now in the next short while I’m going to give you an overview of heart disease in
give you an overview of heart disease in
give you an overview of heart disease in the world heart disease and strokes
the world heart disease and strokes
the world heart disease and strokes these ideas are built not by me but by a
these ideas are built not by me but by a
these ideas are built not by me but by a large number of people around the world
large number of people around the world
large number of people around the world and the chief architect of this thinking
and the chief architect of this thinking
and the chief architect of this thinking was my mentor Richard Peto now Sir
was my mentor Richard Peto now Sir
was my mentor Richard Peto now Sir Richard Peto so the first thing is you
Richard Peto so the first thing is you
Richard Peto so the first thing is you know when you think about heart disease
know when you think about heart disease
know when you think about heart disease you’d say how can we make progress and
you’d say how can we make progress and
you’d say how can we make progress and then once you accept we can make
then once you accept we can make
then once you accept we can make progress in reducing it can we really
progress in reducing it can we really
progress in reducing it can we really have heart disease in the world and I’m
have heart disease in the world and I’m
have heart disease in the world and I’m going to add another word and say having
going to add another word and say having
going to add another word and say having heart disease prematurely that’s before
heart disease prematurely that’s before
heart disease prematurely that’s before the age of 70 within a generation
the age of 70 within a generation
the age of 70 within a generation so within 30 years that is huge
so within 30 years that is huge
so within 30 years that is huge so premature definition of premature
so premature definition of premature
so premature definition of premature changes as you get older it gets pushed
changes as you get older it gets pushed
changes as you get older it gets pushed out so the first thing is to accept that
out so the first thing is to accept that
out so the first thing is to accept that death in old age is inevitable but death
death in old age is inevitable but death
death in old age is inevitable but death before old age is not and the other
before old age is not and the other
before old age is not and the other thing is the causes of death in very
thing is the causes of death in very
thing is the causes of death in very young people children in sort of youth
young people children in sort of youth
young people children in sort of youth and young adulthood that is five to
and young adulthood that is five to
and young adulthood that is five to thirty four years and in adulthood that
thirty four years and in adulthood that
thirty four years and in adulthood that is say 35 to 69 years are different but
is say 35 to 69 years are different but
is say 35 to 69 years are different but they tend to be similar within each
they tend to be similar within each
they tend to be similar within each category and the issues can be Harvard
category and the issues can be Harvard
category and the issues can be Harvard in each range and I’m going to focus
in each range and I’m going to focus
in each range and I’m going to focus largely on the 35 to 69 today in the
largely on the 35 to 69 today in the
largely on the 35 to 69 today in the world there are 53 million deaths every
world there are 53 million deaths every
world there are 53 million deaths every year give or take a few million now of
year give or take a few million now of
year give or take a few million now of these 30 million are below the age of 70
these 30 million are below the age of 70
these 30 million are below the age of 70 and 23 million are over the age of 70
and 23 million are over the age of 70
and 23 million are over the age of 70 and in those below the age of 70 about 7
and in those below the age of 70 about 7
and in those below the age of 70 about 7 million deaths occur between the ages of
million deaths occur between the ages of
million deaths occur between the ages of 0 & 4
0 & 4
0 & 4 another five million occur between five
another five million occur between five
another five million occur between five and thirty four but the last majority 18
and thirty four but the last majority 18
and thirty four but the last majority 18 million occurs between 35 and 70 and
million occurs between 35 and 70 and
million occurs between 35 and 70 and that’s the focus of my talk today
that’s the focus of my talk today
that’s the focus of my talk today sometimes she looked forward and to what
sometimes she looked forward and to what
sometimes she looked forward and to what will happen in the future you got to
will happen in the future you got to
will happen in the future you got to look backwards and let us look at the
look backwards and let us look at the
look backwards and let us look at the mortality rates in a country like
mortality rates in a country like
mortality rates in a country like England that kept very good statistics
England that kept very good statistics
England that kept very good statistics for a long time so I’m going to show you
for a long time so I’m going to show you
for a long time so I’m going to show you data in 1910 1960 and 2010 and look at
data in 1910 1960 and 2010 and look at
data in 1910 1960 and 2010 and look at the risks at the age of five and at the
