Editor's Choice |
Cultural climate, physical climate, life, and death
When processing manuscripts submitted to the IJE it is sometimes possible to get the sense that epidemiology majors in rediscovering the already discovered. Recognizing the importance of replication (but perhaps not 1000 times?) and of tightening confidence intervals around effect estimates in meta-analyses can help deal with these longeurs, but this does not really counterbalance the pulse-slowing effect of me-too research. The current issue of the IJE is an antidote to such malign thoughts, with very few (no names, no pack drill) examples of the truly mundane. As with other recent debates, reviews, and commentaries1–23in the IJE the focus in this issue is very much on exposures experienced collectively, rather than on individual-level risk factor epidemiology. The effect of climate on health is the focus of our ‘reprint and reflections’ and several of our original papers. In 1980 the IJE published the first major hypothesis paper on the apparent protective effect of sunlight on colon cancer, which we reprint in this issue.24 Based on the simple use of routine data Cedric and Frank Garland showed that within the US there was an inverse association between sunlight and colon cancer mortality and hypothesized that this was due to a protective effect of vitamin D on colon cancer. Since then, as our commentators discuss,15,25–29 much further research has been carried out on the vitamin D–colon cancer link, and a major contributor to this literature, Edward Giovannucci, concludes that the evidence is ‘fairly compelling’ that sunlight and vitamin D are protective.30 One of the original authors, together with colleagues, now expands the hypothesis to suggest that sunlight and vitamin D have protective effects on various cancers, and mechanisms for the protective effects are discussed by Heide Cross.2–7
Climate is seen as a less salubrious exposure by Cheng et al.,31 who show that extreme weather events in northern Australia are linked to clusters of melioidosis caused by pathogens with diverse DNA patterns. Jordi Sunyer and Joan Grimalt suggest that globally the influence of climate change will be to increase health inequalities between rich and poor nations and rich and poor people.32 But what about the long-term health consequences of climate during the intrauterine period and birth? Although there has been discussion of this for nearly a century, the study by Sophie Moore et al.33 from the Gambia showing increased mortality risk across life in those born during the wet season, rekindled interest in this area and led to speculation about possible immune system modulation as the mechanism. Using data from Burkina Faso, Gisela Kynast-Wolf et al.34 fail to replicate this finding and in her commentary Sophie Moore35 reviews current thinking about this issue.
We can easily recognize that the physical climate could be beneficial or detrimental to health, but what about the cultural climate? Initiating a lively exchange in this issue's ‘Point-Counterpoint’ Richard Eckersley36 argues that materialism and individualism are important (negative) influences on population health, and a form of ‘cultural fraud’, whereby images of a lifestyle detrimental to the health of populations and individuals are promoted to serve the economic needs of business, but not the real needs of people. None of our commentators37–39 disagree with Eckersley's basic position, but they raise issues regarding the appropriate domain of the concept of ‘culture’. The exchange highlights the tensions and promise of interdisciplinary research, and, as Eckersley points out, the challenge here is considerable. In interdisciplinary work, he suggests, sometimes key issues may not be agreed upon, indeed it may not be possible to agree on how we disagree.40
Jeremy Kark et al.41 explore the reason for the considerably higher coronary heart disease incidence among Palestinians than among Israelis living in Jerusalem. For coronary deaths the differential was even greater, and these findings will clearly lead to much speculation about the underlying factors. Finally, Laura Jackson et al.42 investigate the potential of a macro-level intervention—landscape design—in reducing Lyme disease risk.
Alexander Trocchi (1925–1984), an enthusiastic participant of what used to be called ‘subcultures’,43 provides a different take on issues of cultural difference in his geography lesson for his sons and daughters.44 Trocchi, a Scottish novelist and poet, is best known for Cain's Book (1963), a fictionalized account of his life as a heroin user in New York in the mid-20th century, and he was perhaps the first person to demonstrate mainlining on live television. His essay ‘The invisible insurrection of a million minds’ was much admired by the Situationists' guru Guy Debord, but not enough to prevent him expelling Trocchi from the Situationist International.
References
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