• Open Access

Public health and the festive season


Most of us celebrate a festive season of some kind in December. There are public health risks that come with these festivities and we thought that it might be worth commenting on these as summarised in a well-known song that ends with this verse:

     On the twelfth day of Christmas

     my true love sent to me

     Twelve drummers drumming

     Eleven pipers piping

     Ten lords a-leaping

     Nine ladies dancing

     Eight maids a-milking

     Seven swans a-swimming

     Six geese a-laying

     Five golden rings

     Four calling birds

     Three French hens

     Two turtle doves

     And a partridge in a pear tree!

There are some nasty risks here. True love, of course, is an altered state of mind, and leads to irrational and risky behaviour (see ANZJPH Volume 27, Issue 2) but there are other broader risks involved.

We Editors put our heads together. While being entirely appreciative of the intention of the giver, we devised what we believe is an appropriate set of precautions for assessing such gifts from a beloved.

It is best to ensure that the Partridge was hatched in an aviary of good repute, and comes with a certificate guaranteeing it free of Escherichia coli and Salmonella species. Similarly, the Pear Tree should be a grafted variety to avoid quince graft virus and fire blight which could devastate our fruit industry. The Two Turtle Doves are wild birds, so monitor the family's temperatures and arrange an immediate visit to the general practitioner should anyone start coughing – atypical pneumonias such as psittacosis needs prompt diagnosis. Three French Hens should arrive direct from the Happy Free Range Hen House and with a veterinary guarantee that they are well adjusted for life in the back yard chicken run. If your True Love has this traditional thing about birds, remember that Calling Birds are migratory, so it is wise to have the above plan in place for atypical pneumonia. It will also work for avian influenza.

Gold Rings are always a thoughtful gift – especially five of them. The share market is so uncertain these days – although gold is not holding its value as well as might be expected, don't you agree?

Now the seven Swans a-Swimming pose a problem unless they come with a title to a hobby farm with a dam, preferably one with water in it. If they are white swans, by law they belong to HM Queen Elizabeth- although it might be OK if you don't eat them. Sadly, they will fight with the six Geese a-Laying, so maybe just forgo the swans. If you harvest the goose eggs, the geese may peck you behind the knees causing unsightly sores and welts suggesting Mycobaterium ulcerans, or maybe a nasty MRSA, both very troublesome. Check your supplies of antibacterial lotion.

Some help around the farmyard is always welcome, but we are not sure about the OH&S implications for eight milkmaids. Still, as long as the cows are guaranteed free from bovine TB you should cope, and you never know, should we be subject to a bioterrorist smallpox attack they might even prove a handy source of cowpox so you don't need to worry about Mantoux tests and tuberculosis vaccines. For farmhands in contact with livestock, shepherdesses and cowherds included, you will urgently need to consider a Q-fever vaccination program. The beautiful Ladies Dancing are so sweet! They are graceful and co-ordinated – and very athletic but we are worried about the amount of water they drink. The smallholding is probably on tank water which needs to be boiled before drinking – don't want any of those little Giardia problems, especially as the plumbing is often unreliable.

Then there are the men. The Lords a-Leaping are a headache. The poem does not specify the sort of leaping they do, so we don't know whether they need condoms, parachutes, or shock-absorbing track shoes. Very perplexing, too, is the problem that Australia and New Zealand are short on lords; so are these refugees, do they have residency permits and do they have special health needs? We also don't know much about the Pipers Piping who may all need to be referred to a smoking cessation program. Special attention should be paid to the hookas – make sure the water is changed regularly to prevent any likelihood of Legionellosis – another atypical pneumonia to worry about. We are equally concerned about the Drummers Drumming; the Musicians Union recommends ear protection which many do not have, and some appear to have early RSI. We also suggest the drumskins be checked to guarantee they are free of anthrax.

At this stage we Editors decided that our substantial concern with risk would spoil the festivities. True, we need to have immunisation schedules and quarantine and other restrictions but we also need to celebrate (provided, of course, we slap on the sunscreen and imbibe with moderation). So let us recommend a different poem:

     Freude, schöner Götterfunken

     Tochter aus Elysium

     Wir betreten feuertrunken

     Himmlische, dein Heiligtum!

