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Social circumstances and health

Social circumstances and health. Deprivation in 1981. Deprivation in 1991. Deprivation in 2001. Excess Standardised Mortality not explained by deprivation (Scotland v. E&W). Past experiences:Castlemilk. ≥ £244.5m spent over 10 yrs to 2000 Major impact on physical environment

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Social circumstances and health

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  1. Social circumstances and health

  2. Deprivation in 1981

  3. Deprivation in 1991

  4. Deprivation in 2001

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

  6. Past experiences:Castlemilk • ≥ £244.5m spent over 10 yrs to 2000 • Major impact on physical environment • Population decline – but stabilised • 18% reduction of FTE jobs, though higher employment rate • Rise in % with LLT illness (from 21% in ’91 to 32% in ’01). Glasgow figs 19% to 26%.

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

  8. Smoking prevalence - Europe Males

  9. Smoking prevalence - Europe Females

  10. 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

  11. 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

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

  13. PREDICTED HEART DISEASE DEATHS IN RENFREW PAISLEY (MIDSPAN)

  14. PREDICTED AND OBSERVED HEART DEATHS IN RENFREW PAISLEY (MIDSPAN)

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

  16. Carotid artery thickening

  17. Cortisol levels in affluent and deprived Schoolchildren (Montreal)

  18. 3 2 1 0 £0.055 0.056–0.114 0.115–0.210 ³0.211 hs-CRP and Risk of Future MI in Apparently Healthy Men 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.

  19. 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

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

  21. 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

  22. 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- TNF-sR-I

  23. A classification of stress • Positive – tolerable and short lived. Caused by everyday experiences such as meeting new people, frustration and coping with normal discipline. - Concept of “Serve and return” • Tolerable – could affect brain structure but relieved by supportive relationships. Natural disasters, loss of a loved one • Toxic – prolonged, highly active stress response. Associated with abuse, enduring maternal depression, neglect. Absence of continuing supportive relationships fails to build resilience B S McEwen et al 2007

  24. Psobid • Psychological • Sociological and • Biological • Indicators of • Disease

  25. 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

  26. Some early years programmes • Nurse Family Partnership • Infant health and development programme • Perry High/Scope project • Early training project • Carolina Abcderian project • Milwaukee project • The Experience Corps • Pedagogues in Scandinavia • Sure Start in England

  27. Cost benefit of early intervention programmes A Sinclair The Work Foundation 2007

  28. Conclusions • Clear evidence that adverse early life circumstances have distinct biological effects • Some evidence that some early life support projects can improve health, social and economic prospects for children • Successful projects foster engagement between children, their peers and adults in a way that is appropriate to their stage of development • Projects are often poorly evaluated and reports seldom published in peer reviewed literature • Evidence of effectiveness is crucial to influence policy

  29. “We look to Scotland for all our ideas of civilisation.” Voltaire (Francois Marie Arouet, 1694–1778) was responding to the flowering of ideas in eighteenth century Scotland that has become known as ‘The Scottish Enlightenment’..

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