Golden Lecture of Prevention

Building a Global Prevention Network to Share Knowledge and Wisdom:

reaching 1 million with prevention lecture

September 19, 2003

Hippocrates Day

This lecture is dedicated to a man who is currently recognized as the “father” of

medicine. It’s because of his work, healers became doctors instead of sorcerers.

Hippocratic oath is administered during the graduation ceremonies of all modern

medical schools.

Hygeia  In Greek mythology The goddess of health.

Hygiene –The science that deals with the preservation & promotion of health.

Objectives1. To define prevention and highlight its

importance in global health.

2. To discuss the importance of network in the context of the Supercourse and to begin to organize the internet based globalization for prevention

3. To distribute the golden lecture to 1 million faculty, students and professionals all over the world

Definition of Prevention

“Actions aimed at eradicating, eliminating, or minimizing the impact of disease and disability. The concept of prevention is best defined in the context of levels,

traditionally called primary, secondary, and tertiary prevention”

A Dictionary of Epidemiology, Fourth Edition

Edited by John M. Last

Public Health and Sanitation

Achievements of the 20th century: • Improvements in hygiene practices• Improvements in food handling

(refrigeration)• Improvement in water and sewage

treatment• Vaccination practices

Rising Life Expectancy

Source: United Nations (U.N.) Population Division, Demographic Indicators, 1950-2050 (The 1996 Revision) (U.N., New York, 1996).

Prevention and Religion

Washing Hands• Hands should be washed when one

touches something polluted or unclean; likewise, before or after eating.– The Prophet, Peace Be Upon Him, said:

“Whoever sleeps and his hands are not clean from fat and thereby gets harmed should blame no one but himself”

– “The Prophet, Peace Be Upon Him, used to wash his hands before eating”

Historical Examples of Global Prevention Activities

*Model for acute infectious agents

Vaccinationavailable

Streptomycinintroduced

Koch identifiedtuberclebacillus

Death rate for Tuberculosis, 1860-1960, United States, Source: US Bureau of the Census, Historical Statistics of the United States; Colonial Times to 1970 (Washington, D.C: Government Printing Office, 1975), Part 1 pp58,63.  Note: Data between 1860 and 1900 for Massachusetts only.

The Sanitary Revolution and the Ascendancy of Public Health

The sanitary revolution produced the greatest transformation in the pattern of disease that the world had known since nomadic hunter-gatherers settled in permanent villages, and

ultimately developed modern urban industrial communities

Death Rates for Measles in Children Under Age

15, England and Wales, 1850-1970

Source: Thomas McKeown, The Modern Rise of Population (Academic Press, San Francisco, 1976), pp. 93, 96.

Epidemiologic Transition, MexicoDecline in Communicable, Rise of NCDs

1

10

100

1000

1932 1952 1972

Diarrhea

Malaria

TB

Typhoid

CHD

CA

Example of successful prevention program in Cuba VACCINATION PROGRAM RESULTVACCINATION PROGRAM RESULT

POLIO ELIMINATED SINCE 1962DIPHTHERIA ELIMINATED SINCE 1969NEWBORN TETANUS ELIMINATED SINCE 1972CONGENITAL RUBELLA ELIMINATED SINCE 1989MENINGITIS POST MUMPS ELIMINATED SINCE 1989MEASLES ELIMINATED SINCE 1993

WHOOPING COUGH TRANSMISSION INTERRUPTED SINCE 1994RUBELLA TRANSMISSION INTERRUPTED SINCE 1995MUMPS TRANSMISSION INTERRUPTED SINCE 1995

MORBIDITY

MENINGOCOCCICAL DISEASE REDUCTION 93%TYPHOID FEVER REDUCTION 75%B HEPATITIS REDUCTION 52%

Introduction

• Cervical cancer is the 2nd most common cancer among women globally

• Higher cervical cancer mortality in developing countries due to lack of effective screening programs

Costs of malaria control

Government-invests US $99,970/yr, protects 3.4 million people in transmission zone at $0.03 per head

• Population blood surveys (surveillance) – 25%• Vector surveillance (strategic knowledge) – 12%• Case-management (disease-transmission control) -60%

Community• US$4.18 cost per illness-cases incur 83% of cost (=10

days income; 1/3rd for drugs, >1/3rd due to lost income). • Govt pays 17% of cost per illness and creates

treatment system and case-management standards

Estimated impact of AIDS on under-5 child mortality rates – Selected African countries, 2010

Source: US Bureau of the Census

250

200

150

100

50

0

per 1000 live births with AIDS

Botswana Kenya Malawi Tanzania Zambia Zimbabwe

without AIDS

NZ

FRANSPN

USSR

CHN

SING

HK

USAAUST

CAN

FIN

ITY

SCOT

750

500

250

0

Death Rates for Coronary Heart Disease by Country Men Ages 35-74, 1970 and 1993 (Rate/100,000)

JPN

“Genes load the gun.Lifestyle pulls the trigger”

Dr. Elliot Joslin

Lifestyle Factors

Mean LDL-C level at follow-up (mg/dL)

Relation Between CHD Events and LDL-C in Recent Statin Trials

0

5

10

15

20

25

30

90 110 130 150 170 190 210

% withCHD event

2° Prevention

1° Prevention

26 37

101160

201

451

552.5

700

0

200

400

600

800

1995 1996 1997 1998 1999 2000 2001 2002

Prevention and Internet: Internet “Epidemic”

N

um

ber

of

Inte

rnet

use

rs (

mil

lio

ns)

Year

Methods: Supercourse model

Teacher in Alexandria

Teacher in Tanzania

Teacher in Cairo

Teacher in Paris

Teacher in Pittsburgh

Teacher in Moscow

Inexpensive Low to High bandwidth systems designed to reach large numbers of healthy people to prevent disease.

Expensive High bandwidth systems designed to reach small numbers of sick people to cure disease.

452

101202

503

1312

0

200

400

600

800

1000

1200

1400

Sept-97 Sept-98 Sept-99 Sept-OO Sep-02 May_03

Conclusions

Increased life expectancy in the past century was achieved through the improvement of sanitation and prevention

Successful prevention in the past and in the future needs to be rooted in the networking of health professionals around the world to share their knowledge

Internet based Information sharing is the key to prevention and a “golden” world

What is the future of prevention?

• Globalization of Prevention• Networking of people in

prevention• Sharing of data, knowledge

and wisdom

Please forward the Golden Lecture to faculty, students and health professionals in your country

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