- Email: [email protected]
No one is an island, entire of themselves
p u b l i c h e a l t h 1 2 5 ( 2 0 1 1 ) 4 8 5 e4 8 6
available at www.sciencedirect.com
Public Health journal homepage: www.elsevier.com/puhe
Editorial
No one is an island, entire of themselves
At first glance, the contents page of this August issue of Public Health reflects the usual attractive mix of papers covering topics in health protection, health promotion and health service quality and efficiency. However, this is not quite the case, as there is a theme linking several of the papers e and no, it is not just that four papers this month consider aspects of the influenza A (H1N1) pandemic! There is a clue to the theme in the flagrant misquotation which we have used as a title for this Editorial. Most of you will have recognised that our title echoes the work of the English lawyer and clergyman and poet John Donne (1572-1631 CE). Donne delighted in writing poetry which used metaphysical comparisons to explore life, love, faith and human desire. His poetry and prose is characterised by the use of metaphors and similes which are at one level absurd, yet force the reader to reflect more deeply on the underlying meaning of the metaphor. So it is with his famous opening to his prose Meditation 17, dating from the 1624 work Devotions upon Emergent Occasions: “No man is an island, entire of itself; every man is a piece of the continent, a part of the main,”1 For those of us who are in the business of public health, the absurdity lies in the recognition that an individual could ever be considered in isolation from their community (whether a community of place or a community of interest), or from the wider population from which they are drawn. But at a deeper, metaphysical level, the metaphor prompts another consideration. What are the consequences of being an individual e or a community e who becomes an island? One paper which explores this is the paper which considers the health status of ethnic Russians who now live in the former Soviet Republics beyond the Russian Federation.2 These minority communities only exist because of a national policy of population relocation carried out in the mid twentieth century. As a result, these populations provide a natural experiment in what happens to the health status of communities that have become an “island” set outside of their natural “continent”. That some of these migrant populations have relatively poorer health experiences than the populations in which they now reside will not come as a surprise, but what of those where migration would seem to have had
little or even had a positive effect? It is clear is that we are still searching for the relative contributions of the many underlying causes of such health inequalities. Whilst some of the inequality may well find its roots in the types of forcible resettlement, where whole families and villages were taken kicking and screaming to their new homes, it is too simplistic to see this as the sole factor. Other factors, such as the simple availability of health and health care services, and how people respond to becoming a minority community amongst a wider population will be important factors. This is an issue explored in the paper from Scotland which described the differing views of pregnant Scottish and Polish women towards the decision to accept the vaccination against influenza A (H1N1).3 This work shows that e even when the service availability is equitable and the reasons for migration are primarily positive ones e there are differences in expectations which may give rise to differences in the acceptability of an offered preventative service. Whilst these studies have looked at the individual separated from their natural community or population, in a third paper we present an interesting study which explores the impact of the influenza A (H1N1) virus on a community that is physically constrained by living on an island, in this case the Nicobarese on the Nicobar Islands.4 These peoples live within a tribal society supported by a horticultural economy, along side the Malay communities and the nomadic Shompan peoples of the islands. Whilst the epidemiology of island communities is a fascinating subject in it own right, and the study explores some of the issues associated with this, it also serves to remind us of the way in which an individual perceives themselves in relation to their own community or amongst wider communities will affect self-perception of health and wellbeing. To draw our own metaphysical metaphor, it is this proprioception of community e how the individual sees themselves in relation to the other parts of their “communal” body e which is essential to moving beyond simple descriptions of the health status of minority communities. Perhaps it will only be when we understand such relationships between the person and their communities that we will be in a much stronger position to developing public health actions that have real, lasting impact. Donne wrote his Devotions after having a serious illness, probably arising from an infectious disease, which nearly
486
p u b l i c h e a l t h 1 2 5 ( 2 0 1 1 ) 4 8 5 e4 8 6
ended his life. In Meditation 17, he is concerned with the interconnectedness of people and communities, but he is also exploring the way in which the intimation of mortality is important in helping the living. This meditation also includes the equally famous epithet: “Any man’s death diminishes me, because I am involved in mankind, and therefore never send to know for whom the bell tolls; it tolls for thee.” But Donne does not end his meditation there. It actually ends: “Another may be sick too, and sick to death, and this affliction may lie in his bowels, as gold in a mine, and be of no use to him; but this bell that tells me of his affliction, digs out, and applies that gold to me: if by this consideration of another’s danger, I take mine own into contemplation, and so secure myself, by making my recourse to my God, who is our only security.” As public health professionals we may not be as convinced as John Donne was in the need to rely upon a deity to be best source of security. Nor may we wish to apply the metaphysical conceit as a means of communication. But we would have to agree that there is much to be learned from the deaths of those around us, and that when it comes to the public’s health, the individual is not an island, entire of itself.
