We read with interest the article by Kroll et al., “Ethnic variation in unexplained death in infancy, including sudden infant death syndrome (SIDS), England and Wales 2006-12: national birth cohort study using routine data”[1]. While the five-fold disparity in death rates across ethnic groups is notable, the most striking finding was marked association of infant death with deprivation seen in Table 1, with an OR of 3.45 (95% CI 2.82-4.23) between the most deprived group and the least deprived group. Indeed, 69% of deaths were found in the two most deprived quintiles. The analytical attention on ethnic variation in the paper overshadows the central finding that the majority of risk is driven by poverty.
Furthermore, unmarried status is a potent indicator of socioeconomic status that may cluster with poverty, lack of social support and experiences of racial discrimination. The remaining variation that the paper attributes to possible cultural variation must be broken down into specific known risk factors, such as tobacco exposure, sleep position, preterm birth, alcohol and substance abuse, lack of prenatal care, formula feeding, sofa sharing, and the combination of bedsharing with these other risk factors[2].These known risk factors are also largely clustered around poverty. Even sleep position is indirectly associated with poverty via formula feeding, as videographic data show that bedsharing formula feeding infants are more likely to assume hazardous sleep position...
We read with interest the article by Kroll et al., “Ethnic variation in unexplained death in infancy, including sudden infant death syndrome (SIDS), England and Wales 2006-12: national birth cohort study using routine data”[1]. While the five-fold disparity in death rates across ethnic groups is notable, the most striking finding was marked association of infant death with deprivation seen in Table 1, with an OR of 3.45 (95% CI 2.82-4.23) between the most deprived group and the least deprived group. Indeed, 69% of deaths were found in the two most deprived quintiles. The analytical attention on ethnic variation in the paper overshadows the central finding that the majority of risk is driven by poverty.
Furthermore, unmarried status is a potent indicator of socioeconomic status that may cluster with poverty, lack of social support and experiences of racial discrimination. The remaining variation that the paper attributes to possible cultural variation must be broken down into specific known risk factors, such as tobacco exposure, sleep position, preterm birth, alcohol and substance abuse, lack of prenatal care, formula feeding, sofa sharing, and the combination of bedsharing with these other risk factors[2].These known risk factors are also largely clustered around poverty. Even sleep position is indirectly associated with poverty via formula feeding, as videographic data show that bedsharing formula feeding infants are more likely to assume hazardous sleep positions than breastfeeding infants[3], and prone sleep is generally not seen in breastfeeding infants sleeping with their mothers[4].
While some of the ethnic variation may be driven by genuine cultural traditions, without data on other major known risk factors of SUID associated with poverty, this analysis could lead to a mistaken overemphasis on ethnicity.
1 Kroll ME, Quigley MA, Kurinczuk JJ, et al. Ethnic variation in unexplained deaths in infancy, including sudden infant death syndrome (SIDS), England and Wales 2006-2012: national birth cohort study using routine data. J Epidemiol Community Health 2018.
2 Bartick M, Tomori C. Sudden infant death and social justice: A syndemics approach. Matern Child Nutr 2018 Aug 23:e12652.{Epub ahead of print].
3 Ball HL. Parent-infant bed-sharing behavior : Effects of feeding type and presence of father. Hum Nat 2006;17:301-18.
4 Richard C, Mosko S, McKenna J, et al. Sleeping position, orientation, and proximity in bedsharing infants and mothers. Sleep 1996;19:685-90.
It is bittersweet to see one’s predictions of a fall in life expectancy coming into being.
I work on statistics, but also talk to patients regularly about their diets, lifestyles and
environments. The medical service struggles to deal with the results of poor diet and
pollution. Perhaps it is time for a health service to deal with the causes of illness.
Ancel Keys crusaded against fats. He cherry picked data from only 6 of the available
22 countries. Sugar was then used to make low fat food palatable. Fructose and
galactose, in sugar, milk, corn syrup and fruit, are implicated in cancer, heart disease,
dementia and diabetes.
Are the NHS and social care the priorities? Perhaps money to buy good food is more
important, and maybe we have too much medicine, not too little. I have seen patients
taking up to 29 different drugs. No pharmacologist can work out how they interact.
One patient took 5 drugs for his asthma. People complain of drug side effects and are
just given more drugs to deal with these symptoms.
The Depression was forgotten, and it was assumed we could keep becoming richer,
until 2008. Similarly we cannot just extrapolate the increasing life expectancy figures.
Public health improved after building reservoirs, chlorinating water, installing sewage
systems, reducing overcrowding and setting up smokeless zones.
However, chemical production has increased greatly...
It is bittersweet to see one’s predictions of a fall in life expectancy coming into being.
I work on statistics, but also talk to patients regularly about their diets, lifestyles and
environments. The medical service struggles to deal with the results of poor diet and
pollution. Perhaps it is time for a health service to deal with the causes of illness.