the risks at the age of five and at the
the risks at the age of five and at the age of 70 so these are the survival
age of 70 so these are the survival
age of 70 so these are the survival curves and you will see that at the
curves and you will see that at the
curves and you will see that at the bottom end here is what happened in 1910
bottom end here is what happened in 1910
bottom end here is what happened in 1910 you will see that by the age of 10 about
you will see that by the age of 10 about
you will see that by the age of 10 about 20 percent of children were dead compare
20 percent of children were dead compare
20 percent of children were dead compare that by 1960 where it was under 5% and
that by 1960 where it was under 5% and
that by 1960 where it was under 5% and by 2010 it’s under 1% these are huge
by 2010 it’s under 1% these are huge
by 2010 it’s under 1% these are huge changes within 100 years let’s take the
changes within 100 years let’s take the
changes within 100 years let’s take the age of 50 and you will see but in 1910
age of 50 and you will see but in 1910
age of 50 and you will see but in 1910 about 50% of the people who over born
about 50% of the people who over born
about 50% of the people who over born were dead by the age of 50 compare that
were dead by the age of 50 compare that
were dead by the age of 50 compare that in 1970 we’re still 90 percent were
in 1970 we’re still 90 percent were
in 1970 we’re still 90 percent were alive and by 2010 about 95 percent were
alive and by 2010 about 95 percent were
alive and by 2010 about 95 percent were alive and if you look at 70 you will see
alive and if you look at 70 you will see
alive and if you look at 70 you will see that even at the age of 70 there are
that even at the age of 70 there are
that even at the age of 70 there are many more people who are alive in 2010
many more people who are alive in 2010
many more people who are alive in 2010 compared to 1910 and soon we will have
compared to 1910 and soon we will have
compared to 1910 and soon we will have that will have a lot of people living
that will have a lot of people living
that will have a lot of people living beyond hundred so the last 100 years has
beyond hundred so the last 100 years has
beyond hundred so the last 100 years has seen the biggest advance in human health
seen the biggest advance in human health
seen the biggest advance in human health compared to the history of mankind ever
compared to the history of mankind ever
compared to the history of mankind ever and this has been a tremendous hundred
and this has been a tremendous hundred
and this has been a tremendous hundred years now let us look at what the main
years now let us look at what the main
years now let us look at what the main reasons were so what is given in shaded
reasons were so what is given in shaded
reasons were so what is given in shaded are deaths from tobacco what’s on the
are deaths from tobacco what’s on the
are deaths from tobacco what’s on the white is the added number from known
white is the added number from known
white is the added number from known tobacco deaths and you will see for 1916
tobacco deaths and you will see for 1916
tobacco deaths and you will see for 1916 men to 2010 right now you will see
men to 2010 right now you will see
men to 2010 right now you will see there’s a marked decline
there’s a marked decline
there’s a marked decline for nineteen thousand deaths down to
for nineteen thousand deaths down to
for nineteen thousand deaths down to four thousand over that period of time
four thousand over that period of time
four thousand over that period of time as seventy five percent reduction in
as seventy five percent reduction in
as seventy five percent reduction in that short period of time and if you
that short period of time and if you
that short period of time and if you look at the rest you will see there is a
look at the rest you will see there is a
look at the rest you will see there is a decline but nowhere near there this is
decline but nowhere near there this is
decline but nowhere near there this is two messages
two messages
two messages the biggest killer the mankind has known
the biggest killer the mankind has known
the biggest killer the mankind has known ever in the history is tobacco more than
ever in the history is tobacco more than
ever in the history is tobacco more than the plague more than Wars more than
the plague more than Wars more than
the plague more than Wars more than anything else the second thing is that
anything else the second thing is that
anything else the second thing is that you can actually make big changes in
you can actually make big changes in
you can actually make big changes in relatively short times for instance
relatively short times for instance
relatively short times for instance fifty years in as a fraction of human
fifty years in as a fraction of human
fifty years in as a fraction of human health or is tiny fifty years as you
health or is tiny fifty years as you
health or is tiny fifty years as you know as a proportion of the number of
know as a proportion of the number of
know as a proportion of the number of years people have been in the world so
years people have been in the world so
years people have been in the world so catchy made big changes in a short time
catchy made big changes in a short time
catchy made big changes in a short time now coming back to those same numbers of
now coming back to those same numbers of
