1086
No area of social policy has been as savagely cut as housing in the past decade. And even councils that sold homes were prevented from using more than one-fifth of the proceeds to build new ones. Ministers made it clear they did not want any further council homes for families, only houses to meet special needs-the elderly or disabled. Is this to be reversed? It is not. The most embarrassing front for the Government, of course, is poverty. If the links between poverty and ill-health are complex, there is no doubting the links. As income improves, so does health. In Dr George Davey-Smith’s words: "Studies in differential mortality reiterate the fact that British Society is stratified to a fine grain from top to bottom". Ministers were given plenty of warning of these facts. Soon after they took office in 1979, they were given the report from Sir Douglas Black’s group on the disparities in health and the policies needed to close the gaps-more income support to abolish child poverty, free school meals, more investment in day care and antenatal facilities, more home helps and district nurses for the disabled. Ministers rejected the proposals. Since then, incomes have broadened to their widest point this century. Health inequalities have moved in the same direction. So what does the document say about the Department of Social Security? It is not even mentioned. The document does list those responsible for public health. There are 11 separate names on the list. Symbolically, the Government comes 10th, although even this looks too high since it was the name below, international organisations, which forced the Government to produce the document. Meanwhile the emphasis is on individuals, families, communities, voluntary organisations, health professionals, industry, the media... but not ministers. One might hope that the directors of public health will emerge as the champions of public health. Part of their duty is to assess the health needs of their districts, and monitor the success of local health services. In theory there is nothing to stop these
doctors speaking out on the effects of poverty, poor housing, bad environment, and improper food labels. In practice, they look doomed to be sucked into sorting out the administrative chaos of the new system. The newly restructured NHS is running into trouble. By the 25th day of the new system, almost 1000 redundancies have been announced by opted out hospitals including 600 at Guy’s, the Government’s flagship. This is only the start of the
story. Malcolm Dean
Round the World USSR:
Chernobyl’s psychological legacy
Five years after the Chernobyl disaster, Soviet psychiatrists and psychologists are starting to study the psychological effects of living on radiation-contaminated
terrain-the current lot of an estimated 4-5 million Soviet citizens. Stress-related mental and physical problems have soared in the Soviet Union over the past few years, but, for almost three years after the accident, the Soviet authorities refused to admit the existence of radiation-induced health problems, except among emergency workers and those people evacuated from the 30 km zone around Chernobyl station. All reports to the contrary were dismissed as either "statistically insignificant variations" or symptoms induced by "radiophobia". Although Soviet psychiatrists have not
accepted the concept of radiophobia, the official clampdown on discussion of the problems of the contaminated area naturally inhibited any extensive scientific surveys. Now, psychiatrists are conducting field surveys in eastern Byelorussia, in the Gomel-Mogilev area, where there is an "island" of high radiation levels well away from the main area of contamination-the result of a heavy downpour of rain just as the Chernobyl "plume" passed overhead. According to one of these researchers, Dr Galina Rumyantseva, from Moscow, there is a definite increase in stress-related disorders in the area. There are also several cases of altered perception—eg, people are reporting that they can "see" the radiation, or that the colours of trees and plants growing on irradiated soil have changed. 38% of the sample population has been affected by depression, illusions, or the constant intrusion of radiation as a topic in everyday conversation Psychological support and counselling services for the inhabitants of the contaminated area seem to be almost entirely lacking. There is, however, a treatment programme that offers acupuncture, physiotherapy, and psychological therapy to help patients avoid reacting adversely to words linked with the explosion (eg, sieverts), and nootropic drugs, of which there is no shortage. Although the extent of the fallout was officially acknowledged in 1989, government action has concentrated on material help (such as the 30 roubles a month per head "cost of living" allowance to pay for "clean" food for those who used to grow their own) and free medicines. The concept of loss of quality of life due to the restrictions of living in the contaminated area is not acknowledged. And the long-term troubles of people facing what has been described as a "cancer lottery" have yet to be
investigated. Vera Rich
Germany:
Effects of the
Chernobyl accident
The people here are still, five years after the event, worried about possible radiation-induced health damage resulting from the accident at Chernobyl. Experts, though, believe that the damage is only slight. A recent international comparison showed that West Germany was in 14th place regarding exposure to radioactive material. But it was mainly southern Bavaria that was contaminated by the heavy rainfalls at the end of April, 1986. People in this region have received an additional dose of about 0.4 mSv in the past five years, mostly from caesium, compared with 0.2 mSv for the population of the united Germany as a whole. Since the exposure to natural radioactive sources is about 11 mSv in five years, experts have not detected, and do not expect to detect, any rise in radiation-induced disease. In the long term an increase of about 8000 persons per million inhabitants dying of cancer due to radioactive material from Chernobyl is expected, from extrapolation of data from Hiroshima to very low doses. Cohort studies of southern Bavarian babies born from 1986 onwards will be continued-more for public reassurance than for scientific reasons. So far there has been no cause for major concern. Apart from a few newspaper stories highlighting the birth of animals with unusual deformities, there have been only two reports by scientists. Scientists from Bremen reported trends in infant mortality that could have been due to different levels of radioactive contamination within
Germany (Lancet 1989; ii: 1081), but
