502

Conferences

PROSPECTS IN HEALTH EDUCATIONFROM A CORRESPONDENT

A CONFERENCE for medical officers of health, organisedby the Central Council for Health Education, was heldin London on Feb. 21-24.

The Future of Public Health

Dr. I. A. G. MACQUEEN taxed his colleagues roundly withfailure to use new methods and new thinking in meeting modernhealth challenges. In 1930 the need had been for environmentalhygiene, infectious-disease control, and attention to the

physical health of mother, baby, and schoolchild, the healthdepartment being essentially medical. With these tasks

declining rapidly, we had not, in 1960, adapted health depart-ments to the problems of this decade-notably, to accidents ofall kinds, health education, the prevention of maladjustmentand delinquency, rehabilitation of the handicapped, and thewelfare of the elderly. Home accidents killed more people thanpoliomyelitis or tuberculosis at their peak ever did, and therewas wide agreement that the roots of mental disturance and

delinquency lay in the pre-school years. These tasks were too

important to leave, and if the health department did not meetthese responsibilities other bodies would, and there was thereal possibility that staff and functions would pass from healthdepartments to others. Dr. MacQueen wanted to meet thesechallenges by substituting a team-work " democratic "

approach for the past autocratic one, and by expanding theduties of the health visitors or public-health nurses, whoshould be more numerous and better paid. Health and welfaredepartments should be amalgamated forthwith, and medicalofficers of health should turn their attention to new fields of

research-e.g., the epidemiology of disease in the decliningyears. This stimulating point of view evoked much sympa-thetic discussion subsequently, and it was noted that publichealth is still very badly taught, especially in London.

What the Public Thinks

As chairman of the recent B.M.A. committee on the futureof broadcasting, Dr. H. D. CHALKE launched a not unexpectedattack on commercial advertising, especially on television.These techniques were devilishly effective, and we shouldclaim a much bigger purse to use television, strip cartoons, andso on for health purposes-to dispel, for example, such

ignorance as was shown by the 28% of the population whobelieved tuberculosis to be non-infective. His studies inCamberwell-in which medical students’ help had beeninvaluable-showed too that only 1 mother in 6 or 7 knewwhat vaccination meant. Dr. Chalke had then found out byquestionary what forms of publicity reach the public: among600-700 replies, mostly from higher-income groups, televisionemerged well ahead of all others, though radio and news-papers were rated high by adults. Pamphlets and posters wererated so low that they had been eliminated from his clinics (butby no means everyone at the meeting agreed with this assess-ment) : if used, posters round the wall should repeat one simplemessage, then all be changed after a week to a new one. Indiscussion the suggestions were made that insurance companiesbe asked to subsidise health education and accident prevention,and that council rent collectors or those surveying propertymight help with questionaries: each area differed and

comparisons of attitudes might be fruitful.Medicine on Television

Dr. RICHARD Fox spoke of the complexities and problems ofmedical programme production, which required the closest

cooperation between a lay producer who understood scienceand a medical man who knew something of journalism.Ethical problems loomed large but they were not new: thesize of the audience and clarity of the image merely broughtthe issues into sharper focus. While any medical publicity oreducation interfered to some extent in the relations between

a doctor and his patients, 85% of over 100 general practitionershad thought such interference beneficial and only 8% hadbeen against televising medical topics. This accorded well withcurrent B.M.A. policy, which had emerged from its apparentambiguity of recent months and was now keen on healtheducation by this means. Television was so powerful that doctorsin popular series, be they never so anonymous, could becomenational figures, with names and photographs in the press.Such publicity, useful though it might be to the public imageof the profession, might be expected to fill the consulting.room, and for this reason Dr. Fox suggested that performersshould be chosen from academic or local-authority fields, or,failing that, from those who were whole-time in the N.H.S.Though television had been shown to change attitudes, hewas less certain how far it influenced behaviour: after a recentpropaganda programme on immunisation, for example, thenumbers coming forward had dropped. (Dr. CHALKE, on theother hand, said he had done a normal year’s immunisation in aday or two after his 6 o’clock news appeal regarding diphtheriain Camberwell.) Finally, Dr. Fox called for a more aggressiveapproach by the B.B.C.-it was the only mass medium free ofpressure groups and advertising revenue-to the commercialisa-tion and debasement of moral and aesthetic tastes perpetrateddaily on the other channel.Mr. JAMES McCLOY, a B.B.C. producer who was also a