now coming back to those same numbers of the fifty three million this is just to
the fifty three million this is just to
the fifty three million this is just to remind you you know zero two four seven
remind you you know zero two four seven
remind you you know zero two four seven million five to thirty four five million
million five to thirty four five million
million five to thirty four five million and 35 to 70 eighteen million and I’m
and 35 to 70 eighteen million and I’m
and 35 to 70 eighteen million and I’m not going to focus on the 70 plus
not going to focus on the 70 plus
not going to focus on the 70 plus million now if you look at this
million now if you look at this
million now if you look at this worldwide because I showed you
worldwide because I showed you
worldwide because I showed you numbers for England if you look at it
numbers for England if you look at it
numbers for England if you look at it worldwide we’re seeing a parallel
worldwide we’re seeing a parallel
worldwide we’re seeing a parallel decline 1950 25% of was the childhood
decline 1950 25% of was the childhood
decline 1950 25% of was the childhood mortality by 2010 it was five percent
mortality by 2010 it was five percent
mortality by 2010 it was five percent this is huge to see that worldwide this
this is huge to see that worldwide this
this is huge to see that worldwide this happened both in the rich countries and
happened both in the rich countries and
happened both in the rich countries and in the poor countries and this happened
in the poor countries and this happened
in the poor countries and this happened in the countries with a lot of
in the countries with a lot of
in the countries with a lot of technology and those with relatively
technology and those with relatively
technology and those with relatively little technology so this is telling you
little technology so this is telling you
little technology so this is telling you that social changes and some aspects of
that social changes and some aspects of
that social changes and some aspects of healthcare like a midwife going in
healthcare like a midwife going in
healthcare like a midwife going in looking at ending a bird is what made a
looking at ending a bird is what made a
looking at ending a bird is what made a difference as opposed to high-tech care
difference as opposed to high-tech care
difference as opposed to high-tech care now this one is looking at the world
now this one is looking at the world
now this one is looking at the world mortality by the different age groups so
mortality by the different age groups so
mortality by the different age groups so when you look at this
when you look at this
when you look at this what you’re seeing is down down here the
what you’re seeing is down down here the
what you’re seeing is down down here the earlier period you know 1970 down here
earlier period you know 1970 down here
earlier period you know 1970 down here this is 2010 and you will see in
this is 2010 and you will see in
this is 2010 and you will see in age group 0 to 4 in the world as a whole
age group 0 to 4 in the world as a whole
age group 0 to 4 in the world as a whole that is the left panel there’s a decline
that is the left panel there’s a decline
that is the left panel there’s a decline 5 to 49 declines 0 to 49 that is least
5 to 49 declines 0 to 49 that is least
5 to 49 declines 0 to 49 that is least you put together decline and 50 to 70 a
you put together decline and 50 to 70 a
you put together decline and 50 to 70 a decline you are seeing that in the
decline you are seeing that in the
decline you are seeing that in the low-income countries you’ve seen that in
low-income countries you’ve seen that in
low-income countries you’ve seen that in the high-income countries and you sing
the high-income countries and you sing
the high-income countries and you sing that in the low middle and the upper
that in the low middle and the upper
that in the low middle and the upper middle if we take the world as a whole
middle if we take the world as a whole
middle if we take the world as a whole you have 20% of the world is high-income
you have 20% of the world is high-income
you have 20% of the world is high-income countries 20% is low income countries
countries 20% is low income countries
countries 20% is low income countries 60% are middle-income countries with
60% are middle-income countries with
60% are middle-income countries with half being high middle and half being
half being high middle and half being
half being high middle and half being low middle that’s an easy way to
low middle that’s an easy way to
low middle that’s an easy way to remember now one way to look at what’s
remember now one way to look at what’s
remember now one way to look at what’s happening is to take the 25 most
happening is to take the 25 most
happening is to take the 25 most populous countries in the world that
populous countries in the world that
populous countries in the world that constitutes 75% of the global population
constitutes 75% of the global population
constitutes 75% of the global population and Canada doesn’t count you know so
and Canada doesn’t count you know so
and Canada doesn’t count you know so this doesn’t include Canada but includes
this doesn’t include Canada but includes
this doesn’t include Canada but includes the United States and the UK in other
the United States and the UK in other
the United States and the UK in other countries where the trends are identical
