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School of Public Health, University of Hong Kong The Hedley Lecture The Hedley Lecture The future of public health: an extra terrestrial perspective 28.

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Presentation on theme: "School of Public Health, University of Hong Kong The Hedley Lecture The Hedley Lecture The future of public health: an extra terrestrial perspective 28."— Presentation transcript:

1 School of Public Health, University of Hong Kong The Hedley Lecture The Hedley Lecture The future of public health: an extra terrestrial perspective 28 th April 2010 Anthony J Hedley Department of Community Medicine School of Public Health University of Hong Kong

2 School of Public Health, University of Hong Kong Fruitful partnerships in public health

3 School of Public Health, University of Hong Kong What should be the next public health priorities? What can we learn about the state of our planet’s health from the perspective of space? What must we learn from 150 years of public health? Are the new exposure sciences and gene- environment interactions relevant to urban planning? Can we develop new approach to risk communication and partnerships in public health?

4 School of Public Health, University of Hong Kong

5 Planet Earth Source: BBC Documentary: Planet Earth

6 School of Public Health, University of Hong Kong Hippocrates (400 BC) Airs, Waters, Places Health for all in 21 st Century The human right to

7 School of Public Health, University of Hong Kong Hippocrates (400 BC) Airs, Waters, Places Health for all in 21 st Century The human right to Clean Water Clean Air Clean Food

8 School of Public Health, University of Hong Kong Individual susceptibility Environment Behaviour Determinants of Population Health

9 School of Public Health, University of Hong Kong Health Environment Behaviour Happiness Public Health Function

10 School of Public Health, University of Hong Kong Our transformation of Airs, Waters and Places

11 School of Public Health, University of Hong Kong Our transformation of Airs, Waters and Places

12 School of Public Health, University of Hong Kong Vulcanism, life and public health Source: Youtube video http://www.youtube.com/watch?v=qVWiL7yzIvI&feature=related

13 School of Public Health, University of Hong Kong Moon Saturn V Rocket

14 School of Public Health, University of Hong Kong Horsemen of the Apocalypse War Famine Pestilence Death

15 School of Public Health, University of Hong Kong Horsemen of the Apocalypse War Famine Pestilence Death

16 School of Public Health, University of Hong Kong Global Public Health 40 years on from Apollo 11? Enormous variation and inequity: Neglect of maternal and child health Epidemiological transition to chronic disease Emergent infectious diseases Health afflictions of poverty & income inequality Unsustainable use of natural resources

17 School of Public Health, University of Hong Kong Pioneer spacecraft Hello…Hello… Source: Google video http://video.google.com/videoplay?docid=1595145142442845127#

18 School of Public Health, University of Hong Kong

19 Source: http://francisthemulenews.wordpress.com/2009/09/16/el-proyecto-seti-cumple-50-anos-desde-que-se-publico-en-nature/

20 School of Public Health, University of Hong Kong The role of risk communication Host Agent Vector Health

21 School of Public Health, University of Hong Kong The role of risk communication Host Agent Vector Health

22 School of Public Health, University of Hong Kong The role of risk communication Host Agent Vector Health

23 School of Public Health, University of Hong Kong The role of risk communication Host Agent Vector Health

24 School of Public Health, University of Hong Kong Belief systems: the antithesis of science ? For science to guide our governance there must be people (a sufficient number) who believe in it Acceptance of science has potentially many thresholds dependent on understanding or prejudice

25 School of Public Health, University of Hong Kong Charles Darwin

26 School of Public Health, University of Hong Kong Mike HuckabeeSam Brownback Tom Tancredo Creationism is no way to create an Intelligent Design for public health

27 School of Public Health, University of Hong Kong Belief – an unassailable platform? Denial vs scepticism We need mechanisms to prevent denial corrupting scientific debate and disabling public confidence in science, but distinguish denial from intellectually honest arguments of scepticism Kemp J, Milne R, Reay DS. Nature 2010.

28 School of Public Health, University of Hong Kong Number of biomedical articles published 2000 - 2009 Source: Clinical Trial Magnifier 2009; 2:12 www.ClinicalTrialMagnifier.com 2000200120022003200420052006200720082009 Year of publication 480,142 492,153 510,089 536,322 573,577 614,864 662,548 703,055 747,198 799,173

29 School of Public Health, University of Hong Kong The public health function: navigating the evidence UncertaintyPrecautionary Principle Safety Accountability ? $

30 School of Public Health, University of Hong Kong – Decision Analysis in Public Health True Positives True Negatives True Result Test Result False Positives False Negatives – + +

31 School of Public Health, University of Hong Kong – Decision Analysis in Public Health True Positives True Negatives True Result Test Result False Positives False Negatives – + +

