Past, Present, and Future Perspectives on REVES, and “My...
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Dr. Sandy Reynolds George Myers Memorial Lecture, REVES 28 Vienna, Austria Past, Present, and Future Perspectives on REVES, and “My Brilliant Career”
Transcript of Past, Present, and Future Perspectives on REVES, and “My...
Dr. Sandy ReynoldsGeorge Myers Memorial Lecture,
REVES 28Vienna, Austria
Past, Present, and Future Perspectives on REVES, and “My Brilliant Career”
Agenda
1. The PastREVES and My Career – vaguely, 1990 through 2015
2. The PresentThe State of Health in the World (largely according to OECD and WHO)
3. The FutureFuture Health Concerns
Who Ruled the World? 1990Margaret Thatcher
Francois Mitterand
Li Peng Helmut Kohl
Mikhail Gorbachev
Toshiki Kaifu
George H.W. Bush
Who Rules The World: Now
David Cameron
FrancoisHollande Vladimir Putin
Shinzo Abe
Le Keqiang
Angela Merkel
Barack Obama
Well, some things never change
1990
NOW
And In the Future?
In the Beginning:1989-1990■ REVES
– 1990 Geneva– 1990 Durham
■ MOI!
– Still in Banking in New England
26,09
21,74
17,39
13,04
4,35
13,044,35
Methods DefDisab Xnatldef Single HE Mult HE PsyCog HlthTrends
Then 1991-1993
■ REVES– 1991 Leiden– 1992 Ottawa– 1993?
■ MOI– Fall, 1991 – USC!
Then 1994-5!
■ REVES– 1994 Canberra– 1995 Chicago
■ MOI – – started working
with Eileen! 1994– 1995 – PhD
1996
■ REVES– 1996 – Rome!
■ MOI –– Graduation and– USF!!
1997- 2000
■ REVES– 1997 Tokyo– 1999 London– 2000 Los Angeles
■ MOI– Publish, Publish,
Publish■ My own
Guardianship Research
■ With Eileen and Saito
2001 - 2003
■ REVES– 2001 Vancouver– 2002 Hammamet– 2003 Guadalajara
■ MOI– Publish, Publish,
Publish■ My own
Guardianship Research
■ With Eileen and Saito
– 2002 – TENURE!!!– And my first REVES
in 2003!
2004 - 2006
■ REVES– 2004 Bruges– 2005 Beijing– 2006 Amsterdam
■ MOI – Sabbatical with
Eileen– Publish, Publish,
Publish■ Obesity and Active
Life Expectancy■ With Eileen and
Saito– And Spin-offs– Treasurer of GSA!!
2007 – REVES and I COINCIDE:St. Petersburg
Beach, Florida
2007 – REVES and I COINCIDEBernard
2008 - 2011
■ REVES – 2008 Manila– 2009 Copenhagen– 2010 Havana!– 2011 Paris!!!!!
■ MOI– Publish, Publish– Administrative Work– Finished up as GSA
Treasurer – 2010– Master Chorale of Tampa
BayME
2012 - 2014
■ REVES– 2012 Taipei– 2013 Austin– 2014 Edinburgh
■ MOI
– Publish, Publish– Administrative Work– Master Chorale of Tampa
Bay
2015-2016
■ REVES -– 2015 Singapore– 2016 Vienna
ME - RETIREMENT!!!
REVES Agendas, 1990 - 2014
And My Career
0
2
4
6
8
10
12
14
16
18
1990 1991 1992 1994 1995 1996 1997 1998 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Topic Trends – Beginning, Middle and End
0,0
5,0
10,0
15,0
20,0
25,0
1990-1994 2000-2004 2010-2014
Methods Definition HlthExp CauseCoV HlthTrend Macro Mortality Diversity
Meanwhile, what’s been going on in the World?