countries where the trends are identical
countries where the trends are identical and we look at the mortality in these
and we look at the mortality in these
and we look at the mortality in these three age groups the first thing to do
three age groups the first thing to do
three age groups the first thing to do is to look at mortality zero to four and
is to look at mortality zero to four and
is to look at mortality zero to four and you’ll see in practically every country
you’ll see in practically every country
you’ll see in practically every country there’s a decline so what you’re seeing
there’s a decline so what you’re seeing
there’s a decline so what you’re seeing on the top is the earliest period which
on the top is the earliest period which
on the top is the earliest period which is 1970 and that 40 years later 2010 and
is 1970 and that 40 years later 2010 and
is 1970 and that 40 years later 2010 and this blob there like the head of a sperm
this blob there like the head of a sperm
this blob there like the head of a sperm is the most recent and in every case the
is the most recent and in every case the
is the most recent and in every case the head of the sperm is swimming downwards
head of the sperm is swimming downwards
head of the sperm is swimming downwards you know going south and you’ll see that
you know going south and you’ll see that
you know going south and you’ll see that every country you’ll see that in the
every country you’ll see that in the
every country you’ll see that in the rich countries at the far right end
rich countries at the far right end
rich countries at the far right end which started low but kept on going
which started low but kept on going
which started low but kept on going lower and the poor countries at the left
lower and the poor countries at the left
lower and the poor countries at the left hand like the Democratic Republic of
hand like the Democratic Republic of
hand like the Democratic Republic of Congo that started high and still
Congo that started high and still
Congo that started high and still remains high so that’s good news so
remains high so that’s good news so
remains high so that’s good news so whatever we did globally hug everybody
whatever we did globally hug everybody
whatever we did globally hug everybody now this is between the ages of 5 and 49
now this is between the ages of 5 and 49
now this is between the ages of 5 and 49 generally the same pattern except for a
generally the same pattern except for a
generally the same pattern except for a few chain of differences you will see in
few chain of differences you will see in
few chain of differences you will see in countries like South Africa and the left
countries like South Africa and the left
countries like South Africa and the left it actually went up and this is the HIV
it actually went up and this is the HIV
it actually went up and this is the HIV epidemic you will see countries like
epidemic you will see countries like
epidemic you will see countries like Iran barry’s Iran somewhere there
Iran barry’s Iran somewhere there
Iran barry’s Iran somewhere there well Iran when they had the war with
well Iran when they had the war with
well Iran when they had the war with Iraq several million people died so then
Iraq several million people died so then
Iraq several million people died so then war can interfere with it or you can
war can interfere with it or you can
war can interfere with it or you can look at countries like Russia which is
look at countries like Russia which is
look at countries like Russia which is down here you’ll see that she went up
down here you’ll see that she went up
down here you’ll see that she went up and that is social upheaval
and that is social upheaval
and that is social upheaval after the fall of the Soviet Union and
after the fall of the Soviet Union and
after the fall of the Soviet Union and yells during elseís time there was
yells during elseís time there was
yells during elseís time there was massive chaos and then alcoholism
massive chaos and then alcoholism
massive chaos and then alcoholism increased
increased
increased deaths from violence increase so barring
deaths from violence increase so barring
deaths from violence increase so barring those two two or three exceptions in
those two two or three exceptions in
those two two or three exceptions in every country went down and some of
every country went down and some of
every country went down and some of these arrows Oh are over India and some
these arrows Oh are over India and some
these arrows Oh are over India and some of them are over China to show you that
of them are over China to show you that
of them are over China to show you that even the poor countries changed now this
even the poor countries changed now this
even the poor countries changed now this is 50 to 69 again the same pattern you
is 50 to 69 again the same pattern you
is 50 to 69 again the same pattern you will see indeed came down ETOP
will see indeed came down ETOP
will see indeed came down ETOP one of the big countries in Africa came
one of the big countries in Africa came
one of the big countries in Africa came down I think that’s China and this is
down I think that’s China and this is
down I think that’s China and this is the u.s. so rich and poor countries in
the u.s. so rich and poor countries in
the u.s. so rich and poor countries in different continents came down and what
different continents came down and what