biologist, said that medical programmes were very popular andcould expect regular audiences of 5-10 million: medicine, infact, did well in the fight for restricted programme time, anddoctors, he had found from long experience, came off better ontelevision than those from any other non-acting profession.Programmes were put across in three ways-as dramatiseddocumentary, as a reconstruction on film with real people(On Call to a Nation), or studio-built (Matters of Medicine).Mr. McCloy believed it best to use " real doctors in anintimate approach and to eschew all deception: he tried tobring the television set " into the circle round the hearth"rather than to erect a proscenium arch between the viewer andthe " performer ". (Wide appreciation was expressed in theconference, however, for Emergency-Ward 10, and the issue of ," real " versus " dramatised " medical propaganda split the ’

conference.) Straight health talk Mr. McCloy believed less ’,effective than the indirect approach. The B.B.C. audience- !research department’s surveys had failed to show adverseeffects : any change in emotional level, even after surgicalscenes, had been towards lessening of anxiety and hypo-chondria, and increasing confidence in the general practitioner.

Describing his brief appearances on the medium, Dr. I. A.MAcDouGALL had kind words to say about his experience withthe B.B.C. The producer had been most courteous and hadlet him handle the material as he thought fit. But the I.T.A.,over a discussion on cancer and cigarettes, had demanded aflippant approach and prevented him from putting his case ashe wished to. Dr. C. S. NicoL had also met many problemswith lay producers and scriptwriters over the I.T.A. programmeon venereal disease. There had been months of battle "to getthings right " and Dr. Nicol said that any future " expert"must prepare himself for this. The programme had beenpraised in the British Medical Yournal and had flooded V.D.clinics throughout the land, though only 20% of these newcases were found to have the disease: at St. Thomas’s theattendance rose from 90 to 150 per week. It had been aninvaluable opportunity to bring present dangers before thepublic, and one for which they had long campaigned.

How to Handle JournalistsMedical officers of health, said Dr. HARVEY FLACK, editor

’

of Family Doctor, should make the best possible use of localpublications, be ready to advise on the subediting of medicalmatters, give interviews on current topics, and send outadvance copies of their annual reports with the items ofparticular importance written simply and clearly indicated.It must be made plain that anything said to a journalist waslegitimately taken down and might be printed-even if said overthe telephone-but where it was made clear what is "off the

503

record" and what was for publication, Dr. Flack, in 25 years’journalism, had never known the confidence broken. An

editor, furthermore, would, if asked, always have the materialread out over the telephone before publication. Documents

released to the Press should have the dateline clearly shownand it should be appropriate to the printing problems of thechosen papers. Medical writing for the lay press requiredpractice, for medical training promoted jargon. Family Doctor,he was glad to say, had a circulation of over 100,000 and hadmade a profit for some years. It, and the pamphlets and books,made a big contribution to health education. Both it and theCentral Council for Health Education were pleased to printpropaganda pamphlets very cheaply-but only in very largenumbers. Dr. Flack counselled against itinerant advertiserswho offered to print such pamphlets free, using local revenuefrom advertising. Such attempts to use the medical officer ofhealth and his local authority to make money could c-ily bringboth into disrepute. Doctors should also beware the public-relations " ghost " writer who would take some publishedcomment, "angle" " it to serve a commercial end, and seekpermission to print under the doctor’s name.

* ’*’ ’*’

It was good to find a large group of medical officersof health stimulated by present challenges and anxious todo more than " chasing decimal points down the vitalstatistics of our over-fed country "1 as a writer in TheWiddicombe File put it when he criticised the tendency ofpreventive medicine to bask in the glory of past triumphs.The challenge of preventive psychiatry was much to thefore, and experiments could start soon-early attemptsmust be on an experimental footing, for little is known ofthis approach, and that little is so far discouraging.2 2 Itwas very encouraging, however, to learn that some

medical officers of health propose to use mental-hospitalstaff rather than appoint new local-authority psychiatrists,and their repeated requests for closer local-authority/mental-hospital liaison should be emphasised again andagain. On this showing, the medical officer of healthmay win the new and illustrious future that his social

importance clearly merits.

1. Lancet, 1956, ii, 939.2. McCord, W., McCord, J. Origins of Crime, New York, 1959.3. The Two-year Mass Radiography Campaign in Scotland, 1957-1958.

H.M. Stationery Office, 1961. Pp. 98. 7s.