The Regions
30
40
50
60
70
80
90
1950 1975 2009 2025 2050
Life Expectancy at Birth - MALESAfrica Asia Europe LAC N America Oceania
WHO Global Database: Indicators
Life Expectancy at Birth: Global, High and Low Income Countries, Men and Women
Source: WHO, Global Health Observatory Data Repository, Life Expectancy, 2016
51 53
61
71 7276
40
50
60
70
80
90
1990 2000 2013
Men
Low Income High Income
54 55
64
78 80 82
40
50
60
70
80
90
1990 2000 2013
Women
Low Income High Income
Specific Countries: LE at Birth, 1970 and 2011
78,781,1
82,7
73,5
82,0
74,2
69,0
78,0
82,2 81,9
53,0
81,8
50,0
55,0
60,0
65,0
70,0
75,0
80,0
85,0
1970 2011
Death Rates– All Causes (rates per 100,000 pop.)
Source: European Health for All Database
873,7
689,4739,9
1046,8
1192,6
823,9
938,7
583,1
484,6553,1
893,1
1134,0
536,9
731,9
0,0
200,0
400,0
600,0
800,0
1000,0
1200,0
1400,0
Denmark France Greece Lithuania Russia UK US
1990 2011-2013
Death Rates– Circulatory Diseases
Source: European Health for All Database
363,6
205,6
370,8
586,0
668,7
365,2387,1
135,9107,2
217,6
451,1
613,3
140,7
206,0
0,0
100,0
200,0
300,0
400,0
500,0
600,0
700,0
800,0
Denmark France Greece Lithuania Russia UK US
1990 2011-2013
Death Rates– Cancer
Source: European Health for All Database
231,8
201,2
158,9
193,4201,5
220,5 216,0
185,4
158,6152,7
182,2 173,4165,8 163,2
0,0
50,0
100,0
150,0
200,0
250,0
Denmark France Greece Lithuania Russia UK US
1990 2011-2013
Death Rates– Respiratory System
Source: European Health for All Database
63,4
43,839,4
47,5
63,2
85,0
74,0
59,2
26,3
47,3
27,3
44,7
70,1
58,0
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
90,0
Denmark France Greece Lithuania Russia UK US
1990 2011-2013
Death Rates– Diabetes
Source: European Health for All Database
12,2
8,0 7,15,6
6,5
10,4
20,7
14,6
9,1
5,66,9
5,2 5,3
31,2
0,0
5,0
10,0
15,0
20,0
25,0
30,0
35,0
Denmark France Greece Lithuania Russia UK US
1990 2011-2013
Death Rates– External Causes
Source: European Health for All Database
61,7
72,0
40,4
122,7
135,7
33,4 36,328,9
42,2
26,1
109,2
126,8
27,5
39,4
0,0
20,0
40,0
60,0
80,0
100,0
120,0
140,0
160,0
Denmark France Greece Lithuania Russia UK US
1990 2011-2013
Death Rates from Suicide, Selected Countries, 2011
12,5
6,7
20,9
38,3
10,1
4,8
22,5
14,316,2
11,7
7,4
0
5
10
15
20
25
30
35
40
45
Suicide
US
UK
Japan
Korea
Australia
Mexico
RussFed
CzechRep
France
Sweden
Israel
Trends in Suicide, Selected Countries, 1990-2011
% Change per Capita in Adult Alcohol Consumption, Selected Countries, 1990-2011
-7
2
-21
-2-6
4
62
2
-21
16
-29
33
-40
-20
0
20
40
60
80
Alcohol
US
UK
Japan
Korea
Australia
Mexico
RussFed
CzechRep
France
Sweden
SoAfrica
Israel
% Change in Smoking Rates, Selected Countries, 2000-2011
-23
-27 -26
-11
-24
-3
5
-14
-31
-43
-23
-50
-40
-30
-20
-10
0
10
US
UK
Japan
Korea
Australia
RussFed
CzechRep
France
Sweden
SoAfrica
Israel
Prevalence of Obesity Among Adults in Selected Countries, 2011
0
5
10
15
20
25
30
35
40
Women Men
Future Health Issues
■ Air Pollution
■ Global Warming
■ Increasing Population Diversity and Refugees!