different continents came down and what you’re seeing out here is that again you
you’re seeing out here is that again you
you’re seeing out here is that again you know this is Russia you’ll see
know this is Russia you’ll see
know this is Russia you’ll see alcoholism violence and social upheaval
alcoholism violence and social upheaval
alcoholism violence and social upheaval was was destructive so this is bringing
was was destructive so this is bringing
was was destructive so this is bringing me to my second point the determinants
me to my second point the determinants
me to my second point the determinants of health are the big dial issues in
of health are the big dial issues in
of health are the big dial issues in society it’s not necessarily medical
society it’s not necessarily medical
society it’s not necessarily medical care in Western countries where social
care in Western countries where social
care in Western countries where social circumstances are more or less stable
circumstances are more or less stable
circumstances are more or less stable medical care plays a much bigger role in
medical care plays a much bigger role in
medical care plays a much bigger role in the poorer countries where social
the poorer countries where social
the poorer countries where social factors dominate social factors play a
factors dominate social factors play a
factors dominate social factors play a bigger role now worldwide there are only
bigger role now worldwide there are only
bigger role now worldwide there are only four or five causes that are the big
four or five causes that are the big
four or five causes that are the big causes of death premature deaths the
causes of death premature deaths the
causes of death premature deaths the first is tobacco which I talked about
first is tobacco which I talked about
first is tobacco which I talked about HIV an epidemic like HIV or even
HIV an epidemic like HIV or even
HIV an epidemic like HIV or even epidemic like Ebola spread worldwide
epidemic like Ebola spread worldwide
epidemic like Ebola spread worldwide that would be a disaster
that would be a disaster
that would be a disaster alcohol adiposity and war and these are
alcohol adiposity and war and these are
alcohol adiposity and war and these are the only things that have fluctuated
the only things that have fluctuated
the only things that have fluctuated between populations over time so let me
between populations over time so let me
between populations over time so let me give you an example of the UK and these
give you an example of the UK and these
give you an example of the UK and these are male mortality the top line and the
are male mortality the top line and the
are male mortality the top line and the bottom is female mortality the X is the
bottom is female mortality the X is the
bottom is female mortality the X is the time I finished my PhD it had nothing to
time I finished my PhD it had nothing to
time I finished my PhD it had nothing to do
do
do the with the with the decline it’s just
the with the with the decline it’s just
the with the with the decline it’s just that that’s the way of me remembering
that that’s the way of me remembering
that that’s the way of me remembering and you will see this massive big
and you will see this massive big
and you will see this massive big decrease where it was about what is it
decrease where it was about what is it
decrease where it was about what is it about 20% or so I can’t read it from 25%
about 20% or so I can’t read it from 25%
about 20% or so I can’t read it from 25% of the debts in males down to about 5%
of the debts in males down to about 5%
of the debts in males down to about 5% in that 30 40 years that’s huge
in that 30 40 years that’s huge
in that 30 40 years that’s huge 75 percent reduction you’ll see women as
75 percent reduction you’ll see women as
75 percent reduction you’ll see women as well showed that decline however not all
well showed that decline however not all
well showed that decline however not all countries showed this this is Hungary
countries showed this this is Hungary
countries showed this this is Hungary that showed initially an increase in men
that showed initially an increase in men
that showed initially an increase in men and then a decline and this is to do
and then a decline and this is to do
and then a decline and this is to do again with the fall of the Soviet empire
again with the fall of the Soviet empire
again with the fall of the Soviet empire that the initial reaction was chaos
that the initial reaction was chaos
that the initial reaction was chaos whenever a regime is overthrown you’re
whenever a regime is overthrown you’re
whenever a regime is overthrown you’re going to get chaos it had happened in
going to get chaos it had happened in
going to get chaos it had happened in England during the Civil War after the
England during the Civil War after the
England during the Civil War after the Civil War
Civil War
Civil War it happened in France it happened in
it happened in France it happened in
it happened in France it happened in Russia it’s happening right right now in
Russia it’s happening right right now in
Russia it’s happening right right now in the Middle East so you’ve got to
the Middle East so you’ve got to
the Middle East so you’ve got to anticipate once you have regime change
anticipate once you have regime change
anticipate once you have regime change it’s chaos for a few decades
it’s chaos for a few decades
