Subway launches loyalty program with surprise rewards and a confusing token system

Mmm bread.

Subway, the world’s largest fast food chain, is launching a new loyalty program, called Subway MyWay Rewards, that will offer customers surprise treats and tokens that eventually mature into dollars.

The move is a step toward earning more customer love, as well as making the Subway experience more digital — since it comes with a mobile app refresh. 

Subway MyWay Rewards launches in the U.S. and Canada in March and will be available at 28,500 restaurants. With Subway’s scale, it’ll be one of the largest loyalty programs in the world, though MyWay is far from Subway’s first effort in this arena. For example, the chain previously offered free meals with a punch card system called Sub Club. That was discontinued in 2005 in part due to fraud, as Wired reported. The new system tries to avoid that by making it all mobile. 

“We really designed the program with the consumer in mind. You don’t have to read the fine print,” Subway’s Chief Digital Officer Carissa Ganelli told Mashable of MyWay Rewards. 

Here’s a look at Subway’s new mobile app for tracking rewards: 

Image: subway

Image: subway

Subway’s offer of surprises is easy to understand and sounds a lot like Panera Bread’s MyPanera, but the tokens are a bit more complicated. (Fortunately, they aren’t related to cryptocurrency or ICOs or anything like that.) Call them points, if that helps. 

Here’s how the tokens system works:

  • For every dollar customers spend at Subway they earn 4 tokens

  • Reach 200 tokens and receive $2.00 in Subway credit 

So, if Subway customers wanted to maybe earn enough tokens to cover an entire Subway sandwich. Let’s just say one that costs about $6.00. That’s 600 tokens, which means spending $150. Yeah, it’s not easy, but we’re talking about free sandwiches here. The rewards also can be applied to cookies, drinks, salads, soups, or whatever else they’re serving up at Subway. 

Thankfully, keeping track of rewards is pretty easy. MyWay Rewards members can look them up on Subway’s website, the mobile app, or ask in-person at a Subway location. 

The program’s structure is what the people — at least those who Subway surveyed — asked for, according to Ganelli. 

“The $2 threshold was something that’s going to absolutely enable us to reward our members more frequently,” Ganelli said. 

In addition to instituting a $2 reward, Subway gleamed from its customer surveys that people want surprise rewards. 

“You won’t know when you’ve earned our reward until you’ve earned it,” Ganelli said and shared an example of me earning a free drink and being notified via Subway’s mobile app. “That’s awesome. I got a present today because who doesn’t like surprises of delicious stuff?”

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Evolution Could Destroy Our Ability To Tolerate Alcohol

Recent studies have shown that we are still evolving and now, new research published in Nature Ecology and Evolution suggests we could be developing a gene that wrecks our tolerance for alcohol. 

Researchers at the University of Pennsylvania analyzed the genomes of some 2,500 people from 26 populations across four continents using data collected by the 1,000 Genomes Project. The team then singled out specific traits or “genomic hotspots” that pop up in various, divergent populations – say, changes to an area of the gene responsible for producing glycophorins, which has occurred in parts of Africa and Asia. For this to have happened, the mutation must have emerged independently in these two different populations and persisted. Alternatively, if there had been just one initial mutation, it would have had to travel like Speedy Gonzales across the two continents.

“What this new study shows is that selection has also been tending to make some genes similar between populations,” John Hawks, from the University of Wisconsin-Madison, told New Scientist, “to help people adapt to recent changes in our ecologies”.

In the study, the researchers highlight five areas of recent change. This includes the adaption to the glycophorin gene cluster – which has been linked to malaria resistance – in Asia and Africa, two areas where the mosquito-borne disease poses a severe health risk. In Europe, the team noticed an increase in genes related to the breakdown of an amino acid called homocysteine, which in high levels can cause heart disease. Meanwhile, all five African populations studied showed changes to a gene that affects the positioning of the urethral opening (DGKK) and, in non-African populations, there appeared to be positive selection for two genomes inherited from our Neanderthal neighbors.