Ancel Keys crusaded against fats. He cherry picked data from only 6 of the available
22 countries. Sugar was then used to make low fat food palatable. Fructose and
galactose, in sugar, milk, corn syrup and fruit, are implicated in cancer, heart disease,
dementia and diabetes.
Are the NHS and social care the priorities? Perhaps money to buy good food is more
important, and maybe we have too much medicine, not too little. I have seen patients
taking up to 29 different drugs. No pharmacologist can work out how they interact.
One patient took 5 drugs for his asthma. People complain of drug side effects and are
just given more drugs to deal with these symptoms.
The Depression was forgotten, and it was assumed we could keep becoming richer,
until 2008. Similarly we cannot just extrapolate the increasing life expectancy figures.
Public health improved after building reservoirs, chlorinating water, installing sewage
systems, reducing overcrowding and setting up smokeless zones.
However, chemical production has increased greatly since 1945, polluting air and
water. Many chemicals are in household products. Animal feed is often from poorly
tested GM crops. One food can contain a variety of pesticides, herbicides and food
additives. Heavy traffic pollutes the towns. Cars and machines have made exercise
optional. Antibiotics have been abused in agriculture and medicine, damaging gut
bacteria and producing drug resistant infections. Amalgam fillings, fluorescent lights
and some vaccines contain mercury. Vaccines and some water supplies contain
aluminium. People are exposed to cordless phones, microwaves, phone masts and
wifi. Over the counter, prescription, alcohol and illegal drugs interact. Many drugs
cause nutritional deficiencies, for example statin drugs cause coenzyme Q10
deficiency. Food banks cannot provide fresh food. People have had to move away
from their families to find work, and are no longer nearby to help relatives. These
factors interact.
The increases in, autism, asthma, dementia, diabetes and cancer should warn us to
make life healthier for the population, rather than dealing with damage already done.
We should maximise healthy life expectancy, not mere existence.
References:
1. Moss M, Freed D. The Cow and the Coronary: Epidemiology,
Biochemistry and Immunology. Int J Cardiol 2003; 87: 203-216.
2. Moss M. Drugs as Anti-nutrients. J Nutr Env Med 2007; 16(2):149-
166. DOI: 10.1080/13590840701352740.
In “Years of life lost due to encounters with law enforcement in the USA, 2015–2016,” Bui et al. estimate the public health impact of police use of force by a simple computation of the years of life lost by the people killed by police.[1] Unnecessary use of force by police is a problem demanding serious attention, and leadership in policing has responded with interventions and training in recent years to improve de-escalation techniques and reduce the incidence of unnecessary or unlawful use of force. Bui et al.’s analysis, however, fails to consider three key factors in these analyses: first, the distinction between necessary and unnecessary/unlawful uses of force; second, the potential impacts on years of life lost had the police not have intervened in these specific scenarios; and third, the broader impacts of police intervention on public health.
Police may use lethal force when they have sufficient reason to believe that a person poses a risk of serious physical injury or death to another person. A reporter for The Washington Post concludes that “the vast majority of individuals shot and killed by police officers… were armed with guns and killed after attacking police officers or civilians or making other direct threats.”[2] Unnecessary or unjustified use of force by police are thought to account for about five percent of the total number of incidents of use of force,[2] with great skeptics acknowledging they are certainly fewer than 50%.[3] Including sensitivit...
In “Years of life lost due to encounters with law enforcement in the USA, 2015–2016,” Bui et al. estimate the public health impact of police use of force by a simple computation of the years of life lost by the people killed by police.[1] Unnecessary use of force by police is a problem demanding serious attention, and leadership in policing has responded with interventions and training in recent years to improve de-escalation techniques and reduce the incidence of unnecessary or unlawful use of force. Bui et al.’s analysis, however, fails to consider three key factors in these analyses: first, the distinction between necessary and unnecessary/unlawful uses of force; second, the potential impacts on years of life lost had the police not have intervened in these specific scenarios; and third, the broader impacts of police intervention on public health.
Police may use lethal force when they have sufficient reason to believe that a person poses a risk of serious physical injury or death to another person. A reporter for The Washington Post concludes that “the vast majority of individuals shot and killed by police officers… were armed with guns and killed after attacking police officers or civilians or making other direct threats.”[2] Unnecessary or unjustified use of force by police are thought to account for about five percent of the total number of incidents of use of force,[2] with great skeptics acknowledging they are certainly fewer than 50%.[3] Including sensitivity analyses to account for necessary versus unnecessary/unlawful use of force, including the range of reasonable estimates of the proportion of incidents in which use of force was unjustified, would allow for more meaningful insights from Bui et al.’s estimates.
