20 th century trends in life expectancy in Scotland and 16 other Western European countries Males 30 40 50 60 70 80 19001910192019301940195019601970198019902000 Year of birth Life expectancy in years Scotland
Health Inequalities u Are they due to: –Poverty? –Diet ? –Tobacco?
“.....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: u Comprehensible u Manageable u Meaningful
STRESS AND GRADE OF EMPLOYMENT: MEN Salivary Cortisol Time of Day Steptoe et al. 2003, Psychosomatic Medicine, 65, 461-470
Environmental determinants of inflammatory status CRP (median) mg/dl affluent deprived
P<0.001 P=0.03 Quartile of hs-CRP (Range, mg/dL) P Trend <0.001 0.055 0.056–0.114 0.056–0.114 0.115–0.210 0.115–0.210 0.211 0.211 Relative Risk of MI Ridker. N Engl J Med. 1997;336:973–979. 0 1 2 3 1234 hs-CRP and Risk of Future MI in Apparently Healthy Men
Inflammation in plaques Inflammatory cells MMPs, IL-6, IL-15, IL-18, CRP Lumen Core Cap Thin Fibrous Cap InflammatoryCells SMCapoptosis Degradedmatrix Unstable cytokinesMMP
0 1 2 3 4 5 00.511.522.533.544.55 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 CRP SAA IL-6/IL-6sR TNF- TNF- sR-I triglyceride Low HDL small LDL Atherogenic Lipoprotein Phenotype Pro-inflammatory state skeletal muscle Insulin resistance
Attachment theory “Infants develop the attachment behaviours that optimally enhance their survival in their own characteristic environments.” Crittenden, 2000
Attachment theory u 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 u Increasingly recognised as determinant of later emotional, cognitive and social outcomes
“Serve and return” “ The ‘instruction’ to attend to the primary caregiver is genetic, the outcome depends on what happens” Balbernie, 2001
Engaged to respond to danger Disengaged... Who needs to bother about differential calculus?
The Dunedin cohort u 1000 children recruited in late 1972/3 u At age 3, “at risk” children identified on the basis of chaotic circumstances, emotional behaviour, negativity and poor attentiveness u 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
Telomeres u Ends of chromosomes u Sense and signal damage u Home of repair systems u Integrate energy production and utilisation u Anti-cancer Telomere length predictive for mortality
“Physical activity” or sweaty exercise? u Are we being too modest in our aspirations for fitness? u Should we make more use of sport as a means to get people active? u 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 education Health related behaviours
Opportunity to escape poverty, decent housing, social networks, self esteem and sense of control Consistent parenting, safe, nurturing early years, supportive education Health related behaviours Comprehensible Manageable Meaningful