Most interestingly, perhaps, are the modifications to the alcohol dehydrogenase cluster (ADH), which could be changing how we process alcohol. Dehydrogenase is the enzyme that breaks down alcohol, which it does by metabolizing it into a compound called acetaldehyde. This toxic chemical is responsible for your pounding headache the morning after a night out. Fortunately, the body is able to turn this into another substance that is non-toxic called acetate relatively quickly and we feel better after a day or so.

However, evolution could be finding a way to curb humanity’s alcohol addiction by creating new variants of ADH that affect our tolerance to booze and our body’s ability to convert acetaldehyde to acetate. Essentially, it means we would feel ill after just a small amount of drink.

So far, these genes have only been detected in East Asia and West Africa, but time will tell how far they spread. 

For more predictions on how humans will look and behave in the future, check out this video from AsapSCIENCE.


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Government loses clean air court case

Image copyright PA

Campaigners have won a third High Court victory over the UK government’s plans to tackle air pollution.

The judge in the case said the Government plan was “unlawful” and that more action was needed in 45 English local authority areas.

He said ministers had to ensure that in each of the areas, steps were taken to comply with the law as soon as possible.

The case was brought by ClientEarth, a group of activist lawyers.

Mr Justice Garnham said: “Because the obligation is zone-specific, the fact that each of the 45 local authority areas will achieve compliance in any event by 2021 is of no immediate significance.

“The Environment Secretary must ensure that, in each of the 45 areas, steps are taken to achieve compliance as soon as possible, by the quickest route possible and by a means that makes that outcome likely.”

He added: “In effect, these local authorities are being urged and encouraged to come up with proposals to improve air quality over the next three years, but are not being required to do so. In my judgment, that sort of exhortation is not sufficient.”

As a result of previous rulings, the government drew up new plans for reducing nitrogen dioxide pollution, much of which comes from vehicles, to within legal limits.

Its latest case was brought against the Environment Secretary and the Transport Secretary, while a claim against the Welsh Government was discontinued after it agreed to work with ClientEarth on new proposals.

A raft of recent studies and reports have linked air pollution to heart disease and lung problems, including asthma.

The Royal Colleges of Physicians and of Paediatrics and Child Health says that outdoor air pollution is contributing to some 40,000 early deaths a year in the UK.

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New cancer test isn’t ready for prime time

(CNN)A simple blood test to detect cancer early. How great is that?

