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Wellbeing and its determinants. CSP Congress 2009 Liverpool 16 October 2009. Social circumstances and health. 80. 70. 60. Life expectancy in years. Scotland. 50. 40. 30. 1900. 1910. 1920. 1930. 1940. 1950. 1960. 1970. 1980. 1990. 2000. Year of birth. - PowerPoint PPT Presentation
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Wellbeing and its determinantsCSP Congress 2009Liverpool16 October 2009
Social circumstances and health
20th century trends in life expectancy in Scotland and 16 other Western European countriesMales
Health InequalitiesAre they due to:Poverty?Diet ?Tobacco?
Deprivation in 1981
Deprivation in 1991
Deprivation in 2001
Excess Standardised Mortality not explained by deprivation(Scotland v. E&W)
Coronary heart disease mortalityMen aged 15-74 yearsAge-standardised mortality per 100,000
World Health Organization (1997 and 2003) www.heartstats.org
Chart1
4523
3518
3234
3018
3030
2931
2921
2832
2826
2719
2637
2627
2617
2524
2432
2323
2325
2324
2222
2225
2128
2021
2027
1826
1721
1712
1717
1623
1627
1513
1414
1119
Boys
Girls
% regular smokers
Prevalence of smoking by country, in 15 year olds by sex, 2000/01, Europe
ES Fig 4.3 web05
Notes:"Smoking" defined as smoking at least once a week.
Sources:World Health Organization (1997) Smoking drinking and drug taking in the European Region. WHO: Copenhagen;
World Health Organization (2003) Young people's health in context. Health Behaviour in School-aged Children (HBSC) study:
international report from the 2001/02 survey. WHO: Copenhagen.www.heartstats.org
ES Fig 4.3 web05
4523
3518
3234
3018
3030
2931
2921
2832
2826
2719
2637
2627
2617
2524
2432
2323
2325
2324
2222
2225
2128
2021
2027
1826
1721
1712
1717
1623
1627
1513
1414
1119
Boys
Girls
% regular smokers
Prevalence of smoking by country, in 15 year olds by sex, 2000/01, Europe
data
Table 4.4 Prevalence of smoking, 15 year olds, 1989/90, 1993/94 and 2000/01
%%
BoysGirls
Ukraine4523
Lithuania3518
Germany3234
Estonia3018
Slovenia3030
Czech Republic2931
Latvia2921
Finland2832
Hungary2826
Russian Federation2719
Austria2637
France2627
Poland2617
Switzerland2524
Spain2432
Belgium - Flemish speaking2323
Croatia2325
Netherlands2324
Belgium - French speaking2222
Italy2225
United Kingdom - England2128
Ireland2021
Norway2027
Portugal1826
Denmark1721
Israel1712
Malta1717
United Kingdom - Scotland1623
United Kingdom - Wales1627
Macedonia, FYR1513
Greece1414
Sweden1119
BoysGirls
Austria2637
Germany3234
Finland2832
Spain2432
Czech Republic2931
Slovenia3030
United Kingdom - England2128
France2627
Norway2027
United Kingdom - Wales1627
Hungary2826
Portugal1826
Croatia2325
Italy2225
Switzerland2524
Netherlands2324
Ukraine4523
Belgium - Flemish speaking2323
United Kingdom - Scotland1623
Belgium - French speaking2222
Latvia2921
Ireland2021
Denmark1721
Russian Federation2719
Sweden1119
Lithuania3518
Estonia3018
Poland2617
Malta1717
Greece1414
Macedonia, FYR1513
Israel1712
Smoking prevalence - EuropeMales
Smoking prevalence - EuropeFemales
Comparison of lung cancer mortality in West of Scotland and 3 major cohortsWest of ScotlandUK doctorsAmerican Cancer Society volunteers US veteransAverage annualdeath rate /100,000
020406080100never1-1415-2425+daily cigarette consumptionRate per 10,000manualnon-manual
Risk of death - by level of hopelessnessRHREverson et al 1996
Carotid artery thickening
00-046
-1.2
-1
-0.8
-0.6
-0.4
-0.2
0
10
20
30
40
50
Months of Orphanage Rearing
Log10 Salivary Cortisol
*linear trendline
Evening Cortisol Levels Increase with
Months of Orphanage Rearing *
The Founders Network
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:ComprehensibleManageableMeaningful
STRESS AND GRADE OF EMPLOYMENT: MENSalivary CortisolTime of DaySteptoe et al. 2003, Psychosomatic Medicine, 65, 461-470
Environmental determinants of inflammatory status CRP (median) mg/dlaffluentdeprived
Inflammation in plaquesInflammatory cells
MMPs, IL-6, IL-15, IL-18, CRPLumenCoreCapThin Fibrous CapInflammatoryCellsSMC apoptosisDegradedmatrixUnstablecytokinesMMP
01234500.511.522.533.544.55Q1 : 4.18 mg/lYears in study% diabeticCRP and cumulative risk of type 2 diabetesFreeman et al. Diabetes 2002,51;1596
Adipocyte programming insulin resistance, inflammation and ALPAdipose storesNEFAsliverCRPSAAIL-6/IL-6sRTNF-a/ TNF-a sR-ItriglycerideLow HDLsmall LDLAtherogenicLipoproteinPhenotypePro-inflammatorystate
skeletal muscleInsulin resistance
Its all about the brain
All shapes and sizes!
Attachment theoryInfants develop the attachment behaviours that optimally enhance their survival in their own characteristic environments.Crittenden, 2000
Attachment theoryAinsworthDeep emotional connection that infant develops with primary caregiverReflects an internal working modelexpressing the infants expectations of parental behaviour in meaningful situationsBasis for development of later relationshipsIncreasingly recognised as determinant of later emotional, cognitive and social outcomes
Serve and returnThe instruction to attend to the primary caregiver is genetic, the outcome depends on what happensBalbernie, 2001
Engaged to respond to dangerDisengaged...Who needs to bother about differential calculus?
The Dunedin cohort1000 children recruited in late 1972/3At age 3, at risk children identified on the basis of chaotic circumstances, emotional behaviour, negativity and poor attentivenessAs adults, those at risk were more likely to :be unemployedhave criminal convictions (especially for violence) been pregnant as a teenagerhave a substance abuse problemexhibit signs of insulin resistance and metabolic syndrome
Telomeres
Ends of chromosomesSense and signal damageHome of repair systemsIntegrate energy production and utilisationAnti-cancerTelomere length predictive for mortality
Telomere length in twins by occupation
Physical activity or sweaty exercise?Are we being too modest in our aspirations for fitness?Should we make more use of sport as a means to get people active?By embracing physical activity, are we admitting defeat?
Opportunity to escape poverty, decent housing, social networks, self esteem and sense of control
Consistent parenting, safe, nurturing early years, supportive educationHealth related behaviours
Opportunity to escape poverty, decent housing, social networks, self esteem and sense of control
Consistent parenting, safe, nurturing early years, supportive educationHealth related behavioursComprehensibleManageableMeaningful
*****9*10**