Additionally, as noted above, police use of lethal force often occurs in the context of imminent threats to the safety of others. So one of the counterfactuals of police use of force is the years of life that would have been lost were it not for police intervention. These are not merely co-occurring outcomes; one specifically seeks to bring about the other. In the language of public health, police use of force is intended to reduce imminent risks of morbidity and mortality. Estimates for years of potential life lost by other potential victims, had the police not intervened, are entirely missing from Bui et al.’s model.
Finally, there are broader impacts of policing at the individual and population levels that are not captured in these analyses. The substantial reduction in homicide in America over the past two and a half decades has been characterized as a “public health triumph,” and police work—including the use of force in the face of imminent morbidity and mortality risks—has played a non-negligible part in it. It has added hundreds of thousands of years of life to the population, since, for example, “the impact of the decline in homicide on the life expectancy of black men is roughly equivalent to the impact of eliminating obesity altogether.”[4]
To compare the deaths caused by policing to those caused meningitis or bicycle crashes is facile because unlike diseases or accidents, policing is an intervention. When police interventions are done well, they also stand to reduce their own incidence: for example, as the violent crime rate in New York City decreased precipitously, so did the need for its police to make forceful interventions.[5] As a result, shootings by police in New York City have fallen to record lows along with violent crime.[6]
In that same way public health officials seek to reduce the iatrogenic effects of interventions (think of the prescribing of opioid analgesics), police seek ways to reduce the use of unnecessary and unlawful force, and to make force less necessary to begin with. Practitioners have made strides in this regard. The police killing of unarmed people has shown significant declines in the US in the last three years,[7] and innovative use of force curricula are being introduced across the nation.[8]
The victims whose lives were saved by police interventions may have counterfactual stories to tell, but they are not just anecdotal. The interventionist nature of policing should shape the structure of research questions. Future models estimating the impact of use of police force on public health outcomes should explicitly account for justified versus unjustified use of force, the counterfactual of lack of police intervention, and the broader context of policing efforts on the outcomes of interest to more precisely estimate the magnitude of the impact of unlawful police intervention on public health. In a model with these additional inputs, the 57,754 years of life lost due to use of force by police in 2016 would likely decline to a level well below the threshold of a public health emergency from a population-level perspective.
REFERENCES
[1] Bui AL, Coates MM, Matthay EC. Years of life lost due to encounters with law enforcement in the USA, 2015-2016. J Epidemiol Community Health 2018;72:715-8
The paper by Kondo and Ishikawa uncritically investigates a public health program that contradicts the journal’s values. We are aware of the concerns raised and have already begun to address them, with more action to come. We are conducting an audit of our editorial processes to determine where errors were made and will be publishing e-letters that articulate the concerns about the paper. The Editors have attached the statement below to the paper as an ‘Editorial Note’. This represents an interim measure to assert our principles. In the coming days, we publish additional E-letters to provide more detail on the actions we will take to ensure that we are consistently upholding these principles going forward.
The Editorial Note reads:
“The study reported in this article examines a health intervention which uses gendered stereotypes of the nursing profession and suggestive uniforms that play on women’s sexuality to encourage people to engage in health checkups. The intervention was not under the control of the authors and the study was approved by an institutional research ethics board.”
“The Journal of Epidemiology & Community Health condemns the use of sexism, gender and professional stereotypes and other forms of discriminatory or exploitive behaviour for any purpose, including health promotion programs. In light of concerns raised about this paper, we are conducting an audit of our review process and will put in place measures to ensure that the m...
The paper by Kondo and Ishikawa uncritically investigates a public health program that contradicts the journal’s values. We are aware of the concerns raised and have already begun to address them, with more action to come. We are conducting an audit of our editorial processes to determine where errors were made and will be publishing e-letters that articulate the concerns about the paper. The Editors have attached the statement below to the paper as an ‘Editorial Note’. This represents an interim measure to assert our principles. In the coming days, we publish additional E-letters to provide more detail on the actions we will take to ensure that we are consistently upholding these principles going forward.
The Editorial Note reads:
“The study reported in this article examines a health intervention which uses gendered stereotypes of the nursing profession and suggestive uniforms that play on women’s sexuality to encourage people to engage in health checkups. The intervention was not under the control of the authors and the study was approved by an institutional research ethics board.”
“The Journal of Epidemiology & Community Health condemns the use of sexism, gender and professional stereotypes and other forms of discriminatory or exploitive behaviour for any purpose, including health promotion programs. In light of concerns raised about this paper, we are conducting an audit of our review process and will put in place measures to ensure that the material we publish condemns sexism, racism and other forms of discrimination and embodies principles of inclusion and non-discrimination.”
