Transcript “Golden” Lecture of the Global Health Network Supercourse

Golden Lecture
of Prevention
Building a Global Prevention Network to
Share Knowledge and Wisdom:
reaching 1 million with prevention
lecture
Hygeia
In Greek mythology The goddess of health.
Hygiene –The science that deals with the
preservation & promotion of health.
September 19, 2003
Hippocrates Day
This lecture is dedicated to a man who is
currently recognized as the “father” of
medicine. It’s because of his work, healers
became doctors instead of sorcerers.
Hippocratic oath is administered during the
graduation ceremonies of all modern
medical schools.
Objectives
1. To define prevention and highlight its
importance in global health.
2. To discuss the importance of network in
the context of the Supercourse and to
begin to organize the internet based
globalization for prevention
3. To distribute the golden lecture to 1
million faculty, students and
professionals all over the world
Definition of Prevention
“Actions aimed at eradicating, eliminating,
or minimizing the impact of disease and
disability. The concept of prevention is
best defined in the context of levels,
traditionally called primary, secondary,
and tertiary prevention”
A Dictionary of Epidemiology, Fourth Edition
Edited by John M. Last
Public Health and Sanitation
Achievements of the 20th century:
• Improvements in hygiene practices
• Improvements in food handling
(refrigeration)
• Improvement in water and sewage
treatment
• Vaccination practices
Rising Life Expectancy
Source: United Nations (U.N.) Population Division, Demographic
Indicators, 1950-2050 (The 1996 Revision) (U.N., New York,
1996).
Prevention and Religion
Washing Hands
• Hands should be washed when one
touches something polluted or unclean;
likewise, before or after eating.
– The Prophet, Peace Be Upon Him, said:
“Whoever sleeps and his hands are not clean
from fat and thereby gets harmed should
blame no one but himself”
– “The Prophet, Peace Be Upon Him, used to
wash his hands before eating”
Historical Examples of Global
Prevention Activities
*Model for acute infectious agents
Koch
identified
tubercle
bacillus
Death rate for Tuberculosis, 1860-1960, United
States, Source: US Bureau of the Census,
Historical Statistics of the United States; Colonial
Times to 1970 (Washington, D.C: Government
Printing Office, 1975), Part 1 pp58,63. Note:
Data between 1860 and 1900 for Massachusetts
only.
Streptomycin
introduced
Vaccination
available
The Sanitary Revolution and the
Ascendancy of Public Health
The sanitary revolution produced the greatest
transformation in the pattern of disease that
the world had known since nomadic huntergatherers settled in permanent villages, and
ultimately developed modern urban
industrial communities
Death Rates for Measles in Children Under Age
15, England and Wales, 1850-1970
Source: Thomas McKeown, The Modern Rise of Population (Academic Press, San
Francisco, 1976), pp. 93, 96.
Epidemiologic Transition, Mexico
Decline in Communicable, Rise of NCDs
1000
Diarrhea
Malaria
100
TB
CHD
Typhoid
CA
10
1
1932
1952
1972
Example of successful
prevention program in Cuba
VACCINATION PROGRAM RESULT
POLIO
DIPHTHERIA
NEWBORN TETANUS
CONGENITAL RUBELLA
MENINGITIS POST MUMPS
MEASLES
WHOOPING COUGH
RUBELLA
MUMPS
ELIMINATED SINCE 1962
ELIMINATED SINCE 1969
ELIMINATED SINCE 1972
ELIMINATED SINCE 1989
ELIMINATED SINCE 1989
ELIMINATED SINCE 1993
TRANSMISSION INTERRUPTED SINCE 1994
TRANSMISSION INTERRUPTED SINCE 1995
TRANSMISSION INTERRUPTED SINCE 1995
MORBIDITY
MENINGOCOCCICAL DISEASE
TYPHOID FEVER
B HEPATITIS
REDUCTION
REDUCTION
REDUCTION
93%
75%
52%
Introduction
• Cervical cancer is the 2nd most common
cancer among women globally
• Higher cervical cancer mortality in
developing countries due to lack of
effective screening programs
Costs of malaria control
Government-invests US $99,970/yr, protects 3.4 million
people in transmission zone at $0.03 per head
• Population blood surveys (surveillance) – 25%
• Vector surveillance (strategic knowledge) – 12%
• Case-management (disease-transmission control) -60%
Community
• US$4.18 cost per illness-cases incur 83% of cost (=10
days income; 1/3rd for drugs, >1/3rd due to lost income).
• Govt pays 17% of cost per illness and creates
treatment system and case-management standards
Estimated impact of AIDS on under-5 child
mortality rates – Selected African countries, 2010
with AIDS
250 per 1000 live births
without AIDS
200
150
100
50
0
Botswana
Kenya
Source: US Bureau of the Census
Malawi
Tanzania
Zambia
Zimbabwe
750
Death Rates for Coronary Heart Disease by Country
Men Ages 35-74, 1970 and 1993 (Rate/100,000)
CAN
AUS USA
SCOT T
NZ
500
SING
USSR
ITY
250
SPN
JPN
CHN
0
H
K
FRAN
FIN
Lifestyle Factors
“Genes load the gun.
Lifestyle pulls the trigger”
Dr. Elliot Joslin
Relation Between CHD Events and
LDL-C in Recent Statin Trials
30
2° Prevention
25
20
% with
15
CHD event
1° Prevention
10
5
0
90
110
130
150
170
190
Mean LDL-C level at follow-up (mg/dL)
210
Number of Internet users (millions)
Prevention and Internet:
Internet “Epidemic”
800
700
600
552.5
451
400
201
160
200
101
26
37
1995
1996
0
1997
1998
Year
1999
2000
2001
2002
Methods: Supercourse model
Teacher in
Alexandria
Teacher in
Tanzania
Teacher in
Paris
Teacher in
Cairo
Teacher in
Pittsburgh
Teacher in
Moscow
Inexpensive Low to High bandwidth
systems designed to reach large numbers
of healthy people to prevent disease.
Expensive High bandwidth systems
designed to reach small numbers of sick
people to cure disease.
1400
1312
1200
1000
800
600
503
400
202
200
4
52
101
0
Sept-97
Sept-98
Sept-99
Sept-OO
Sep-02
May_03
Conclusions
Increased life expectancy in the past century
was achieved through the improvement of
sanitation and prevention
Successful prevention in the past and in
the future needs to be rooted in the
networking of health professionals around
the world to share their knowledge
Internet based Information sharing is the
key to prevention and a “golden” world
What is the future of prevention?
• Globalization of Prevention
• Networking of people in
prevention
• Sharing of data, knowledge
and wisdom
Please forward the Golden Lecture to faculty,
students and health professionals in your country
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