The health in later life of channel islanders exposed to the 1940-45 occupation and siege

Events during the Second World War resulted in a number of 'natural experiments' that have offered an invaluable opportunity for exploring the long-term impact of acute periods of deprivation on health in later life. Following the pioneering work by researchers examining the 1944-45 Dutch hunger winter and the 900-day siege of Leningrad (1941-1943), this Chapter presents ongoing research on a series of cohorts exposed to a period of chronic and acute deprivation that occurred contemporaneously on the British Channel Islands - the only part of the British Isles to be occupied by the Germans during the second world war. The 1940-45 occupation of the Channel Islands, which culminated in a 9-month siege following the Allied liberation of Normandy, involved both a gradual decline in the availability of food, fuel and essential supplies associated with the rationing and requisitioning of resources by the German garrison, but also a period of intense deprivation during the 1944-45 siege when the only supplies to reach the islands were delivered by the International Committee of the Red Cross in response to pleas from the beleaguered civilian administration. Official and anecdotal reports suggest that once the islands' economies had adapted to their change in circumstances, most islanders coped with the early stages of the occupation relatively well, relying on their savings, bartering, garden produce, foraging and ingenious recipes to cope with whatever food was available (including that available through the black market). However, the poor and those in urban areas with limited access to off-ration foods are reported to have struggled to cope even before the final phase of the occupation (the 1944-45 siege) when black market stocks had been depleted and there were limited supplies of off-ration foods available that were not subject to confiscation by the besieged German garrison. Indeed, many reports suggest that even the wealthiest members of society and those living in rural areas (whose produce was more systematically monitored by the German authorities) suffered substantial nutritional challenges during the siege. Drawing on this evidence of a similar pattern of chronic and acute deprivation to that found to be associated with health in later life by researchers on both the Dutch hunger winter and Leningrad siege studies, the Channel Islands Occupation Birth Cohorts Study set out to examine whether exposure to the occupation and siege might have a similar association with the health of this population. This Chapter describes the epidemiological analyses that have been conducted to-date to address this question. It draws on findings from three separate cohorts, linking data from multiple sources (including birth records, population registration documents, health care utilisation data and death notifications) to assess whether exposure to the occupation in early life was associated, in later life, with higher: blood pressure; blood glucose levels; total blood cholesterol concentrations; body mass index; rates of hospital admission for acute cardiovascular events; all-cause and/or cause-specific mortality; and rates of poor self-reported health. These analyses suggest that there is some evidence of an increased risk of metabolic dysfunction, elevated body mass index, hospital admissions for acute cardiovascular events, mortality and self-reported health, while the absence of an increased risk of elevated blood pressure or total blood cholesterol levels may partly reflect ongoing challenges associated with linking sufficient numbers of individuals across enough of the available datasets to generate samples for analysis that are sufficiently large and sufficiently well-specified to permit robust analysis. These challenges are being addressed in ongoing research which draws on the recently released 'permission to return' forms from Channel Islanders who were resident on the mainland during the occupation (either because they were away, left or were evacuated before the occupation began). These contain information that will help to better identify unexposed islanders who returned to live on the islands and unexposed individuals born during the occupation to islanders resident on the mainland. © 2013 by Nova Science Publishers, Inc. All rights reserved.