Editor's Choice |
Allende, Cochrane, war and terrorism
This year is probably the 50th anniversary of the International Epidemiology Association (IEA). In 1955 the International Corresponding Club, which later became the IEA, was established and a bulletin was produced. However, it was not until 1957 that an international meeting was held. So in this issue we have reflections on the origins and development of the IEA.1,2 Breslow highlights the way in which the success of epidemiology as a basic medical science has tended to detract from the application of epidemiological knowledge to improve health. Jørn Olsen, our president-elect, thinks Breslow may be wrong as he feels that the focus of interest is determined by political fashions that will continue to change.3
Certainly the political opportunity was popular Socialism in Chile during the 1930s when Salvadore Allende came to prominence. We present excerpts from his book, La Realidad Médico-Social Chilena,4 written shortly after his appointment as Minister of Health in 1938, after qualifying as a doctor in 1932. This remarkable analysis of the social determinants of disease and death underpinned his view that only radical social change—land reform, nationalization of industry—could alleviate the situation.5 Muir and Angell provide a historical context within which we can begin to understand how Allende's committed public health approach failed in the face of Pinochet's military coup and the rise of capitalism.6 It is a sign of our politically sophisticated times that contemporary public health policy can, in the face of data showing continuing and growing health inequalities in England, come up with a policy of Choosing Health—emphasizing the role of the state in promoting individual choice.7
Primary prevention of alcohol misuse among young people is the topic of our latest addition—the Cochrane Column.8 Many of you will be familiar with the Cochrane Collaboration (named after the epidemiologist, Archie Cochrane), which exists to produce systematic reviews of the effects of interventions to improve health. Although Cochrane reviews are readily available in the Cochrane Library, they are not often used as evidence to support public health policies. In order to draw your attention to reviews relevant to public health, Taryn Young, South African Cochrane Centre, will select suitable reviews and commission commentaries on them. If you are interested in supporting this venture, please contact us.
Infant ‘back to sleep’ campaigns are considered to have had an impact on sudden infant death syndrome. Gilbert and colleagues review the historical and observational evidence, providing an intriguing picture of collective professional and familial forgetting of knowledge gathered prior to 1970.9 Had systematic reviews been more widely conducted in medical practice, it would have been clear by 1970 that sleeping on the front was less safe than on the back, and by 1986 further evidence showed that sleeping on the front was less safe than any other sleeping position10. Textbooks, including Dr Spock's best seller Baby & Child Care, continued to recommend sleeping on the front up to 1988.
Surprisingly, published data on the Gulf War syndrome has only examined the experience of US, British, and other troops foreign to the Gulf region. In this issue we provide the first attempt to examine the health problems of coalition forces from the Gulf region. Remarkably low hospitalization rates were found, with a small increase in those exposed to combat11. Our commentators review the evidence on the Gulf War syndrome, another piece of which we have published here,12 to demonstrate how little secure knowledge has been achieved despite considerable research expenditure13,14. But if war does not seem to have much impact on subsequent hospitalizations, it may have effects on the ratio of male to female live births. Serious stressors, such as war or rapid economic decline, are hypothesized to reduce the chances of male survival or of male conceptions. Testing the first hypothesis using time trend data from California, a correlation between unemployment rates and excess male fetal deaths was found. The authors urge caution in making inferences from these ecological findings to individual unemployment and obstetric risks.15 The findings are echoed by a report of a more prominent disaster—11 September 2001—where Catalano also found an excess male fetal mortality in the months following the attack.16
Finally, our theme in this issue is mental health. Psychosocial factors are most strongly associated with the complaint of vaginal discharge, and although reporting of this symptom is extremely common in South Asia, the standard approach focusing on treating presumed common reproductive tract infections may not work. Patel's paper demonstrates that this symptom may be better understood as the cultural equivalent of other common medically unexplained symptoms such as irritable bowel syndrome or chronic backache.16
References
1 Pemberton J. Commentary: On the article by Lester Breslow on the origins and development of the IEA. Int J Epidemiol 2005;34:729–1.
2 Breslow L. Origins and development of the International Epidemiological Association. Int J Epidemiol 2005;34:725–9.
3 Olsen J. Editorial: The future role of the IEA. Int J Epidemiol 2005;34:723–4
4 Allende S. Medical and Social Reality in Chile. La Realidad Médico-Social Chilena, Santiago, Chile. Ministerio de Salubridad, 1939. (Reprinted: Int J Epidemiol 2005;34:732–6.)
5 Waitzkin H. Commentary: Salvador Allende and the birth of Latin American social medicine. Int J Epidemiol 2005;34:739–41.
6 Muir R. Angell A. Commentary: Salvador Allende: his role in Chilean politics. Int J Epidemiol 2005;34:736–739.
7 Department of Health. Choosing Health: making healthier choices easier. CM 6375. London, 2004
8 Foxcroft DR, Ireland D, Lister-Sharp DJ, Lowe G, Breen R. Primary prevention for alcohol misuse in young people. The CochraneDatabase of Systematic Reviews 2002, Issue 3. Art. No.: CD003024. doi:10.1002/14651858.CD003024. (Summarized: Int J Epidemiol 2005;34:758–59)
9 Gilbert R, Salanti G, Harden M, See S. Infant sleeping position and the sudden infant death syndrome: systematic review of observational studies and historical review of recommendations from 1940 to 2002 Int J Epidemiol 2005;34:874–87.
10 Young C, Horton R. Putting clinical trials into context. Lancet 2005;366:107–8.[CrossRef][ISI][Medline]
11 Gackstetter GD, Hooper TI, Al Qahtani MS, et al. Assessing the potential health impact of the 1991 Gulf War on Saudi Arabian National Guard Soldiers. Int J Epidemiol 2005;34:801–9.
12 Kelsall H. Macdonell R, Sim M, et al Neurological status of Australian veterans of the 1991 Gulf War and the effect of medical and chemical exposures. Int J Epidemiol 2005;34:810–19.
13 Hotopf M, Wessely S. Can epidemiology clear the fog of war? Lessons from the 1990–91 Gulf War. Int J Epidemiol 2005;34:791–800.
14 Hyams KC. Commentary: Adding to our comprehension of Gulf War health questions. Int J Epidemiol 2005;34:808–9.
15 Catalano R, Bruckner T, Anderson E, Gould JB. Fetal death sex ratios: a test of the economic stress hypothesis. Int J Epidemiol 2005;34:944–8.
16 Catalano R, Bruckner T, Gould J, Eskenazi B, Anderson E. Sex ratios in California following the terrorist attacks of September 11th, 2001. Human Reprod 2005;20:1221–7.
17 Epidemiological approaches to disasters. Epidemiologic Reviews 2005;27:1–121.
18 Patel V, Pednekar S, Weiss H. et al. Why do women complain of vaginal discharge? A population survey of infectious and pyschosocial risk factors in a South Asian community. Int J Epidemiol 2005;34:853–62.
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