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Press releases Saturday 23 July 2005
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Translations of these press releases into Albanian, Croatian, Czech, Polish, Romanian, and Russian are available at: http://bmj.bmjjournals.com/cgi/content/full/331/7509/DC2
(1) WEALTH DOESN’T ALWAYS EQUAL HEALTH
(2) GOVERNMENT POLICY CHANGES LEAD TO DRAMATIC DROP IN HEART DISEASE DEATHS IN POLAND
(3) LUNG CANCER DEATHS IN THE EU: DECLINING IN MEN BUT NOT WOMEN
(4) NUCLEAR WEAPONS CONTINUE TO POSE A SERIOUS HEALTH RISK IN EUROPE
(5) POLAND LOSES RECORD NUMBERS OF DOCTORS TO THE UK
(6) SPOUSAL VIOLENCE AFFECTS ONE IN THREE ALBANIAN WIVES
(7) ‘VALUE TO THE
SYSTEM’ DETERMINED HEALTHCARE FOR COMMUNIST EAST GERMANY’S ELDERLY
(1) WEALTH DOESN’T ALWAYS EQUAL HEALTH
(Association of socioeconomic
position with insulin resistance among children from Denmark, Estonia, and
Portugal: cross sectional study)
http://bmj.com/cgi/content/full/331/7510/183
(Commentary: Health inequalities
and social dynamics in Europe)
http://bmj.com/cgi/content/full/331/7510/186
Across Europe, children from poor families don’t necessarily have worse health than children with more affluent and better educated parents, say researchers in this week’s BMJ.
These findings challenge the widely held view that adverse social circumstances in childhood lead to an increased risk of coronary heart disease in later life.
The study involved 3,189 randomly selected schoolchildren from Denmark (one of the richest countries in Europe), and two poorer countries, Estonia and Portugal. Insulin resistance (a pre-cursor of heart disease) was measured for each child.
Among Danish children, those with the most educated and highest earning parents were the least insulin resistant. But the opposite was true for children from Estonia and Portugal - those from the most educated and highest earning parents were the most insulin resistant.
The higher levels of insulin resistance among children of better educated parents in Estonia and Portugal may be the result of adoption of Western lifestyles, suggest the authors.
These results are an important reminder that socioeconomic inequalities are dynamic and vary over time and between countries, they conclude.
In an accompanying commentary, researchers question whether consumption of Western style "junk" food is creating the pattern of high insulin resistance among children of highly educated parents. Instead they suggest that anomalies like these help point towards gaps in our understanding and warn against too simplistic a view of health inequalities.
Contacts:
Paper: Debbie Lawlor, Senior Lecturer
in Epidemiology and Public Health Medicine, Department of Social Medicine,
University of Bristol, UK
Email: d.a.lawlor@bristol.ac.uk
Commentary: Professor Denny Vagero,
Centre for Health Equity Studies, Stockholm University/Karolinska Institute,
Stockholm, Sweden
Email: denny.vagero@chess.su.se
(2) GOVERNMENT POLICY CHANGES LEAD TO DRAMATIC DROP IN HEART DISEASE DEATHS IN POLAND
(Changes in dietary fat and
declining coronary heart disease in Poland: population based study)
http://bmj.com/cgi/content/full/331/7510/187
(Commentary: Will Europe’s
agricultural policy damage progress on cardiovascular disease?)
http://bmj.com/cgi/content/full/331/7510/188
Changes in government economic policy on food subsidies in Poland has led to a drastic drop in deaths from coronary heart disease, says a study in this week’s BMJ.
In 1991 the Polish government cut subsidies for saturated fats - i.e. from dairy and animal sources. Researchers examined how this affected diet in the general population, and whether there were any changes to death rates from heart disease.
The study found that by 2002, deaths from coronary heart disease had dropped by over a third in the 45-64 age group - a 38% drop for men and 42% for women.
Over a similar period (to 1999), people were consuming 7% less saturated fat, while consumption of polyunsaturated fats had risen by 57%.
The sharp drop in deaths cannot simply be explained by the effect of any polyunsaturated fat, say the authors, but is likely to be related to the type consumed. Rapeseed and to a lesser extent soya bean oil made up most of the rising numbers of polyunsaturated fats available in Poland in the 1990s - both of which contain omega 3 and omega 6 fatty acids, also thought to reduce heart problems. The researchers also looked at changes in smoking trends and fruit consumption after 1991, to see if these could account for the drop in mortality rates.
They found that the fall in numbers of people smoking - which would also result in fewer deaths from heart disease - did not match the dramatic drop in death rates after 1991. And although consumption of imported fruit rose during the 1990s - from 2.8kg/year per person in 1990 to 10.4kg/year by 1999 - the increase was not enough to influence death rates by more than 1 or 2%.
