Golden Lecture of Prevention

1. Golden Lecture of Prevention Building a Global Prevention Network to Share Knowledge and Wisdom

2. Hygeia In Greek mythology The goddess of health. Hygiene –The science that deals with the preservation & promotion of health. September 19, 2003 Hippocrates Day This lecture is dedicated to a man who is currently recognized as the “father” of medicine. It’s because of his work, healers became doctors instead of sorcerers. Hippocratic oath is administered during the graduation ceremonies of all modern medical schools.

3. Objectives • To define prevention and highlight its importance in global health. 2. To discuss the importance of network in the context of the Supercourse and to begin to organize the internet based globalization for prevention 3. To distribute the golden lecture to 1 million faculty, students and professionals all over the world

4. Definition of Prevention “Actions aimed at eradicating, eliminating, or minimizing the impact of disease and disability. The concept of prevention is best defined in the context of levels, traditionally called primary, secondary, and tertiary prevention” A Dictionary of Epidemiology, Fourth Edition Edited by John M. Last

5. Public Health and Sanitation Achievements of the 20th century: • Improvements in hygiene practices • Improvements in food handling (refrigeration) • Improvement in Water and sewage treatment • Vaccination practices

6. Rising Life Expectancy Source: United Nations (U.N.) Population Division, Demographic Indicators, 1950-2050 (The 1996 Revision) (U.N., New York, 1996).

7. Prevention and Religion Washing Hands • Hands should be washed when one touches something polluted or unclean; likewise, before or after eating. • The Prophet, Peace Be Upon Him, said: “Whoever sleeps and his hands are not clean from fat and thereby gets harmed should blame no one but himself” • “The Prophet, Peace Be Upon Him, used to wash his hands before eating”

8. Historical Examples of Global Prevention Activities

9. Death rate for Tuberculosis, 1860-1960, United States, Source: US Bureau of the Census, Historical Statictics of the United States; Colonial Times to 1970 (Washington, D.C.:Government Printing Office, 1975), Part 1 pp58,63.  Note: Data between 1860 and 1900 for Massachusetts only. Koch identified tubercle bacillus Streptomycin introduced Vaccination available

10. The Sanitary Revolution and the Ascendancy of Public Health The sanitary revolution produced the greatest transformation in the pattern of disease that the world had known since nomadic hunter-gatherers settled in permanent villages, and ultimately developed modern urban industrial communities

11. Death Rates for Measles in Children Under Age 15, England and Wales, 1850-1970 Source: Thomas McKeown, The Modern Rise of Population (Academic Press, San Francisco, 1976), pp. 93, 96.

12. Diarrhea Malaria CHD CA TB Typhoid Epidemiologic Transition, MexicoDecline in Communicable, Rise of NCDs

14. Example of successful prevention program in CubaVACCINATION PROGRAM RESULT POLIO ELIMINATED SINCE 1962 DIPHTHERIA ELIMINATED SINCE 1969 NEWBORN TETANUS ELIMINATED SINCE 1972 CONGENITAL RUBELLA ELIMINATED SINCE 1989 MENINGITIS POST MUMPS ELIMINATED SINCE 1989 MEASLES ELIMINATED SINCE 1993 WHOOPING COUGHTRANSMISSION INTERRUPTED SINCE 1994 RUBELLATRANSMISSION INTERRUPTEDSINCE 1995 MUMPS TRANSMISSION INTERRUPTEDSINCE 1995 MORBIDITY MENINGOCOCCICAL DISEASE REDUCTION 93% TYFHOID FEVER REDUCTION 75% B HEPATITIS REDUCTION 52%

15. Introduction • Cervical cancer is the 2nd most common cancer among women globally • Higher cervical cancer mortality in developing countries due to lack of effective screening programs

16. Costs of malaria control Government-invests US $99,970/yr, protects 3.4 million people in transmission zone at $0.03 per head • Population blood surveys (surveillance) – 25% • Vector surveillance (strategic knowledge) – 12% • Case-management (disease-transmission control) -60% Community • US$4.18 cost per illness-casesincur 83% of cost (=10 days income; 1/3rd for drugs, >1/3rd due to lost income). • Govt pays 17% of cost per illnessand creates treatment system and case-management standards

17. Death Rates for Coronary Heart Disease by Country Men Ages 35-74, 1970 and 1993 (Rate/100,000) 750 FIN USA AUST SCOT NZ CAN 500 SING USSR 250 ITY SPN FRAN JPN HK CHN 0

18. Lifestyle Factors “Genes load the gun.Lifestyle pulls the trigger” Dr. Elliot Joslin

19. Relation Between CHD Events and LDL-C in Recent Statin Trials 30 2° Prevention 25 20 % with 15 1° Prevention CHD event 10 5 0 90 110 130 150 170 190 210 Mean LDL-C level at follow-up (mg/dL) PI=placebo; Rx=treatment .

22. Prevention and Internet: Internet “Epidemic” Number of Internet users (millions) Year

23. Teacher in Alexandria Teacher in Cairo Teacher in Pittsburgh Teacher in Tanzania Teacher in Paris Teacher in Moscow Methods: Supercourse model

24. Telepreventive Medicine Inexpensive Low to High bandwidth systems designed to reach large numbers of healthy people to prevent disease. Tele-Medicine Expensive High bandwidth systems designed to reach small numbers of sick people to cure disease.

25. Supercourse Lecture Growth

26. Conclusions Increased life expectancy in the past century was achieved through the improvement of sanitation and prevention Successful prevention in the past and in the future needs to be rooted in the networking of health professionals around the world to share their knowledge Internet based Information sharing is the key to prevention and a “golden” world

27. What is the future of prevention? • Globalization of Prevention • Networking of people in prevention • Sharing of data, knowledge and wisdom Please forward the Golden Lecture to faculty, students and health professionals in your country