294 e-Letters

  • Local versus Nationwide

    This is an excellent article which serves to highlight the value of Public Health work in economic terms. The findings need to be taken into account as future health and social care systems evolve. For example, in the UK, Sustainability & Transformation Plans (STPs) will only truly be sustainable if they get past paying lip service to Public Health programmes and actually invest in their implementation.

    One aspect of the paper that is less helpful, however, is the distinction between 'local' and 'national' Public Health programmes. Such a distinction is arguably unclear and invalid given the fact that many national programmes require effective local implementation in order to be effective. This local implementation includes local investment, local co-design of delivery and local promotion and engagement of stakeholders and residents. In the UK, this work is undertaken by Public Health teams in local authorities in partnership with Clinical Commissioning Groups, Primary Care teams, Pharmacists and the Voluntary Sector. Effective local implementation also relies to some degree on co-design with residents.

    To take an example from the list of 'National' interventions, family planning programmes in the UK are usually funded from the local Public Health budget and implemented according to a local strategy. For example, in some areas universal provision is supplemented by outreach services aimed at offering vulnerable women...

    Show More
  • Misleading representation of SCHER Report
    John F Beal

    Sirs, Peckham et al's selective reporting of the findings of the SCHER report (2011) risks giving readers of your journal a highly misleading interpretation of data on the fluoride intake of children in areas supplied with water containing 1 mg/l of fluoride.

    Careful analysis of the full detail of the SCHER report (2011) shows that 6 to 12 year olds will not exceed the recommended upper limit (UL) of 2.5 mg per...

    Show More
  • Hepatitis C elimination by 2030 is feasible in developed countries but challenging in resource poor developing countries
    Gee Yen Shin

    The World Health Organisation's setting of global viral hepatitis elimination targets, focused on hepatitis B & C, is most welcome1. In their commentary article, Hellard, Sacks-Davis & Doyle describe strategies by which hepatitis C elimination by 2030 can be achieved by a combination of direct acting antiviral drugs against hepatitis C, opioid substitution therapy and needle and syringe programmes...

    Show More
  • A missed opportunity? Fluoridation and hypothyroidism - correlation or causation.
    Douglas W Cross

    The analysis of data on the prevalence of hypothyroidism in areas with different concentrations of fluoride in the public drinking water supplies, by workers at the University of Kent,[1] is interesting but by no means conclusive. The authors rightly emphasise that their findings do not prove that fluoridation causes people to develop the condition,but only that there is a clear correlation. In fact this study raises m...

    Show More
  • SEP, Increased Incidence of Brain Cancer, and Potential Role of Mobile Phone Usage.
    Sarah J Scott

    In relation to the reported findings in this study of a correlation between higher socioeconomic position and incidence of brain tumour, specifically giloma and acoustic neuroma, among a cohort of Swedish-born residents, the authors postulate 'completeness of cancer registration' and 'detection bias' as a potential explanation.

    This seems unlikely, especially given the progressive nature of brain tumour pathology...

    Show More
  • Working longer, working better?
    Alexis Descatha
    Sir, We have read with particular interest the paper by Wu C. et al. on the association of retirement age with mortality among older adults in a large US study.[1] We need deeper understanding of the association found between a 1-year age increment in the 2,956 participants and an 11% lower risk of all-cause mortality (95% confidence interval 8-15%). The authors conclude that "early retirement may be a risk factor for mortality a...
    Show More
  • Early life social conditions and adult cancers: a fundamental research question
    Michelle Kelly-Irving

    We commend the authors for taking the hypothesis that cancer may have its roots in early life social conditions seriously [1]. Social inequalities exist for many cancer types and are usually attributed to differences in lifestyles and behaviours. Thus, attempts at primary prevention are often confined to relatively proximal disease risk factors at the individual level.

    Cancer development has mainly been conside...

    Show More
  • Measuring the impact of green space interventions in deprived neighbourhoods on physical activity and health
    Karine Bernard

    Droomers et al. examined the association between green space interventions in Dutch deprived neighborhoods and short-term impacts on physical activity (PA) and perceived general health (PGH) among adults. The authors reported an absence of short-term positive effects on PA and health from improvements in green space in deprived neighbourhoods.[1]

    The authors made significant efforts to control for the clusterin...

    Show More
  • Response to: Ribeiro, et al. "Where do people live longer and shorter lives? An ecological study of old-age survival across 4404 small areas from 18 European countries"
    Katharine Timpson

    Ribeiro and colleagues' identify high mortality rates at older ages in the post-industrial UK areas of Merseyside and West Central Scotland (WCS). They suggest that poverty and a lack of social cohesion may be part of the explanation for this finding (1). Merseyside and WCS are characterised by wide intra-regional variation in mortality rates compared to other deindustrialised areas across Europe, possibly reflecting grea...

    Show More
  • How stakeholder participation could increase inequities. The inverse equity hypothesis lens.
    Ramiro Manzano

    Recent review from Harris et al [1] sets the alternative hypothesis that greater degree of stakeholders participation can produce a contextually valid synthesis. Aware of the importance of stakeholders in healthcare, a null hypothesis may come to mind: Stakeholders increase inequity by biasing synthesis. Let us give you some theoretical framework. Research on public health interventions should include academic researcher...

    Show More