Trends in mortality

Trends in life expectancy

“The EPIC Formula” Don’t smoke Eat a diet rich in fruit and vegetables, whole grains and low in red meat Exercise at least 3.5 hr/week Body mass index less than 30

Reduction in risk: EPIC-Potsdam 4 Healthy behaviours Any chronic disease78% (72% to 83%) Heart Attack83% (47% to 93%) Stroke50% (-18% to 79%) Diabetes93% (88% to 95%) Cancer36% (5% to 57%) Ford et al Arch Int Med 2009

Health behaviours and mortality Khaw et al PLoS Med 2008

Nurse’s health study Van Dam et al BMJ 2008

Diet

Obesity trends in Scotland

Trends in physical activity

Trends in lung cancer rates – men and women

Aaron Antonovsky

“.....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: Comprehensible Manageable Meaningful

STRESS AND GRADE OF EMPLOYMENT: MEN Salivary Cortisol Time of Day Steptoe et al. 2003, Psychosomatic Medicine, 65,

Attachment theory 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 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

Education allows social networks to become richer, self esteem to develop and a sense of control is enhanced. Resources to manage the environment become established Effective nurturing, consistent parenting allows a sense of control to develop. The environment becomes structured and understandable Through having a sense of purpose, health related behaviours become easier to adopt Comprehensible Manageable Worthwhile

Opportunity, decent housing, social networks, self esteem and sense of control Consistent parenting, safe, nurturing early years, supportive education Health related behaviours

Opportunity, decent housing, social networks, self esteem and sense of control Consistent parenting, safe, nurturing early years, supportive education Health related behaviours Comprehensible Manageable Worthwhile