has become a cultural punchline. But is it anatomically accurate?
The short answer? Not really. The full picture reveals a more complex – and far more interesting – interplay between anatomy, physiology and social conditioning. Women might feel like they need to go more often, but their actual bladder size isn’t significantly different.
The detrusor is a layer of smooth muscle that forms the bladder wall. Its unusual elasticity – a quality known as compliance – allows it to stretch without triggering constant “full” signals. When nature calls, it contracts forcefully to empty the bladder.
An inner lining, the transitional epithelium, behaves like biological origami, it stretches and flattens to accommodate expanding volume, all while shielding underlying tissues from the toxic contents of stored urine.
Thanks to this clever design, your bladder can expand and contract throughout a lifetime without tearing, losing tone, or sounding false alarms – most of the time.
So where does sex come into it?
In structural terms, male and female bladders are more alike than different. Both comfortably hold around 400–600 millilitres of urine. What surrounds the bladder can influence sensation and urgency, and this is where the differences begin.
In men, the bladder nestles above the prostate and in front of the rectum. In women, it sits in a more crowded pelvic compartment, sharing space with the uterus and vagina. During pregnancy, the growing uterus can compress the bladder – hence the dash to the loo every 20 minutes in the third trimester.
Even outside pregnancy, spatial constraints may mean the bladder triggers a sense of urgency earlier. Some studies suggest women are more likely to feel bladder fullness at lower volumes – possibly due to hormonal influences, increased sensory input or the dynamic relationship between pelvic floor support and bladder stretch.
The pelvic floor – a sling of muscles supporting the bladder, uterus and bowel – is crucial. In women, it can be weakened by childbirth, hormonal shifts or simply time, altering the coordination between holding on and letting go.
Much of that control hinges on the external urethral sphincter – a ring of voluntary muscle that acts as the bladder’s gatekeeper, helping you wait for a socially convenient time to void.
A part of the pelvic floor complex, and like any muscle, it can lose tone or be retrained. Meanwhile, urinary tract infections (more common in women due to a shorter urethra) can leave the bladder hypersensitive, upping the frequency of urination even after the infection has passed.
Toileting habits can vary across cultures. But from a young age, many girls are often taught to “go, just in case” or avoid public toilets. These habits can train the bladder to empty prematurely, reducing its capacity to stretch.
Meanwhile, boys are often given more leeway – or encouraged to wait. Anyone who has ever “hovered” over a toilet seat will also recognise that hygiene concerns will influence behaviour. Over time, the bladder learns. You can’t change its size, but you can train its tolerance.
Bladder training, a technique championed by the NHS and the British Association of Urological Surgeons, involves gradually increasing the time between toilet trips. This helps reset the feedback loop between bladder and brain, restoring capacity and reducing the sensation of urgency.
Often combined with pelvic floor exercises, it’s an effective, non-invasive way to take back control – especially for those with overactive bladder syndrome or stress incontinence.
So women may not have smaller bladders, but they may have less room to manoeuvre, both anatomically and socially. The next time someone rolls their eyes at a toilet stop, remind them: it’s not about weak willpower or tiny tanks. It’s about anatomy, habit and hormones.
Michelle Spear does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