Air Pollution■ Particulate Matter2.5 and Ozone Production
Source: OECD Environmental Outlook to 2050: The Consequences of Inaction, http://dx.doi.org/10.1787/9789264122246-en
“Worst” areas for Ozone(% days 8-hr max>100 μg/m3) and PM2.5 (Annual mean)
City Ozone City PM 2.5
Rome 32.3 Bucharest 38.2Athens 32.2 Budapest 33.7Marseille 28.0 Ljubljana 29.4Ljubljana 23.9 Athens 29.4Toulouse 22.9 Valencia 23.0
Pascal, Corso, Chanel et al., 2013
“Worst” areas for Ozone(% days 8-hr max>100 μg/m3) and PM2.5 (Annual mean)
City Ozone City PM 2.5
Rome 32.3 Bucharest 38.2Athens 32.2 Budapest 33.7Marseille 28.0 Ljubljana 29.4Ljubljana 23.9 Athens 29.4Toulouse 22.9 Valencia 23.0
Pascal, Corso, Chanel et al., 2013
“Best” areas for Ozone(% days 8-hr max>100 μg/m3) and PM2.5 (Annual mean)
City Ozone City PM 2.5
Dublin 0.7 Stockholm 9.4Seville 1.0 Dublin 10.5Bilbao 2.2 Malaga 12.8Valencia 2.6 London 13.1London 3.2 Toulouse 14.2
Pascal, Corso, Chanel et al., 2013
“Best” areas for Ozone(% days 8-hr max>100 μg/m3) and PM2.5 (Annual mean)
City Ozone City PM 2.5
Dublin 0.7 Stockholm 9.4Seville 1.0 Dublin 10.5Bilbao 2.2 Malaga 12.8Valencia 2.6 London 13.1London 3.2 Toulouse 14.2
Pascal, Corso, Chanel et al., 2013
So you think there’s little we can do about Air Pollution?
Climate Change – Global Warming
■ Greenhouse Gases– O3
– CO2,
– Methane – CFCs (less so, these days)
■ Several threats to Public Health– Natural Disasters – Floods, Wildfires, Extreme Storms– Heat Waves and Sea-level Rise
Natural Disasters■ Storms, floods, cyclones, landslides, wildfires, droughts
– 1970 to 2012 8,335 disasters ■ 1.94 million deaths■ $2.4US Trillion in economic losses
– Consequences■ Large-scale dislocation of populations■ Often to places ill-prepared to cope■ Displaced pops often subject to:
– Undernutrition, violence, sexual abuse, mental illness including PTSD
– Crude mortality rate as much as 30x base rate, often highest in children <5 years
Patz, Grabow, & Limaye, 2014; Haines et al., 2006
Heat Waves■ Mortality relationship is J-shaped with high mortality at
highest temperatures
■ European 2003 heat wave– Killed 40,000 in 2 weeks
Patz, Grabow, & Limaye, 2014; Ballester, Robine, Herrmann, & Rodo, 2011;
Place Excess Mortality
England and Wales 2,091
Italy 3,134
France 14,802
Portugal 1,854
Spain 4,151
Switzerland 975
Netherlands 2,200
Germany 1,410
TOTAL: 30,617
Haines et al., 2006
Heat Waves
■ Clearly a Public Health Issue– How prepared are we?– Death toll in 2003 implies not too well!
■ Need emphasis on public education■ Subsidies for elderly re: HVAC systems?■ “Safe” zones in cities – Urban Heat Islands!
Sea-level rise■ 14 of the world’s 19 Mega-cities are situated at sea-level
Patz, Grabow, & Limaye, 2014
Sea-level rise
■ Global sea levels rose 17 cm during 20th Century (>1/2 foot)
■ Pace of rise will accelerate during 21st Century– Midrange estimates – 26- to 98-cm rise by 2080 (> 3
feet)– Loss of up to 22% of world’s coastal wetlands– 200 million people at risk for:
■ Displacement■ Salt water intrusion into freshwater aquifers■ Disruption of storm water drainage and sewage disposal
systems, YET
The Catastrophe That Must Not Be Named368
By now you may have heard that Florida Gov. Rick Scott is a flat-out global warming denier, even though his state is arguably the most vulnerable to sea level rise and other problems that are surely to come if we do nothing.
•But even doing nothing is too much for Scott. Four former officials at Florida’s Department of Environmental Protection have claimedthat Scott put out an unwritten rule ordering that no one at the DEP even use the phrases global warming or climate change in any of their communications.
