Life expectancy trends

Life expectancy trendsLife expectancy: Scotland & other Western European Countries, 1851-2005

Source: Human Mortality Database

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

1851

-185

3

1855

-185

7

1859

-186

1

1863

-186

5

1867

-186

9

1871

-187

3

1875

-187

7

1879

-188

1

1883

-188

5

1887

-188

9

1891

-189

3

1895

-189

7

1899

-190

1

1903

-190

5

1907

-190

9

1911

-191

3

1915

-191

7

1919

-192

1

1923

-192

5

1927

-192

9

1931

-193

3

1935

-193

7

1939

-194

1

1943

-194

5

1947

-194

9

1951

-195

3

1955

-195

7

1959

-196

1

1963

-196

5

1967

-196

9

1971

-197

3

1975

-197

7

1979

-198

1

1983

-198

5

1987

-198

9

1991

-199

3

1995

-199

7

1999

-200

1

2003

-200

5

Portugal

Scotland

Trends in male life expectancy: Scotland

Richest 20%

Poorest 20%

World Health Organization (1997 and 2003)

www.heartstats.org

Prevalence of smoking by country, in 15 year olds by sex, 2000/01, Europe

0

5

10

15

20

25

30

35

40

45

50

Ukraine

Lith

uania

Ger

man

y

Eston

ia

Slove

nia

Czech

Repu

blic

Latvi

a

Finlan

d

Hungar

y

Russia

n Fede

ratio

n

Austri

a

Franc

e

Polan

d

Switzer

land

Spain

Belgiu

m -

Flemish

spe

aking

Croat

ia

Nether

land

s

Belgiu

m -

Frenc

h sp

eakin

gIta

ly

United

Kin

gdom

- Eng

land

Irelan

d

Norway

Portu

gal

Denm

arkIs

rael

Malt

a

United

Kin

gdom

- Sco

tland

United

Kin

gdom

- W

ales

Mac

edonia,

FYR

Gre

ece

Sweden

% r

egu

lar

smo

kers

Boys

Girls

Smoking prevalence - Males

Males

Smoking prevalence - Females

Females

Income deprivation - LiverpoolLiverpool LSOAs: income deprivation distribution

Source: DWP

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

Total city: 24.6%

Income deprivation - GlasgowGlasgow merged DZs: income deprivation distribution

Source: GCPH, based on SIMD/DWP data

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

Total city: 24.8%

Standardised mortality rates by cause, all ages: Glasgow relative to Liverpool & Manchester

All ages, both sexes: cause-specific standardised mortality ratios 2003-07, Glasgow relative to Liverpool & Manchester, standardised by age, sex and deprivation decile

Calculated from various sources

112.2 111.9126.7

248.5

131.7

168.0

229.5

0

50

100

150

200

250

300

350

All cancers(malignantneoplasms)

Circulatory system Lung cancer External causes Suicide (inc.undetermined intent)

Alcohol Drugs-relatedpoisonings

Sta

ndar

dise

d m

orta

lity

ratio

Source: Walsh D, Bendel N., Jones R, Hanlon P. It’s not ‘just deprivation’: why do equally deprived UK cities experience different health outcomes? Public Health, 2010

All cause mortality males 15-44

Cirrhosis mortality males 15-44

Workers in the 1950s

Alvin Toffler – Future Shock 1970 “To survive, to avert what we have termed future

shock, the individual must become infinitely more adaptable and capable than ever before. We must search out totally new ways to anchor ourselves, for all the old roots - religion, nation, community, family, or profession - are now shaking under the hurricane impact of the accelerative thrust.

Aaron Antonovsky 1923-1994

“.....expresses the extent to which one has a feeling of confidence that the stimuli deriving from one's internal and external environments in the course of living are structured, predictable and explicable, that one has the internal resources to meet the demands posed by these stimuli and, finally, that these demands are seen as challenges, worthy of investment and engagement."

Sense of coherence....

For the creation of health....

....the social and physical environment must be:

Comprehensible Manageable Meaningful ......or the individual would experience

chronic stress

“A child who lacks a sense of coherence interprets all the events around him as noise not as information. This he finds very stressful”

Antonovsky

00-046

-1.2

-1

-0.8

-0.6

-0.4

-0.2

0 10 20 30 40 50

Months of Orphanage Rearing

*linear trendline

Evening Cortisol Levels Increase withMonths of Orphanage Rearing *

The Founders’ Network

STRESS AND GRADE OF EMPLOYMENT: MEN

Salivary Cortisol

Time of DaySteptoe et al. 2003, Psychosomatic Medicine, 65, 461-470

Depcat % smokers Never-smokers Smokers

1 36.8 0.71 1.42

2 35.9 1.00 2.34

3 39.1 1.11 2.25

4 44.1 1.21 2.44

5 46.6 1.13 2.53

6 49.3 1.25 3.07

7 55.5 1.48 3.29

Environmental determinants of inflammatory status

CRP (median) mg/dl

affluent

deprived

Inflammation in plaques

Inflammatory cells

MMPs, IL-6, IL-15, IL-18, CRP

Lumen

Core

Cap

Thin Fibrous Cap

InflammatoryCells

SMC apoptosis

Degradedmatrix

Unstable

cytokines MMP

0

1

2

3

4

5

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5

Q1 : <0.66 mg/l

Q5: > 4.18 mg/l

Years in study

% diabetic

CRP and cumulative risk of type 2 diabetes

Freeman et al. Diabetes 2002,51;1596

Adipocyte programming insulin resistance, inflammation and ALP

Adipose stores

NEFAs

liver

CRPSAA

IL-6/IL-6sR

TNF- / aTNF- a sR-I

triglyceride

Low HDLsmall LDL

AtherogenicLipoproteinPhenotype

Pro-inflammatorystate

skeletal muscleInsulin resistance

Persistence hunting

Adding insult to injury…….