32 School of Public Health, University of Hong Kong Environment, Behaviour, Health and Cholera Sir Edwin Chadwick The Public Health Act 1848

33 School of Public Health, University of Hong Kong “Who will pay for all this sewering and watering?” “There was no clear answer to the problem of what legislative means would best achieve sanitary ends”

34 School of Public Health, University of Hong Kong “The Rise of a Sanitary City” 1882 Sir Osbert Chadwick

35 School of Public Health, University of Hong Kong “The Rise of a Sanitary City” 1882 MR. CHADWICK’S REPORTS ON THE SANITARY CONDITION OF HONG KONG; WITH APPENDICES AND PLANS. Colonial Office, November 1882. Eastern, No. 38. Printed for the use of the Colonial Office. Sir Osbert Chadwick

36 School of Public Health, University of Hong Kong Sir Kai Ho Kai MBCM, MRCS, LRCP, KCMG Barrister at law, Lincolns Inn Ho Kai’s Memorandum of Objection 1887 “By this Ordinance … millions of dollars will be sacrificed, vested interests interfered with and public confidence shaken to its foundation” Economics …… not public health

37 School of Public Health, University of Hong Kong Tai Ping Shan 1890s The epicentre of … plague Staffordshire Regiment

38 School of Public Health, University of Hong Kong “What all my reports could not do, the epidemic has done” Dr PBC Ayres 1840-1899 Colonial Surgeon 1873-1897

39 School of Public Health, University of Hong Kong The threat to public health from uniformed beliefs President of South Africa: “AIDS is not caused by HIV” Mullahs of Nigeria: “Polio vaccine is a western conspiracy” Vatican officials: “Condoms are unreliable so should not be used” Bankers, executives, government in Hong Kong: “Air pollution is no worse than anywhere else”

40 School of Public Health, University of Hong Kong Who wants an epidemic of emerging infectious diseases?

41 School of Public Health, University of Hong Kong Who wants an epidemic of emerging infectious diseases?

42 School of Public Health, University of Hong Kong Professor Gordon Stewart University of Glasgow Who wants an epidemic of whooping cough?

43 School of Public Health, University of Hong Kong Professor Gordon Stewart University of Glasgow Who wants an epidemic of whooping cough?

44 School of Public Health, University of Hong Kong Professor Gordon Stewart University of Glasgow Who wants an epidemic of whooping cough?

45 School of Public Health, University of Hong Kong Andrew Wakefield Who wants an epidemic of mumps, measles and rubella?

46 School of Public Health, University of Hong Kong Andrew Wakefield Who wants an epidemic of mumps, measles and rubella?

47 School of Public Health, University of Hong Kong Why communicate science? Why? The need to serve Town and Gown The justification for research funding Universities’ demands for higher profiles What? Setting standards in scientific communication Using the media for coverage and effective communication Avoidance of misinterpretation

48 School of Public Health, University of Hong Kong Unwanted consequences Commercialism Sensationalism through complicity between scientists and journalists False hopes and unwarranted fears Failure to make limitations transparent Losses in translation

49 School of Public Health, University of Hong Kong Source: CJ Hamilton. www.solarviews.com/eng/author.htm

50 School of Public Health, University of Hong Kong Source: Titan’s surface organics surpass oil reserves on Earth. http://www.nasa.gov/centers/jpl/news/cassini-20080213.html

51 School of Public Health, University of Hong Kong NITROGEN (N 2 ) Hydrogen Cyanide (HCN) Methane (CH 4 ) Ethane (C 2 H 6 ) Acetylene (C 2 H 2 ) Acetonitrile (CH 3 CN) Carbon Dioxide CO 2 Carbon Monoxide (CO) Benzene (C 6 H 6 ) Source: Titan’s surface organics surpass oil reserves on Earth. http://www.nasa.gov/centers/jpl/news/cassini-20080213.html

52 School of Public Health, University of Hong Kong “Where there’s smoke there’s hydrogen cyanide” Health Canada From the evidence base…… heart disease, cancers and deaths

53 School of Public Health, University of Hong Kong ……to health legislation

54 School of Public Health, University of Hong Kong The legislation provided exemptions for “qualified premises”

55 School of Public Health, University of Hong Kong Lai HK et al 2010

56 School of Public Health, University of Hong Kong Emergent diseases: the rhetoric of false positives

57 School of Public Health, University of Hong Kong Source: MacKenzie D. New Scientist 3 April 2010; 11

58 School of Public Health, University of Hong Kong The public health function needs to send clearer signals Signal

59 School of Public Health, University of Hong Kong The public health function needs to send clearer signals ReceiverSignal

