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

1
Getting a lifelimits to health in the 21st
century
CHRISTOPHER DYE
Maximizing what? Controlling environment Controlli
ng 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)

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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
Life expectancy at birth (years)
10
40
8
30
6
20
Women
4
Men
10
2
Women - Men
0
0
1900
1920
1940
1960
1980
2000
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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
22
2 Public health "sanitation revolution"
John Snow (1813-1858)
Edwin Chadwick (1800-1890)
Sanitary Condition of the Labouring Population
of Great Britain (1842)
On The Mode of Communication of Cholera (1855)
23
3 Microbiology diagnostics vaccines
drugs
C17th
C19th
C20th
1890s
24
"Malnutrition-infection complex"
Fewer infections e.g. less diarrhoea
Better nutrition
25
but mostly not with drugs or vaccines
26
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
27
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
28
"Common consensus to invest in the future"
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Controlling genes and behaviour
30

• "I have set before you life and death, the
  blessing and the curse therefore choose life"
• Deuteronomy 3019

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Causes of obesitythe burden of personal choice
Source Parliamentary Office of Technology
(postnote) Sept. 2003
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THE (UNLIMITED?) POWER OF TECHNOLOGY
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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
37
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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
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Losing control?
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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

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Teenage mothers 2000
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Emerging and re-emerging zoonoses, 19962004
Cryptospporidiosis Leptospirossis Lyme Borreliosis
47
Apocalypse soon?

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

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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
1980
1985
1990
1995
2000
2005
1.1
49
"limit temperature increases from global warming
to 2-2.5C above the 1750 pre-industrial level"
Scientific Expert Group Report on Climate Change,
Feb 2007
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PERILS OF SOCIAL COLLAPSE Survival from age 45 to
70 in Sweden and Russia
Bobak, M. et al. BMJ 2004329767
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Getting a life
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"We suffer from the asymmetry between our
knowledge of nature and our knowledge of man,
between outside awareness and self-ignorance"
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How to live to 100... and enjoy itNew Sci 3 June
2006

• Go for the burn
• Don't be a loner
• Consider relocation
• Make a virtue out of a vice
• Exercise the grey cells
• Smile!
• Nurture your inner hypochondriac
• Watch what you eat
• Take a few risks

If I had known I was going to live this long I
would have taken better care of myself"H
Doernemann, aged 110
56
Getting a life

• Achievement of C18-C20 England was to control
  environment, preventing a few major causes of
  illness through nutrition and removing sources of
  infection
• - technology and its organized application
• Challenge of C21 is to control genes (technology)
  and behaviour (burden of choice)
• - while maintaining gains of C18-C20
• Development needs "a common consensus to invest
  in the future"
• ".balance individual and market freedoms with
  public leadership"