1124
Fat is favourite
Despite the known association between consumption of saturated fat and cardiovascular disease, high-fat diets remain popular; given the choice, most people consistently eat 35-40% of their energy as fat. According to Mela,’ this preference is not explained on nutritional grounds, since the need for fatty acids and fat-soluble vitamins can be satisfied by diets that are very low in total fat content. Nor is it clear whether preferences for fat are innate or learned. Texture preferences are unlikely to be innate, says Mela, because the capacity to discriminate textures, though sensitive, is a response to non-specific mechanical and frictional forces in the mouth. He also points out that the notion that fat-associated aromas might be innately preferred is flawed because these aromas tend to be unique to individual foods-it is difficult, for example, to identify an aroma common to cream, deep-fried foods, and cooked meat. Preferences for fat flavours, Mela suggests, are more likely to be learned responses, linked to the energy content (satisfaction potential) of the food. If Mela is right, food technologists face a difficult challenge in trying to make low-calorie fat substitutes acceptable to consumers. 1. Mela DJ. The basis of dietary fat preferences. Trends Food Sci Technol 1990; 1:
necessity for expansion of current provision. The challenges of integrating prevention, care, and cure remain with us. The Victorian public health legacy, Webster argues, should be used to challenge and inspire a society dependent upon its now collapsing sewers.
Niggardly official responses to the Black report and its practical recommendations stand in direct contrast to Government views in Victoria’s era. In 1871 the Royal Sanitary Commission observed: "The constant relation between the health and vigour of the people and the welfare and commercial prosperity of the state requires no argument. Franklin’s aphorism, ’public health is public wealth’, is undeniable." Webster, in this commemorative booklet commissioned jointly by the Institution of Environmental Health Officers and the Public Health Alliance, searches in vain for such an appraisal in current Government thinking and calls for medical and public opinion to redress the situation. Our own era has much to learn from the vitality of Victorian values. 1. Webster C. The Victorian public health legacy, a challenge to the future. 1990. Pp 18. £5. Available from the Public Health Alliance, Room 204, Snow Hill House, 10-15 Livery St, Birmingham, B3 2PE, UK 2. Department of Health and Social Security. Inequalities in health. Report ofa research working group London: Department of Health, 1990.
71-73.
Drug abusers in prison Renaissance of public health? In a new publication1 commemorating the death of the Victorian sanitary reformer Sir Edwin Chadwick, Dr Charles Webster calls for a renaissance of public health activity and argues for the resurgence of a high-profile public health service. Webster, an authority on 17th century medicine and official historian of the National Health Service, regards a shortsighted those who are content to regard the past as being merely of antiquarian interest.
The Victorians built the infrastructure of sewers upon which we still depend. They established facilities for the safe disposal of the dead and erected model housing for the living. Our century inherited from them administrative machinery to oversee safe sewage disposal separate from fresh water supply, the protection of foodstuffs from infection and adulteration, the control of noxious and dangerous industries, and the prevention and containment of
epidemics. In the present century impetus for further reform was lost, and the establishment of the National Health Service and its subsequent reorganisations have done little to revive it. Recent recognition of the dangers of modem food production and processing techniques, of environmental pollution, and of the contamination of drinking water has rudely awakened those who thought Victorian provision adequate to modem needs. The need to improve the physical environment, to tackle widening health inequalities, and to increase the emphasis on health promotion and education all point to the Illustration trum I’trmlr. IS32
By the very nature of its illegality, the present drug-abuse epidemic has led to a substantial increase in the proportion of the prison population who are drug addicts. In the UK during the second half of the 1980s around 4000 people per year received custodial sentences for drug-related offences, double the number sentenced at the beginning of the decade.’ In parts of the USA the situation is worse: of the 40 763 prison inmates in New York State at the end of 1987, over half were in jail for drug-related offencesThe strain on prison health services is considerable, a problem further exacerbated by the number of drug abusers who are HIV positive. A World Health Organisation publication2 examines the methods used to identify drug abusers on admission to prison and health-care provision for drug-abusing inmates. It also looks at the ethics of treating, against their will, people who are incarcerated; and systems of non-voluntary treatment in France, Germany, Sweden, and the USA are described, with that in the USA said to be of some value. Other issues discussed include the particular health problems of drug abuse, such as AIDS and suicide. Few would argue with the report’s recommendation that health-care services in prisons should compare to those enjoyed by the general population. However, the suggestion that condoms be distributed to inmates to limit the spread of AIDS (along with improved anti-AIDS education) will not be universally applauded. The squalid state of many British prisons is probably not widely known outside the UK. The report adds to the country’s embarrassment by citing the UK as a particular example of overcrowding and poor hygiene causing health problems for drug-abusing inmates. 1. Statistics of the misuse of drugs: seizures and offenders dealt with, United Kingdom, 1989. Home Office Statistical Bulletin no 24/90. Price £2 50. ISSN 01-436384. Obtainable from the Statistical Department, Lunar House, Croydon, Surrey CR0 9YD, UK. 2. Drug abusers in prisons. WHO Regional Publications, European series, no 27, 1990. Price Sw fr 10. Pp 52. ISBN 9-289011181. Obtainable from WHO Distribution and Sales, 1211 Geneva 27, Switzerland (order no 1310027) or by post from HM Stationery Office Books Publication Centre, 51 Nine Elms Lane, London SW18 5DR, UK.