A widely reported study in the journal Science described a liquid biopsy test — CancerSEEK — which combined measuring eight tumor biomarkers with testing for pieces of DNA with cancer associated mutations in 16 genes.
It’s not one test; it’s a battery of tests. And while collecting the blood may be simple, the subsequent analysis is extraordinarily complex.
    The task at hand is particularly challenging. We all have pieces of DNA in our blood. Distinguishing the tumor DNA from the background DNA requires finding the mutations specifically associated with cancer.
    Adding to the complexity, healthy individuals can have mutations. To avoid labeling innocuous mutations as cancerous requires a bunch of statistical fine-tuning.
    In other words, there are a lot of steps in a liquid biopsy and much potential for things to go awry.
    To their credit, the CancerSEEK investigators were very forthright that the study conditions were ideal for the test to accurately detect cancer. The liquid biopsy simply had to discriminate between patients with known cancer (the majority of whom had symptoms) and healthy individuals. And the statistical fine-tuning was tailored to the study participants — with the knowledge of who had, and who did not have, cancer.
    Although the test was able to detect most of the late-stage cancers, it detected less than half of the stage 1 cancers.
    But doctors don’t screen to find advanced cancer, we screen to find early cancer. And we don’t screen people with symptoms of cancer, we screen people who don’t have symptoms of cancer.
    There’s no doubt that there would be more detection errors in the less controlled environment of the real world.
    Just how often was made clear in a recent JAMA-Oncology study. Forty patients with metastatic prostate cancer received liquid biopsies to tailor therapy in real time to the genetics of their spreading tumors. That’s the vision for precision medicine.
    But the investigators added a little twist. They wanted to know whether it mattered which lab the liquid biopsies were sent to. So they sent each patient’s blood for two different commercial liquid biopsies: Guardant360 and PlasmaSELECT. Both tests were designed to detect mutations in the same genes.
    Yet in over half of the 40 patients, the tests gave different answers about which mutations were present. Different liquid biopsy tests give different answers in a majority of patients? That’s not precision, that’s awful.
    Sure, the analyses of liquid biopsies will improve. But if this much confusion exists about what mutations are present in the blood of patients with metastatic cancer (who have a lot of tumor DNA), imagine the uncertainty that will exist for asymptomatic individuals not known to have cancer — the very people who would be screened.
    And then there is the question of what to do with a positive result. This is very different than detecting a concerning lung nodule on a screening chest CT scan or a concerning breast mass on a screening mammogram. In these cases, it’s clear what to do to get a definitive answer: surgically biopsy the nodule or the mass. But with a liquid biopsy, the anatomic location of a cancer can be a mystery. It may not even be clear what organ the cancer is in.
    Imagine what this might mean for a patient: A doctor says, “It looks like you have cancer, but we are not sure where.”
    Even if there is certainty that the cancer is in, say, the liver, doctors may not know where in the organ. What to do then? Randomly biopsy different parts of the liver?
    This is doubly concerning when screening average-risk individuals, because most positive results are expected to be false alarms. We typically learn that a screening test is falsely positive because a surgical biopsy is normal. But absent the knowledge of where to biopsy, how can we ever be sure a positive liquid biopsy is wrong?
    Doctors won’t know where to look, but we will keep looking. Liquid biopsies are a recipe for more health anxiety, more procedures, more complications and more overdiagnoses. Not to mention, more out-of-pocket costs for our patients.
    Of course, we should continue to study liquid biopsies. The detection of circulating tumor DNA may ultimately prove useful in selected settings, such as tailoring therapy for aggressive cancers that are rapidly mutating. But the real enthusiasm is for screening average-risk individuals.

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    One reason is obvious: there is a lot of money to be made. A Goldman Sachs video estimated the potential liquid biopsy market to be $14 billion annually, adding “and we’re just at the beginning.” That kind of money doesn’t come from testing the few patients with aggressive cancer, that comes from screening millions of people.
    And there is a less obvious reason: it is easier for a new test to pass regulatory muster than it is for a new drug. While the FDA has a longstanding mandate to protect us from snake oil treatments, this often doesn’t extend to snake oil testing.
    The enthusiasm for finding things that might benefit people in the future ignores the fact that doing so can cause people to have problems now. In short, a bad test can do as much damage as a bad drug. Worrisome liquid biopsies will start a cascade of subsequent, not-so-simple tests and procedures. People will be hurt in the process.

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    With AI, Your Apple Watch Could Flag Signs of Diabetes

    Before modern chemistry brought doctors blood and urine tests for diagnosing diabetes, they had to rely on their taste buds. Sweet-tasting pee has long been the disease’s telltale biomarker; mellitus literally means honey. Too much sugar in your bodily fluids means your metabolism has gone haywire—either your cells aren’t making insulin or they’re not responding to it.

    But a little over a decade ago, a group of researchers discovered a less obvious link. One of the complications of diabetes is nerve damage, and in the cardiovascular system that damage can cause irregular heart rates. Which you can measure, either with electricity or light. So one day soon, doctors might diagnose diabetes with their patients’ wrist bling instead of blood pricks or pee strips. Oh, what difference a few centuries make.

