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Wellbeing and its determinants

Wellbeing and its determinants. CSP Congress 2009 Liverpool 16 October 2009. Social circumstances and health. 80. 70. 60. Life expectancy in years. Scotland. 50. 40. 30. 1900. 1910. 1920. 1930. 1940. 1950. 1960. 1970. 1980. 1990. 2000. Year of birth.

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Wellbeing and its determinants

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  1. Wellbeing and its determinants CSP Congress 2009 Liverpool 16 October 2009

  2. Social circumstances and health

  3. 80 70 60 Life expectancy in years Scotland 50 40 30 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 Year of birth 20th century trends in life expectancy in Scotland and 16 other Western European countries Males

  4. Health Inequalities • Are they due to: • Poverty? • Diet ? • Tobacco?

  5. Deprivation in 1981

  6. Deprivation in 1991

  7. Deprivation in 2001

  8. Excess Standardised Mortality not explained by deprivation(Scotland v. E&W)

  9. Coronary heart disease mortalityMen aged 15-74 years Age-standardised mortality per 100,000

  10. World Health Organization (1997 and 2003) www.heartstats.org

  11. Smoking prevalence - Europe Males

  12. Smoking prevalence - Europe Females

  13. Comparison of lung cancer mortality in West of Scotland and 3 major cohorts West of Scotland Average annual death rate /100,000 American Cancer Society volunteers UK doctors US veterans

  14. Lung cancer mortality by social class 100 80 manual 60 Rate per 10,000 40 non-manual 20 0 never 1-14 15-24 25+ daily cigarette consumption

  15. Risk of death - by level of hopelessness RHR Everson et al 1996

  16. Carotid artery thickening

  17. Aaron Antonovsky 1923-1994

  18. Sense of coherence.... “.....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."

  19. For the creation of health.... ....the social and physical environment must be: • Comprehensible • Manageable • Meaningful

  20. STRESS AND GRADE OF EMPLOYMENT: MEN Salivary Cortisol Time of Day Steptoeet al. 2003, Psychosomatic Medicine, 65, 461-470

  21. Environmental determinants of inflammatory status CRP(median) mg/dl affluent deprived

  22. hs-CRP and Risk of Future MI in Apparently Healthy Men 3 2 1 0 £0.055 0.056–0.114 0.115–0.210 ³0.211 P Trend <0.001 P<0.001 P<0.001 P=0.03 Relative Risk of MI 1 2 3 4 Quartile of hs-CRP (Range, mg/dL) Ridker. N Engl J Med. 1997;336:973–979.

  23. Inflammation in plaques cytokines MMP Lumen Inflammatory Cells Degraded matrix SMC apoptosis Cap Core Inflammatory cells MMPs, IL-6, IL-15, IL-18, CRP Thin Fibrous Cap Unstable

  24. CRP and cumulative risk of type 2 diabetes % diabetic Q5: > 4.18 mg/l 5 4 3 2 1 Q1 : <0.66 mg/l 0 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 Years in study Freeman et al. Diabetes 2002,51;1596

  25. Adipocyte programminginsulin resistance, inflammation and ALP skeletal muscle Insulin resistance triglyceride Atherogenic Lipoprotein Phenotype NEFAs Low HDL small LDL Adipose stores liver IL-6/IL-6sR CRP SAA Pro-inflammatory state TNF-a/ TNF-a sR-I

  26. Its all about the brain

  27. All shapes and sizes!

  28. Attachment theory “Infants develop the attachment behaviours that optimally enhance their survival in their own characteristic environments.” Crittenden, 2000

  29. 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

  30. “Serve and return” “The ‘instruction’ to attend to the primary caregiver is genetic, the outcome depends on what happens” Balbernie, 2001

  31. Disengaged... Who needs to bother about differential calculus? Engaged to respond to danger

  32. The Dunedin cohort 1000 children recruited in late 1972/3 At age 3, “at risk” children identified on the basis of chaotic circumstances, emotional behaviour, negativity and poor attentiveness As adults, those “at risk” were more likely to : be unemployed have criminal convictions (especially for violence) been pregnant as a teenager have a substance abuse problem exhibit signs of insulin resistance and metabolic syndrome

  33. Telomeres Ends of chromosomes Sense and signal damage Home of repair systems Integrate energy production and utilisation Anti-cancer Telomere length predictive for mortality

  34. Telomere length in twins by occupation

  35. “Physical activity” or sweaty exercise? • Are we being too modest in our aspirations for fitness? • Should we make more use of sport as a means to get people active? • By embracing “physical activity”, are we admitting defeat?

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

  37. Opportunity to escape poverty, decent housing, social networks, self esteem and sense of control Consistent parenting, safe, nurturing early years, supportive education Health related behaviours Meaningful Manageable Comprehensible

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