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Health and Civilization: Challenges for the 21st Century Dr Shigeru Omi Regional Director World Health Organization Western Pacific Regional Office 1 History of disease and civilization Period Event Disease Prehistory human beings lived as hunters and gatherers of food No major communicable diseases 1st Wave Hunter-gatherers ‘settled’ into agrarian villages small pox, measles, chickenpox,Tuberculosis Contact between different civilizations (through trade and travel ) small pox, measles From Europe to Asia via the Silk Road “Black Death” /bubonic plague Started in Europe in the 6th century Smallpox, measles, influenza, typhus To America from Europe (destroyed 90% of the population) Syphilis To Europe from America Malaria, yellow fever To Europe from Africa (5,000 –2,500 years ago) 2nd Wave (2500(2500-700 years ago) 3rd Wave (700 years ago and onwards) 4th Wave ? Trans-oceanic movement of seafarers ? ? Place Sumeria, Egypt ? (McMicheal, A.J., Human frontiers, environments and diseases Cambridge University Press, 2001) 2 At least one out of four people dies from a major disease of the time. Time Place Disease 450 BC Athens Plague 1348 AD Europe “Black death” 16th century America Smallpox,measles, influenza,typhus Today ? Developed countries and Noncommunicable some developing countries diseases Tatukawa ,Syoji Byoki no syakaishi NHK books, 1970 3 Disease and Civilization Interaction Disease Civilization 4 Characteristics of civilization today 1. Globalization The flow of people, goods and information is unprecedented 2. Urbanization There are more than 20 megacities today 3. Consumerism Consumption has become an end in itself 4. Pervasiveness of science and technology Science and technology is penetrating every corner of the world 5 Health issues today 6 Issue 1. Emergence of new infectious diseases • Globally in the past 20 years, on the average, one new infectious disease emerges each year. 7 Emerging disease Human Immunodeficiency Virus 1 (HIV 1) Human Immunodeficiency Virus 2 (HIV 2) Enterocytozoon Bieneusi Human Herpesvirus 6 (HHV 6) Hepatitis C virus Hepatitis E virus Guanarito Virus Barmah Forest Virus Bartonella henselae Sin Nombre Hantavirus Cyclospora cayatenensis Sabia Virus Hendra Virus Human Herpesvirus 8 Lyssavirus (in Australia) Nipah Virus New Variant Creuzfeldt-Jacob Disease West Nile Virus (in the United States) SARS CoV Monkeypox (in the United States) Date identified 1983 1985 1985 1986 1989 1990 1991 1992 1992 1993 1994 1994 1994 1994 1996 1996 1996 1999 2003 2003 8 Issue 1. Emergence of new infectious diseases • Globalisation, urbanization - Unprecedented mobility of people and goods, and concentration of population (SARS would have been a local disease) • Consumerism (For example, Avian flu) - Insanitary and unhygienic husbandry practices 9 Issue 2. Re-emergence of infectious diseases (SARS • Death ≒ 800 ) Tuberculosis Death = 50,000 per day, worldwide (Communicable diseases were believed to be things of the past) 10 Issue 2. Re-emergence of infectious diseases • Urbanization - Urbanization often results in unhygienic and congested living conditions for vulnerable groups such as the poor and migrant populations. - Urban slams and squatters represent fertile breeding grounds for emerging infectious diseases • Globalisation, consumerism and pervasiveness of science and technology - ageing society 11 Issue 3: Increase of noncommunicable disease Disease burden in developing countries 49 15 9 1990 (%) 27 Infectious disease Maternal disease Trauma 22 21 14 Psychiatric disease Non-communicable disease DALY = Disability-Adjusted Life Year 43 2020 (%) (Source: WHO, Evidence, Information and Policy,122000) Issue 3. Increase of noncommunicable disease • Urbanization, globalisation - Environmental degradation Air and water pollution, climate change etc – - Unhealthy lifestyle Sedentary lifestyle Unhealthy diet Tobacco use 13 ? Death rate Per 100,000 30 25 20 15 10 5 0 1993-1997 1998-2002 14 Suicide Death rate Per 100,000 30 25 20 15 10 5 0 1993-1997 1998-2002 15 Issue 4. Increase of people suffering from mental health problems • Urbanization, globalisation -highly competitive society associated with excessive stress -lack of connectedness due to the breakdown of communities and families 16 Issue 5. Low level of satisfaction among consumers with the quality of health services despite advances in science and technology • Only 55% of patients diagnosed and treated adequately. (United States of America, Report of Institute of Medicine, 1999) • Around 10% of hospital patients suffer adverse events. (United Kingdom, An Organization with a Memory, Department of Health, 1999) 17 Patient Satisfaction 100 90 80 70 60 50 40 30 20 10 0 Denmark Sweden USA Japan Health care expenditure per capita (OECD Data, 2002) 18 Issue 5. Low level of satisfaction among consumers with the quality of health services despite advances in science and technology • Globalisation, pervasiveness of science and technology -negligence of psychosocial factor as well as patient safety due to excessive reliance on technology and mechanistic approaches. 19 Health issues and civilization Characteristics of civilization Health issues 1. Globalisation Issue 1. Emergence of new infectious diseases 2. Urbanization Issue 2. Re-emergence of infectious diseases 3. Consumerism Issue 3. Increase of noncommunciable disease 4. Pervasiveness of science and technology Issue 4. Increase of people suffering from mental health problems Issue 5. Low level of satisfaction among consumers with the quality health services despite advance in science and technology 20 Redefine the ways in which humans co-exist with other species. 21 Strengthen cross-boundary cooperation. 22 Revitalize the community. 23 Concept of “New Community” Members of community: (Previously decision-making was top down.) participate in decision making (Previously communities were closed and self-contained without dynamic interactions. ) are open to innovative ideas and other communities. (Previously the interest of the community had to come first, recently the interests of individuals have been over-emphasized.) strike a balance between their individual interests with the collective interest of the community. 24 Empower individuals including consumers. 25 Promote corporate social responsibility. 26 Provide safety nets for vulnerable populations. 27 Bring psychosocial factors into the mainstream of development. 28 Patients with moderate to severe coronary heart disease who changed their intensive lifestyle, (with vegetarian food, aerobic exercise, stress management training, smoking cessation, group psychosocial support ) reversed coronary arteriosclerosis by 7.9% of diameter after 5 years, whereas those who didn’t change worsened. JAMA. 1998;280:2001-2007 Patients who received coronary artery bypass graft, with moderate to severe depression had higher rates of death than those without depression Lancet. 2003;362:604-609 29 Summary of actions Redefine the ways in which humans co-exist with other species. Strengthen cross-boundary cooperation. Revitalize the community. Empower individuals including consumers. Promote corporate social responsibility. Provide safety nets for vulnerable populations. Bring psychosocial factors into the mainstream of development. 30 Message for the Future • • • Depart from narrow vision, fragmented approach and turf mentality. Shift emphasis from economy driven to human-centred society. Nurture that which is good and be bold in creating the better. 31