Public Health

Mass Radiography in Scotland1,844,268 people participated in a mass radiography cam-

paign in parts of Scotland in 1957-58.3 This represented 68%of the total adult population of these areas. In Edinburgh,Glasgow, Aberdeen, and Dundee the response-rate was ashigh as 76%. This excellent result was largely due to effectivepublicity.

12,094 new cases of tuberculosis were found, 4328 beingregarded as active cases (2-35 per 1000), the remainder (7766,4’26 per 1000) having tuberculosis requiring observation.Other conditions detected included bronchiectasis and emphy-sematous disorders (4956), cardiac abnormalities (4338),pneumonoconiosis (2529), and malignant tumours (746).Two-thirds of the cases of tuberculosis were found in

Glasgow and four-fifths of the total in the four cities. Most ofthe active cases were found in younger women and older men.Nearly two-thirds of the active cases were in men.A supplementary survey carried out in Edinburgh on those

who did not cooperate in the original survey suggested that theprevalence of the disease may be higher among those notpresenting themselves for examination. The considerable costand effort involved in the supplementary survey was, however,not commensurate with the results achieved.

In England Now

A Running Commentary by Peripatetic Correspondents

NOTHING is more fascinating to us non-combatants, clutch-ing our Saturday sixpences in our hot little hands, than thespectacle of financial moguls clobbering each other a outrancewith bags of bullion. Living only for their work, to judge bytheir expense accounts, these warriors are a harassed and

battle-weary bunch, with one eye on Mr. Clore and the otheron the Director of Public Prosecutions, while the InlandRevenue’s hatchet-men breathe heavily down the backs oftheir necks. Never are they sure whether that sharp pain inthe wallet area is due to the impact of a take-over bid, or iscaused by one of the emboli which T.V. assures them arehurtling along their arteries like tube-trains in the rush hour.And now they, or anyway their ambitious understudies, arebedevilled by two sinister and omnipotent characters knownonly as " Roscoe " and " J.B.", whose assignment is to eat withthem in public and entrap them into vinous and gastronomicgaffes.

Chain-smoking so furiously that I could hear the tobacco-tarhissing as it dripped into his gastric ulcer, one Would-beDirector wept as he told me that whatever he ate in restaurants,be it a simple langouste de Méditerranée au Thermidor (becausethe baked beans were off) or spam and salad, he always foundhimself drinking Liebfraumilch B--e N-n, and it gave him thewaterbrash something terrible ...

In contrast, one of his colleagues has nightmares in whichRoscoe having demanded a boiled egg and old J.B. (nothingbut the best for old J.B.) ortolans au Roi Prédéric IX, the wine-waiter announces, " No B--e N-n in the joint, Mac., bettermake it three caffs." One has the impression that the GreyEminence J.B. and the omniverous Roscoe are foreign agentsseeking to undermine the confidence of British finance. If so,the Institute of Would-be Directors could now strike back byengaging a Young Doctor to sit in on all business lunches wherethese two are in action.Then when Roscoe clamours for sole paupiettes and J.B., the

awkward old so-and-so, rissoles (and let’s see him pick a wineto suit that lot) the Young Doctor would announce that

rissoles, on top of smoked salmon or whatever else old J.B. hadbeen previously doing his gastric mucosa no good with, wouldsend his blood-cholesterol up so high it could run a diesel....At this point the Would-be Director takes the trick by orderinga pot of tea for four and a plate of sicklies, thereby emergingfrom the contretemps with diminished blood-pressure andheightened reputation.

We had just completed examining the last candidates and aquick assessment of the results suggested a very small pass-list.However, a great many candidates were borderline and a reviewof their papers was obviously indicated. A motion to delayfurther consideration until post cibum was carried nem. con. andthe examiners adjourned to a neighbouring establishment forappropriate restoration of metabolic reserves. My colleaguesall supplemented their diet with moderate amounts of a liquidcapable of yielding calories on oxidation as well as producingcertain additional interesting effects; being teetotal I preferredto take a liquid with only solvent properties.When we began rescrutiny of the examination results

several candidates’ papers were now judged to be rather betterthan our earlier assessment had indicated and the marks could

justifiably be adjusted to permit a pass. In one case, however,I disagreed with my colleagues’ desire to raise the marks enoughto turn the scale until one of them in exasperation explainedmy stubbornness by the remark: " It’s that - water youdrink! " The candidate got his pass, but he certainly does notknow of the metabolic mechanism which led to it.

Question for study: What steps may be taken to ensure thatexaminers receive proper preparation for. their examinations ?