J. Dunn & M. Bobak
Co-Editors, Journal of Epidemiology & Community Health
I felt deeply offended after reading ‘Affective stimuli in behavioural interventions soliciting for health check-up services and the service users’ socioeconomic statuses: a study at Japanese pachinko parlours’ by Kondo and Ishikawa (Kondo N, Ishikawa Y. J Epidemiol Community Health 2018; 0:1–6. doi:10.1136/jech-2017-209943). As a Japanese woman and a registered nurse, I found phrases such as ‘young women wearing mildly erotic nurse costumes’ or ‘solicitation by young women wearing sexy nurse costumes’ to be derogatory and disrespectful. If the authors needed to clarify the point of their hypothesis on the possible relationship between sexual stimuli and health behaviours, which is already disturbing enough as a research topic, it would be enough to mention ‘a person wearing mildly erotic clothes’ or ‘invitation by persons wearing sexy costumes.’ When the authors add (and the editors retain) such words as ‘young women’ or ‘nurses’ to describe the distinctive features of the intervention, they tacitly accept and capitalize on stereotypes and prejudices against young women and nurses, and assume that readers will share such insulting views as well. I was very disappointed that the paper was developed by the authors, reviewed by peer reviewers, and accepted in its current form by the editor-in-chief of the Journal of Epidemiology and Community Health. I sincerely hope that the authors, reviewers, and editor-in-chief give some more thought to how social disparity could persist...
I felt deeply offended after reading ‘Affective stimuli in behavioural interventions soliciting for health check-up services and the service users’ socioeconomic statuses: a study at Japanese pachinko parlours’ by Kondo and Ishikawa (Kondo N, Ishikawa Y. J Epidemiol Community Health 2018; 0:1–6. doi:10.1136/jech-2017-209943). As a Japanese woman and a registered nurse, I found phrases such as ‘young women wearing mildly erotic nurse costumes’ or ‘solicitation by young women wearing sexy nurse costumes’ to be derogatory and disrespectful. If the authors needed to clarify the point of their hypothesis on the possible relationship between sexual stimuli and health behaviours, which is already disturbing enough as a research topic, it would be enough to mention ‘a person wearing mildly erotic clothes’ or ‘invitation by persons wearing sexy costumes.’ When the authors add (and the editors retain) such words as ‘young women’ or ‘nurses’ to describe the distinctive features of the intervention, they tacitly accept and capitalize on stereotypes and prejudices against young women and nurses, and assume that readers will share such insulting views as well. I was very disappointed that the paper was developed by the authors, reviewed by peer reviewers, and accepted in its current form by the editor-in-chief of the Journal of Epidemiology and Community Health. I sincerely hope that the authors, reviewers, and editor-in-chief give some more thought to how social disparity could persist by promoting stereotyped, derogatory views on a certain group of people.
Noriko Yamamoto-Mitani, PhD, RN
The University of Tokyo
We read an article recently published online in Journal of Epidemiology and Community Health by Dr.Kondo and Dr.Ishikawa with great interest and appreciate the authors' efforts to seek effective interventions for socioeconomically vulnerable people to have a health check-up. They suggested "hedonic stimuli" promote socially vulnerable people to have health check-up services. The "heroic effect" in this research directed to one gender only (mostly). We consider they should have performed the analysis which compares the difference of the intervention effect between on male (sensitive to this heroic stimuli) and on female (insensitive to the stimuli) in order to consider interactions (e.g. simply wearing healthcare staff's costumes). We believe that the difference in effect size between genders is the true intervention effect arisen from the "hedonic stimuli". We suggest it should be investigated using the original data of Table 2.
I am writing to express my strong concern on the article "Affective stimuli in behavioural interventions soliciting for health check-up services and the service users' socioeconomic statuses: A study at Japanese pachinko parlours," authored by N. Kondo and Y. Ishikawa (2018). Seeing an article which encourages the objectification of women being published in this peer-reviewed journal is both shocking and disappointing. In that article, the authors suggest that an intervention involving "young female staff" wearing "sexually attractive nurse costumes"/ "erotic nurse costumes" could be effective in "soliciting" men to engage in health check-ups. I am extremely disappointed by the use of such methods, as well as such terms, in Kondo and Ishikawa's study, and strongly in doubt that they are objectifying and inappropriately sexualising women and the nursing staff in Japan.
It is clear that ethics and code of morality are always the first and the top priority in research. Involving ethically incorrect practices (i.e., asking young women to wear erotic nurse costumes to engage men in healthcare service in this case) and even providing supportive evidence for their effectiveness to the public via an open-access journal are by no means acceptable. Despite my disappointment in the authors and the relevant private healthcare company using those gender-stereotyped practices, I am also provoked by the indifference of th...
I am writing to express my strong concern on the article "Affective stimuli in behavioural interventions soliciting for health check-up services and the service users' socioeconomic statuses: A study at Japanese pachinko parlours," authored by N. Kondo and Y. Ishikawa (2018). Seeing an article which encourages the objectification of women being published in this peer-reviewed journal is both shocking and disappointing. In that article, the authors suggest that an intervention involving "young female staff" wearing "sexually attractive nurse costumes"/ "erotic nurse costumes" could be effective in "soliciting" men to engage in health check-ups. I am extremely disappointed by the use of such methods, as well as such terms, in Kondo and Ishikawa's study, and strongly in doubt that they are objectifying and inappropriately sexualising women and the nursing staff in Japan.