references
1. Donne J. Devotions upon emergent occasions: meditation 17. In: Alford H, editor. The Works of John Donne, vol. III. London: John W Parker; 1624. p. 1839. 2. Groenewold WG, van Ginneken JK. Health status of Russian minorities in former Soviet Republics. Public Health 2011;125(8): 487e93. 3. Sim JA, Ulanika AA, Gorman D, Katikireddi SV. Out of two bad choices, I took the slightly better one’: vaccination dilemmas for Scottish and Polish migrant women during the H1N1 influenza pandemic. Public Health 2011;125(8):505e11. 4. Singh SS, Muruganandam N, Chaaitanya IK, Bhattacharya D, Sugunan AP, Nayak AK, et al. H1N1 influenza A outbreak among the Nicobarese, an aboriginal tribe of the Andaman and Nicobar Islands, India. Public Health 2011;125(8):501e4.
P. Mackie*, F. Sim The Royal Society for Public Health, John Snow House, 59 Mansell Street, London E1 8AN, United Kingdom *Corresponding author. E-mail address: [email protected] (P. Mackie)
0033-3506/$ e see front matter ª 2011 Published by Elsevier Ltd on behalf of The Royal Society for Public Health. doi:10.1016/j.puhe.2011.07.007
In this issue Despite being a holiday period in many Northern hemisphere countries, we have decided that this August issue of Public Health is a good time to present you with some serious public health reading to keep your brains active. The health status of minority communities is a feature in many populations and we lead with a paper exploring the health experience of the minority Russian populations in the former Soviet Republics beyond Russia. The lessons to be learned from the recent pandemic of influenza A H1N1 are still being identified. In this area we have four papers: two which explore the experience of the outbreak in discrete communities (one military and the second, island communities); and two which consider issues around the decision to accept vaccination in targeted populations. In relation to lifestyle factors, we present papers concerning maternal obesity, falls prevention, alcohol-related hospitalisations and access to green spaces for dog-walking. All of which remind us of how much addressing such issues remains a key part of public health action. The internet is increasing becoming a major provider of public health information and evidence. Two papers explore the development of new internet based approaches to keep us all well informed. Finally, we have what may be a cautionary “sting in the tail” for The Glasgow Effect..
available at www.sciencedirect.com
Public Health journal homepage: www.elsevier.com/puhe
Editorial
No one is an island, entire of themselves
At first glance, the contents page of this August issue of Public Health reflects the usual attractive mix of papers covering topics in health protection, health promotion and health service quality and efficiency. However, this is not quite the case, as there is a theme linking several of the papers e and no, it is not just that four papers this month consider aspects of the influenza A (H1N1) pandemic! There is a clue to the theme in the flagrant misquotation which we have used as a title for this Editorial. Most of you will have recognised that our title echoes the work of the English lawyer and clergyman and poet John Donne (1572-1631 CE). Donne delighted in writing poetry which used metaphysical comparisons to explore life, love, faith and human desire. His poetry and prose is characterised by the use of metaphors and similes which are at one level absurd, yet force the reader to reflect more deeply on the underlying meaning of the metaphor. So it is with his famous opening to his prose Meditation 17, dating from the 1624 work Devotions upon Emergent Occasions: “No man is an island, entire of itself; every man is a piece of the continent, a part of the main,”1 For those of us who are in the business of public health, the absurdity lies in the recognition that an individual could ever be considered in isolation from their community (whether a community of place or a community of interest), or from the wider population from which they are drawn. But at a deeper, metaphysical level, the metaphor prompts another consideration. What are the consequences of being an individual e or a community e who becomes an island? One paper which explores this is the paper which considers the health status of ethnic Russians who now live in the former Soviet Republics beyond the Russian Federation.2 These minority communities only exist because of a national policy of population relocation carried out in the mid twentieth century. As a result, these populations provide a natural experiment in what happens to the health status of communities that have become an “island” set outside of their natural “continent”. That some of these migrant populations have relatively poorer health experiences than the populations in which they now reside will not come as a surprise, but what of those where migration would seem to have had