The molecular biology of a cuddle

Attachment theory

Ainsworth Deep emotional connection that infant develops with

primary caregiver Reflects an “internal working model”expressing the

infant’s expectations of parental behaviour in meaningful situations

Basis for development of later relationships Increasingly recognised as determinant of later emotional,

cognitive and social outcomes

Adverse childhood events study

Physical/sexual/emotional abuse Neglect (physical/emotional) Domestic substance abuse Domestic violence Parental mental illness Parental criminality

Adverse childhood events risk of alcoholism

Hillis et al 2011

Adverse childhood eventsrisk of perpetrating violenceBoys experiencing physical abuse

Duke et al 2010

Risk of heart disease and early adversity

The Dunedin cohort

1000 children recruited in late 1972/3 At age 3, “at risk” children identified on the basis of

chaotic circumstances, emotional behaviour, negativity and poor attentiveness

As adults, those “at risk” were more likely to : be unemployed have criminal convictions (especially for violence) been pregnant as a teenager have a substance abuse problem exhibit signs of insulin resistance and metabolic syndrome

Creating wellbeing

Sense of coherence

Seeing the world as:StructuredPredictable

Feeling that it is:ManageableMeaningful

Wanting to engage

Generalised resistance resources

Family Intelligence

WorkMaterialIdentity

Cultural stabilityOptimism

Stable set of answers

Events

Stress

Resolution

Wellbeing

Do social conditions determine the incidence of disease? For centuries they have and they still do in

the developing world–Plague, leprosy, polio, diphtheria,

typhoid, tuberculosis–BUT in the developed countries

It is mainly our physiological response to social conditions which largely determines our risk of chronic ill health

Health Deficits approach Focuses on problems, needs and

deficiencies in a community such as deprivation, illness and health damaging behaviours. It designs services to fill the gaps and fix the problems. As a result, communities can feel disempowered. People become passive recipients of services rather than active agents in their own lives

Social connectedness 148 studies comprising 308,849

participants, high levels of social integration conferred a 50% increased likelihood of survival.

Complex patterns of social integration conferred a 90% increase in survival.

Simple indicators such as living alone versus living with others conferred a survival benefit of only 19%.

Health Assets

A health asset is any factor or resource which enhances the ability of individuals, communities and populations to maintain their health and sustain wellbeing. The assets can operate…as protective and promoting factors to buffer against life’s stresses

Morgan 2009

Alienation and Frankenstein

"I came across people, other beings which I could see were almost like myself. Or so I thought at first when I approached them, though, I found that they did not consider me as one of their own kind. As soon as they saw me, their faces became twisted with fear. They shouted at me and threw things and ran away from me, just as my own maker had done. So this is what I learned about myself - that I was a disgusting creature. Even though I had given them no cause, all men hated me."

The pathology of poverty

24th European Congress of Pathology

Prague11th September 2012

Jimmy Reid 1971

Rectorial Address

“Let me right at the outset define what I mean by alienation. It is the cry of men who feel themselves the victims of blind economic forces beyond their control. It's the frustration of ordinary people excluded from the processes of decision making. The feeling of despair and hopelessness that pervades people who feel with justification that they have no real say in shaping or determining their own destinies....”

Improving complex systems

Build secure knowledge of the problem Build the will to change Execute the change Drive the change with data

Central line infection rate (per thousand line days)

0

0.5

1

1.5

2

2.5

3

3.5

4

Jan-

08

Mar

-08

May

-08

Jul-0

8

Sep

-08

Nov

-08

Jan-

09

Mar

-09

May

-09

Jul-0

9

Sep

-09

Nov

-09

Jan-

10

Mar

-10

May

-10

Jul-1

0

Sep

-10

Nov

-10

Jan-

11

Mar

-11

May

-11

Jul-1

1

Sep

-11

Nov

-11

2.8

0.84

70% reduction

% ICU mortality

18.2%

13.9%

24% improvement

Oct-Dec 200

6

Jan-Mar 200

7

Apr-Jun 200

7

Jul-Sep 200

7

Oct-Dec 200

7

Jan-Mar 200

8

Apr-Jun 200

8

Jul-Sep 200

8

Oct-Dec 200

8

Jan-Mar 200

9

Apr-Jun 200

9

Jul-Sep 200

9

Oct-Dec 200

9

Jan-Mar 201

0

Apr-Jun 201

0

Jul-Sep 201

0

Oct-Dec 201

0

Jan-Mar 201

1

Apr-Jun 201

1

Jul-Sep 201

1

Oct-Dec 201

1

Jan-Mar 201

2

Apr-Jun 201

2

Jul-Sep 2012p

0.8

0.9

1.0

1.1

Sta

nd

ard

ise

d M

ort

alit

y R

ati

o

HSMR up to September 2012

12.4% reduction