It is clear that ethics and code of morality are always the first and the top priority in research. Involving ethically incorrect practices (i.e., asking young women to wear erotic nurse costumes to engage men in healthcare service in this case) and even providing supportive evidence for their effectiveness to the public via an open-access journal are by no means acceptable. Despite my disappointment in the authors and the relevant private healthcare company using those gender-stereotyped practices, I am also provoked by the indifference of the ethics committee board, the reviewers of that article, and the Editor of this journal when they took no actions when seeing such social unjust. Problems undoubtedly appear if the society has become so used to some inappropriate marketing gimmicks involving gender stereotypes that they do not feel anything wrong about them. I am very much concerned about the possibility that the use of those sexually arousal practices to gratify one's sexual desire in healthcare services would be linked to the promotion of sexism and stereotypes on nursing staff.
I do have faith in the journal editors that they would make every effort to assert the journal principle and disapprove all means of gender and professional stereotypes and discriminations. Here I hope that the editors would consider taking stronger actions regarding that article in the coming future.
We read the article published online in Journal of Epidemiology and Community Health by Dr.Kondo and Dr.Ishikawa with great sorrow and have major concern on the authors' unethical design by regarding young women wearing sexy nurse costumes as a form of acceptable behavioural intervention. As an experienced clinician who can fully appreciate the difficulty in motivating clients for health check-up, the proposed incentive/strategy is totally unethical which insults all ladies and is a strong humiliation to our professional nurses and even to the respectable Japanese culture. We can hardly believe why this kind of study with major methodology flaw can obtain an ethical approval and even being accepted and published by an esteemed journal like Journal of Epidemiology and Community Health. We are terribly sorry to say that this kind of practice is totally unacceptable in clinical medicine and academic world, hence I am writing to ask for a more serious explanation from the Editor on the Journal's and his standpoint on this classical "black" and "white" issue. The authors should be adviced to withdraw this paper as soon as possible, otherwise the integrity of future studies published in the Journal may be unnecessarily affected.
In this paper we sought to explore the idea that the delivery of health promoting interventions could be tailored in ways that might increase uptake among hard-to-reach populations, potentially helping to reduce health inequalities. In hindsight, we realise that the specific intervention used in this study was extremely inappropriate. We acknowledge that the intervention involved drew on stereotypes for female nurses, reinforced the objectification of both women and nurses, thus reinforcing gender inequalities. We also acknowledge criticism that some of the terms we used in translating our paper into English caused offense to some readers.
We are deeply sorry for our poor judgement and for the negative impacts of this paper. As health inequalities researchers, we are very concerned about the macrosocial determinants of health inequality and recognize that gender inequalities are one such determinant. While it has been very difficult for us to receive such a negative response to our paper, we are grateful to those who have helped us understand its limitations and how we can avoid these in future.
Response to Tsujimoto and Kataoka
We thank the Tsujimoto and Kataoka for their comments. While we agree that it would be helpful to formally test for gender differences in the effect of the study intervention, we are unable to conduct such an analysis since permission to use the data, as approved by the ethics board, has now expired. As we discuss in the paper...
In this paper we sought to explore the idea that the delivery of health promoting interventions could be tailored in ways that might increase uptake among hard-to-reach populations, potentially helping to reduce health inequalities. In hindsight, we realise that the specific intervention used in this study was extremely inappropriate. We acknowledge that the intervention involved drew on stereotypes for female nurses, reinforced the objectification of both women and nurses, thus reinforcing gender inequalities. We also acknowledge criticism that some of the terms we used in translating our paper into English caused offense to some readers.
We are deeply sorry for our poor judgement and for the negative impacts of this paper. As health inequalities researchers, we are very concerned about the macrosocial determinants of health inequality and recognize that gender inequalities are one such determinant. While it has been very difficult for us to receive such a negative response to our paper, we are grateful to those who have helped us understand its limitations and how we can avoid these in future.
Response to Tsujimoto and Kataoka
We thank the Tsujimoto and Kataoka for their comments. While we agree that it would be helpful to formally test for gender differences in the effect of the study intervention, we are unable to conduct such an analysis since permission to use the data, as approved by the ethics board, has now expired. As we discuss in the paper, however, the proportion of study participants in the intervention group (rather than the control group) was similar for women and men; and the association between intervention uptake and low-SES was of similar magnitude for women and men (Table 2). Thus it is possible that the higher levels of health check uptake in the intervention group are due to factors other than sexual attraction (as noted in our discussion of possible mechanisms to explain the observed association). We agree that this question warrants further investigation.