it’s chaos for a few decades and then it starts to stabilize and you
and then it starts to stabilize and you
and then it starts to stabilize and you can see in women it was fairly stable
can see in women it was fairly stable
can see in women it was fairly stable and then both in men and women it
and then both in men and women it
and then both in men and women it declined this is Russia show you the
declined this is Russia show you the
declined this is Russia show you the erratic nature especially in men less so
erratic nature especially in men less so
erratic nature especially in men less so in women but there was no improvement of
in women but there was no improvement of
in women but there was no improvement of women till more recent times so the
women till more recent times so the
women till more recent times so the question is can be harvested of
question is can be harvested of
question is can be harvested of mortality and the first thing is if you
mortality and the first thing is if you
mortality and the first thing is if you had a heart attack or a stroke
had a heart attack or a stroke
had a heart attack or a stroke we have enough treatments today that
we have enough treatments today that
we have enough treatments today that collectively put together can reduce the
collectively put together can reduce the
collectively put together can reduce the risk of another heart attack
risk of another heart attack
risk of another heart attack by 50% to 70% and what you can what you
by 50% to 70% and what you can what you
by 50% to 70% and what you can what you do is you get people to stop smoking
do is you get people to stop smoking
do is you get people to stop smoking give them aspirin cholesterol-lowering
give them aspirin cholesterol-lowering
give them aspirin cholesterol-lowering and a blood pressure lowering drug and
and a blood pressure lowering drug and
and a blood pressure lowering drug and you can reduce it by 70% now there are
you can reduce it by 70% now there are
you can reduce it by 70% now there are new medications that combines everything
new medications that combines everything
new medications that combines everything except the smoking part of it and you
except the smoking part of it and you
except the smoking part of it and you can make big big impacts
can make big big impacts
can make big big impacts there’s no reason today it’s available
there’s no reason today it’s available
there’s no reason today it’s available about 25 cents a day there’s no reason
about 25 cents a day there’s no reason
about 25 cents a day there’s no reason in future it can’t be available at five
in future it can’t be available at five
in future it can’t be available at five cents a day so imagine having a
cents a day so imagine having a
cents a day so imagine having a medication at five cents a day
medication at five cents a day
medication at five cents a day high-risk people reducing mortality by
high-risk people reducing mortality by
high-risk people reducing mortality by 50 to 60% and then on top of that if you
50 to 60% and then on top of that if you
50 to 60% and then on top of that if you get people to stop smoking you added to
get people to stop smoking you added to
get people to stop smoking you added to 75% that is huge isn’t it now that’s the
75% that is huge isn’t it now that’s the
75% that is huge isn’t it now that’s the same thing now what I want to show you a
same thing now what I want to show you a
same thing now what I want to show you a slide on how bats tobacco’s and how bad
slide on how bats tobacco’s and how bad
slide on how bats tobacco’s and how bad tobacco is in women and the reason I
tobacco is in women and the reason I
tobacco is in women and the reason I focus on women in zin today in Canada
focus on women in zin today in Canada
focus on women in zin today in Canada young women are more often smokers than
young women are more often smokers than
young women are more often smokers than men men have declined historically women
men men have declined historically women
men men have declined historically women were more sensible than men today it’s
were more sensible than men today it’s
were more sensible than men today it’s reversed so what this is showing you is
reversed so what this is showing you is
reversed so what this is showing you is this is a study where they took a
this is a study where they took a
this is a study where they took a million women in the UK and then follow
million women in the UK and then follow
million women in the UK and then follow us them do you smoke
us them do you smoke
us them do you smoke how much do you smoke when did you quit
how much do you smoke when did you quit
how much do you smoke when did you quit and you will see even as little as ten
and you will see even as little as ten
and you will see even as little as ten cigarettes a day doubles the risk of
cigarettes a day doubles the risk of
cigarettes a day doubles the risk of death 15 three triples and 20 quadruples
death 15 three triples and 20 quadruples
death 15 three triples and 20 quadruples so if any of you know people who smoke
so if any of you know people who smoke
so if any of you know people who smoke just the biggest favor you can do them
just the biggest favor you can do them
just the biggest favor you can do them do for them is to persuade them to smoke
do for them is to persuade them to smoke
do for them is to persuade them to smoke smoking and the other thing about this
smoking and the other thing about this