little or even had a positive effect? It is clear is that we are still searching for the relative contributions of the many underlying causes of such health inequalities. Whilst some of the inequality may well find its roots in the types of forcible resettlement, where whole families and villages were taken kicking and screaming to their new homes, it is too simplistic to see this as the sole factor. Other factors, such as the simple availability of health and health care services, and how people respond to becoming a minority community amongst a wider population will be important factors. This is an issue explored in the paper from Scotland which described the differing views of pregnant Scottish and Polish women towards the decision to accept the vaccination against influenza A (H1N1).3 This work shows that e even when the service availability is equitable and the reasons for migration are primarily positive ones e there are differences in expectations which may give rise to differences in the acceptability of an offered preventative service. Whilst these studies have looked at the individual separated from their natural community or population, in a third paper we present an interesting study which explores the impact of the influenza A (H1N1) virus on a community that is physically constrained by living on an island, in this case the Nicobarese on the Nicobar Islands.4 These peoples live within a tribal society supported by a horticultural economy, along side the Malay communities and the nomadic Shompan peoples of the islands. Whilst the epidemiology of island communities is a fascinating subject in it own right, and the study explores some of the issues associated with this, it also serves to remind us of the way in which an individual perceives themselves in relation to their own community or amongst wider communities will affect self-perception of health and wellbeing. To draw our own metaphysical metaphor, it is this proprioception of community e how the individual sees themselves in relation to the other parts of their “communal” body e which is essential to moving beyond simple descriptions of the health status of minority communities. Perhaps it will only be when we understand such relationships between the person and their communities that we will be in a much stronger position to developing public health actions that have real, lasting impact. Donne wrote his Devotions after having a serious illness, probably arising from an infectious disease, which nearly
486
p u b l i c h e a l t h 1 2 5 ( 2 0 1 1 ) 4 8 5 e4 8 6
ended his life. In Meditation 17, he is concerned with the interconnectedness of people and communities, but he is also exploring the way in which the intimation of mortality is important in helping the living. This meditation also includes the equally famous epithet: “Any man’s death diminishes me, because I am involved in mankind, and therefore never send to know for whom the bell tolls; it tolls for thee.” But Donne does not end his meditation there. It actually ends: “Another may be sick too, and sick to death, and this affliction may lie in his bowels, as gold in a mine, and be of no use to him; but this bell that tells me of his affliction, digs out, and applies that gold to me: if by this consideration of another’s danger, I take mine own into contemplation, and so secure myself, by making my recourse to my God, who is our only security.” As public health professionals we may not be as convinced as John Donne was in the need to rely upon a deity to be best source of security. Nor may we wish to apply the metaphysical conceit as a means of communication. But we would have to agree that there is much to be learned from the deaths of those around us, and that when it comes to the public’s health, the individual is not an island, entire of itself.
references
1. Donne J. Devotions upon emergent occasions: meditation 17. In: Alford H, editor. The Works of John Donne, vol. III. London: John W Parker; 1624. p. 1839. 2. Groenewold WG, van Ginneken JK. Health status of Russian minorities in former Soviet Republics. Public Health 2011;125(8): 487e93. 3. Sim JA, Ulanika AA, Gorman D, Katikireddi SV. Out of two bad choices, I took the slightly better one’: vaccination dilemmas for Scottish and Polish migrant women during the H1N1 influenza pandemic. Public Health 2011;125(8):505e11. 4. Singh SS, Muruganandam N, Chaaitanya IK, Bhattacharya D, Sugunan AP, Nayak AK, et al. H1N1 influenza A outbreak among the Nicobarese, an aboriginal tribe of the Andaman and Nicobar Islands, India. Public Health 2011;125(8):501e4.
P. Mackie*, F. Sim The Royal Society for Public Health, John Snow House, 59 Mansell Street, London E1 8AN, United Kingdom *Corresponding author. E-mail address: [email protected] (P. Mackie)
0033-3506/$ e see front matter ª 2011 Published by Elsevier Ltd on behalf of The Royal Society for Public Health. doi:10.1016/j.puhe.2011.07.007
In this issue Despite being a holiday period in many Northern hemisphere countries, we have decided that this August issue of Public Health is a good time to present you with some serious public health reading to keep your brains active. The health status of minority communities is a feature in many populations and we lead with a paper exploring the health experience of the minority Russian populations in the former Soviet Republics beyond Russia. The lessons to be learned from the recent pandemic of influenza A H1N1 are still being identified. In this area we have four papers: two which explore the experience of the outbreak in discrete communities (one military and the second, island communities); and two which consider issues around the decision to accept vaccination in targeted populations. In relation to lifestyle factors, we present papers concerning maternal obesity, falls prevention, alcohol-related hospitalisations and access to green spaces for dog-walking. All of which remind us of how much addressing such issues remains a key part of public health action. The internet is increasing becoming a major provider of public health information and evidence. Two papers explore the development of new internet based approaches to keep us all well informed. Finally, we have what may be a cautionary “sting in the tail” for The Glasgow Effect..