This is the second E-letter from the Editors of the Journal of Epidemiology & Community Health concerning a paper by Kondo and Ishikawa [http://jech.bmj.com/content/early/2018/01/12/jech-2017-209943]. The paper examined the impact of an intervention to encourage people of lower socio-economic status attending pachinko parlours in Japan to undergo health checkups. The intervention, which was not controlled by the authors, used gendered stereotypes of the nursing profession and suggestive uniforms that play on women’s sexuality to encourage people to engage in health checkups. The study conducted was granted ethical approval by an institutional research ethics board.
JECH condemns the use of sexism, gender and professional stereotypes and other forms of discriminatory practice or language for any purpose, including health promotion programs. The intervention studied in the article contradicts our principles. Concerns about this paper have been sent to us and we have published these as E-letters that are attached to the article.
We have conducted an audit of our review processes and determined that an improbable chain of accidental human processing errors in the online editorial system meant that we failed to give this paper the usual scrutiny and oversight our submissions receive. In our time as Editors, we have overseen more than 10,000 manuscript submissions prior to this withou...
This is the second E-letter from the Editors of the Journal of Epidemiology & Community Health concerning a paper by Kondo and Ishikawa [http://jech.bmj.com/content/early/2018/01/12/jech-2017-209943]. The paper examined the impact of an intervention to encourage people of lower socio-economic status attending pachinko parlours in Japan to undergo health checkups. The intervention, which was not controlled by the authors, used gendered stereotypes of the nursing profession and suggestive uniforms that play on women’s sexuality to encourage people to engage in health checkups. The study conducted was granted ethical approval by an institutional research ethics board.
JECH condemns the use of sexism, gender and professional stereotypes and other forms of discriminatory practice or language for any purpose, including health promotion programs. The intervention studied in the article contradicts our principles. Concerns about this paper have been sent to us and we have published these as E-letters that are attached to the article.
We have conducted an audit of our review processes and determined that an improbable chain of accidental human processing errors in the online editorial system meant that we failed to give this paper the usual scrutiny and oversight our submissions receive. In our time as Editors, we have overseen more than 10,000 manuscript submissions prior to this without incident, and we deeply regret this lapse. We have already identified how similar situations can be avoided in the future. Effective immediately, we will implement changes to our web-based submission system to add extra checks and sign-offs in the editorial process in order to avoid errors and ensure we uphold our editorial principles.
Research published in articles in JECH will inevitably study social situations where sexism, racism and other forms of discrimination, injustice and exploitation are present, but we as Editors have a responsibility to ensure that our published content names such practices and condemns them as socially unacceptable. Reporting such practices uncritically or neutrally is not acceptable, and perpetuates societal perceptions that such practices are normal and/or unproblematic. In this particular case, we failed to meet this standard, and we sincerely apologize to all of our readers for this lapse in oversight.
In addition, we are also taking this opportunity to make additional improvements to the journal. First, we will develop a statement of principles for submissions to ensure that discriminatory and/or exploitative practices are examined in a critical fashion and our articles avoid discriminatory language. Second, the Editors will write to the Institutional Research Ethics Board that gave approval for this study and make that body aware of our concerns, the concerns published in E-letters, and other concerns we have received.
We are mindful of the fact that the journal’s reputation is important to an entire community of scholars and readers, and we take that very seriously. We will use this incident as an opportunity to address not only the direct challenges of consistently attaining the highest standards for editorial handling of manuscripts, but also solidifying the values that underpin the journal and the scholarship it publishes. It has not escaped our attention that many of the voices who rightly critiqued our error also provided informed and thoughtful insights, and it is our commitment that the journal be a trusted platform for such rigorous, critical scholarship that challenges health and social inequities both locally and globally.
We read with interest the article by Kroll et al., “Ethnic variation in unexplained death in infancy, including sudden infant death syndrome (SIDS), England and Wales 2006-12: national birth cohort study using routine data”[1]. While the five-fold disparity in death rates across ethnic groups is notable, the most striking finding was marked association of infant death with deprivation seen in Table 1, with an OR of 3.45 (95% CI 2.82-4.23) between the most deprived group and the least deprived group. Indeed, 69% of deaths were found in the two most deprived quintiles. The analytical attention on ethnic variation in the paper overshadows the central finding that the majority of risk is driven by poverty.
Furthermore, unmarried status is a potent indicator of socioeconomic status that may cluster with poverty, lack of social support and experiences of racial discrimination. The remaining variation that the paper attributes to possible cultural variation must be broken down into specific known risk factors, such as tobacco exposure, sleep position, preterm birth, alcohol and substance abuse, lack of prenatal care, formula feeding, sofa sharing, and the combination of bedsharing with these other risk factors[2].These known risk factors are also largely clustered around poverty. Even sleep position is indirectly associated with poverty via formula feeding, as videographic data show that bedsharing formula feeding infants are more likely to assume hazardous sleep position...
Show MoreIt is bittersweet to see one’s predictions of a fall in life expectancy coming into being.
