Psychiatric illness among British Afro-Caribbeans.

Abstract

Healthy citiesWe are concerned lest the letter by Drs F L R Williams and 0 H Lloyd (14 May, p 1399) deflects attention from the main aim of the Healthy Cities project, which is a major opportunity for health authorities, district councils, regional authorities, and all who work with populations in a social or medical context to come together to improve the health of the community.The aim is to achieve measurable reductions in morbidity and mortality.Populations exhibit considerable heterogeneity of lifestyle, and this allows the prospect of success in an international project."Health for all" is relevant to everyone, but comparison between large urban areas and small towns can be mis- leading.The interpretation of comparative health statistics for towns and cities of widely different populations requires caution.Professor Martin J Gardner and Mr Douglas G Altman (30 April, p 1210) emphasise the importance of giving confidence intervals when rates are reported.Excesses of mortality in small areas, therefore, may not mean what they seem.Even if a town is at the top of a league table once, or even twice, this may not be of significance.Drs Williams and Lloyd state that over the period 1979-83 Glasgow had an excess mortality (compared with Scotland as a whole) of 15%.This statistic conceals the fact that the 20% of the population of Glasgow living in the most dis- advantaged areas has an excess mortality of 48%, whereas the 20% living in the least disadvantaged areas has a standardised mortality rate 8% below that of Scotland.In fact, the most disadvantaged communities in Glasgow have standardised mortality rates up to 70% greater than those for Scotland.The publication of data for Glasgow as a whole, rather than for its constituent communities, obscures this fact.It is, therefore, inappropriate to compare cities the size of Glasgow with smaller communities without recognising such internal variations.

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