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

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Ageing male syndrome. Cuts down men in their prime (Jenapharm) Attention deficit syndrome ... Exercise the grey cells. Smile! Nurture your inner hypochondriac ... – PowerPoint PPT presentation

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Title: 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)

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
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
19
(No Transcript)
20
(No Transcript)
21
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"
29
Controlling genes and behaviour
30
  • "I have set before you life and death, the
    blessing and the curse therefore choose life"
  • Deuteronomy 3019

31
(No Transcript)
32
Causes of obesitythe burden of personal choice
Source Parliamentary Office of Technology
(postnote) Sept. 2003
33
(No Transcript)
34
THE (UNLIMITED?) POWER OF TECHNOLOGY
35
(No Transcript)
36
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
(No Transcript)
38
(No Transcript)
39
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
40
(No Transcript)
41
Losing control?
42
(No Transcript)
43
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

44
Teenage mothers 2000
45
(No Transcript)
46
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

48
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
50
(No Transcript)
51
(No Transcript)
52
PERILS OF SOCIAL COLLAPSE Survival from age 45 to
70 in Sweden and Russia
Bobak, M. et al. BMJ 2004329767
53
Getting a life
54
"We suffer from the asymmetry between our
knowledge of nature and our knowledge of man,
between outside awareness and self-ignorance"
55
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"
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