    In 2005, heart rate sensors were something only elite athletes and very sick people used. Today, one in five Americans own one. Which is why there’s now a deep learning company trying to make something out of the connection between heart rate and diabetes. On Wednesday, at the annual AAAI Conference on Artificial Intelligence in New Orleans, digital health-tracking startup Cardiogram presented research suggesting the Apple Watch’s heart rate sensor and step counter can make a good guess at whether or not a person has diabetes—when paired with the right machine-learning algorithms, of course.

    Apple has been eyeing a career change—from personal trainer to personal physician—for its signature wearable for a while now. In November the company teamed up with health insurer Aetna to give away more than 500,000 Apple Watches as part of a pilot to try to reduce health costs. And it embarked on a study with Stanford to test the watch’s skills at detecting irregular heartbeats, which can lead to stroke or heart attack. This most recent collaboration between Cardiogram—a San Francisco-based startup staffed by former Google engineers—and a landmark UC San Francisco heart health study is just the latest in these moves.

    Cardiogram offers a free app for organizing heart-rate data from the Apple Watch and devices with similar sensors—from companies like Fitbit, Garmin, and Android Wear. It uses the same kind of artificial neural networks that Google uses to turn speech into text, and repurposes them to interpret heart-rate and step-count data. On its own, that data is mostly meaningless for detecting disease, and not just because the sensors themselves have significant errors. Training a model that can pick out condition-specific patterns requires labeled data. To learn what a diabetic heart rate signature looks, it needs some diabetics.

    That’s where UCSF comes in. In 2013 it kicked off a major heart disease project called the Health eHeart study, aiming to collect massive amounts of digital health data on one million people. As of mid-January, the study had registered 196,000 participants, who each fill out a survey about known medical conditions, family histories, medications, and blood test results. About 40,000 of them have also opted to link that information with their Cardiogram app.

    “That’s where we get our labels,” says Cardiogram co-founder Brandon Ballinger, who previously worked as a tech lead on Google’s speech recognition software. “In medicine, your labeled answers each represent a life at risk. Compared to what an internet company is working with, it’s actually a very small number of examples.”

    So Cardiogram has had to adopt some tricks from the tech world to train its neural network, DeepHeart, to spot human disease. One of these is a technique called semi-supervised sequence learning, which was originally invented to work on text data like Amazon product reviews. But instead of a sequence of words, they sub in a sequence of heart rate measurements—about 4,000 per week. Some fancy math compresses that information into a single number summarizing the amount of heart rate variability. Then those summaries are what get tied to labeled patient data, and the real training can begin.

    Using this method, DeepHeart was able to spot diabetics who weren’t part of the training group 85 percent of the time. The results are on par with the company’s previous work: Last year, the Cardiogram and UCSF released results showing that DeepHeart could wrestle one week’s worth of a person’s Apple Watch data into predictions for hypertension, sleep apnea, and atrial fibrillation with accuracy rates between 80 and 90 percent.

    So how do Cardiogram’s algorithms make good guesses without directly measuring the amount of sugar in someone’s blood? Nobody really knows.

    “Diabetes is very clearly a cardiovascular condition, but it’s not one with an obvious physiological connection to heart rate variability,” says Mark Pletcher, one of the principal investigators of the Health eHeart study and a co-author on the paper presented Wednesday. When you train machine learning algorithms on data without knowing the mechanisms behind the underlying patterns, you often get a signal without understanding why. “It makes me nervous, frankly. We’ve had a lot of internal discussions about whether this could be picking up medications diabetics use or some other extraneous factor. But we haven’t come up with anything.”

    That’s the kind of thing that sends up red flags for Eric Topol, a cardiologist and Director of the Scripps Translational Science Institute, where he’s leading the digital health arm of the NIH’s billion dollar Precision Medicine Initiative. “This combines features of the black box of algorithms and the black box of biology,” he says, of the Cardiogram study. “It’s unconvincing and shaky. At best it would be considered hypothesis-generating.” The hypothesis here being that DeepHeart might be picking up a diabetes signal. But it might be picking up something else.