smoking and the other thing about this is not only the risk rate for people who
is not only the risk rate for people who
is not only the risk rate for people who smoke but if you get people to stop
smoke but if you get people to stop
smoke but if you get people to stop smoking before the age of 40 you can
smoking before the age of 40 you can
smoking before the age of 40 you can virtually eliminate the risk of smoking
virtually eliminate the risk of smoking
virtually eliminate the risk of smoking so the perfect way to smoke is start to
so the perfect way to smoke is start to
so the perfect way to smoke is start to smoke when you’re born and keep on
smoke when you’re born and keep on
smoke when you’re born and keep on smoking till you’ve become 39 years and
smoking till you’ve become 39 years and
smoking till you’ve become 39 years and then stop and then you’ll live forever
then stop and then you’ll live forever
then stop and then you’ll live forever so these are the data that shows us so
so these are the data that shows us so
so these are the data that shows us so this is people stopping smoking at the
this is people stopping smoking at the
this is people stopping smoking at the age of 20 and this is the risk that is
age of 20 and this is the risk that is
age of 20 and this is the risk that is three folders in the people who continue
three folders in the people who continue
three folders in the people who continue to smoke and for the next 20 years so if
to smoke and for the next 20 years so if
to smoke and for the next 20 years so if they stopped at the age of 20 and and
they stopped at the age of 20 and and
they stopped at the age of 20 and and seriously they may have smoked for five
seriously they may have smoked for five
seriously they may have smoked for five years the risk is not increased if they
years the risk is not increased if they
years the risk is not increased if they smoke around thirty years you’ll see the
smoke around thirty years you’ll see the
smoke around thirty years you’ll see the risk is only increased by five percent
risk is only increased by five percent
risk is only increased by five percent it’s not huge if they stopped at the age
it’s not huge if they stopped at the age
it’s not huge if they stopped at the age of 40 the risk is only one point to fall
of 40 the risk is only one point to fall
of 40 the risk is only one point to fall competitor percent and somebody
competitor percent and somebody
competitor percent and somebody continued to smoke so
continued to smoke so
continued to smoke so and obviously they smoked stop
and obviously they smoked stop
and obviously they smoked stop at 50 you still avoid most of the deaths
at 50 you still avoid most of the deaths
at 50 you still avoid most of the deaths due to smoking so stopping smoking at
due to smoking so stopping smoking at
due to smoking so stopping smoking at any age is very important but smoking
any age is very important but smoking
any age is very important but smoking stopping smoking before the age of 30 or
stopping smoking before the age of 30 or
stopping smoking before the age of 30 or 40 it will nearly eliminate most of the
40 it will nearly eliminate most of the
40 it will nearly eliminate most of the risk of smoking the other thing is
risk of smoking the other thing is
risk of smoking the other thing is elevated blood pressure if your blood
elevated blood pressure if your blood
elevated blood pressure if your blood pressure is higher than by about 10
pressure is higher than by about 10
pressure is higher than by about 10 millimeters now most of you know that
millimeters now most of you know that
millimeters now most of you know that the average blood pressure in a
the average blood pressure in a
the average blood pressure in a population is around 125 to 130 or so
population is around 125 to 130 or so
population is around 125 to 130 or so that is systolic the upper number okay
that is systolic the upper number okay
that is systolic the upper number okay now if it is lowered in people with high
now if it is lowered in people with high
now if it is lowered in people with high blood pressure by 10 millimeters and you
blood pressure by 10 millimeters and you
blood pressure by 10 millimeters and you can do that today easily by one or two
can do that today easily by one or two
can do that today easily by one or two low doses of one or two blood pressure
low doses of one or two blood pressure
low doses of one or two blood pressure lowering drugs which together needing to
lowering drugs which together needing to
lowering drugs which together needing to be more than 10 or 15 cents a day you
be more than 10 or 15 cents a day you
be more than 10 or 15 cents a day you can reduce the risk by 1/4 that’s big
can reduce the risk by 1/4 that’s big
can reduce the risk by 1/4 that’s big and cholesterol is the other big cause
and cholesterol is the other big cause
and cholesterol is the other big cause of heart disease and strokes and if you
of heart disease and strokes and if you
of heart disease and strokes and if you give a drug called a statin that impairs
give a drug called a statin that impairs
give a drug called a statin that impairs the production of the bad cholesterol
the production of the bad cholesterol
the production of the bad cholesterol LDL cholesterol or what’s called the
LDL cholesterol or what’s called the
LDL cholesterol or what’s called the low-density lipoprotein cholesterol all
low-density lipoprotein cholesterol all