Obstetrics at The Royal London Hospital The
department of obstetrics
at The Royal London Hospital will be divided into two sections--one hospital and one community-as advocated by The Lancet (see Dec 23/30, 1989, p 1492). Dr Vythilingam Sivapathasundaram has been appointed consultant obstetrician to assist Mrs Wendy Savage in the community obstetrics action. Prof J. G. Grudzinskas remains head of the hospital section. now
Fat is favourite
Despite the known association between consumption of saturated fat and cardiovascular disease, high-fat diets remain popular; given the choice, most people consistently eat 35-40% of their energy as fat. According to Mela,’ this preference is not explained on nutritional grounds, since the need for fatty acids and fat-soluble vitamins can be satisfied by diets that are very low in total fat content. Nor is it clear whether preferences for fat are innate or learned. Texture preferences are unlikely to be innate, says Mela, because the capacity to discriminate textures, though sensitive, is a response to non-specific mechanical and frictional forces in the mouth. He also points out that the notion that fat-associated aromas might be innately preferred is flawed because these aromas tend to be unique to individual foods-it is difficult, for example, to identify an aroma common to cream, deep-fried foods, and cooked meat. Preferences for fat flavours, Mela suggests, are more likely to be learned responses, linked to the energy content (satisfaction potential) of the food. If Mela is right, food technologists face a difficult challenge in trying to make low-calorie fat substitutes acceptable to consumers. 1. Mela DJ. The basis of dietary fat preferences. Trends Food Sci Technol 1990; 1:
necessity for expansion of current provision. The challenges of integrating prevention, care, and cure remain with us. The Victorian public health legacy, Webster argues, should be used to challenge and inspire a society dependent upon its now collapsing sewers.
Niggardly official responses to the Black report and its practical recommendations stand in direct contrast to Government views in Victoria’s era. In 1871 the Royal Sanitary Commission observed: "The constant relation between the health and vigour of the people and the welfare and commercial prosperity of the state requires no argument. Franklin’s aphorism, ’public health is public wealth’, is undeniable." Webster, in this commemorative booklet commissioned jointly by the Institution of Environmental Health Officers and the Public Health Alliance, searches in vain for such an appraisal in current Government thinking and calls for medical and public opinion to redress the situation. Our own era has much to learn from the vitality of Victorian values. 1. Webster C. The Victorian public health legacy, a challenge to the future. 1990. Pp 18. £5. Available from the Public Health Alliance, Room 204, Snow Hill House, 10-15 Livery St, Birmingham, B3 2PE, UK 2. Department of Health and Social Security. Inequalities in health. Report ofa research working group London: Department of Health, 1990.
71-73.
Drug abusers in prison Renaissance of public health? In a new publication1 commemorating the death of the Victorian sanitary reformer Sir Edwin Chadwick, Dr Charles Webster calls for a renaissance of public health activity and argues for the resurgence of a high-profile public health service. Webster, an authority on 17th century medicine and official historian of the National Health Service, regards a shortsighted those who are content to regard the past as being merely of antiquarian interest.
The Victorians built the infrastructure of sewers upon which we still depend. They established facilities for the safe disposal of the dead and erected model housing for the living. Our century inherited from them administrative machinery to oversee safe sewage disposal separate from fresh water supply, the protection of foodstuffs from infection and adulteration, the control of noxious and dangerous industries, and the prevention and containment of
epidemics. In the present century impetus for further reform was lost, and the establishment of the National Health Service and its subsequent reorganisations have done little to revive it. Recent recognition of the dangers of modem food production and processing techniques, of environmental pollution, and of the contamination of drinking water has rudely awakened those who thought Victorian provision adequate to modem needs. The need to improve the physical environment, to tackle widening health inequalities, and to increase the emphasis on health promotion and education all point to the Illustration trum I’trmlr. IS32
By the very nature of its illegality, the present drug-abuse epidemic has led to a substantial increase in the proportion of the prison population who are drug addicts. In the UK during the second half of the 1980s around 4000 people per year received custodial sentences for drug-related offences, double the number sentenced at the beginning of the decade.’ In parts of the USA the situation is worse: of the 40 763 prison inmates in New York State at the end of 1987, over half were in jail for drug-related offencesThe strain on prison health services is considerable, a problem further exacerbated by the number of drug abusers who are HIV positive. A World Health Organisation publication2 examines the methods used to identify drug abusers on admission to prison and health-care provision for drug-abusing inmates. It also looks at the ethics of treating, against their will, people who are incarcerated; and systems of non-voluntary treatment in France, Germany, Sweden, and the USA are described, with that in the USA said to be of some value. Other issues discussed include the particular health problems of drug abuse, such as AIDS and suicide. Few would argue with the report’s recommendation that health-care services in prisons should compare to those enjoyed by the general population. However, the suggestion that condoms be distributed to inmates to limit the spread of AIDS (along with improved anti-AIDS education) will not be universally applauded. The squalid state of many British prisons is probably not widely known outside the UK. The report adds to the country’s embarrassment by citing the UK as a particular example of overcrowding and poor hygiene causing health problems for drug-abusing inmates. 1. Statistics of the misuse of drugs: seizures and offenders dealt with, United Kingdom, 1989. Home Office Statistical Bulletin no 24/90. Price £2 50. ISSN 01-436384. Obtainable from the Statistical Department, Lunar House, Croydon, Surrey CR0 9YD, UK. 2. Drug abusers in prisons. WHO Regional Publications, European series, no 27, 1990. Price Sw fr 10. Pp 52. ISBN 9-289011181. Obtainable from WHO Distribution and Sales, 1211 Geneva 27, Switzerland (order no 1310027) or by post from HM Stationery Office Books Publication Centre, 51 Nine Elms Lane, London SW18 5DR, UK.
Obstetrics at The Royal London Hospital The
department of obstetrics
at The Royal London Hospital will be divided into two sections--one hospital and one community-as advocated by The Lancet (see Dec 23/30, 1989, p 1492). Dr Vythilingam Sivapathasundaram has been appointed consultant obstetrician to assist Mrs Wendy Savage in the community obstetrics action. Prof J. G. Grudzinskas remains head of the hospital section. now
