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A watershed-trouble making for health features in an issue with plenty to debate
  1. Carlos Alvarez-Dardet,
  2. John R Ashton, Joint Editors

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    This month we have contributions on a range of topics relevant to a more active approach to public health improvement. Beginning with global health, Ilona Kickbusch, one of the real policy trailblazers, puts forward her proposals for a new global social contract on health. Nothing could be more timely in the aftermath of the Iraq fiasco and the demoralisation of the international agencies charged with global security. Nancy Milio provides an appropriate companion piece, in which she nails the dangers of spin for health and security, and in Speaker’s Corner—again, completely apposite—Bernard Choi argues the case for the fire alarm approach to public health, with more real time data more actively deployed. Too often, public health practitioners behave as if their task is finished when they have completed an analysis, when in fact it is only just beginning. The real art of public health is in achieving change, something that goes well beyond a narrow, technical view of our craft. To make the point, Nancy Krieger, in a further Editorial, argues that a superficially attractive local referendum proposition in California (Proposition 54), which would end classification by race, ethnicity, colour, or national origin, is in fact a reactionary move that would lead to “no data, no problem” and denial of continuing racial discrimination.
 See pages 630, 631, 634, 632

    Three very different Gallery pieces this month, one poignantly juxtaposing life and death on a hospital corridor, one from England reporting the success of the new National School Fruit Scheme in which large numbers of 4–6 year old children are receiving free daily fruit in the classroom, and a historical reflection on small stature and a local commercial need for small shoes.
 See pages 633, 722, 679

    In Evidence Based Public Health Policy and Practice, we have a report from Salford in Greater Manchester of the application of Health Impact Assessment to sustainable futures; and from Finland, the home of progressive tobacco control policies, an evaluation of more than 30 years’ work suggests that the impact on smoking initiation in youth has been worth pursuing—lessons here for all those countries currently actively exploring environmental approaches to tobacco control.
 See pages 642, 649

    A paper from the London School of Economics stakes out the foundations for action on equity of access to health care; and in a paper from New Zealand, which will be of wide interest, the dynamics of population health change in relation to life expectancy is explored in an innovative way.
 See pages 655, 659

    All this talk of bias (see Nancy Milio) means that our Glossary this month, in Continuing Professional Education, assumes a particular relevance.
 See page 635

    Main research findings this month include:

    • Older people retain a legacy of their past socioeconomic position in relation to their current health status.

    • Higher cognitive performance at age 7 was found to be related to a significantly reduced risk of serious illness in adulthood in the United States.

    • In Sweden, children of teenage mothers had higher risk of hospital admission from violent as well as unintentional injury.

    • Being in a manual occupational social class, having no educational qualifications, and living in a deprived area all independently predicted significantly lower consumption of fruit and vegetables in the English county of Norfolk (see Gallery).

    • Further evidence is produced of the growing importance of social cohesion and other area level characteristics on smoking behaviour among adults; and from Spain comes a report of poorer perceived health among smoking teenagers.

    • The British regional heart study finds that sex differences in body fat distribution may explain sex differences in arterial atherosclerosis.

    • In answer to the question, can cardiovascular risk factors and lifestyle explain the educational inequalities in mortality from ischaemic heart disease, and other heart diseases in Norwegians?, Strand and Tverdal conclude that, after simultaneous adjustments for all recorded risk factors, the excess ischaemic heart disease mortality in the low educational groups was reduced by 91% for men and 67% for women.

    • Meanwhile, the Finnish 10-town study finds that the rate of medically certified absences from work and the total number of absence days per year have high predictive validity for future disability pension, in particular due to musculoskeletal disorder.

    See pages 667, 674, 680, 686, 692, 698, 700, 705, 710

    There are two offerings in Theory and Methods: firstly, a simple model for potential use with misclassified binary outcomes in epidemiology; and, secondly, an approach for putting inter-rater agreement in defining chemical incidents on a more robust footing.
 See pages 712, 718

    Finally, an interesting miscellany in Hygieia, and reports of Beaglehole’s new global public health book and reflections from Sheldon Segal on his extensive experience in demography.
 See pages 724, 723

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