    Ballinger is quick to counter these kinds of criticisms. If your wearable tells you you’re at increased risk for diabetes, and you go to the doctor and get diagnosed by traditional means, then you’re still getting the standard quality of care, he says. So what if it’s a black box that gets you in the door? Still, he recognizes the need for prospective validation to really demonstrate the AI’s accuracy—screening people who have not yet been diagnosed with diabetes, and following them to see if they did in fact develop the disease. He says the company is actively investing in those kinds of future studies.

    With the right testing, Ballinger sees business potential in his black box intelligence. Cardiogram’s app for Apple Watch and other devices is free today. But the startup plans to add features that advise a user be tested for atrial fibrillation, high blood pressure, sleep apnea, or diabetes as soon as later this year. To stay on the right side of the US Food and Drug Administration, the app can’t function as a standalone diagnostic, more like some friendly advice. But the kind of advice an insurer might cover if they thought it would get people into treatment earlier and save healthcare costs.

    Which leaves them a long way to go, given the evidence that’s currently out there. Or rather, lack thereof. “Setting aside the accuracy piece, which is something the FDA would want to know about, there’s almost no data out there on whether or not these wearables can actually change patient outcomes,” says Brennan Spiegel, a gastroenterologist and the director of Health Services Research at Cedars-Sinai in Los Angeles. “Creating the tech isn’t the hard part. The hard part is using the tech to change patient behavior. And that’s really hard to do. It’s not a computer science, it’s behavioral and social science.”

    Still, if the Health eHeart and Cardiogram studies can say one thing pretty definitively at this point, it’s that people are eager to engage with apps capable of medical-grade measurements, if and when they become available. The question is if a healthier you is truly just a push notification away.

    Intelligent Wearables

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    Spare me your eternal happiness. I just want to sweat and go home | Johanna Leggatt

    My ideal workout contains no Fitbits or philosophy, no one talks about love and we dont look forward to it

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    Eight things that were bigger killers in the 1970s

    Image copyright Alamy

    Humans tend towards pessimism when it comes to observing the world around them, research indicates.

    A recent Ipsos Mori survey suggests we frequently think things are worse than they are, from murder rates to the prevalence of diabetes. But very often our perceptions don’t align with reality.

    Here are eight things Britons are less likely to die of today than only a few decades ago – although in many cases improvements have slowed in recent years, and modern life has brought new problems too.

    1. Winter

    More people die in winter than in summer because of cold weather and higher rates of infectious illnesses such as flu.

    But the difference between the number of people dying in winter compared with summer has fallen since the 1970s, when it averaged more than 40,000 extra deaths.

    By 2015-16, there were fewer than 25,000 excess deaths a year in winter compared with in summer.

    Much of this is because of general improvements in health, but our homes are also better heated and insulated now.

    These days almost all homes have some form of double glazing but in the early 1970s fewer than 8% did, according to The Ministry of Housing, Communities and Local Government.

    Image copyright Getty Images

    Despite an overall downward trend in winter deaths, there are significant fluctuations year-on-year. That can be because of a particularly cold winter or bad flu strain.

    The highest number of excess winter deaths in recent times was in 1999-2000.

    “The main strain of flu that year affected older people more than the young, which likely contributed to the high number of winter deaths,” says Dr Annie Campbell, from the Office for National Statistics (ONS).

    Similarly, in 2014-15 the flu jab turned out to be less effective than usual in protecting people against the strain in circulation that winter.

    To allow for some of these natural variations, the ONS also produces a five-year average each year.

    It’s too soon to say how this winter’s flu season and reported pressures on the NHS will affect the picture – the ONS does publish figures on how many deaths have been registered each week, showing there were more death registrations in the week beginning 12 January 2018 than any single week since January 2015.

    But if you look at the whole winter period so far, figures from Public Health England suggest that there have been fewer excess deaths among the over-65s than the year before, or in 2014-15 when the strain of flu used in vaccines turned out not to be as good a match as usual to the main strain circulating that winter.

