First cousin marriages: a public health issue?

In 2002, 42.2 per cent of all births in Bradford were to families of Pakistani origin, and a further 5.8 per cent were to others from the Indian subcontinent. The incidence of deafness amongst Asian children in Bradford is 4.60/1000 (compared with 1.38/1000 amongst non-Asian children). For cerebral palsy the incidence amongst Asian children is 5.48/1000 - which compares with 3.18/1000 amongst non-Asian children. It is estimated locally that 75 per cent of the cases involve parents who have a consanguineous marriage.

Seen in isolation, the numbers at stake for any one particular illness or condition may seem irrelevant but, taken together, a more serious picture emerges. Bradford Royal Infirmary has identified 138 different autosomal recessive disorders, and has become a centre of excellence as a result of the experience it has gained from caring for such a disproportionately high number of cases.

If someone chooses to have unprotected sex, drink alcohol, eat greasy food and smoke cigarettes then they are aware of the risks - there is a greater chance of catching HIV (human immunodeficiency virus) or Chlamydia, and suffering from liver damage, obesity and lung cancer. Through public awareness programmes and education, people are actively discouraged from taking such unnecessary risks and adopting a healthy lifestyle. At the end of the day, it is up to the individual to make the choice - but they are given the opportunity to make that choice from an informed position.

Public health programmes are not solely for the benefit of the individual - they are also for the benefit of the wider society. Prevention is better - and cheaper - than cure. The NHS is one of our greatest assets and everyone can expect the best of care whatever their problem, but it does not have unlimited resources. If we were able to reduce the number of people who were dependent on increasingly expensive combination therapy to hold HIV at bay, we could spend more on research to find a cure. The more we save on combating liver or lung cancer or on palliative care, the more we can direct towards finding a cure for cancer. The more people we persuade to avoid taking a risk that might prejudice their well-being, the greater the chance of a better, longer life. For the sake of the individual and for wider society - we must not be afraid to address these issues.

The majority of first cousin marriages involve a husband or wife coming from the Indian subcontinent. Literacy amongst women in Mir Pur - from where the vast majority of the Pakistani community in the Bradford District originates - is about 3 per cent. Are those families given the chance to make an informed decision with regard to family planning? Do they understand the risks that are involved in having children from a consanguineous marriage?

Not only do we have to deal with the problem of illiteracy but we must tackle our own inhibitions and move away from political correctness. Anyone who seeks to excuse the passing on of terrible illness due to cultural traditions needs to know that that sort of culture is unacceptable in the twenty first century.

We owe it to parents, families, the unborn children and society as a whole to have the courage to openly discuss this issue as a relevant and important public health matter.