GLOBAL HEALTH DAY

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GLOBAL HEALTH DAY

• INSIGHTS INTO GLOBAL HEALTH
• Alfred Sommer, MD, MHS
• Professor and Dean Emeritus
• Johns Hopkins Bloomberg School of Public Health
• Friday, November 14, 2008

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In eighteenth century French villages, the
median age of marriage was older than the median
age of death.
C.P. Snow
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Biological Factors
Social Factors
HEALTH
Community Factors
Economic Factors
Julio Frenck, 1993
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Carpe Diem ! For Smallpox Eradication

• last indigenous case 1976
• Declaration of Eradication 1980
• AIDS recognized 1981

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Polio Failure of ImmunizationCompliance

• Kano State, Nigeria
• Vashon Island, Washington
• Amish community, Minnesota
• (persistent shedding of immune
  compromised child)

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Genome vs. Envirome
Global Epidemics

• Coronary artery disease
• Asthma
• Diabetes

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Genes vs. Environment
Japanese ? U.S.A.

• gastric cancer ??
• heart disease ??

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Viral and Environmental Carcinogenesis
Liver Cancer
Urinary Aflatoxin
Hepatitis BAntigen No Yes
No
Yes
(case/ control) (4/ 105)
R.R. 1.0
(case/ control) (11/ 88)
R.R. 3.3
(6/ 19)
6.8
(17/ 5)
53.9
Shanghai nested case - control study
Ross, Lancet, 1992 Qian, Cancer Epi., 1993
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Unsuspected Infectious Causesof Chronic Disease

• Liver cancer (HpB, HpC, aflatoxin)
• Cevical cancer (HPV)
• Gastric ulcers/cancer (H.pylori)
• Jakob Creutzfeldt (prions)

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Health
Rich Web of Causality
Dust and Mites ? Asthma Asthma ? Panic
Attacks Bill Eaton Panic Attacks ? Suicide Jim
Anthony
MITES ? SUICIDE
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Chaotic Complexity of Whole-Body Biology
Exam (stress) ? D hypothalamus ?? pituitary
response ? ? adrenal cortex ?? cortisol levels ?
? WBC ?chromosome 10 (TCF gene) ?suppressed
expression of interleukin ? ? WBC response to
pathogens
EXAM ? INCREASED INFECTION
Genome
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In a population where everyone smokes Lung Cancer
is aGenetic disease
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Epidemic of Obesity
(Children)
weights had been stable before 1980
Lancet, 2001
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Economics ofSuper-Sizing
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Why? Increased Obesity in US 1990 - 2000
Food Consumption ? 8

140 additional pounds of food per person each
year
NY Times, July 7, 2002
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Food For Thought
Jane Brody NY Times, July 16, 2002
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Food Perceptions Differ From Reality

• Chicken McNuggets have twice the fat per ounce
  as a McDonalds hamburger !
• Fast Food Nation

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Health Education - Healthier Behavior?
Even when smokers were told they had genetic
predisposition to smoking-related cancersno
more likely to quit than their counterparts who
had no such tendency
NY Times, July 16, 2002
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Behavioral Determinants(Societal Web)
Communities Society
Organizations
Social Networks
Individual
(Family, friends)
(Churches, schools, workplace)
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Obesity
Public Health Interventions

• education
• legislation
• litigation
• regulation
• taxation

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Systems Change OvercomesComplex-Determined
Health Outcomes
(7-valent pneumococcal conjugate Vaccine Reduces
Racial Disparityof Invasive Pneumococcal Disease)
Flannery et alJAMA, 2004
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clean water, productive soils, and a
functioning health-care system are just as
relevant to development as foreign exchange
rates.
Jeffery Sachs The End of Poverty, 2005
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GGI HEALTH TARGETS

• REDUCE U-5MR BY TWO-THIRDS
• REDUCE MMR BY THREE-QUARTERS
• HALT THE SPREAD
• REDUCE THE INCIDENCE AND DEATHS
• -- HIV/AIDS
• -- MALARIA
• BY 2015 (1990 RATES AS BASELINE)

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The Developed world got wealthy, and then it got
healthy.Can the Developing world get healthy,
before it gets wealthy ?
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