Journal of Public Health Advance Access originally published online on February 15, 2006
Journal of Public Health 2006 28(1):1-2; doi:10.1093/pubmed/fdi081
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Editorial |
The postman’s dilemma
Norman Vetter
Editor, Journal of Public Health
When I was in sixth form and in my early days as a medical student I would, every Christmas, take a temporary job delivering letters and parcels. This entailed getting to the Chepstow sorting office by 7 a.m. to get the first van to the post office in a small village called Llantrissant. Here, the postmistress and assistant postmistress would ply me (the van continued on to Monmouth or Ulan Bator or somewhere) with tea and fruit cake until I was fit enough to do my round.
This entailed a walk of about five miles around the more isolated farmhouses in the area, of which there were many. I knew the area a little but needed to be given detailed instructions on how to get to the more remote farms. Some appeared to have no road, simply a slightly marked track across fields. The two at the apogee of my round were Pant Glas and Hygga. I never saw anyone at either farm but simply left my pile of Christmas cards and occasional parcels in the front porch.
One morning, it was freezing cold – the area is over 1000 ft above sea level – when I noticed some activity in the farmyard of Pant Glas. There were three border collies facing me in a semicircle; chests on the ground bottoms in the air; making no noise whatsoever. A fourth then closed the circle behind. I felt no particular concern as I had been here before, though had never previously seen the dogs. However, they showed no obvious signs of aggression other than their body position. I had grown up on farms, though the dogs there, in the soft lowlands, were just for playing with and shouting at, not working ones.
Suddenly a fifth dog came racing from my left across the ring taking a piece out of my left trouser leg and a portion of the calf beneath it and shot on out of the right side of the circle. At this point, I made my apologies and left, as the News of the World used to say; quite fast with my bag to the rear. The dogs seemed to regard this as a result and ignored me.
The moral of the story is that you can worry about tsunamis, SARS, terrorist attacks, bird flu, but it is the one you have not noticed yet that is the bugger.
Last autumn, Professor Larry Gostin, from the John Hopkins Bloomberg School of Public Health and Director of the Center for Law and the Public’s Health, and a previous Director of MIND, came to Cardiff to give three talks in 2 days, most impressively with minimal notes and no audio-visual aids. His central message in those talks was that major national or international incidents are unique, rare and nasty when they happen. He made the point that there is no point in preparing for a pandemic of bird flu if your next major incident is going to be a bombing or something you had not thought of, like a huge explosion in an oil depot. For this reason, public health needs to be strong, well organized and flexible; being aware of potential threats but not too specialized.1 His point was that the law therefore needs to protect the existence, and encourage the training of a cadre of public health specialists’ capable of leading the response to such threats.
He made a parallel plea at an international level that the WHO needs to ‘...include (1) a robust mission, emphasizing the WHO’s core public health purposes, functions, and essential services; (2) broad scope, flexibly covering diverse health threats; (3) global surveillance, developing informational networks of official and unofficial data sources; (4) national public health systems, setting performance criteria, measuring outcomes, and holding states accountable; (5) human rights protection, setting science-based standards and fair procedures; and (6) good governance, adopting the principles of fairness, objectivity, and transparency’.2
Recent work by members of the Faculty Board3 has shown the pressures, financial and in terms of the workforce, that will be put on the specialty in the next few years, at a time when the latest ‘redisorganisation’4 will also be taking effect. This will result in the usual obsession with structural change to the detriment of developing policies and measuring outcomes.
Somehow we need to rise above these problems. We have plenty of stimuli, if we should need them. The potential public health problems are more obviously greater than that they have been for some decades; The hospital treatment model continues to fail, as an answer to the nation’s health problems, possibly because of a lack of commitment by professional leaders to the National Health Service (NHS) or a lack of commitment of the NHS to professional leaders.5 Importantly, successive government documents have pointed out the importance of public health, though they seem less keen on seeing through the vital legislative back-up that Larry Gostin, as a lawyer, understands so well.6
I guess we need to re-kindle the fire in our belly that the founders of our specialty had about the well-being of the public.7 There is still plenty for us to be angry about; disease and poverty are as closely aligned as ever on a national8,9 and international10 scale. But it is not all bad news when the Tories have discovered world poverty.
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References |
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- Gostin LO. Pandemic influenza: public health preparedness for the next global health emergency. J Law Med Ethics 2004; 32: 565–573.[Medline]
- Gostin LO, Bayer R, Fairchild AL. Ethical and legal challenges posed by severe acute respiratory syndrome: implications for the control of severe infectious disease threats. JAMA 2003; 290: 3229–3237.
[Abstract/Free Full Text] - Faculty of Public Health. Public health, threats and opportunities. A discussion paper. Available from http://www.fphm.org.uk/policy_communication/downloads/policy/2005/public_health%20_threats_and_opportunities_20051212.pdf (8 January 2006, date last accessed).
- Smith J, Walshe K, Hunter DJ. The "redisorganisation" of the NHS. Br Med J 2001; 323: 1262–1263.
[Free Full Text] - Shapiro J, Smith S. Lessons for the NHS from Kaiser Permanente. Br Med J 2003; 327: 1241–1242.
[Free Full Text] - Dyer O. UK government is condemned for compromise on smoking ban. Br Med J 2005; 331: 1039.
- National Library of Wales. Archie Cochrane (1909–88), medical pioneer. Available from http://www.gtj.org.uk/en/item10/20241 (8 January 2006, date last accessed).
- NEA. Guidance note for Primary Care Trusts. PCT local plans and fuel poverty 2003–2006. Available from http://www.nea.org.uk/downloads/publications/guidance_note_revised.pdf (9 January 2006, date last accessed).
- Seguin L, Xu Q, Gauvin L, Zunzunegui MV, Potvin L, Frohlich KL. Understanding the dimensions of socioeconomic status that influence toddlers’ health: unique impact of lack of money for basic needs in Quebec’s birth cohort. J Epidemiol Commun Hlth 2005; 59: 42–48.
[Abstract/Free Full Text] - Leach B, Palluzzi J, Munderi P. Prescription for healthy development: increasing access to medicines. Available from http://www.unmillenniumproject.org/documents/TF5-medicines-Complete.pdf (9 January 2006, date last accessed).
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