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 disease 78% (72% to 83%)

Heart Attack 83% (47% to 93%)

Stroke 50% (-18% to 79%)

Diabetes 93% (88% to 95%)

Cancer 36% (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

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

1961-65 1966-70 1971-75 1976-80 1981-85 1986-90 1991-95 1996-00 2001-05 2006-10 2011-15 2016-20

Nu

mb

er

of

cases (

5 y

ears

)

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

180.0

200.0

ES

R p

er

100,0

00

Male numbers

Female numbers

Male rate

Female rate

Aaron Antonovsky 1923-1994

“.....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

00-046

-1.2

-1

-0.8

-0.6

-0.4

-0.2

0 10 20 30 40 50

Months of Orphanage Rearing

*linear trendline

Evening Cortisol Levels Increase withMonths of Orphanage Rearing *

The Founders’ Network

STRESS AND GRADE OF EMPLOYMENT: MEN

0

2

4

6

8

10

12

14

16

18

2008

-8.3

0

10-1

0.30

12-1

2.30

14-1

4.30

16-1

6.30

18-1

8.30

20-2

0.30

22-2

2.30

nmol

/l Higher GradeLower Grade

Salivary Cortisol

Time of DaySteptoe et al. 2003, Psychosomatic Medicine, 65, 461-470

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 Opportunity, decent housing, social networks, housing, social networks, self esteem and sense of self esteem and sense of

controlcontrol

Consistent parenting, Consistent parenting, safe, nurturing early safe, nurturing early

years, supportive years, supportive educationeducation

Health related Health related behavioursbehaviours

Opportunity, decent Opportunity, decent housing, social networks, housing, social networks, self esteem and sense of self esteem and sense of

controlcontrol

Consistent parenting, Consistent parenting, safe, nurturing early safe, nurturing early

years, supportive years, supportive educationeducation

Health related Health related behavioursbehaviours

Comprehensible

Manageable

Worthwhile