Mecanismos de comunicación directa:

May’s (1993) claim, cited in Blaxter et al (2001:207) that documents “...do not

examine the four key official sources of travel health guidance examined in this

study.

The UK document, published by the DH at a time of devolution to Scotland and

Wales, hasthe Chief Medical Officers of all four UK countries as signatories to this

text. Such consensus was not always apparent in health care policy and practice,

e.g. the Department of Health for England produced Essence of Care in 2001 (DH,

2001b), but Wales produced a very similar document, Fundamentals of Care,

under its own auspices in 2003 (Welsh Assembly Government, 2003).

All four documents note the social context of increased global travel as a stimulus

for their guidance. The Canadian document goes further, implying medico-legal

issues as a driving force for their production: the guidelines were written in

response to there being “...no general travel medicine practice

guidelines...available”; and also because of “Concerns about the quality of advice

provided to Canadian travellers...”, including practitioners who are ill-equipped,

out of date, and incorrect: the consequences of which have included deaths

(CATMAT, 1999:2). This stance is in keeping with western trends to challenge

orthodox medicine standards, yet does not seem ready to acknowledge the role

and responsibility of the traveller, or to be yet aware of the main risks to travellers’

lives abroad (pre-existing conditions, accidents), of which tropical and infectious

diseases play a relatively small part. The other documents do recognise the

traveller as bearing some responsibility for their own health, although the

emphasis is still on their responsibility to consult a doctor prior to travelling. Other

means of educating themselves to manage their own health are not well

addressed in any document, nor is the concept of the patient possibly being an

experienced traveller given credence. The traveller is a ‘blank slate’, requiring

The Canadian and UK guidance pre-dated SARS and avian influenza alerts, and

also the global rise in terrorist activities, the advent of which is commonly noted to

be the attacks on New York and Washington on September 11th 2001. The WHO

and US guidance was published later, but only the US guidance makes brief

reference to such risks.

All documents give the clear impression of being written for travellers from

industrialised western nations. While this is understandable – they were compiled

for health professionals within such countries – there are some issues arising out

of such a specific social lens.

Firstly, the original Canadian Guidelines for the Practice of Travel Medicine

(CATMAT, 1999) was supplemented by the document, Statement on Ethics and

Travel (CATMAT, 2003) because it is of direct relevance to the processes that

occur within the pre-travel health consultation. This eight-page statement outlines

in some detail how the growth of travel and tourism has impacted both positively

and negatively on the well-being of host cultures and environments. Its publication

occurs within a social context that is witnessing a groundswell of western

awareness of ecological issues, which can be evidenced elsewhere in the

literature (Pattullo and Minelli, 2006).

CATMAT (2003) states that part of the pre-travel health consultation should be the

education of travellers about their impact on the host nation, providing them with

an “...ethic that will ensure preservation of the host culture and its environment...”

(p.3). This is the main recognition of global travel having a two-way impact – not

host nation can be damaged – environmentally, culturally and health-wise – by

western travellers.

Secondly, although all documents make brief mention of the needs of returning

travellers, this is not a prominent topic. The documents do not adequately address

the concept of post-travel ill health in returning travellers, or indeed the health of

migrant workers travelling to a western nation (Table 7). The emphasis is always

on the health of the citizen leaving their home nation to travel, and yet the flip side

of the coin is that any traveller coming back to – or to a country for the first time –

may be hosting non-indigenous infections and health problems. A sense of an

incomplete circle of health care is given out by the emphasis on pre-travel

prevention without due regard to post-travel management of health and illness.

The political context of the documents is also worthy of note. The Canadian

document was produced by a recognised advisory committee to the Assistant

Deputy Minister, Health Protection Branch, Health Canada – so it is an

authoritative document, but is received at a moderate hierarchical level in the

government health department. This is in keeping with UK documentation,

whereby travel health issues do not feature highly in overall health agendas.

There is a divide between DH guidance, focusing on infectious risks, and FCO

guidance, focusing on socio-political risks to travellers’ safety. In contrast, the

WHO and US documents stem from bigger departments that give an impression

of a much more integrated approach to placing travel on their respective health