These results concur with other studies which show that partly substituting polyunsaturated fats for saturated fats in the diet, while maintaining a low intake of trans fatty acids, can reduce deaths from heart disease.
An accompanying commentary notes that Poland and the Czech Republic are exceptions in the east/west European divide, bucking a thirty-year trend which has seen heart disease rates rising or stagnant in central and eastern states, while falling rapidly in the west.
Poland’s experience is largely down to better nutrition since political reform, say the authors. However, while this study looks at the results of economic policy, it underestimates Poland’s agricultural strategy which invested heavily in domestic produce. The researchers considered the effects of imported fruit consumption, but didn’t account for home grown fruit and vegetables in people’s diets, says the commentary, which may also protect the heart.
These improvements may be at risk with Poland’s recent entrance to the European Union, say the authors. The EU’s Common Agricultural Policy “places large scale agricultural production and economics above health”, failing to produce the range of foods the population needs, and subsidising animal fats, tobacco and alcohol production. Reform of the Policy is currently on Brussels agenda, but seems clouded by “political horse trading”, say the authors.
Contacts:
Paper: Professor Witold Zatonski,
Cancer Epidemiology and Prevention Division Cancer Center, Institute of Oncology,
Warsaw, Poland
Email: canepid@coi.waw.pl
or
Professor Walter Willett, Harvard
School of Public Health, Boston, Massachusetts, USA
Email: walter.willett@channing.harvard.edu
Commentary: Professor Martin McKee,
European Centre on Health of Societies in Transition, London School of Hygiene
and Tropical Medicine, London, UK
Email: martin.mckee@lshtm.ac.uk
(3) LUNG CANCER DEATHS IN THE EU: DECLINING IN MEN BUT NOT WOMEN
(Lung cancer mortality at
ages 35-54 in the European Union: ecological study of evolving tobacco epidemics)
http://bmj.com/cgi/content/full/331/7510/189
(Commentary: Making the transition
to action)
http://bmj.com/cgi/content/full/331/7510/191
Among men, lung cancer deaths are now falling in most EU countries, including all new member states from central and eastern Europe, but they are still rising among women, find researchers in this week’s BMJ.
Tobacco remains Europe’s single biggest cause of preventable death, and tobacco related diseases cause 650,000 unnecessary deaths every year in the EU.
The research team calculated lung cancer deaths in the 15 original EU member states and new members from central and eastern Europe. These figures can provide a useful measure of a population’s exposure to smoking, especially among 35-54 year olds, when around 80-90% of cases are caused by smoking.
They found that most EU countries are now experiencing falling death rates from lung cancer in men. Only four countries (Portugal, Greece, Spain, and France) show no evidence of a decline across the 35-54 age range.
In contrast, mortality from lung cancer in women is still rising in most EU countries, except for the United Kingdom and, to some extent, Ireland and Denmark. The greatest increases were in France, Spain, and Hungary.
Rates for women in Hungary exceeded those for women in all other member states (mirroring those for Hungarian men) and also exceed the rates for men in more than half the states in the EU.
The authors suggest that product modification may have contributed to the declining prevalence in young men. In Poland, for example, tar yields fell by more than half between 1984 and 1999, and other changes to cigarettes have been made.
Lung cancer epidemics among women show no consistent pattern that follows those in men, add the authors. The very high mortality figures for Hungary merit further investigation.
Throughout Europe, tobacco companies have proved adept at expanding and maintaining their markets, especially among women, say authors of an accompanying commentary. Despite having declined, tobacco related deaths in males remain frighteningly high.
It’s time for Europe’s doctors to treat tobacco dependence in their patients. But it’s also time to move out of the consulting room and demand that our governments take effective action too, they conclude.
Contacts:
Paper: Witold Zatonski, Director,
Cancer Centre Institute of Oncology, Cancer Epidemiology and Prevention Division,
Warsaw, Poland
Email: canepid@coi.waw.pl
Commentary: Tanith Muller, Director,
Tobacco Control Resource Centre, BMA, Edinburgh, Scotland
Email: tmuller@bma.org.uk
(4) NUCLEAR WEAPONS CONTINUE TO POSE A SERIOUS HEALTH RISK IN EUROPE
(Letter: Nuclear weapons
are another post-communist health hazard)
http://bmj.com/cgi/content/full/331/7510/237
Nuclear weapons in various European countries, particularly Russia, pose a serious threat to health, argues a letter in this week’s BMJ.
Recent estimates are that Russia alone has 7,800 operational nuclear warheads - some of which are on high alert status says Nick Wilson, a public health lecturer and member of International Physicians for the Prevention of Nuclear War. Their continued presence means that accidental explosion or missile launch is always a threat. There is also a risk of nuclear weapon materials being stolen or sold on to terrorists, he argues.
Maintaining these weapons eats in to national economies adds the author, leaving less funds for healthcare and other vital services.
