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Getting a life: limits to health in the 21 st century

Getting a life: limits to health in the 21 st century. CHRISTOPHER DYE. Maximizing what? Controlling environment Controlling genes & behaviour Losing control?. Maximizing what?. Industrial (r)evolution, health (r)evolution. Life expectancy in England 1600-2000. 80. Wrigley & Schofield.

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Getting a life: limits to health in the 21 st century

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  1. Getting a life:limits to health in the 21st century CHRISTOPHER DYE Maximizing what? Controlling environment Controlling genes & behaviour Losing control?

  2. Maximizing what?

  3. Industrial (r)evolution, health (r)evolution Life expectancy in England 1600-2000 80 Wrigley & Schofield 70 Human Mortality Database 60 Life expectancy at birth (years) 50 40 30 20 1600 1700 1800 1900 2000

  4. Long life, quality life?

  5. W Europe: causes of death 2002

  6. W Europe: causes of disability 2002

  7. W Europe: years of health lost

  8. HALE and hearty?

  9. Four qualities of life?Ruut Veenhoven

  10. HAPPY LIFE YEARS IN 1995-2005

  11. Reclaiming our health"Diagnosis – the most common disease" (K Kraus) • Sisi syndrome Depressed, but pretending to be active and positive about life (GSK) • Female menopause Hormones needed • Ageing male syndrome Cuts down men in their prime (Jenapharm) • Attention deficit syndrome Hippihop and the small white tablet (Novartis)

  12. Controlling the environment

  13. What limits good health?

  14. THE SPECTRUM OF LIFE SPANS From hunter-gatherers to… … Japanese women

  15. Evolution: "Nasty, brutish..." Survival of hunter-gatherers and Japanese 100 80 60 Percent surviving 40 20 Hunter-gatherers Japanese women 0 0 20 40 60 80 100 Age (years)

  16. Survival in England & Wales, 1840-2000 1.0 0.8 2000 0.6 Survival proportion 1840 0.4 0.2 0.0 0 5-9 15-19 25-29 35-39 45-49 55-59 65-69 75-79 85-89 95-99 Age class (years)

  17. Longevity in England & Wales Survival improved first in children then in adults 1.0 0.8 0-15 yr 0.6 Five-year survival 15-60 yr 0.4 60-80 yr 0.2 0.0 1840 1860 1880 1900 1920 1940 1960 1980 2000

  18. England: Increase in lifespan slowed after 1950 90 20 18 80 16 70 14 60 12 50 (years) Difference Women - Men 10 Life expectancy at birth (years) 40 8 30 6 20 Women 4 Men 10 2 Women - Men 0 0 1900 1920 1940 1960 1980 2000

  19. 1 Agriculture and nutritionelimination of famine in England (1) Agriculture Elimination of famine in England 14 Excess food only 20-30% pre 17th 12 century, with same fluctuation in yield 10 8 Number of famines each century 6 4 2 0 average 17th 18th 19th 20th pre-17th Centuries

  20. 2 Public health "sanitation revolution" John Snow (1813-1858) Edwin Chadwick (1800-1890) On The Mode of Communication of Cholera (1855) Sanitary Condition of the Labouring Population of Great Britain (1842)

  21. 3 Microbiology diagnostics vaccines drugs C17th C19th C20th 1890s

  22. "Malnutrition-infection complex" Fewer infections e.g. less diarrhoea Better nutrition

  23. but mostly not with drugs or vaccines

  24. Infectious causes of death in ICD-10 4 13/60m deaths in 2002 from infections 3 86% caused by top 5 Millions of deaths in 2002 2 1 0 Malaria Measles Tetanus HIV/AIDS Pertussis Diarrhoea Hepatitis B Meningitis* Tuberculosis STDs exc HIV Low respiratory Tropical diseases

  25. DIARRHEA: 1.8 MILLION DEATHS/YEAR methods for prevention and cure 5000 Cure 4000 Prevention 3000 Cost/year healthy life ($/DALY) 2000 1000 0 Latrines Water pump Oral rehydration Water & sanitation Cholera or rota vacc Breastfeeding promo

  26. "Common consensus to invest in the future"

  27. Controlling genes and behaviour

  28. "…I have set before you life and death, the blessing and the curse; therefore choose life…" Deuteronomy 30:19

  29. Causes of obesity:the burden of personal choice Source: Parliamentary Office of Technology (postnote) Sept. 2003

  30. THE (UNLIMITED?) POWER OF TECHNOLOGY

  31. When will life expectancy reach 100? 100 90 80 Life expectancy at birth (years) 70 Japan USA 60 Sweden UK UK projected 50 1950 2000 2050 2100

  32. Fixing the faults of old age?"in the end costs exceed benefits" "…as each life-limiting process is countered, some other process will become limiting" Doug Wallace U California

  33. Losing control?

  34. Thomas Robert Malthus1766-1834 Principle of Population (1798) population, if unchecked, increases geometrically 2, 4, 8, 16, 32, 64, 128… but food supply grows arithmetically 1, 2, 3, 4, 5, 6, 7, 8… so population outruns food supply

  35. Teenage mothers 2000

  36. Ebola and CCHF Influenza H5N1 Hantavirus Lassa fever Monkeypox Nipah Hendra NV-CJD Rift Valley Fever SARS CoV VEE Yellow fever West Nile Brucellosis E Coli O157 Multidrug resistant Salmonella Plague Emerging and re-emerging zoonoses, 1996–2004 Cryptospporidiosis Leptospirossis Lyme Borreliosis

  37. Apocalypse soon? • Unavoidable transmission route • Highly infectious • High proportion of people exposed • Transmission rapid compared with response time (everyone gets infected before knowing) • Fatal

  38. 12 1 3 4 5 8 9 6 14 15 16 7 10 2 13 25 years of AIDS People living with HIV 50 9 In 1991-1993, HIV prevalence in young pregnant women in Uganda and in young men in Thailand begins to decrease 45 Million 40 1 Immune deficiency in gay men in USA 2 Acquired Immune Deficiency Syndrome (AIDS) is defined 35 10 Highly Active Antiretroviral Treatment launched 3 The Human Immune Deficiency Virus (HIV) is identified as the cause of AIDS 30 11 HIV infected in 2005: 40 million Died in 2005: 3 million Total deaths: 25 million Children orphaned by AIDS in sub-Saharan Africa 25 4 In Africa, a heterosexual AIDS epidemic is revealed 20 8 The first therapy for AIDS – zidovudine, or AZT -- is approved for use in the USA 15 10 5 0 2005 1980 1985 1990 1995 2000 1.1

  39. "…limit temperature increases from global warming to 2-2.5°C above the 1750 pre-industrial level…" Scientific Expert Group Report on Climate Change, Feb 2007

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