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Population Health: Challenges for Science and Society

Population Health: Challenges for Science and Society. David Mechanic, Ph.D. Institute for Health, Health Care Policy and Aging Research Rutgers, the State University of New Jersey. 1 st Matilda White Riley Annual Lecture in the Behavioral and Social Sciences

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Population Health: Challenges for Science and Society

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  1. Population Health: Challenges for Science and Society David Mechanic, Ph.D. Institute for Health, Health Care Policy and Aging Research Rutgers, the State University of New Jersey 1st Matilda White Riley Annual Lecture in the Behavioral and Social Sciences National Institutes of Health Bethesda, MD May 22, 2006

  2. Exhibit 1 Presentation Outline • The importance of social selection – • role of selection in shaping health outcomes • Early influences on later disease • Broad social factors affecting population health • and social disparities • Intervention strategies

  3. 50 40 30 20 10 0 18-23 24-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+ Vietnam World War II Exhibit 2 Respondents’ Reports of WWII and Vietnam as Especially Important (By Age Group) % (107) (182) (143) (171) (109) (91) (90) (77) (91) (76) (62) (49) Source: Schumann and Scott, American Sociological Review, 54(3), June 1989

  4. Exhibit 3 Birth Weight and Coronary Heart Disease Hazard ratios (95% confidence intervals) for death from coronary heart disease according to birthweight and weight at 1 year in 10636 men born in Hertfordshire between 1911 and 1930, inclusive. Death from Coronary Heart Disease Weight (pounds (kg))Before 65 YearsAll Ages Birthweight ≤ 5.5 (2.5) (n=486) 1.50 (0.98-2.31) 1.37 (1.00-1.86) 5.5-6.5 (2.9) (n=1385) 1.27 (0.89-1.83) 1.29 (1.01-1.66) 6.5-7.5 (2.9-3.4) (n=3162) 1.17 (0.84-1.63) 1.14 (0.91-1.44) 7.5-8.5 (3.4-3.9) (n=3308) 1.07 (0.77-1.49) 1.12 (0.89-1.40) 8.5-9.5 (3.9-4.3) (n=1564) 0.96 (0.66-1.39) 0.97 (0.75-1.25) >9.5 (4.3) (n=731) 1.00 1.00 p for trend 0.001 0.005 1 year old ≤ 18 (8.2) (n=715) 2.22 (1.33-3.73) 1.89 (1.34-2.66) 18-20 (8.2-9.1) (n=1806) 1.80 (1.11-2.93) 1.58 (1.15-2.16) 20-22 (9.1-10.0) (n=3404) 1.96 (1.23-3.12) 1.66 (1.23-2.25) 22-24 (10.0-10.9) (n=2824) 1.52 (0.95-2.45) 1.36 (1.00-1.85) 24-26 (10.9-11.8) (n=1391) 1.36 (0.82-2.26) 1.29 (0.93-1.78) >26 (11.8) (n=496) 1.00 1.00 p for trend <0.001 <0.001 Source: Barker, Philosophical Translations of the Royal Society of London, 359(1449), September 29, 2004

  5. Exhibit 4 Growth Patterns and Coronary Heart Disease Mean Z scores for height, weight, and body-mass index in the first 11 years after birth among boys who had coronary heart disease as adults. The mean values for all boys are set at zero, with deviations from the mean expressed as a standard deviation (z scores). Adapted from Barker, et al., New England Journal of Medicine, 353(17): 1802-1809, 2005

  6. Exhibit 5 Father’s Social Class, Educational Attainment, and Social Class in Adulthood are Associated with Coronary Heart Disease in Adult Men+ No of cases/ Hazard ratios P value No of men(95% CI)for trend Infancy Fathers’ social class: Upper middle 20/449 1.00 0.0006 Lower middle 48/709 1.44 (0.86 to 2.43) Labourer 202/2258 2.01 (1.27 to 3.18) Education Level of Education: High 32/721 1.00 0.0001 Middle 111/1489 1.87 (1.26 to 2.77) Low 133/1373 2.25 (1.53 to 3.30) Adult Life (1980) Social class: Higher official 62/1247 1.00 <0.0001 Lower official 69/888 1.62 (1.15 to 2.28) Self employed 22/240 1.83 (1.12 to 2.97) Labourer 132/1301 2.15 (1.59 to 2.91) + Adapted from Barker et al., British Medical Journal, 323, no. 7324, December 1, 2001, page 1274