The threat posed by these weapons can only be tackled if European countries progress quickly towards a Europe free of nuclear weapons, and relevant countries - particularly Russia, France and the UK - meet their nuclear disarmament obligations. Within Europe, states with US nuclear weapons based on their territories should follow Greece in removing these weapons, says the author.
These weapons are “not able to deal with real security threats now facing the world”, concludes the author. Unless removed they will continue to put European countries and others at risk.
Contact:
Dr Nick Wilson, Senior Lecturer
in Public Health, Wellington School of Medicine, Otago University, New Zealand
Email: nwilson@actrix.gen.nz
(5) POLAND LOSES RECORD NUMBERS OF DOCTORS TO THE UK
(Letter: Poland is losing
its doctors)
http://bmj.com/cgi/content/full/331/7510/235
Poland is losing significant numbers of its doctors to the UK and other Western nations of the European Union, says a letter in this week’s BMJ.
Following accession to the EU, nearly 500 Polish doctors registered with the UK’s General Medical Council in one year - 30 times as many as in the previous year. The Scandanavian countries are also a popular destination for doctors leaving Poland, say the authors.
Despite the arrival of democracy, current conditions for doctors in Poland drive them to seek work in the West, argue the authors. Salaries are so low that many doctors work in several places or decide to work as sales reps for the pharmaceutical industry.
The career structure also poses problems, effectively preventing many doctors from specialising - leaving them no choice but to leave Poland if they want to gain expertise in a chosen area. The lack of new diagnostic technologies and treatments also spurs doctors to seek opportunities for developing their skills elsewhere.
The healthcare systems of former communist countries may have changed, but the working conditions of Poland’s doctors have not improved, conclude the authors.
Contact:
Malgorzata Bala, Jagiellonian University
Medical College, Institute of Public Health, Krakow, Poland
Email: gosiabala@mp.pl
(6) SPOUSAL VIOLENCE AFFECTS ONE IN THREE ALBANIAN WIVES
(Factors associated with
spousal physical violence in Albania: cross sectional study)
http://bmj.com/cgi/content/full/331/7510/197
Intimate partner violence affects women worldwide, but in Albania, more than a third of married women experience violence from their husbands during a year, and more empowered women are at greater risk, according to a study in this week's BMJ.
Researchers at the University of Tirana, the capital city of Albania surveyed 1039 married women aged 25-65 living in Tirana.
Women were asked about their experience of being hit, slapped, kicked, or otherwise physically hurt by the husband. Information on other social and demographic characteristics was also collected.
More than a third (37%) of women had experienced violence. Risk was greatest among women aged 25-34, women with more than 12 years of education, women in white collar jobs, women with least educated husbands, and women married to men raised in rural areas. Women were also at higher risk if they were more educated than their husbands.
These findings, related to women’s and men’s status, are in keeping with theories that argue that violence is used to enforce gender hierarchies and, particularly, when men have a sense of powerlessness because their social position makes them feel “unsuccessful” as men, say the authors.
Research from other countries has often shown that the most educationally and socially empowered women gain a level of protection, but such protection is not seen among the women of Tirana, possibly because Albania is known to be a country with particularly conservative ideas about sex roles.
Among the challenges for post-communist Albania, and it’s health professionals, is the need to reduce the prevalence of intimate partner violence, as well as to provide support for women who are in, or who have been in, violent relationships and to be aware of the ways in which intimate partner violence influences psychological and physical health, they conclude.
Contact:
Genc Burazeri, Lecturer in Epidemiology,
Department of Public Health, Faculty of Medicine, University of Tirana, Albania
Email: gburazeri@yahoo.com
(7) ‘VALUE TO THE SYSTEM’ DETERMINED HEALTHCARE FOR COMMUNIST EAST GERMANY’S ELDERLY
(Letter: Some patients in
former East Germany were more equal than others)
http://bmj.com/cgi/content/full/331/7510/234
Under the communist regime in East Germany, elderly patients’ healthcare depended on whether they could contribute to the workforce, says a letter in this week’s BMJ.
While those working and therefore judged “valuable to the system” could access medical treatment when needed, retired patients were considered a “drain on the public purse” says Dr Herbert Nehrlich, an East German doctor now living in Australia.
X-rays and other diagnostic tests were denied people of a certain age, and retired East Germans were not hindered from travelling to the West, or staying there, he adds.
Conversely East German workers benefited from programmes to maintain and improve fitness including subsidies for sports, and breaks during the working day for sporting activities.
Health inequalities between East and West Germany should be ironed out over time, says Dr Nehrlich, although higher drinking levels in the East were “not discouraged under the communist regime” and remain a problem for those living there now.
Contact:
Dr Herbert Nehrlich, Private Practitioner,
Queensland, Australia
Email: drhhnehrlich@westnet.com.au
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and from:
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