Golden Lecture of Prevention

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Golden Lecture of Prevention

• Building a Global Prevention Network to Share
  Knowledge and Wisdom

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Hygeia   In Greek mythology The goddess of
health. Hygiene The science that deals with the
preservation promotion of health.
September 19, 2003 Hippocrates Day
This lecture is dedicated to a man who is
currently recognized as the father of medicine.
Its because of his work, healers became doctors
instead of sorcerers. Hippocratic oath is
administered during the graduation ceremonies of
all modern medical schools.
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Objectives

• 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

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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

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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

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

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Historical Examples of Global Prevention
Activities
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Death rate for Tuberculosis, 1860-1960, United
States, Source US Bureau of the Census,
Historical Statictics 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.
Koch identified tubercle bacillus
Streptomycin introduced
Vaccination available
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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

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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.
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Epidemiologic Transition, MexicoDecline in
Communicable, Rise of NCDs
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Example of successful prevention program in Cuba
VACCINATION PROGRAM RESULT
POLIO ELIMINATED SINCE
1962 DIPHTHERIA ELIMINATED SINCE 1969 NEWBORN
TETANUS ELIMINATED SINCE 1972 CONGENITAL
RUBELLA ELIMINATED SINCE 1989 MENINGITIS POST
MUMPS ELIMINATED SINCE 1989 MEASLES
ELIMINATED SINCE 1993 WHOOPING COUGH
TRANSMISSION INTERRUPTED SINCE 1994 RUBELLA
TRANSMISSION INTERRUPTED SINCE
1995 MUMPS TRANSMISSION
INTERRUPTED SINCE 1995 MORBIDITY MENINGOCOCCICA
L DISEASE REDUCTION 93 TYFHOID
FEVER REDUCTION 75 B
HEPATITIS REDUCTION 52
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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

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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
• US4.18 cost per illness-cases incur 83 of cost
  (10 days income 1/3rd for drugs, gt1/3rd due to
  lost income).
• Govt pays 17 of cost per illness and creates
  treatment system and case-management standards

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Death Rates for Coronary Heart Disease by Country
Men Ages 35-74, 1970 and 1993 (Rate/100,000)
750
FIN
USA
AUST
SCOT
NZ
CAN
500
SING
USSR
250
ITY
SPN
FRAN
JPN
HK
CHN
0
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Lifestyle Factors
Genes load the gun.Lifestyle pulls the trigger
Dr. Elliot Joslin
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Relation Between CHD Events and LDL-C in Recent
Statin Trials
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2 Prevention
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with
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1 Prevention
CHD event
10
5
0
90
110
130
150
170
190
210
Mean LDL-C level at follow-up (mg/dL)
PIplacebo Rxtreatment .
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Prevention and Internet Internet Epidemic
Number of Internet users (millions)
Year
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Methods Supercourse model
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Telepreventive Medicine
Inexpensive Low to High bandwidth systems
designed to reach large numbers of healthy people
to prevent disease.
Tele-Medicine
Expensive High bandwidth systems designed to
reach small numbers of sick people to cure
disease.
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Supercourse Lecture Growth
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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

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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