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Real yrs

Curriculum Vitae - Curriculum Mortis. 80. 70. 60. 50. Life expectancy. 40. 1956 born. 35 yr. 30. 1978 BA. 1982 DPhil. 20. 1998 Married. 18 yr. 2006 Gresham 35 th Pf Physic. 10. 0. Real yrs. 1956 yrs. Life and death in the new millennium.

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Real yrs

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  1. Curriculum Vitae - Curriculum Mortis 80 70 60 50 Life expectancy 40 1956 born 35 yr 30 1978 BA 1982 DPhil 20 1998 Married 18 yr 2006 Gresham 35th Pf Physic 10 0 Real yrs 1956 yrs

  2. Life and death in the new millennium • Where were the first improvements in health and longevity? • Why did life span double in Britain after 1800? What population processes? Which interventions? • Are we reaching maximum life expectancy? • Are "developing" countries actually developing?

  3. Gresham College"The Third Universitie of England" (1615) 1596 Matthew Gwinne, 1st Professor of Physic, Royal Physician, author of tragedy Nero 1608 "I ever have studied physic…by turning o’er authorities…" (Shakespeare, Pericles) 1647 Professors "so superbiously pettish…" 1720 Lectures "should not be… intermingled with exhortation…" 1799 Lecture in Latin at 12 noon, vernacular at 1pm 1904 WH Thompson (divinity) Nature and Immortality

  4. Terms of engagement • Health of humans in context of environment and evolution • Seeing is believing • Distinguish known versus unknown • Not just what happens but why • Ask scientific questions for which I have no answer • Focus on populations (epidemiology) rather than individuals (clinical)

  5. Q1. Where were the first major improvements in health and longevity?

  6. Industrial (r)evolution, health (r)evolution Life expectancy in England 1300-2000 80 Wrigley & Schofield Human Mortality Database 70 Clark 60 50 Life expectancy at birth (years) 40 30 20 1300 1400 1500 1600 1700 1800 1900 2000

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

  8. 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)

  9. Are humans more flexible than chimpanzees? 100 Wild chimps Captive chimps 80 60 Percent surviving 40 20 0 0 20 40 60 80 Age (years)

  10. Q2. What population processes caused life expectancy double in 150 years?

  11. Fundamental equation of population biology Population = + births change – deaths + immigrants - emigrants

  12. Elim-i-nate the negative, accen-tuate the positive

  13. Feedbackin health & population

  14. Industrial (r)evolution, health (r)evolution Life expectancy in England 1300-2000 80 Wrigley & Schofield Human Mortality Database 70 Clark 60 50 Life expectancy at birth (years) 500+ years of stasis → negative feedback 40 30 20 1300 1400 1500 1600 1700 1800 1900 2000

  15. 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

  16. Malthus in 16-17th century London? Poorer households had more child deaths 300 250 low income, high death rate 200 Infant mortality per 1000 births high income, 150 low death rate 100 8 London parishes 1538-1653 (Landers 1993) 50 0 10 20 30 40 50 60 Households with "substantial" taxable income (%)

  17. POSITIVE FEEDBACK

  18. Rapid increase → positive feedback

  19. John Graunt (1620-1674)Observations on… the Bills of Mortality 1662

  20. Causes of Death in the Bills of Mortality

  21. One death, one cause?

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

  23. Q3.What in(ter)ventions allowed life expectancy double in 150 years?

  24. 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

  25. 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)

  26. 3 Microbiology diagnostics vaccines drugs C17th C19th C20th 1890s

  27. Q4.Are we reaching maximum life expectancy?

  28. Q5.Are"developing" countries developing?

  29. William Gibson "The future is already here, it's just unevenly distributed"

  30. Human population in round numbers (2001) Population 6.2 billion Births 133 million Deaths 60 million Net growth 73 million 1.2% per yr Max growth 85 m in 1980s

  31. Fate of 100 boys born in different countries in 2001 100 Japan UK 80 India 60 Sierra Leone Russia Percent surviving 40 Zimbabwe 20 0 <1 5-9 15-19 25-29 35-39 45-49 55-59 65-69 75-79 85-89 95-99 Age class (years)

  32. Global distribution of afflictionscommunicable, non-communicable, injuries

  33. Where 60 million people die double burden of disease in low-income countries 8 Low-middle income High income 6 Deaths per million population 4 2 0 Communicable, Non- Injuries pregnancy, communicable nutrition

  34. Life expectancy is converging in low- and high- income countries 80 Low-middle income High income 70 60 Life expectancy (years) 50 40 30 1960 1990 2002

  35. Thomas Jefferson "Every generation needs a new revolution"

  36. Life expectancy gains and losses worldwide since 1960 10 1960-1990 8 1990-2002 1900-1950 6 4 1850-1900 Years gained per decade 2 0 -2 -4 E Asia S Asia Britain Eurasia Mid East SS Africa L America

  37. Chou En-lai Q: What has been the impact of the French revolution? A: "It's too early to tell"

  38. China: the short march to long life 85 78 1952 73 1975 75 71 69 2002 65 65 Life expectancy at birth (yr) 55 50 48 45 41 38 35 UK China Africa

  39. History of longevity • Human longevity - astonishingly plastic product of evolution life span x2 in Western Europe 1800-1950 • Escaping Malthus, the power of positive feedback from environmental to genetic control • Direct route to longer life nutrition → epidemiology (public health) → microbiology (diagnosis, drugs and vaccines) • Not underestimating… science, social institutions, capital, skilled labour

  40. "Developing" countries • Life spans range from hunter-gatherers to industrial but converging, with some exceptions • Cheap, effective technology to exploit +ve feedback outpaced the 1800-1950 revolution China and others since 1950 • Lagging countries suffer old problems and new "infection-malnutrition", now with chronic disease and AIDS; major reversals in E Europe & Africa • Technology only partly compensates for lack of science, institutions, capital, and labour

  41. William StewartUS Surgeon General 1969 "It is time to close the book on infectious diseases…"

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