Global Public Health Futurology: Food for thought in uncertain times Dr Justin Varney National Lead for Adult Health and Wellbeing Public Health England Justin.varney@phe.gov.uk

Four paradigms to frame the future Expanding life expectancy and changing identities Urbanisation The internet and digital innovation Climate change There are many other aspects that will have an impact.

Oldest age at which 50% of babies born in 2007 are predicted to still be alive (100yr life) If you live to a 100yrs, how many careers will you have? How many places will you live in? How many partners will you have? About 1/3rd of children born in 2013 will reach their 100th Birthday and the predicted average age at death for men will be 90.7yrs and 94yrs for women (ONS) With each passing year, the newly born live about three months longer than those born the prior year. The traditional three stage life: school, work, retirement is unlikely to continue and this means new HR paradigms, new patterns of work. Each generation has different cultural and behavioural norms, the Millennials are the post-Google generation.

For the first time in history, more than 50% of the world’s population lives in an urban area. By 2050, 70% of the world’s population will be living in towns and cities. (WHO) The majority of global population projected growth is in urban hubs, while rural population declines.An estimated 30-50% of urban inhabitants in developing nations live in impoverished slums and squatter settlements. The number of mega-cities rose from just one in 1950 to 23 in 1995, with 17 of them in the developing world. By 2015, the number is projected to grow to 36; 23 of these mega- cities will be located in Asia (Baqui A) Increased economic opportunities & increased access to services Unsustainable population demands on resources & environmental impacts

The internet is the ’coffee’ of the Millennial generation A systematic review found no evidence that normal internet use had a negative impact on lifestyle behaviours or neural physiology. (Mills 2014) A longitudinal study of internet and media use in adolescents concluded that heavy use of the Internet and video gaming may be more a symptom of mental health problems than a cause. Moderate use of the Internet is supportive of healthy development (Romer et al 2013) Evidence that gaming improves visual processing (Green et al 2007) & social media interaction can be an adjunct to treatment of depression (Pereira J 2014) & brain injury (Straudi et al 2017) Some evidence that heavy use, particularly studies in ’addicted gamers’ (>10-12hrs/day), found changes in pre-frontal cortex and grey matter density, particularly in areas associated with empathy, suppression of impulses and prioritisation. Worldwide, there are over 1.94 billion monthly active Facebook users for March 2017 which is an 18 percent increase year over year. 5 new profiles are created every second. (Zephoria)

Each year of the 21st century is among the hottest in history The temperature of the earth will soon become 5.8 degrees higher. More than 1 million species have already faced extinction due to global warming In the near future, around a hundred million people will see 3 feet of sea level rise. Global warming caused $100 billion worth of damage in the United States alone in 2005. (List 25) Climate change Climate change impact on health - https://tn.gov/health/article/climate-change Potential climate change impact - http://www.atmo.arizona.edu/students/courselinks/fall12/atmo336/lectures/sec6/impacts.gif

Implications for public health at home and abroad Ageing CVD decline Vascular dysfunction Cognitive decline Loss of muscle & bone density Reduced gut motility Reduced liver & kidney efficiency Physical activity Smoking cessation Alcohol moderation Diet & nutrition Mental wellbeing Upstream solutions require public health to be at every table making the case to embed prevention in every strand of public and private life. Getting to the table means marketing the solution and the outcomes to the narratives of the audiences, primarily economic, rather than pure health. People power and social narrative is changing and public health will need to better understand and engage with this in a proactive way rather than just be reactive. ‘The narrative of public health must speak to Davos as much as to the WHO audience.’

Investing in prevention is key at an individual level to being able to enjoy life, remain economically active and independent into later life. For the public sector, ensuring individuals are active across the life course and investing in their own health is essential to the economic viability of local communities and the sustainability of the public sector.

Public Health Futurology