life expectancy trends
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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
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