Snow on cholera--the special lecture in the Second British Epidemiology and Public Health Course at Kansai Systems Laboratory on 24 August 1996.

The Second British Epidemiology and Public Health Course was held from 19 to 25 August 1996 in Osaka as a satellite meeting for the 14th International Scientific Meeting of the International Epidemiological Association. Thirty-three researchers from 10 countries participated in the course. Professor Walter W Holland gave a special lecture about Snow on cholera during the course, and the lecture revealed that Henry Whitehead who was a junior priest at that time contributed to Snow's work to prevent the cholera outbreak in Golden Square in 1854. What John Snow did in his life are reviewed in detail in this paper.

Sickness absence and 'working through' illness: a comparison of two professional groups.

BACKGROUND: Few studies have investigated occupational groups reporting low rates of sickness absence because of an assumption that these rates indicate low morbidity. This is inconsistent with the view that sickness absence, which may be caused by social and psychological rather than medical factors, does not equate with morbidity. This paper investigates rates of sickness absence and factors influencing decisions not to take sick leave among doctors and a comparative professional group. METHODS: A postal survey was sent to 670 general practitioners (GPs), 669 hospital doctors and 400 company 'fee earners'. Qualitative interviews were conducted with 64 doctors reporting an illness lasting one month or more in the last three years. RESULTS: Self-reported health status was similar for both groups but GPs reported higher levels of occupational stress. However, doctors were significantly less likely to report short periods of sick leave in the previous year. Over 80 per cent of all respondents had 'worked through' illness, citing cultural and organizational factors behind their decision not to take sick leave. Barriers to sick leave among doctors included the difficulty of arranging cover and attitudes to their own health. CONCLUSIONS: Considerable emphasis has been given to the role of social factors in contributing to rates of sickness absence. These may also contribute to the decision not to take sick leave, resulting in possible inappropriate non-use. Measures to encourage and enable doctors to take sick leave might improve the management of their own health.

Advances in epidemiology and disease prevention.

This review deals with the changes in disease prevalence in the developed and developing world. It highlights the changes brought about by control of infectious diseases and records remaining problems, particularly in tuberculosis (TB) and malaria. The new thinking on risk factors for chronic diseases are described, including evidence on the need for changes in diet, e.g. free radicals, rather than cholesterol screening for the control of coronary heart disease. The current evidence on cancer and diet is described as well as the influence of electromagnetic fields in the aetiology of cancer. The need to develop better methods of assessment of the outcome of health care, rather than purely variations in frequency of treatment, is highlighted. The current concepts on the effects of ozone depletion and greenhouse warming are considered. The need for improved methods of communication of risks is highlighted.

Heaven can wait.

The apparently unlimited demand for health care, finite supply of resources, the internal social market and continuous technological advances have given rise to increasing concern about the performance of health services. We examine an important measure of health care performance--avoidable mortality. Studies extending the scope of avoidable mortality and other outcome indicators are discussed. Although avoidable mortality is limited to providing a warning signal of possible health care deficiencies and is not an appropriate measure for all types of intervention, it still provides us with one of the best guides to the performance of health services.

Changing names.

This article reviews the origin of the term "social medicine" in Great Britain and reviews the understanding, views and work in this field between the middle of the last century to the present. The change to "community medicine" is described as well as the more recent change to "public health medicine." The changes to the role of medical practitioners as well as their status in the medical profession is discussed.

Commentary: recent reforms in the British National Health Service--lessons for the United States.

President Clinton recently announced his reform plan for health care in the United States. The United Kingdom, along with other countries, has already enacted reforms in an effort to overcome the basic problem of having insufficient funds to provide a health service to meet modern demands. This paper briefly describes the recent health reforms in the United Kingdom and highlights some lessons for the United States, which include the need to choose procedures that should be universally provided. Health reforms that involve some fundamental restructuring need to be evaluated everywhere and agreed to by the staff in advance.