I work on statistics, but also talk to patients regularly about their diets, lifestyles and
environments. The medical service struggles to deal with the results of poor diet and
pollution. Perhaps it is time for a health service to deal with the causes of illness.
Ancel Keys crusaded against fats. He cherry picked data from only 6 of the available
22 countries. Sugar was then used to make low fat food palatable. Fructose and
galactose, in sugar, milk, corn syrup and fruit, are implicated in cancer, heart disease,
dementia and diabetes.
Are the NHS and social care the priorities? Perhaps money to buy good food is more
important, and maybe we have too much medicine, not too little. I have seen patients
taking up to 29 different drugs. No pharmacologist can work out how they interact.
One patient took 5 drugs for his asthma. People complain of drug side effects and are
just given more drugs to deal with these symptoms.
The Depression was forgotten, and it was assumed we could keep becoming richer,
until 2008. Similarly we cannot just extrapolate the increasing life expectancy figures.
Public health improved after building reservoirs, chlorinating water, installing sewage
systems, reducing overcrowding and setting up smokeless zones.
However, chemical production has increased greatly...
Show MoreIn “Years of life lost due to encounters with law enforcement in the USA, 2015–2016,” Bui et al. estimate the public health impact of police use of force by a simple computation of the years of life lost by the people killed by police.[1] Unnecessary use of force by police is a problem demanding serious attention, and leadership in policing has responded with interventions and training in recent years to improve de-escalation techniques and reduce the incidence of unnecessary or unlawful use of force. Bui et al.’s analysis, however, fails to consider three key factors in these analyses: first, the distinction between necessary and unnecessary/unlawful uses of force; second, the potential impacts on years of life lost had the police not have intervened in these specific scenarios; and third, the broader impacts of police intervention on public health.
Show MorePolice may use lethal force when they have sufficient reason to believe that a person poses a risk of serious physical injury or death to another person. A reporter for The Washington Post concludes that “the vast majority of individuals shot and killed by police officers… were armed with guns and killed after attacking police officers or civilians or making other direct threats.”[2] Unnecessary or unjustified use of force by police are thought to account for about five percent of the total number of incidents of use of force,[2] with great skeptics acknowledging they are certainly fewer than 50%.[3] Including sensitivit...
The paper by Kondo and Ishikawa uncritically investigates a public health program that contradicts the journal’s values. We are aware of the concerns raised and have already begun to address them, with more action to come. We are conducting an audit of our editorial processes to determine where errors were made and will be publishing e-letters that articulate the concerns about the paper. The Editors have attached the statement below to the paper as an ‘Editorial Note’. This represents an interim measure to assert our principles. In the coming days, we publish additional E-letters to provide more detail on the actions we will take to ensure that we are consistently upholding these principles going forward.
The Editorial Note reads:
“The study reported in this article examines a health intervention which uses gendered stereotypes of the nursing profession and suggestive uniforms that play on women’s sexuality to encourage people to engage in health checkups. The intervention was not under the control of the authors and the study was approved by an institutional research ethics board.”
“The Journal of Epidemiology & Community Health condemns the use of sexism, gender and professional stereotypes and other forms of discriminatory or exploitive behaviour for any purpose, including health promotion programs. In light of concerns raised about this paper, we are conducting an audit of our review process and will put in place measures to ensure that the m...
Show MoreI felt deeply offended after reading ‘Affective stimuli in behavioural interventions soliciting for health check-up services and the service users’ socioeconomic statuses: a study at Japanese pachinko parlours’ by Kondo and Ishikawa (Kondo N, Ishikawa Y. J Epidemiol Community Health 2018; 0:1–6. doi:10.1136/jech-2017-209943). As a Japanese woman and a registered nurse, I found phrases such as ‘young women wearing mildly erotic nurse costumes’ or ‘solicitation by young women wearing sexy nurse costumes’ to be derogatory and disrespectful. If the authors needed to clarify the point of their hypothesis on the possible relationship between sexual stimuli and health behaviours, which is already disturbing enough as a research topic, it would be enough to mention ‘a person wearing mildly erotic clothes’ or ‘invitation by persons wearing sexy costumes.’ When the authors add (and the editors retain) such words as ‘young women’ or ‘nurses’ to describe the distinctive features of the intervention, they tacitly accept and capitalize on stereotypes and prejudices against young women and nurses, and assume that readers will share such insulting views as well. I was very disappointed that the paper was developed by the authors, reviewed by peer reviewers, and accepted in its current form by the editor-in-chief of the Journal of Epidemiology and Community Health. I sincerely hope that the authors, reviewers, and editor-in-chief give some more thought to how social disparity could persist...
