Published by Oxford University Press on behalf of the International Epidemiological Association
Editor's Choice |
Kitchiner and Trotsky on health promotion
In the IJE editorial office it must be admitted that there is occasional loss of the will to live as more papers on the same—admittedly, in their own context very important—health issues arrive. But either a new spin, or rediscovered old material, on these stories excites us. It is easy to look back and show how manuals promoting a lifestyle considered beneficial for health over many centuries have focussed on the same issues as we would see today—considerable physical activity, moderate or no alcohol, no tobacco, plentiful fruits and vegetables, avoidance of animal fat or too much meat, low stress, no fornication and adequate sleep. My favourite amongst such manuals is Dr William Kitchiner's ‘The art of invigorating and prolonging life, by food, clothes, air, exercise, wine, sleep etc’ (the ‘etc’ says it all), published first in 1824. You can imagine the advice presented in this book, but Kitchiner was a realist, and the subtitle of the book was ‘to which is added the pleasure of making a will’. One hopes that Kitchiner followed his own advice with respect to writing a will—by the time the sixth edition of this best seller appeared in 1828 his son had to report that the purveyor of healthy lifestyle advice was dead, at the age of 52.Advice about sexual behaviour features large in lifestyle manuals, generally focusing on abstinence or, failing that, chastity. This issue of the IJE contains two striking papers by Rachel Jewkes on HIV infection in South Africa, illustrating the importance of contextual understanding.1,2 Intimate partner violence adversely influences many of the risk factors for HIV infection in women, and attempting to reduce HIV risk without facing up to the importance of domestic violence may simply not work.1 In men a failure to recognize the importance of male–male sexual contact could be similarly counterproductive.2 In a study of abnormal vaginal discharge in India Vikram Patel and colleagues3 demonstrate that in addition to factors related to infection risk—such as partners' extramarital relationships—there are psychosocial influences on symptom reporting.
Kitchiner advised his readers to ‘take as much exercise as you can in the open air’, and was much concerned with reducing corpulence. Type II diabetes was not identified as such in Kitchiner's time; however, Raquel Villegas and colleagues4 demonstrated the importance of physical activity in reducing diabetes risk in contemporary Shanghai. The open air, however, could be detrimental if it allowed the levels of sunlight exposure that Jiali Han and colleagues5 consider increase the risk of skin cancer. Kitchiner was certain about dietary patterns that would protect against corpulence, and surely would be dismayed by the findings of Lorna Gibson and colleagues6 that there is no robust evidence from randomized trials of beneficial effects of particular diets on long-term weight maintenance in children.
One thing common to all of the health regimens on offer over the centuries is that heavy drinking is a bad thing. The high mortality in the countries of the ex-Soviet Union is the most stark current example of the health effects of excess alcohol consumption. Our historical reprint, of an extended book review by Nick Eberstadt from 25 years ago,7 demonstrates that at the time the mortality crisis in this USSR was first identified, alcohol was considered a likely culprit, and our contemporary commentators relate how this has increasingly become a major issue.8–10 The on–off (but largely on) dependence of the Russian state on tax revenues from alcohol has long been identified as a major factor in the high alcohol consumption; for example, in the 1915 book The Liquor Problem in Russia by the US prohibition campaigner and World League Against Alcoholism activist William Eugene ‘Pussyfoot’ Johnson.11 A year earlier Leon Trotsky—a very different character to Johnson—had written an extended analysis of this issue in the journal Struggle.12 In Russia, Trotsky suggested, ‘government employees worked as agents sent on a mission to make the nation drunk’. He saw vodka as ‘the great national sedative’, one that ‘paralyses the force of opposition by the socially deprived’ whilst simultaneously serving the Russian state by ‘turning alcohol—the physical, moral and social poison—into the main resource for state income’. Ironically prohibition was introduced in Russia soon after Trotsky wrote these lines, and the leading US economist Irving Fisher soon cited this as having ‘wrought a miracle upon the Russian people physically, mentally, morally and economically’.13 The Russian state, deprived of 30% of its income, soon collapsed, of course, and a contemporary English mercenary fighting with the White army considered that ‘the chief contributory cause to the revolution was the prohibition in 1914 of the sale of spirituous liquor’.14 As Vladimir Shkolnikov and David Leon remind us,7 Mikhail Gorbachev launched an anti-alcohol campaign in 1985, which was followed in short order by both improved population health and the demise of the regime that had been ushered in by the previous attempt to control the alcohol problem.
GEORGE DAVEY SMITH
References
1 Jewkes R, Dunkle K, Nduna M et al. Factors associated with HIV sero-status in young rural South African women: connections between intimate partner violence and HIV. Int J Epidemiol 2006;35:1461–68.
2 Jewkes R, Dunkle K, Nduna M et al. Factors associated with HIV sero-positivity in young, rural South African men. Int J Epidemiol 2006;35:1455–60.
3 Patel V, Weiss HA, Kirkwood BR et al. Common genital complaints in women: the contribution of psychosocial and infectious factors in a population-based cohort study in Goa, India. Int J Epidemiol 2006;35:1478–85.
4 Villegas R, Shu X-O, Li H et al. Physical activity and the incidence of type 2 diabetes in the Shanghai women's health study. Int J Epidemiol 2006;35:1553–62.
5 Han J, Colditz GA, Hunter DJ. Risk factors for skin cancers: a nested case-control study within the Nurses' Health Study. Int J Epidemiol 2006;35:1514–21.
6 Gibson LJ, Peto J, Warren JM, dos Santos Silva I. Lack of evidence on diets for obesity for children: a systematic review. Int J Epidemiol 2006;35:1544–52.
7 Eberstadt N. The health crisis in the USSR. The New York Review, February 19, 1981. (Reprinted in Int J Epidemiol 2006;35:1384–94.)
8 Shkolnikov VM, Leon DA. Commentary: N Eberstadt's ‘The health crisis in the USSR’ and sustainable mortality reversal in the post-Soviet space during communism and after. Int J Epidemiol 2006;35:1406–09.
9 Eberstadt N. Commentary: Reflections on ‘The Health Crisis in the USSR’ Int J Epidemiol 2006;35:1394–97.
10 Davis C. Commentary: The Health Crisis in the USSR: reflections on the Nicholas Eberstadt 1981 review of Rising Infant Mortality in the USSR in the 1970s. Int J Epidemiol 2006;35:1400–05.
11 Johnson WE. The liquor problem in Russia. Westerville, OH: The American Issue Publishing Company, 1915.
12 Gosudarstvo i narodnoe khozyastvo', Bor'ba, No. 1, 1914, pp. 3–8.
13 Fisher I. Some impending national problems. J Pol Econ 24:694–711.
14 Herlihy P. The alcoholic empire: vodka and politics in late imperial Russia. Oxford: Oxford University Press, 2002.
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