Wednesday, February 27, 2019

The cracking tale of two 'murders' by a bum that I know


I killed two chairs at Christmas. Not intentionally and not the leaders of my two least favourite committees. Both were made of wood.
The first murder occurred in a playground in our neighbourhood where, with friends from our street, we were enjoying a happy Christmas afternoon catch-up.
The chair was a wooden folder, in its senior years, and gave up when I went to sit on it. Fortunately, my landing strip was designed for falling children and with help I tottered to my feet, none the worse for wear save for the sad loss of a slice of delicious pavlova I had been cradling at the time of the crash.
The second chair murder occurred in the sitting room of a holiday rental in January by the sea. I attempted to stand up after watching too much wonderful tennis and the chair gave way, the rear legs splaying with a puff of bamboo dry rot, tipping me on to the floor and landing on the point of my right shoulder.
You can guess the rest; and now my infra and supraspinatus muscles are resting, with their tendons snapped, with nothing to do.
What to make of these ‘tragedies’?
First, they both happened extremely quickly. One moment I was okay and within a nanosecond I was sprawled. I suppose that is no surprise but, rather as with sudden cardiac death, the message is with falls that unless you prevent them well ahead of the provocative trigger, you have no hope.
Get rid of unsafe chairs, engineer hotspots out of our roads, and encourage smokers to quit.
But second, I wondered what kind of prevention algorithm I would need to avoid future chair murders. Should I check all wooden chairs that I encounter, test their legs and if they are folding chairs make sure the mechanism is clicking closed correctly? Rather boring and probably not practical.
And if I extended this principle to things other than chairs, would I have time in the day to do things other than all the preventive surveillance required?
Third, and a derivative of the second point, these two falls made me stop and consider what we might call the time-economics of prevention more generally.
I recall decades ago a conversation with a single mother from western Sydney who told me just how scarce her time was for anything beyond survival.
An early start to the day to get children fed and to school, then to work a full day to pay bills, home in the early evening to handle kids and household chores.
The attraction of takeaway food was overwhelming and there was no time for exercise. By dinner she was exhausted. Cigarettes provided comfort.
Time is at the heart of it all
Time — whether there is so little of it you can’t prevent a fall or a crash or a heart attack, or enough of it to satisfy so many competing demands on it — is a dimension of prevention.
For both reasons — at times too little, at times too heavy the competing demands — we should be sensitive to this ‘social determinant’ of health in our communications and plans for prevention.
It’s wise and humane not to ask people to do what’s impossible.
Oh, and don’t be like me: keep in mind the well-being of old chairs!


Professor Leeder is an emeritus professor of public health and community medicine at the Menzies Centre for Health Policy and School of Public Health, University of Sydney.

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Tuesday, February 19, 2019