Show MoreWe read an article recently published online in Journal of Epidemiology and Community Health by Dr.Kondo and Dr.Ishikawa with great interest and appreciate the authors' efforts to seek effective interventions for socioeconomically vulnerable people to have a health check-up. They suggested "hedonic stimuli" promote socially vulnerable people to have health check-up services. The "heroic effect" in this research directed to one gender only (mostly). We consider they should have performed the analysis which compares the difference of the intervention effect between on male (sensitive to this heroic stimuli) and on female (insensitive to the stimuli) in order to consider interactions (e.g. simply wearing healthcare staff's costumes). We believe that the difference in effect size between genders is the true intervention effect arisen from the "hedonic stimuli". We suggest it should be investigated using the original data of Table 2.
I am writing to express my strong concern on the article "Affective stimuli in behavioural interventions soliciting for health check-up services and the service users' socioeconomic statuses: A study at Japanese pachinko parlours," authored by N. Kondo and Y. Ishikawa (2018). Seeing an article which encourages the objectification of women being published in this peer-reviewed journal is both shocking and disappointing. In that article, the authors suggest that an intervention involving "young female staff" wearing "sexually attractive nurse costumes"/ "erotic nurse costumes" could be effective in "soliciting" men to engage in health check-ups. I am extremely disappointed by the use of such methods, as well as such terms, in Kondo and Ishikawa's study, and strongly in doubt that they are objectifying and inappropriately sexualising women and the nursing staff in Japan.
It is clear that ethics and code of morality are always the first and the top priority in research. Involving ethically incorrect practices (i.e., asking young women to wear erotic nurse costumes to engage men in healthcare service in this case) and even providing supportive evidence for their effectiveness to the public via an open-access journal are by no means acceptable. Despite my disappointment in the authors and the relevant private healthcare company using those gender-stereotyped practices, I am also provoked by the indifference of th...
Show MoreWe read the article published online in Journal of Epidemiology and Community Health by Dr.Kondo and Dr.Ishikawa with great sorrow and have major concern on the authors' unethical design by regarding young women wearing sexy nurse costumes as a form of acceptable behavioural intervention. As an experienced clinician who can fully appreciate the difficulty in motivating clients for health check-up, the proposed incentive/strategy is totally unethical which insults all ladies and is a strong humiliation to our professional nurses and even to the respectable Japanese culture. We can hardly believe why this kind of study with major methodology flaw can obtain an ethical approval and even being accepted and published by an esteemed journal like Journal of Epidemiology and Community Health. We are terribly sorry to say that this kind of practice is totally unacceptable in clinical medicine and academic world, hence I am writing to ask for a more serious explanation from the Editor on the Journal's and his standpoint on this classical "black" and "white" issue. The authors should be adviced to withdraw this paper as soon as possible, otherwise the integrity of future studies published in the Journal may be unnecessarily affected.
In this paper we sought to explore the idea that the delivery of health promoting interventions could be tailored in ways that might increase uptake among hard-to-reach populations, potentially helping to reduce health inequalities. In hindsight, we realise that the specific intervention used in this study was extremely inappropriate. We acknowledge that the intervention involved drew on stereotypes for female nurses, reinforced the objectification of both women and nurses, thus reinforcing gender inequalities. We also acknowledge criticism that some of the terms we used in translating our paper into English caused offense to some readers.
We are deeply sorry for our poor judgement and for the negative impacts of this paper. As health inequalities researchers, we are very concerned about the macrosocial determinants of health inequality and recognize that gender inequalities are one such determinant. While it has been very difficult for us to receive such a negative response to our paper, we are grateful to those who have helped us understand its limitations and how we can avoid these in future.
Response to Tsujimoto and Kataoka
Show MoreWe thank the Tsujimoto and Kataoka for their comments. While we agree that it would be helpful to formally test for gender differences in the effect of the study intervention, we are unable to conduct such an analysis since permission to use the data, as approved by the ethics board, has now expired. As we discuss in the paper...
This is the second E-letter from the Editors of the Journal of Epidemiology & Community Health concerning a paper by Kondo and Ishikawa [http://jech.bmj.com/content/early/2018/01/12/jech-2017-209943]. The paper examined the impact of an intervention to encourage people of lower socio-economic status attending pachinko parlours in Japan to undergo health checkups. The intervention, which was not controlled by the authors, used gendered stereotypes of the nursing profession and suggestive uniforms that play on women’s sexuality to encourage people to engage in health checkups. The study conducted was granted ethical approval by an institutional research ethics board.
JECH condemns the use of sexism, gender and professional stereotypes and other forms of discriminatory practice or language for any purpose, including health promotion programs. The intervention studied in the article contradicts our principles. Concerns about this paper have been sent to us and we have published these as E-letters that are attached to the article.
We have conducted an audit of our review processes and determined that an improbable chain of accidental human processing errors in the online editorial system meant that we failed to give this paper the usual scrutiny and oversight our submissions receive. In our time as Editors, we have overseen more than 10,000 manuscript submissions prior to this withou...
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