    2. The workplace

    There has been a big drop in fatal injuries at work since 1981.

    Before then, not all industries were required to report workplace injuries, so the data is patchy. But in the industries that did have to report, deaths fell sharply in the 1970s too.

    In the year 1986-87 there were 407 fatal accidents in workplaces around Britain. Three decades later the figure had fallen by two-thirds.

    The size of the workforce has increased a lot in that time, so if we look at the death rate per 100,000 workers, the improvement is even greater.

    This is largely because of Britain’s transformation from an industrial economy to a service-based one. Clearly people working in factories and heavy industry are more at risk of fatal accidents than office workers.

    Coal mining and steel used to be big killers but now employ very few people in the UK. On 2 February it was announced that Eggborough power station in Yorkshire is to close, leaving only a handful of coal-fired stations in the UK.

    Image copyright PA
    Image caption 1972: A pit official at Sutton Colliery in Nottinghamshire

    But these days the figures may be underreported, says Noel Whiteside, a public policy expert at the University of Warwick.

    The number of self-employed people is rising rapidly, making incidents harder to track. If a contractor is killed in a car crash on the way to a job, or has a heart attack while working from home, that would not count as a death in the workplace, she points out.

    There are other reasons to temper optimism with caution.

    Although workplaces are safer now, people generally work longer hours, and it is hard to measure the effects of health problems brought about by overwork. “I don’t think white-collar work was nearly as stressful 40 years ago,” Whiteside says.

    Improvements in general health levels are one reason for a decline in workplace deaths, but “there are some signs in the last two years that life expectancy has started to fall,” says Whiteside.

    3. Infancy

    The death of a baby is far rarer than it used to be. In 1900, one in every six babies died before their first birthday. In 2015, it was one in 270.

    In 1964 the mode age of death was zero, meaning more people died at age zero than at any other age. The most common age at death is now 85 for men and 88 for women.

    In more recent decades, infant mortality has continued to fall sharply. The prevalence of stillbirth has also plummeted.

    One key reason is that levels of smoking and drinking alcohol during pregnancy and early motherhood – big risk factors – have fallen sharply.

    Image copyright Anne Diamond
    Image caption After losing her son to cot death, TV presenter Anne Diamond fronted the Back to Sleep campaign, credited with drastically reducing sudden infant deaths in the UK

    Sudden infant death syndrome, or “cot death”, has become much rarer since the 1980s.

    This is largely attributed to the Back to Sleep campaign, which launched in 1991 and recommended that parents didn’t share a bed with their babies, and put them on their backs.

    In 2016, twins were born in Glasgow after only 23 weeks – the average pregnancy is 38 weeks. Nine months later, the babies were in good health.

    “If the girls had been born just two years ago, they wouldn’t have survived – that’s how fast medical technology is advancing,” a doctor told the mother.

    But progress has slowed since the Millennium, and the UK has worse rates of infant mortality than France, Ireland and Germany.

    There are also big inequalities – babies born to low-income mothers are much more at risk.

    4. Britain’s roads

    A third as many people died on Britain’s roads in 2016 as did in the early 1980s. We drive more now, so the improvement in road safety is even more dramatic than the graph suggests.

    Although all new cars have had to be fitted with seat belts since 1966, wearing them became compulsory in the front seat only in 1983, and in the back in 1991. These legal changes were accompanied by hard-hitting advertising campaigns, which helped change cultural attitudes.

    Image copyright PA
    Image caption 1973: Drummer Keith Moon takes part in a road safety campaign in south London

    Drink-driving has become easier to measure and more harshly punished, and as with seat belts, social attitudes have changed. Four-fifths of British adults agree that “if someone has drunk any alcohol they should not drive”.

    Cars themselves are also safer, with crumple zones and air bags. Road engineering is constantly evolving and improving: dangerous junctions get redesigned, speed bumps and cameras slow drivers down. People drive more slowly now, with limits robustly enforced.