The German is a bit hard to read but it does obscure the gender bias in Schiller's Ode to Joy. We suggest a CD of the poem set to music by Beethoven in the last movement of his Ninth Symphony. In our favourite version Hans Schmidt-Isserstedt conducts the Vienna Philharmonic Orchestra. Dame Joan Sutherland, James King, Marilyn Home and Martti Talvela belt out the lyrics and inspire us to join in a chorus of jubilation, praising Joy, daughter of Elysium, who brings happiness and well-being to any creature from the lowly worm to the holy cherub. It is especially good at volume and without ear plugs. There is always New Year's Eve for fresh resolutions for a safe, happy and joyful 2009.

We ask only that you also resolve to send an article on joy, or on risks, or both, to this Journal in 2009.

We end by thanking those authors who have entrusted their work to us in 2008, but our biggest song of praise is, as always, to our reviewers who are named at the end of this Issue.

In this issue

Our articles this month are varied, as usual. The first group are about geographic inequalities. The so-called brain of trained medical staff from poor to rich countries has been the subject of concern in this journal before. Joel Negin draws attention to a growing problem, the loss to their own communities of Pacific Islander health workers now working in Australia and New Zealand. He argues that Australia and New Zealand need to take action like ending active recruitment of health workers from these countries. Angela Durey and colleagues show that doctors from a variety of other countries are recruited to work in rural and remote Indigenous health settings where they lack professional support and face difficult challenges in delivering culturally appropriate health care. Effective training and resourcing is needed if they are to be retained in this workforce. Continuing the theme of geographical inequalities, Martha Silva and Rob McNeill show that one-sixth of women in New Zealand face difficulties in accessing first trimester termination of pregnancy because of driving distances, especially in rural areas with a higher Māori population. Bridget Kelly and her colleagues show that food marketing linked to childhood obesity is concentrated close to primary schools in Sydney and Wollongong, demonstrating the need to regulate food and soft drink advertisements close to schools.

The next set of papers is about research methods. A key criterion for surveillance is that data are collected for a specific purpose. Christopher Barton and colleagues report on the problems of measuring the health of Australian military personnel; current health data are generally generated from health screens, but there is a need for purpose built data for longitudinal screening. Methodological problems generated by self report data are considered in the next two papers. Wendy Brown and colleagues report a modified self-administered survey that measures the physical activity levels reported by middle-aged women as well as a comparable telephone administered survey. Alison Hayes and colleagues develop height and weight correction equations to get more realistic estimates than self-report. Continuing the weight theme, Catriona Bonfiglioli and colleagues draw on the Human Genome Project to argue that we need to focus on smaller components that can be mapped in manageable chunks. Obesity has no single cause and we need to have a range of meaningful intermediate outcome measures rather than to focus on weight loss alone.

Public health needs programs that are effective in bringing about change. Marisa Gilles and colleagues describe public health interventions and the health of prisoners in a cross-sectional record audit in Western Australia, showing that although being Indigenous carries (predictably) a range of extra health risks, health promotion services can be delivered fairly. Jiunn-Yih Su and Steven Skov argue that a Tiwi Island sexual health program using notification and laboratory data has been shown to be effective and provides a model for other sexual health programs. Michele Grigg and colleagues tell us about the importance of whānau (broadly translated as family) in a smoking cessation mass media campaign based on Quit, directed at the New Zealand Māori population.

The last two papers are about outcomes of two chronic diseases, dementia and colorectal cancer. Binod Nepal and colleagues show that, unfortunately, the effect of living longer is an increase in the time lived with dementia, with women experiencing the greater impact. Louisa Gordon and her team studied work participation patterns following a diagnosis of colorectal cancer and show that both men and women experience reduction in work participation but the reasons appear to be different for women and men.

There is also an excellent collection of letters considering various policy issues (hepatitis B screening, nurse practitioners and research mentor leaders). Two correspondents are responding to articles previously published in the journal, and the last writer has thought about why we need to think outside conventional risk factors for heart disease.

Lastly, we have a set of particularly interesting and thoughtful book reviews which is well worth investigating, complementing our articles and letters rather well. A couple could even be serious contenders for the gift list for that hard-to-please relative!