“King Tide” in Miami, Florida
Climate Change – Indirect Consequences to Human Health
■ Floods – rapid rise floods – mostly drowning plus:
■ Infectious Diseases– Water- and Food-borne– Vector-borne– Mosquito-borne– Tick-borne
■ Diarrheal diseases –– Coastal flooding in low lying areas– Inland flooding in “former socialist economies” (Haines et al., 2006)
■ Already causing 150,000 death/year
Issues of Diversity
■ REVES– Most presentations on diversity have been in 3 areas:
■ SES differences – largely education and occupation■ Regional differences – largely UK and US■ Ethnic differences – largely from the US
■ BUT– There is increasing diversity within the EU– Implications for Differential Health Status and Social
Cohesion
Foreign-born as % of Total Population, 2000 and 2013
Trends in Migration
Asylum Seekers, Average Annual % Change, 2010 - 2014
32,0
12,9
52,8
19,1
38,4
1,9
114,9
3,7
17,2
32,6
-5,8 -4,3
15,625,0
4,5
65,3
-20,0
0,0
20,0
40,0
60,0
80,0
100,0
120,0
140,0
Germany US Turkey Sweden Italy France Hungary UK
Austria Denmark Belgium Poland Spain Japan CzechRep Bulgaria
Source: UNHCR and OECD International Migration Database
And what about their health?
■ EU countries have universal health coverage
■ Does not mean health care is accessed equally
■ Migrants, in particular– Coming from places where ‘authorities’ represent threat– Language, cultural barriers– Underlying health – probably not as good – particularly
maternal and neonatal
And Social Cohesion?■ Threat Hypothesis
– More diverse societies often lead to lower generalized trust and loss of sense of community■ Not just among ethnic minorities■ Also among the dominant groups
■ Diversity causes feelings of threat– And increased negative “out-group” orientations
■ US and Canadian studies– Racially diverse cities, communities, neighborhoods– Generalized trust tends to be lower for ‘visible’ minorities and white majorities
■ Evidence in US???– Mysterious success of Donald Trump– Amplified by level of economic inequality
Source: Hooghe, Reeskens, Stolle, & Trappers, 2006; Strauss, Connerley, & Ammermann, 2003
Impact of Migration on This!
■ Why do we pay attention to Donald Trump talking about patrolling Muslim areas in the US
1. He’s an idiot2. He’s playing on fear – A Republican hallmark in trade
(GWB in 2004)
■ Are citizens of Belgium and France immune to this?
■ If Threat Hypothesis is correct, rapid rises of migrants –particularly ‘visible’ minorities – further erode social cohesion
Future Directions for REVES■ Air Pollution & Global Warming (Climate Change)
– Probably not specifically on our agenda –– Sure hope it is in APHA, PAA
■ More collaboration across countries –– Increasing research being done within EU –– The more the better
■ More emphasis on Issues of Health in Subpopulations –– Definitions?– Adequate attention paid in large scale surveys?– Statistical power – problematic with iMaCh, other
programs
Thank you and Enjoy the Rest of REVES!!
Per Capita Health Expenditures, as % of GDP
9,3 9,311,6 11,2 10,8
6,6
17,9
0
5
10
15
20UK France Denmark Greece Lithuania Russia US
Source: European Health for All Database
Selected Other Countries:
4,7 4,95,5 5,6 5,6
6,4 6,47,1 7,2 7,4
8,8
10,2
11,7
0,0
2,0
4,0
6,0
8,0
10,0
12,0
14,0
2014
By Region
-6,0
-4,0
-2,0
0,0
2,0
4,0
6,0
8,0
10,0
12,0
14,0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
GDP Growth by Region - 2001 to 2014, Projected 2015-2018
East Asia & Pacific Latin America & Caribbean Europe & Central Asia
Middle East & N. Africa Sub-Saharan Africa United States
“Recent” GDP Growth – High Income and Developing Countries
-6,0
-4,0
-2,0
0,0
2,0
4,0
6,0
8,0
10,0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
2001 to 2014, 2015-2018 Projected
High Income Countries Developing Countries
Mid-2000’s Gini Coefficients
