Papers
Maggie Mort, Ian Convery, Josephine Baxter, Cathy Bailey
Objectives To understand the health and social consequences of the 2001 foot and mouth disease epidemic for a rural population. Design Longitudinal qualitative analysis. Setting North Cumbria, the worst affected area in Britain. Sample Purposive sample of 54 respondents divided in six demographically balanced rural occupational and population groups. Main outcome measures 3071 weekly diaries contributed over 18 months; 72 semistructured interviews (with the 54 diarists and 18 others); 12 group discussions with diarists Results The disease epidemic was a human tragedy, not just an animal one. Respondents’ reports showed that life after the foot and mouth disease epidemic was accompanied by distress, feelings of bereavement, fear of a new disaster, loss of trust in authority and systems of control, and the undermining of the value of local knowledge. Distress was experienced across diverse groups well beyond the farming community. Many of these effects continued to feature in the diaries throughout the 18 month period. Conclusions The use of a rural citizens’ panel allowed data capture from a wide spectrum of the rural population and showed that a greater number of workers and residents had traumatic experiences than has previously been reported. Recommendations for future disaster management include joint service reviews of what counts as a disaster, regular NHS and voluntary sector sharing of intelligence, debriefing and peer support for front line workers, increased community involvement in disposal site or disaster management, and wider, more flexible access to regeneration funding and rural health outreach work.
The United Kingdom’s foot and mouth disease epidemic in 2001 has been described as the most serious ever to occur in a country previously free of the disease1 and “a traumatic and devastating experience for all those who were affected by it . . . a national crisis . . . probably one of the greatest social upheavals since the war.”2 Between 6.5 million and 10 million animals were slaughtered across the UK, and in north Cumbria 893 farms had confirmed infected cases, with a further 1934 having complete or partial culls of livestock, representing 70% of farms.34 Restrictions on public rights of way and advice to stay away from the countryside led to a collapse in tourist numbers and loss of recreational use of the landscape for a year.5
In the spring of 2001, the BMJ asked how health services were responding to the crisis.6 Immediate concerns centred on zoonosis,7 and public health clinicians raised concerns about the use of large pyres and mass burials for animal carcass disposal.8 Some contributors called for examination of the anxiety, stress, and other mental health consequences which they believed must follow:9 “at best, major stress and anxiety states; at worst, suicide and its consequences for families. Are these not ‘human consequences’, and indeed public health matters?”10 One correspondent reported that the (then) health authority in the worst affected area had been only “peripherally involved,” and called for a greater public health role in managing the disaster.11
Crucially, because the epidemic was treated as an animal problem, managed by the Ministry of Agriculture, Fisheries, and Food (later Department for Environment, Food, and Rural Affairs, DEFRA), the human tragedy was not accounted for or understood. The epidemic was held to be something affecting farmers, ignoring the large numbers of other occupations and residents drawn into the crisis