  7. Exhibit 6 The Link-Phelan Hypothesis of Social Class as a Fundamental Cause • Risk factors change over time but the social • class/mortality association remains robust • Social class is primarily associated with • mortality from preventable disease • Social class more important than cognitive • capacity in explaining mortality/morbidity

  8. Exhibit 7 National Longitudinal Mortality Study Percent Dying During 9 Year Follow-Up: Men and Women, 25-44 2 1.8 1.8 1.6 1.4 1.2 16+ Years 1 1 12-15 Years <12 Years 0.8 0.5 0.6 0.4 0.3 0.4 0.2 0.2 0 High Preventability Low Preventability Source: Phelan, Link, Diez-Roux, Kawachi and Levin, Journal of Health and Social Behavior, 45(3), 2004

  9. Exhibit 8 National Longitudinal Mortality Study Percent Dying During 9 Year Follow-Up: Men and Women, 45-64 9 8.2 8 16+ Years 7 12-15 Years 6 <12 Years 5 5 4.1 4 3 2.1 1.8 1.8 2 1 0 Low High Preventability Preventability Source: Phelan, Link, Diez-Roux, Kawachi and Levin, Journal of Health and Social Behavior, 45(3), 2004

  10. Exhibit 9

  11. Exhibit 10 Motor Vehicle Fatalities United States, 1966-2004 Fatalities 1966 50,894 1970 52,627 1975 44,525 1980 51,091 1985 43,825 1990 44,599 1995 41,817 2000 41,945 2004 42,636 Adapted from Highway Traffic Safety Administration, National Center for Statistics and Analysis, Traffic Safety Facts 2004, Table 2 (January 2006).

  12. Exhibit 11 Motor Vehicle Fatality Rates Per 100 Million Vehicle Miles Traveled United States, 1966-2004 Fatality Rate VMT per 100 million VMT(In Billions) 1966 5.50 926 1970 4.74 1,110 1975 3.35 1,328 1980 3.35 1,527 1985 2.47 1,775 1990 2.08 2,144 1995 1.73 2,423 2000 1.53 2,747 2004 1.44 2,963 Adapted from Highway Traffic Safety Administration, National Center for Statistics and Analysis, Traffic Safety Facts 2004, Table 2 (January 2006).

  13. Exhibit 12 International Comparison of Infant Mortality Rates - 2000 Infant Deaths/ 1,000 Live Births United States – white 5.7 United States – total 6.9 Some Other Countries Singapore 2.5 Hong Kong 3.0 Japan 3.2 Sweden 3.4 Finland 3.8 Spain 3.9 Czech Republic 4.1 Germany 4.4 France 4.6 US Rank: 27 Adapted from Health, United States, 2004, Tables 19 and 25

  14. Exhibit 13 Black-White Infant Mortality US, 1950-1995 • Absolute Absolute Reduction Reduction Percent White in Rate+ Black in Rate+ Disparity • 1950 26.8 --- 43.9 --- 64 • 1955 23.6 3.2 43.1 .8 83 • 1960 22.9 .7 44.3 (+1.2) 93 • 1965 21.5 1.4 41.7 2.6 94 • 1970 17.8 3.7 32.6 9.1 83 • 1975 14.2 3.6 26.2 6.4 85 • 1983 9.3 4.9 19.2 7.0 106 • 1985 8.9 .4 18.6 .6 • 1990 7.3 1.6 16.9 1.7 132 • 1995 6.3 1.0 14.6 2.3 132 • Total Absolute 20.5 29.3 • Reduction in • Rate, 1950-1995 + Per 1,000 Live Births Adapted from Health, United States

  15. Exhibit 14 Black-White Infant Mortality US, 1950-1998 Absolute Reductions in Rate per 1000 Live Births 10 White Black 8 6 Absolute Reduction in Rate 4 2 0 -2 1950 1955 1960 1965 1970 1975 1983 1985 1990 1995

  16. Exhibit 15 Total Mortality, United States, 1900-1995 14000 12000 10000 8000 Deaths per 100,000 Population 6000 4000 2000 0 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 Age: 75-84 65-74 55-64 From House and Williams, 2000

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