CO2 Emissions attributable to population size and age structure: Germany, 1950 to 2100
Source: Kluge, Zagheni, Loichinger, & Vogt, 2014
Trends in REVES Topics -
0,00
5,00
10,00
15,00
20,00
25,00
30,00
35,00
1990 1991 1992 1994 1995 1996 1997 1998 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Definitional Issues – NOT including Harmonization
Methods
0,00
5,00
10,00
15,00
20,00
25,00
30,00
35,00
Healthy Life Expectancy –Single and Multiple Country
0,00
5,00
10,00
15,00
20,00
25,00
30,00
35,00
1990 1991 1992 1994 1995 1996 1997 1998 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Single Multiple Linear (Single) Linear (Multiple)
Trends in Health/Disabilityand Mortality
0,00
5,00
10,00
15,00
20,00
25,00
30,00
35,00
1990 1991 1992 1994 1995 1996 1997 1998 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Trends Mortality Linear (Trends) Linear (Mortality)
SES/Diversity Issues – US and Elsewhere
0,00
5,00
10,00
15,00
20,00
25,00
30,00
35,00
1990 1991 1992 1994 1995 1996 1997 1998 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
US Other Linear (US) Linear (Other)
Death Rates from Transport Accidents, Selected Countries, 2011
12,4
3,64,5
13,8
6,8
17,5
19,2
8,27,1
3,2
14,1
5,9
0
5
10
15
20
25
Death Rates
US
UK
Japan
Korea
Australia
Mexico
RussFed
CzechRep
France
Sweden
So Africa
Israel
Death Rates– Alcohol-Related
Source: European Health for All Database
60,4
137,5
80,7
156,9
142,5
63,657,1 61,5
34,4
144,7
74,4
48,8
0,0
20,0
40,0
60,0
80,0
100,0
120,0
140,0
160,0
180,0
Denmark France Greece Lithuania Poland UK
1990 2011-2013
Death Rates– Smoking-Related
Source: European Health for All Database
191,5 186,9
278,0
478,2
279,3
408,6
173,5
106,7
181,3
454,9
205,0180,3
0,0
100,0
200,0
300,0
400,0
500,0
600,0
Denmark France Greece Lithuania Poland UK
1990 2011-2013
Global Premature Deaths (in Millions of People) from Selected Environmental Risks, 2010-2050
0
0,5
1
1,5
2
2,5
3
3,5
4
Ground Level Ozone Particulate Matter
2010 2030 2050
Source: OECD Environmental Outlook to 2050: The Consequences of Inaction, http://dx.doi.org/10.1787/9789264122246-en
Using Beijing @ Case Study
■ High population growth, traffic density and levels of particulate matter
■ Biggest culprits:– Residential wood burning– Coal burning– “Mineral aerosols from resuspended road dust”– Solid waste management
■ Result –– Impact on Mort/Morb –
■ Varies by season■ PM2.5 and Potassium had highest impact on non-accidental
mortality– Similar to results found in the Netherlands, Phoenix, Santa
Clara County
Li, Xin, Wang et al., 2015
European Studies
■ Long term exposure to PM2.5 linked to natural cause mortality (Beelen et al., 2014)
– Little difference between 22 cohorts examined– Mortality from Lung Cancer and Stroke, not IHD or
Respiratory Diseases– Association between LT Exp to PM2.5 and Mortality found
even in areas already below EU standards for PM
Excess Mortality during 2003 European Heat WavePlace Excess Mortality
England and Wales 2,091
Italy 3,134
France 14,802
Portugal 1,854
Spain 4,151
Switzerland 975
Netherlands 2,200
Germany 1,410
TOTAL: 30,617
Haines et al., 2006
Big question -■ How well will humans adapt to increasingly hot environment?
– Public health education– Health warning systems– Emergency preparedness– Add Boil water notices– Risk assessment for extreme rainfall events– Risk assessment for health effect of algal blooms– ZIKA!!!– High Pollution day warnings – Food hygiene measures and enforcement
Percent Change in Foreign-Born Residents: 2002-2013 (2012 – France)
18,4
39,6
11,7
47,937,1
-42,6
11,20,1
60,7
9,4
87,8
24,1
46,4
13,9 18,5
-60
-40
-20
0
20
40
60
80
100
Austria Belgium Canada CzechRep Denmark
Estonia France Germany Hungary Netherlands
Norway Switzerland UK US Australia
Source: UNHCR and OECD International Migration Database