No area of social policy has been as savagely cut as housing in the past decade. And even councils that sold homes were prevented from using more than one-fifth of the proceeds to build new ones. Ministers made it clear they did not want any further council homes for families, only houses to meet special needs-the elderly or disabled. Is this to be reversed? It is not. The most embarrassing front for the Government, of course, is poverty. If the links between poverty and ill-health are complex, there is no doubting the links. As income improves, so does health. In Dr George Davey-Smith’s words: "Studies in differential mortality reiterate the fact that British Society is stratified to a fine grain from top to bottom". Ministers were given plenty of warning of these facts. Soon after they took office in 1979, they were given the report from Sir Douglas Black’s group on the disparities in health and the policies needed to close the gaps-more income support to abolish child poverty, free school meals, more investment in day care and antenatal facilities, more home helps and district nurses for the disabled. Ministers rejected the proposals. Since then, incomes have broadened to their widest point this century. Health inequalities have moved in the same direction. So what does the document say about the Department of Social Security? It is not even mentioned. The document does list those responsible for public health. There are 11 separate names on the list. Symbolically, the Government comes 10th, although even this looks too high since it was the name below, international organisations, which forced the Government to produce the document. Meanwhile the emphasis is on individuals, families, communities, voluntary organisations, health professionals, industry, the media... but not ministers. One might hope that the directors of public health will emerge as the champions of public health. Part of their duty is to assess the health needs of their districts, and monitor the success of local health services. In theory there is nothing to stop these
doctors speaking out on the effects of poverty, poor housing, bad environment, and improper food labels. In practice, they look doomed to be sucked into sorting out the administrative chaos of the new system. The newly restructured NHS is running into trouble. By the 25th day of the new system, almost 1000 redundancies have been announced by opted out hospitals including 600 at Guy’s, the Government’s flagship. This is only the start of the
story. Malcolm Dean
Round the World USSR:
Chernobyl’s psychological legacy
Five years after the Chernobyl disaster, Soviet psychiatrists and psychologists are starting to study the psychological effects of living on radiation-contaminated
terrain-the current lot of an estimated 4-5 million Soviet citizens. Stress-related mental and physical problems have soared in the Soviet Union over the past few years, but, for almost three years after the accident, the Soviet authorities refused to admit the existence of radiation-induced health problems, except among emergency workers and those people evacuated from the 30 km zone around Chernobyl station. All reports to the contrary were dismissed as either "statistically insignificant variations" or symptoms induced by "radiophobia". Although Soviet psychiatrists have not
accepted the concept of radiophobia, the official clampdown on discussion of the problems of the contaminated area naturally inhibited any extensive scientific surveys. Now, psychiatrists are conducting field surveys in eastern Byelorussia, in the Gomel-Mogilev area, where there is an "island" of high radiation levels well away from the main area of contamination-the result of a heavy downpour of rain just as the Chernobyl "plume" passed overhead. According to one of these researchers, Dr Galina Rumyantseva, from Moscow, there is a definite increase in stress-related disorders in the area. There are also several cases of altered perception—eg, people are reporting that they can "see" the radiation, or that the colours of trees and plants growing on irradiated soil have changed. 38% of the sample population has been affected by depression, illusions, or the constant intrusion of radiation as a topic in everyday conversation Psychological support and counselling services for the inhabitants of the contaminated area seem to be almost entirely lacking. There is, however, a treatment programme that offers acupuncture, physiotherapy, and psychological therapy to help patients avoid reacting adversely to words linked with the explosion (eg, sieverts), and nootropic drugs, of which there is no shortage. Although the extent of the fallout was officially acknowledged in 1989, government action has concentrated on material help (such as the 30 roubles a month per head "cost of living" allowance to pay for "clean" food for those who used to grow their own) and free medicines. The concept of loss of quality of life due to the restrictions of living in the contaminated area is not acknowledged. And the long-term troubles of people facing what has been described as a "cancer lottery" have yet to be
investigated. Vera Rich
Germany:
Effects of the
Chernobyl accident
The people here are still, five years after the event, worried about possible radiation-induced health damage resulting from the accident at Chernobyl. Experts, though, believe that the damage is only slight. A recent international comparison showed that West Germany was in 14th place regarding exposure to radioactive material. But it was mainly southern Bavaria that was contaminated by the heavy rainfalls at the end of April, 1986. People in this region have received an additional dose of about 0.4 mSv in the past five years, mostly from caesium, compared with 0.2 mSv for the population of the united Germany as a whole. Since the exposure to natural radioactive sources is about 11 mSv in five years, experts have not detected, and do not expect to detect, any rise in radiation-induced disease. In the long term an increase of about 8000 persons per million inhabitants dying of cancer due to radioactive material from Chernobyl is expected, from extrapolation of data from Hiroshima to very low doses. Cohort studies of southern Bavarian babies born from 1986 onwards will be continued-more for public reassurance than for scientific reasons. So far there has been no cause for major concern. Apart from a few newspaper stories highlighting the birth of animals with unusual deformities, there have been only two reports by scientists. Scientists from Bremen reported trends in infant mortality that could have been due to different levels of radioactive contamination within
Germany (Lancet 1989; ii: 1081), but
