Golden Lecture of Prevention Building a Global Prevention Network to Share Knowledge and Wisdom

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

Objectives 1.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

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

Public Health and Sanitation Achievements of the 20 th century: Improvements in hygiene practices Improvements in food handling (refrigeration) Improvement in Water and sewage treatment Vaccination practices

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

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”

Historical Examples of Global Prevention Activities

Vaccination available Streptomycin introduced Koch identified tubercle bacillus Death rate for Tuberculosis, , 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.

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

Death Rates for Measles in Children Under Age 15, England and Wales, Source: Thomas McKeown, The Modern Rise of Population (Academic Press, San Francisco, 1976), pp. 93, 96.

Epidemiologic Transition, Mexico Decline in Communicable, Rise of NCDs Diarrhea Malaria TB Typhoid CHD CA

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 MENINGOCOCCICAL DISEASE REDUCTION 93% TYFHOID FEVER REDUCTION 75% B HEPATITIS REDUCTION 52%

Introduction Cervical cancer is the 2 nd most common cancer among women globally Higher cervical cancer mortality in developing countries due to lack of effective screening programs

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 US$4.18 cost per illness-cases incur 83% of cost (=10 days income; 1/3 rd for drugs, >1/3 rd due to lost income). Govt pays 17% of cost per illness and creates treatment system and case-management standards

NZ FRAN SPN USSR CHN SING HKHK USA AUS T CAN FIN ITY SCOT Death Rates for Coronary Heart Disease by Country Men Ages 35-74, 1970 and 1993 (Rate/100,000) JPN

“Genes load the gun. Lifestyle pulls the trigger” Dr. Elliot Joslin Lifestyle Factors

PI=placebo; Rx=treatment. Mean LDL-C level at follow-up (mg/dL) Relation Between CHD Events and LDL-C in Recent Statin Trials % with CHD event 2° Prevention 1° Prevention

Prevention and Internet: Internet “Epidemic” Number of Internet users (millions) Year

Methods: Supercourse model Teacher in Alexandria Teacher in Tanzania Teacher in Cairo Teacher in Paris Teacher in Pittsburgh Teacher in Moscow

Inexpensive Low to High bandwidth systems designed to reach large numbers of healthy people to prevent disease. Expensive High bandwidth systems designed to reach small numbers of sick people to cure disease.

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

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