- Email: [email protected]
LOCAL GOVERNMENT
203
diacetate, and the supporting pharmacological evidence
and, removed from the scrutiny of representatives of local
ratepayers, the costs might soar and make unwelcome demands on the resources of the boards. may be profitable, Medical officers of health who realise that, in the absence in other myopathies. of adequate nutrition and satisfactory environmental conditions, health services are largely wasted may be mildly surprised that the Ministry of Health thinks that housing LOCAL GOVERNMENT conditions, clean air, and the health, safety, and welfare of LOCAL authorities, shorn in 1948 of most of their employees in offices and shops are not matters of responsibilities for the care of the sick, felt that they were immediate concern to the health department of a local of small interest to a Ministry of Health preoccupied with authority. However, they will be pleased that the evidence, new regional hospital boards and executive councils, and brief and to the point, shows that the Ministry of Health that this interest further diminished in 1951 when a is interested in local government, aware of the defects in separate Ministry, now the Ministry of Housing and Local its organisation, and anxious to see changes long advocated Government, absorbed much of the work of the Ministry by many engaged in it. The terms of reference of the of Health. Subsequently when local authorities were asked Royal Commission confine it to the structure of local to undertake full dental treatment for mothers and young government in relation to its existing functions, which children, B.c.G. and poliomyelitis vaccination, and entirely precludes its dealing with the wider issues of government new duties relating to mental disorder, and to plan tenat local level. Hence there are no direct references to year health and welfare programmes, they believed that hospitals and executive councils. there was growing recognition of the part they could play in health and welfare-quite apart, they hoped, from their ability to relieve the Treasury of some of the cost of the FLUORIDES AND OSTEOPOROSIS health services. This belief is confirmed by the publication last week of the evidence of the Ministry of Health1 to the THE effects of small differences in fluoride intake on Royal Commission considering the structure of local the incidence of osteoporosis have for some time been a government in England (excluding London), with the matter of great interest. Leone and his colleagues1 in a ultimate goal of recommending changes necessary to survey of Bartlett, a Texan township with 8-0 parts per sustain a viable system of local democracy. million of fluoride in its water-supply, found by radioThe evidence shows that the Ministry is aware of the logical examination that 10-15%of the population had indivisibility of the health services and of their links with slightly increased density of the bone shadows and others. It favours one-tier government with rearrange- thickening of the trabeculae, judged by the investigators ment of the present counties and county boroughs to form to be of benefit in counteracting the osteoporotic changes units of at least 200,000 people, but considerably larger of old age. Moreover, the prevalence of osteoporosis seemed when population density allows, covering both town and to be lower than in the nearby town of Cameron where surrounding country areas and related closely to the areas the water contained only 0-4 p.p.m. of fluoride, but the of executive councils and hospital services. The Ministry numbers who had osteoporosis were too few for firm would like to see local authorities with wide powers conclusions. An extension of the study to Framlingham,2 covering personal health and welfare services, communi- a town where the water contained only a minute trace of cable-disease control, and child care and education, as well fluoride, yielded further suggestive data, for an unusually as housing and environmental health including food high incidence of osteoporosis was discovered. Among hygiene and the control of food composition and labelling. 546 residents aged 30-70 years 77 cases of osteoporosis The recognition of the disadvantages in over-large were found, many being men in the younger age-groups. authorities has been reinforced by the experience of the The prevalence of increased bone density and of coarsened new drive that is being brought to the development of trabeculation was much lower in Framlingham than in London’s personal health and welfare services in areas Bartlett, and seemed to be comparable with that in much smaller than those of the former London and Cameron. Middlesex counties. However, the Ministry, aware of the From the Harvard department of nutrition, Bernstein frustrations and misunderstandings that can arise where and his colleaguesnow report that they examined large county councils delegate their health and welfare 715 residents over the age of 45 in an area of North functions to district councils, recommends discontinuance Dakota with only 0-15-0-3 p.p.m. of fluoride in its of such delegation, and the need for it would cease if drinking-waters, and they compared the results with those smaller one-tier authorities were established. from 300 similar residents in-an adjacent area consuming The Guillebaud Committee in 1956 recommended that waters with 4-0-5-8 p.p.m. In women aged 55 and over, the ambulance service provided since 1948 by counties and the prevalence of reduced bone density of the lumbar county boroughs should remain with these authorities on spine in the low-fluoride area was double that in the highgrounds of economy; and, when changes took place in fluoride district-a highly significant difference. DifferLondon in 1965, the service was left with the Greater ences in the numbers of people with one or more London Council. In 1964 the T.U.C. favoured its transfer collapsed vertebrae were even more striking: in the to regional hospital boards, and a year later the Minister 55-64 age-group the figure was 20-8°°in the low-fluoride undertook to keep under review the arguments for and area and 3-1% in the high-fluoride area; and in those against a national service. He now favours its transfer to of 65 and over it was 25.30% compared with 9-5%. No the regional hospital boards, but they may well look this 1. Leone, N. C., Stevenson, C. H., Hilbish, R. F., Sosman, M. C. Am. J. glft horse in the mouth. Local authorities have had Rœntg. 1955, 74, 874. 2. Leone, N. C., Stevenson, C. H., Besse, B., Hawes, L. H., Dawber, difficulty in curbing unreasonable demands on the service;
from animal tissue
experiments, indicate that further trials not only in myasthenia gravis but also
1. Royal Commission on Local Government in England: written evidence of the Ministry of Health. H.M. Stationery Office, 1967. 3s. 6d.
3.