    Over the past few years improvements in the death rate have slowed, and even reversed slightly in some years. But the long-term picture is clear: Britain’s roads are far safer than they were.

    5. Drowning

    Since the early 1980s, there has been a sizeable reduction in deaths from accidental drowning.

    This is largely down to general improvements in safety around inland waters such as lakes and rivers, and better search-and-rescue responses at sea.

    Disasters such as the 1989 Marchioness boat collision on the Thames, which killed 51 people, and the 1993 Lyme Bay canoeing tragedy helped strengthen regulation.

    More recently, big floods in 2007 led to search-and-rescue systems being reviewed.

    Better safety measures in public swimming pools have also led to a reduction in deaths, from about 50 a year in the late 1970s.

    These days incidences of drowning in local swimming pools are vanishingly rare, despite the fact that more people use them.

    However, the way data is collected has changed over time, making it difficult to make direct comparisons.

    6. Cardiovascular disease

    Cardiovascular disease- both heart disease and strokes – is still one of the biggest killers in the UK. But fewer people are dying from it than they were 50 years ago, partly because of better diagnosis and treatment.

    The introduction of a technique known as percutaneous coronary intervention to treat heart attacks – by widening the arteries using a small tube called a stent – has also improved survival rates.

    The growing use of cholesterol-lowering statins from the mid-1990s onwards led to gradual improvements in mortality.

    However, big improvements were seen before many of these medical interventions were introduced, mainly driven by a better understanding of the impact of lifestyle factors such as diet and exercise on our health.

    In particular, people began smoking less and eating less saturated fat – though some of these gains have begun to be offset by a rise in obesity.

    In 1971, heart disease caused most deaths in the UK, killing about 330,000 people. By 2015, this had fallen to just under 160,000, about a quarter of all deaths.

    Despite improvements, heart disease still kills more men and women in England and Wales than any other disease except dementia and – while treatment has improved the chance of survival – more people are now living with heart failure and its effects.

    Life expectancy has increased by 13 years since the foundation of the NHS, which is something to celebrate – but an ageing population is bringing new pressures.

    7. Smogs

    The big killer smogs that plague cities such as Delhi and Beijing are a thing of the past in Britain.

    In previous decades, though, it was not uncommon for smogs to kill several hundred people in only a few days.

    Image copyright Getty Images
    Image caption London’s December 1952 “pea-souper” smog contributed to thousands of deaths

    Households and factories used to burn a lot more coal – and in certain atmospheric conditions, the dirty air would not disperse, says Peter Brimblecoomb, whose book The Big Smoke looks at London smogs between the 1870s and 1970s.

    The worst in recent memory was London’s “pea-souper” of December 1952, which contributed to the deaths of an estimated 4,000 people.

    “The smoke-like pollution was so toxic, it was even reported to have choked cows to death in the fields,” according to the Met Office.

    “In the Isle of Dogs area, the fog there was so thick people could not see their feet.”

    In response, the government passed the Clean Air Act in 1956, which reduced the use of smoky fuels, and other laws followed.

    We burn far less coal these days. (The unusually low 1984 figure was because of that year’s miners’ strike.)

    Coal’s role in generating electricity has been replaced by cleaner forms of energy – natural gas, nuclear power, and more recently, renewable sources.

    In June 2017, for the first time, wind, nuclear and solar power generated more UK power than gas and coal combined.

    Image copyright OLI SCARFF/AFP/Getty Images
    Image caption The Kellingley Colliery in Yorkshire shut down in December 2015

    There were smaller deadly smogs in 1991, 2003 and 2014, points out Gary Fuller, an academic at King’s College London.

    However, long-term exposure to everyday air pollution term has greater impact than short smogs – and the death rate for this might not be falling, says Anna Hansell, of Imperial College London.

    She says that while the overall levels of air pollutants have decreased, the pollutants are more toxic.