60 School of Public Health, University of Hong Kong Receiver Health protection The public health function needs to send clearer signals Signal

61 School of Public Health, University of Hong Kong Contemporary spectroscopic human signatures

62 School of Public Health, University of Hong Kong Spectroscopic human signatures Asian Brown Cloud

63 School of Public Health, University of Hong Kong Light bulb earth Source: Youtube video recorded by the Defense Meteorlogical Satellite Program. http://www.youtube.com/watch?v=PKiNUSX6zSE

64 School of Public Health, University of Hong Kong Our shrinking universe

65 School of Public Health, University of Hong Kong Our shrinking universe

66 School of Public Health, University of Hong Kong Cauldron cities Source: Black H. Environmental Health Perspectives 2010; 118: A35

67 School of Public Health, University of Hong Kong Unwalkable cities

68 School of Public Health, University of Hong Kong Light bulb Hong Kong

69 School of Public Health, University of Hong Kong Source: Holzman DC. Environmental Health Perspectives 2010; 118: A22-A27. BIOLOGICAL & BEHAVIORAL EFFECTS Melatonin Cortisol Heart Rate Brain blood flow Circadian rhythm PRIMARY OPTIC TRACT Visual Effects Light: a major environmental health agent

70 School of Public Health, University of Hong Kong Source: Spivey A. Environmental Health Perspectives 2010; 118: A28-A33.

71 School of Public Health, University of Hong Kong Blue light  leptin  lipid pathway to obesity, diabetes and cardiovascular disease

72 School of Public Health, University of Hong Kong

73 Are our cities oncogenic?

74 School of Public Health, University of Hong Kong

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77 Sunday 1 August 2004 Photo: Edward Stokes; Hong Kong Conservation Photography Foundation

78 School of Public Health, University of Hong Kong Tuesday 4 January 2005 Photo: Edward Stokes; Hong Kong Conservation Photography Foundation

79 School of Public Health, University of Hong Kong Source: Hong Kong Observatory Loss of visibility is a serious health hazard

80 School of Public Health, University of Hong Kong Source: Hong Kong Observatory We are looking at the emergence of a long term epidemic Loss of visibility is a serious health hazard

81 School of Public Health, University of Hong Kong Our shrinking planet

82 School of Public Health, University of Hong Kong Nasal Oral Larynx Lung Heart Brain Encyclopaedia Britannica, Inc. Large blood vessels Air pollution targets vital organs

83 School of Public Health, University of Hong Kong Low visibility kills: There is a strong association between daily visibility and daily deaths in Hong Kong Logrisk All ages Source: TQ Thach et al 2010

84 School of Public Health, University of Hong Kong Thursday, June 14, 2008

85 School of Public Health, University of Hong Kong The Hong Kong-Macao-Zhuhai Bridge: A new vector for traffic pollution and illness Source: China Daily

86 School of Public Health, University of Hong Kong

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89 Source: Buller DJ. American Scientist 2009; 300:74

90 School of Public Health, University of Hong Kong Physical inactivity causes an injury to finely tuned skeletal muscle and to whole body metabolism Muscle gene expression, is the key to survival

91 School of Public Health, University of Hong Kong Gene expression, not just health education, is the key to survival Source: Booth FW, Neufer PD. American Scientist 2005; 93:28-35

92 School of Public Health, University of Hong Kong A species affected by poor diet and sendentariness Tobacco Diet / Exercise Alcohol Infection Toxins Vehicles Firearms Sex Drugs Source: Booth FW, Neufer PD. American Scientist 2005; 93:28-35

93 School of Public Health, University of Hong Kong Honda Easy Riders = lazy genes Source: Youtube video. http://www.youtube.com/watch?v=PENSEenxRQo

94 School of Public Health, University of Hong Kong Academia – NGOs – Wider Public Integrity of published research Advocacy vs credibility Probabilistic vs definitive predictive messages Reliable and efficient pathways to effective communication Is it possible to create a new beginning in public health advocacy ensuring a strong evidence base but greatly widening the conduits for its translation and transmission

95 School of Public Health, University of Hong Kong Dealing with the “great disconnect” What science says and the public hears Beliefs Scientific illiteracy Distortion Bureaucracy Bill Barron: The Great Disconnect The HKUST and Civic Exchange

96 School of Public Health, University of Hong Kong

97 ICPHP Independent Commission for Public Health Protection Independent of government Funded and resourced Priorities relevant to a modern urban setting Synthesis and evaluation rather than discovery Filter and translate evidence into risk communication and policy making tools Externalize trade-offs Bring multidisciplinary skills to bear on complex issues Support government in meeting its duty of care in public health protection

98 School of Public Health, University of Hong Kong 德蔭香江


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