Madam, - Your columnist Maurice Neligan clearly has a problem with epidemiology and some difficulty with the concept of public health. Over the past two years, he has used his Irish Times column as a vehicle for irritable carping on Ireland's efforts to reduce the toll of suffering and premature death due to smoking. Given that at least 25 per cent of heart attacks in Ireland each year can be attributed to smoking, this is a somewhat perplexing fixation for an eminent cardiac surgeon.
In his March 21st Heartbeat column he regales us with the spectre of epidemiologists "transmuting bullshit into airline tickets" and travelling the world to discuss "the myth of everlasting human life available to us if only we would do as we are told". At one level this is amusing polemic and is perhaps best ignored. However, there is a danger that readers will assume that Mr Neligan knows what he is talking about.
Epidemiologists study the distribution and causes of disease in the population and the effectiveness of health services. Public health practitioners apply the findings from epidemiological and related biological and social science research to highlight the determinants of health in the population and to work with others to create the conditions for a healthy society. Unfortunately, the majority of people on this planet, including a significant proportion of Irish people, do not enjoy the conditions of a healthy society. Those who suffer ill health and face early death due to society's aversion to prevention and neglect of public health systems do not aspire to everlasting life but would settle for a life expectancy close to that of the average Irish Times reader.
It may also be of interest to Mr Neligan that in Ireland coronary heart disease mortality rates fell by 47 per cent between 1985 and 2000. Thus in 2000 there were almost 4,000 fewer deaths from heart disease in Ireland than in 1985. Approximately half of this mortality reduction can be attributed to primary prevention, including favourable changes in smoking rates and average cholesterol levels in the population.
A small group of epidemiologists, public health practitioners and preventive cardiologists have worked hard and effectively in Ireland over several decades to prevent heart disease. Much has been achieved despite the deeply embedded reluctance to invest in prevention and fully engage with the wider public health agenda in the Irish health system.
Investment in new drugs and other forms of health technology alone will not adequately address the problem of heart disease or other major causes of death in Ireland. There is a need for clear-headed debate on the determinants of health in Ireland and priorities for our health system and wider society based on understanding and mutual respect between those who adopt public health and clinical perspectives on health and disease. - Yours, etc,
Prof IVAN PERRY, Department of Epidemiology and Public Health, University College Cork.