T. R. Archs ind. Hlth, 1960, 21, 326. Bernstein, D. S., Sadowsky, N., Hegsted, D. M., Guri, C. D., Stare, F. V. J. Am. med. Ass. 1966, 198, 499.
diacetate, and the supporting pharmacological evidence
and, removed from the scrutiny of representatives of local
ratepayers, the costs might soar and make unwelcome demands on the resources of the boards. may be profitable, Medical officers of health who realise that, in the absence in other myopathies. of adequate nutrition and satisfactory environmental conditions, health services are largely wasted may be mildly surprised that the Ministry of Health thinks that housing LOCAL GOVERNMENT conditions, clean air, and the health, safety, and welfare of LOCAL authorities, shorn in 1948 of most of their employees in offices and shops are not matters of responsibilities for the care of the sick, felt that they were immediate concern to the health department of a local of small interest to a Ministry of Health preoccupied with authority. However, they will be pleased that the evidence, new regional hospital boards and executive councils, and brief and to the point, shows that the Ministry of Health that this interest further diminished in 1951 when a is interested in local government, aware of the defects in separate Ministry, now the Ministry of Housing and Local its organisation, and anxious to see changes long advocated Government, absorbed much of the work of the Ministry by many engaged in it. The terms of reference of the of Health. Subsequently when local authorities were asked Royal Commission confine it to the structure of local to undertake full dental treatment for mothers and young government in relation to its existing functions, which children, B.c.G. and poliomyelitis vaccination, and entirely precludes its dealing with the wider issues of government new duties relating to mental disorder, and to plan tenat local level. Hence there are no direct references to year health and welfare programmes, they believed that hospitals and executive councils. there was growing recognition of the part they could play in health and welfare-quite apart, they hoped, from their ability to relieve the Treasury of some of the cost of the FLUORIDES AND OSTEOPOROSIS health services. This belief is confirmed by the publication last week of the evidence of the Ministry of Health1 to the THE effects of small differences in fluoride intake on Royal Commission considering the structure of local the incidence of osteoporosis have for some time been a government in England (excluding London), with the matter of great interest. Leone and his colleagues1 in a ultimate goal of recommending changes necessary to survey of Bartlett, a Texan township with 8-0 parts per sustain a viable system of local democracy. million of fluoride in its water-supply, found by radioThe evidence shows that the Ministry is aware of the logical examination that 10-15%of the population had indivisibility of the health services and of their links with slightly increased density of the bone shadows and others. It favours one-tier government with rearrange- thickening of the trabeculae, judged by the investigators ment of the present counties and county boroughs to form to be of benefit in counteracting the osteoporotic changes units of at least 200,000 people, but considerably larger of old age. Moreover, the prevalence of osteoporosis seemed when population density allows, covering both town and to be lower than in the nearby town of Cameron where surrounding country areas and related closely to the areas the water contained only 0-4 p.p.m. of fluoride, but the of executive councils and hospital services. The Ministry numbers who had osteoporosis were too few for firm would like to see local authorities with wide powers conclusions. An extension of the study to Framlingham,2 covering personal health and welfare services, communi- a town where the water contained only a minute trace of cable-disease control, and child care and education, as well fluoride, yielded further suggestive data, for an unusually as housing and environmental health including food high incidence of osteoporosis was discovered. Among hygiene and the control of food composition and labelling. 546 residents aged 30-70 years 77 cases of osteoporosis The recognition of the disadvantages in over-large were found, many being men in the younger age-groups. authorities has been reinforced by the experience of the The prevalence of increased bone density and of coarsened new drive that is being brought to the development of trabeculation was much lower in Framlingham than in London’s personal health and welfare services in areas Bartlett, and seemed to be comparable with that in much smaller than those of the former London and Cameron. Middlesex counties. However, the Ministry, aware of the From the Harvard department of nutrition, Bernstein frustrations and misunderstandings that can arise where and his colleaguesnow report that they examined large county councils delegate their health and welfare 715 residents over the age of 45 in an area of North functions to district councils, recommends discontinuance Dakota with only 0-15-0-3 p.p.m. of fluoride in its of such delegation, and the need for it would cease if drinking-waters, and they compared the results with those smaller one-tier authorities were established. from 300 similar residents in-an adjacent area consuming The Guillebaud Committee in 1956 recommended that waters with 4-0-5-8 p.p.m. In women aged 55 and over, the ambulance service provided since 1948 by counties and the prevalence of reduced bone density of the lumbar county boroughs should remain with these authorities on spine in the low-fluoride area was double that in the highgrounds of economy; and, when changes took place in fluoride district-a highly significant difference. DifferLondon in 1965, the service was left with the Greater ences in the numbers of people with one or more London Council. In 1964 the T.U.C. favoured its transfer collapsed vertebrae were even more striking: in the to regional hospital boards, and a year later the Minister 55-64 age-group the figure was 20-8°°in the low-fluoride undertook to keep under review the arguments for and area and 3-1% in the high-fluoride area; and in those against a national service. He now favours its transfer to of 65 and over it was 25.30% compared with 9-5%. No the regional hospital boards, but they may well look this 1. Leone, N. C., Stevenson, C. H., Hilbish, R. F., Sosman, M. C. Am. J. glft horse in the mouth. Local authorities have had Rœntg. 1955, 74, 874. 2. Leone, N. C., Stevenson, C. H., Besse, B., Hawes, L. H., Dawber, difficulty in curbing unreasonable demands on the service;
from animal tissue
experiments, indicate that further trials not only in myasthenia gravis but also
1. Royal Commission on Local Government in England: written evidence of the Ministry of Health. H.M. Stationery Office, 1967. 3s. 6d.
3.
T. R. Archs ind. Hlth, 1960, 21, 326. Bernstein, D. S., Sadowsky, N., Hegsted, D. M., Guri, C. D., Stare, F. V. J. Am. med. Ass. 1966, 198, 499.