Adrienne Willcox is a nurse, and wrote this whilst employed as a senior lecturer in community health at the University of Gloucestershire. Adrienne is undertaking a PhD into the concept of quality in the pre-travel health consultation.

HAVE YOU ever baulked at the cost of a yellow fever vaccination, worried about the possible side-effects of anti-malarial tablets or suffered “travellers’ diarrhoea” whilst abroad? The chances are that you have had these or similar concerns because most of us have traveled abroad before and will continue to do so in the future. This report provides a succinct overview of the issues surrounding the pre- and post-travel health of the UK citizen and points out how future policy and practice research could help to reduce the burden of human and financial costs incurred by travel abroad. The findings are the result of a collaborative project between The Foreign Policy Centre, Demos, The Nuffield Trust and Control Risks Group; the roles of these organisations are usefully outlined in the report, but they have in common the aim of highlighting the effects of globalization on public and individual lives.

Part One notes the rise in international travel and its impact on health, and recognises that we are travelling overseas more often than ever before. In 2002 UK citizens made 60 million trips abroad, more than one for every member of the population. There is a growing trend in travel to exotic and distant locations. The ability to transport ourselves to almost anywhere in the world within 24 hours results in up to 50 per cent of us becoming ill or injured whilst abroad. The demands of preventative, diagnostic and therapeutic care are having an increasing impact on the NHS. There are some proactive comments in the report such as “migrant flows to the UK are undoubtedly the major factor in the arrival of these diseases”, which perhaps deserve more sensitive explanation. “Migrant” is not a neutral word, nor does it present a common understanding. Of the 24 infections listed, many (such as HIV) are brought back by UK citizens returning after holidays or business travel, and others (such as salmonellosis) can result from the UK demand for foreign food trade rather than migration. The role of climate change, which the Department of Health predicts could lead to the re-introduction of malaria and the emergence of West Nile fever, is not mentioned. The point is brief but well made that the UK also plays a part in the spread of diseases and other health-related problems elsewhere.

Part Two examines the challenges for travel health advice providers in giving advice that is both sound and reaches the people who need it. There are many barriers to overcome in achieving this, and the report outlines these comprehensively. Travellers have misconceptions about the risks they face, and perhaps only 40-50 per cent seek any advice before travel. Travellers may also assume that other bodies, such as travel agents, tour operators or employers will take responsibility for health matters, and this point is nicely balanced with recognition of the need for individual responsibility throughout the report. Part Four develops this theme, advising that there can also be unintended consequences of travel health advice, including creating unreasonable expectations or false perceptions that risks can be eliminated. There are gaps in our knowledge base and research and faults in the delivery of information that is under or over cautious, or promotes only a negative message.

But who are “travel health advice providers”? Part Three rationally argues the case for developing networks between key stakeholders in the travel business – including conduits for the dissemination of health information such as insurance companies, airlines, specialist press and sports groups. The purpose of the visit, likely activities and the identity of the traveller should be taken into account if a strategic approach to health advice is to be achieved. This, arguably, is the model consultations, although the report is justified
in emphasising that comprehensive advice needs to be society-wide, and not only from top-down government or medical sources. However, the authors do refer consistently to the “local GP” or “doctor”, whereas most studies concur that practice nurses perform the majority of pre-travel health consultations in the UK. There should also be greater aware-ness of the roles of private travel clinics and occupational health units, which, like nurses, are not mentioned in the report. It is also anomalous that the work of the UK Foreign Office receives several paragraphs of attention but the Department of Health does not. The Foreign and Commonwealth Office (FCO) Consular Services leaflets are extremely useful on topics related to personal and legal safety abroad. They stress the need for UK travellers to take out comprehensive travel and medical insurance, and the Know Before You Go campaign is an excellent example of both strategic networking and a resource for individual travellers. The FCO does not venture into the area of specific health or vaccination advice for travellers as this is much more appropriate for the Department of Health. At practitioner level there does not seem to be much visible joined-up policy making between the FCO and the Department of Health, and the authors stress the need for this to be developed with the World Health Organisation. No mention is made of Department of Health initiatives such as the funding of the National Travel Health Network and Centre (NaTHNaC) whose aim is “protecting the health of British travellers”. The role of the Health Protection Agency is also omitted.

A 24-page report is bound to have some omissions in trying to address a complex and growing field of health issues succinctly. This, together with some rather dated and incomplete references, detracts from its impact. Nevertheless, reading Healthy Travel will provide a quick and useful overview of a global issue that has national, local and individual consequences. We are all likely to travel abroad – it is up to us as travellers, practitioners and policy makers to recognise the challenges addressed in this report.