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Fat is favourite

Despite the known association between consumption of saturatedfat and cardiovascular disease, high-fat diets remain popular; giventhe choice, most people consistently eat 35-40% of their energy asfat. According to Mela,’ this preference is not explained onnutritional grounds, since the need for fatty acids and fat-solublevitamins can be satisfied by diets that are very low in total fatcontent. Nor is it clear whether preferences for fat are innate orlearned. Texture preferences are unlikely to be innate, says Mela,because the capacity to discriminate textures, though sensitive, is aresponse to non-specific mechanical and frictional forces in themouth. He also points out that the notion that fat-associated aromasmight be innately preferred is flawed because these aromas tend tobe unique to individual foods-it is difficult, for example, to identifyan aroma common to cream, deep-fried foods, and cooked meat.Preferences for fat flavours, Mela suggests, are more likely to belearned responses, linked to the energy content (satisfactionpotential) of the food. If Mela is right, food technologists face adifficult challenge in trying to make low-calorie fat substitutesacceptable to consumers.

1. Mela DJ. The basis of dietary fat preferences. Trends Food Sci Technol 1990; 1: 71-73.

Renaissance of public health?

In a new publication1 commemorating the death of the Victoriansanitary reformer Sir Edwin Chadwick, Dr Charles Webster callsfor a renaissance of public health activity and argues for theresurgence of a high-profile public health service. Webster, anauthority on 17th century medicine and official historian of theNational Health Service, regards a shortsighted those who arecontent to regard the past as being merely of antiquarian interest.The Victorians built the infrastructure of sewers upon which westill depend. They established facilities for the safe disposal of thedead and erected model housing for the living. Our centuryinherited from them administrative machinery to oversee safesewage disposal separate from fresh water supply, the protection offoodstuffs from infection and adulteration, the control of noxiousand dangerous industries, and the prevention and containment ofepidemics.

In the present century impetus for further reform was lost, andthe establishment of the National Health Service and its subsequentreorganisations have done little to revive it. Recent recognition ofthe dangers of modem food production and processing techniques,of environmental pollution, and of the contamination of drinkingwater has rudely awakened those who thought Victorian provisionadequate to modem needs. The need to improve the physicalenvironment, to tackle widening health inequalities, and to increasethe emphasis on health promotion and education all point to the

Illustration trum I’trmlr. IS32

necessity for expansion of current provision. The challenges ofintegrating prevention, care, and cure remain with us. TheVictorian public health legacy, Webster argues, should be used tochallenge and inspire a society dependent upon its now collapsingsewers.

Niggardly official responses to the Black report and its practicalrecommendations stand in direct contrast to Government views inVictoria’s era. In 1871 the Royal Sanitary Commission observed:"The constant relation between the health and vigour of the peopleand the welfare and commercial prosperity of the state requires noargument. Franklin’s aphorism, ’public health is public wealth’, isundeniable." Webster, in this commemorative bookletcommissioned jointly by the Institution of Environmental HealthOfficers and the Public Health Alliance, searches in vain for such anappraisal in current Government thinking and calls for medical andpublic opinion to redress the situation. Our own era has much tolearn from the vitality of Victorian values.

1. Webster C. The Victorian public health legacy, a challenge to the future. 1990. Pp 18.£5. Available from the Public Health Alliance, Room 204, Snow Hill House, 10-15Livery St, Birmingham, B3 2PE, UK

2. Department of Health and Social Security. Inequalities in health. Report of a researchworking group London: Department of Health, 1990.

Drug abusers in prison

By the very nature of its illegality, the present drug-abuse epidemichas led to a substantial increase in the proportion of the prisonpopulation who are drug addicts. In the UK during the second halfof the 1980s around 4000 people per year received custodialsentences for drug-related offences, double the number sentencedat the beginning of the decade.’ In parts of the USA the situation isworse: of the 40 763 prison inmates in New York State at the end of1987, over half were in jail for drug-related offences The strain onprison health services is considerable, a problem furtherexacerbated by the number of drug abusers who are HIV positive. AWorld Health Organisation publication2 examines the methodsused to identify drug abusers on admission to prison and health-careprovision for drug-abusing inmates. It also looks at the ethics oftreating, against their will, people who are incarcerated; and systemsof non-voluntary treatment in France, Germany, Sweden, and theUSA are described, with that in the USA said to be of some value.Other issues discussed include the particular health problems ofdrug abuse, such as AIDS and suicide.Few would argue with the report’s recommendation that

health-care services in prisons should compare to those enjoyed bythe general population. However, the suggestion that condoms bedistributed to inmates to limit the spread of AIDS (along withimproved anti-AIDS education) will not be universally applauded.The squalid state of many British prisons is probably not widelyknown outside the UK. The report adds to the country’sembarrassment by citing the UK as a particular example ofovercrowding and poor hygiene causing health problems for

drug-abusing inmates.

1. Statistics of the misuse of drugs: seizures and offenders dealt with, United Kingdom,1989. Home Office Statistical Bulletin no 24/90. Price £2 50. ISSN 01-436384.Obtainable from the Statistical Department, Lunar House, Croydon, Surrey CR09YD, UK.

2. Drug abusers in prisons. WHO Regional Publications, European series, no 27, 1990.Price Sw fr 10. Pp 52. ISBN 9-289011181. Obtainable from WHO Distributionand Sales, 1211 Geneva 27, Switzerland (order no 1310027) or by post from HMStationery Office Books Publication Centre, 51 Nine Elms Lane, London SW185DR, UK.

Obstetrics at The Royal London HospitalThe department of obstetrics at The Royal London Hospital willnow be divided into two sections--one hospital and one

community-as advocated by The Lancet (see Dec 23/30, 1989,p 1492). Dr Vythilingam Sivapathasundaram has been appointedconsultant obstetrician to assist Mrs Wendy Savage in the

community obstetrics action. Prof J. G. Grudzinskas remains headof the hospital section.