THE PURSUIT OF THE PUBLIC HEALTH MILLENNIUM

In this issue, one of the foremost current commentators on inequalities in health, Johan Mackenbach, invokes Thomas More’s Utopia to discuss the issue of radical aspiration for health improvement today in comparison with the nineteenth century.1 He draws on the metaphor of the “Land of Cockaigne”, a legendary land of milk and honey, to explore how in high-income countries' health problems associated with obesity now continue to be socially patterned, with inequality bearing down most on poorer people. Since the demise of communism, millennial movements have tended to focus on the globalisation of capitalism and the aspirations of fundamentalist Muslims. John Gray, in his recent book Black mass: apocalyptic religion and the death of utopia, draws on the recently deceased Norman Cohn’s magnum opus to argue the case for the problematic status of those caught up with millennium-type ambitions.2 3 If nothing else, those of us who entered public health to change the world need to be aware of how inequalities are both a moving target, and how the poor are always with us.

See pages 2

In this vein, we carry a Glossary on the welfare state in this month’s Continuing Professional Education section, See pages 3; and in Evidence-Based Policy and Practice a report on how smoke-free environments not only protect hospitality workers and patrons from exposure to second-hand smoke, but also have an impact on how quickly they lose their money on electronic gaming machines, See pages 11. In Public Health Past and Present, Luc Berlivet unpacks the transformation of health education in France in the late 1970s, with helpful insights into the tension between health-education effectiveness and political acceptability. Berlivet is talking about tobacco, but it is highly pertinent to a whole range of social–behavioural–lifestyle issues such as alcohol, drug misuse and commercial sex where governments press on with failing policies despite the option of pursuing more pragmatic approaches that might yield benefits—not least to those at the bottom of the heap.

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Research Reports this month include many contributions that relate one way or another to the need for a joined-up and pragmatic approach to inequality issues in public health:

• from Richmond, Virginia comes the finding that previous induced abortion is a significant risk factor for subsequent low birthweight and preterm birth, while failing to contextualise this finding in relation to the decisions women have to take in other aspects of their lives; See pages 16

• from Denmark, Osler and colleagues report the finding of failure to thrive in childhood and suicidal behaviour in Danish men, reinforcing, however indirectly, the public health desirability of planned parenthood as a high-level goal; See pages 23

• meanwhile, from Oslo, Bristol and Glasgow come findings that clarify the associations between area of residence throughout life and their influence on mortality; See pages 29

• a cohort study from Finland finds an effect of Sense of Coherence on the role of alcohol consumption and injuries; See pages 35

• many of the findings we’ve been reporting recently reinforce the conclusion of Wang et al from Canada that the imbalance between work and family life may be a stronger risk factor than work stress for mental disorder; See pages 42

• leg length as a biomarker of early life exposures affecting pre-pubertal growth is inversely associated with adult disease; See pages 48

• low-level job control, high environmental stress and low household income have an additive effect on both physical activity and health status; See pages 54

• the rate of acute myocardial infarction increases with decreased neighbourhood safety and cohesion. You can see how many of this paper’s findings all begin to connect: beyond commonly-evoked effects of the physical environment, neighbourhood social interaction patterns may have a decisive influence on ischaemic heart disease, with a particularly strong effect on survival after acute myocardial infarction; See pages 62

• lower levels of ultraviolet B irradiance were independently associated with higher incidence rates of lung cancer in 111 countries, raising the tantalising question of whether vitamin D inadequacy might contribute to lung cancer incidence; See pages 69

• while absolute differences in all-cause and coronary heart disease mortality in Britain have reduced between 1978 and 2005, relative differences persist and may have increased. Utopian goals continue to frustrate.

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In Theory and Methods, Bowling and Windsor explore the impact of question order and response choice on self-rated health status in the English Longitudinal Study of Ageing (ELSA). See pages 81

And finally, some useful books are recommended in the Book Review section. It is worth looking particularly at Cwikel on social epidemiology and public health activism, Asthana and Halliday on What works in tackling health inequalities, and Kristiansen and Mooney on Evidence-based medicine in its place.