    8. Lung cancer

    Lung cancer deaths have fallen by more than 20% since the early 1970s, almost entirely because fewer people smoke.

    Unlike most cancers, five and 10-year survival rates for lung cancer have barely improved since the early 1970s.

    Instead, falling deaths rates are down to fewer people getting the disease in the first place.

    However, there are significant gender differences.

    Between the early 1970s and the 1980s, smoking prevalence fell among men and increased among women, and this trend is now reflected in today’s mortality rates.

    While the death rate among men has fallen by more than half since 1980, it has actually increased among women, as more in their 60s and older are dying of lung cancer.

    Recent NHS figures suggest that 80% of deaths from trachea, lung and bronchus cancer were attributed to smoking.

    And the dramatic fall in the number of smokers is chiefly because of fewer people starting in the first place, rather than existing smokers quitting.

    Smoking rates really started falling only with the deaths of those in the generation who became adults before public campaigning around the dangers of smoking gathered pace.

    You can see this reflected in deaths from lung cancer now, as rates have significantly decreased overall but have increased in the over-80s, who are more likely to have smoked.

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    What’s behind rich people pretending to be self-made?

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    ‘Frozen’ man’s brother demands truth

    Image caption Jeremy Barnard told the BBC he wanted someone held accountable following his brother’s death

    A man thought to have frozen to death hours after the authorities were alerted he was at risk should have been checked on, his brother has said.

    Tony Barnard, 57, was found dead in freezing conditions in December by neighbours outside the home in Suffolk he had been evicted from.

    He died 16 hours after concerns were first raised for his welfare.

    His brother Jeremy said an apology from the authorities involved in his final hours would not be “good enough”.

    “I am devastated he died on his own,” he said.

    “Someone should have gone round to check on him. It’s horrible.”

    Suffolk Police confirmed it had referred itself to the Independent Office for Police Conduct (IOPC) over its handling of the case.

    The matter was also raised at Prime Minister’s Questions in the House of Commons after criticism of the response by the East of England Ambulance Service.

    The ambulance service is investigating what happened and has previously said Mr Barnard had died in the garden of the Lowestoft house during a very busy period.

    Image caption One of Anthony Barnard’s neighbours dialled 999 after seeing him in the back garden

    Jeremy Barnard told the BBC he wanted someone held accountable.

    “I don’t think sorry is good enough,” he said.

    “The police knew he had been evicted. They didn’t know if he was ill or whether he was going to cause damage.”

    However, Mr Barnard said he did not want the ambulance service or police to be “held responsible” for what happened.

    His concern he said, rested with the handling of the call.

    “The ambulance were phoned and I understand it was talked back to the police and they made the decision not to do anything,” he said.

    ‘Sitting outside’

    Concerns about Mr Barnard were first raised with social services, who referred the call to the police. Officers then contacted the ambulance service.

    It said the call, received at 15:46 GMT on 27 December, was a “report of concerns for a man who was conscious and breathing and sitting outside at an address in Lowestoft”.

    “We were informed he had no obvious injuries or medical complaint and, following triage, the call was categorised as a non-emergency call not requiring a response,” an ambulance service spokesman said.

    The father-of-two was found outside in temperatures as low as minus three on 28 December after a second 999 call by neighbours. Mr Barnard was not breathing.

    The paramedic rapid response “attended in eight minutes”.

    Donated bone marrow

    The BBC has obtained a copy of the 57-year-old’s death certificate, which showed the cause of death was a heart attack, heart disease and colon cancer.

    Suffolk Coroner’s Office confirmed there would be no inquest.

    The Independent Office for Police Conduct said: “Our investigation will examine the call-handling and police response to these calls.”

    Tony Barnard was divorced and turned to drink after set-backs in his life, according to his brother.

    More than 30 years ago he donated bone marrow to another brother who was suffering from leukaemia, but it failed to save him.

    Three months before he was found dead, Mr Barnard had been evicted from his home after being made bankrupt.

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