FEEDBACK LETTER OF THE WEEK

Published: 02/12/2004, Volume II4, No. 5934 Page 22

Raj Persaud, consultant psychiatrist, South London and Maudsley trust and Gresham professor for public understanding of psychiatry

The public health white paper (news, pages 5-6, 18 November) is much more significant than the media realises, because it marks a turning away from hospitals as the tools for improving health and a new interest in what really impacts on public health - widespread population behavioural changes.

But the white paper does not ask the crucial question of why so many do not seem to be motivated to look after their own health. It is this neglect of mental variables and a continued addiction to the physical that renders this white paper scientifically oldfashioned - as illustrated by the famous 'Roseto effect'.

Roseto, an Italian-American community in Pennsylvania, was studied in the 1950s and 1960s by cardiologist Stewart Wolf. He observed that heart attack rates in the community were about 50 per cent lower than in four surrounding communities, in spite of having a similar levels of fat intake, smoking and exercise.

The striking feature of the town was the close-knit social relations, family and religious traditions and intraethnic marriages.

It is intriguing to contrast that with Framingham, the US town selected for studies that established the risk factors for future heart disease. But did the investigators stumble upon a population that experiences such a low degree of emotional and social stress that the only risk factors likely to emerge would have been physical?

The white paper's plans to introduce screening programmes, give out vouchers for fresh fruit and vegetables to disadvantaged pregnant women and restrict the advertising of unhealthy foods and drink to children indicate that, at last, the government is getting past its obsession with waiting lists.

But it also reminds us that it still continues to neglect the profound role our minds play in the state of our bodies.