low-density lipoprotein cholesterol all if you know these good cholesterol and
if you know these good cholesterol and
if you know these good cholesterol and bad cholesterol this is the bad
bad cholesterol this is the bad
bad cholesterol this is the bad cholesterol if you can reduce it by 2
cholesterol if you can reduce it by 2
cholesterol if you can reduce it by 2 million moles that is by about a third
million moles that is by about a third
million moles that is by about a third you’ll reduce the risk by 40% so smoking
you’ll reduce the risk by 40% so smoking
you’ll reduce the risk by 40% so smoking big effect blood pressure big effect
big effect blood pressure big effect
big effect blood pressure big effect cholesterol lowering big effect and if
cholesterol lowering big effect and if
cholesterol lowering big effect and if you put it all together you’ll have big
you put it all together you’ll have big
you put it all together you’ll have big effects now one of the things about
effects now one of the things about
effects now one of the things about smoking I’ve heard people say is we
smoking I’ve heard people say is we
smoking I’ve heard people say is we beaten tobacco there’s nothing more
beaten tobacco there’s nothing more
beaten tobacco there’s nothing more incorrect than that in the last century
incorrect than that in the last century
incorrect than that in the last century that’s down at the bottom in yellow 100
that’s down at the bottom in yellow 100
that’s down at the bottom in yellow 100 million people died from tobacco in this
million people died from tobacco in this
million people died from tobacco in this century if the current rates of tobacco
century if the current rates of tobacco
century if the current rates of tobacco smoking continues 1 billion people will
smoking continues 1 billion people will
smoking continues 1 billion people will die and the reason is in the last
die and the reason is in the last
die and the reason is in the last century the rates of smoking increased
century the rates of smoking increased
century the rates of smoking increased till the 1950s and 60s especially in
till the 1950s and 60s especially in
till the 1950s and 60s especially in women it was later
women it was later
women it was later whereís and second it was confined
whereís and second it was confined
whereís and second it was confined largely to Western countries
largely to Western countries
largely to Western countries in this century we have exported the
in this century we have exported the
in this century we have exported the epidemic of tobacco to China to India
epidemic of tobacco to China to India
epidemic of tobacco to China to India which are much more populous than Canada
which are much more populous than Canada
which are much more populous than Canada the u.s. of the UK and remember this is
the u.s. of the UK and remember this is
the u.s. of the UK and remember this is smoking through the whole century and in
smoking through the whole century and in
smoking through the whole century and in the next 20 years that’s a top-line 2000
the next 20 years that’s a top-line 2000
the next 20 years that’s a top-line 2000 to 2019 hundred million will die those
to 2019 hundred million will die those
to 2019 hundred million will die those hundred million are current smokers so
hundred million are current smokers so
hundred million are current smokers so advising children to stop smoking won’t
advising children to stop smoking won’t
advising children to stop smoking won’t touch those hundred million deaths the
touch those hundred million deaths the
touch those hundred million deaths the next 20 to 30 years 2020 to 2050 250
next 20 to 30 years 2020 to 2050 250
next 20 to 30 years 2020 to 2050 250 million will die half of them are
million will die half of them are
million will die half of them are current smokers half of them will be new
current smokers half of them will be new
current smokers half of them will be new smokers and obviously from 2050 to 2100
smokers and obviously from 2050 to 2100
smokers and obviously from 2050 to 2100 there will to be 500 million deaths and
there will to be 500 million deaths and
there will to be 500 million deaths and all of them will be new smokers so the
all of them will be new smokers so the
all of them will be new smokers so the best way to have an impact in the next
best way to have an impact in the next
best way to have an impact in the next 30 years is to get people to quit and if
30 years is to get people to quit and if
30 years is to get people to quit and if you get them to quit their children will
you get them to quit their children will
you get them to quit their children will not start smoking right now a public
not start smoking right now a public
not start smoking right now a public health strategy is emphasizing childhood
health strategy is emphasizing childhood
health strategy is emphasizing childhood cessation over quitting programs like in
cessation over quitting programs like in
cessation over quitting programs like in Hamilton is practically no quitting
Hamilton is practically no quitting
Hamilton is practically no quitting program for tobacco control so this is
program for tobacco control so this is
program for tobacco control so this is the kind of thing we need now one of the
the kind of thing we need now one of the
the kind of thing we need now one of the biggest things you can do to control
biggest things you can do to control
biggest things you can do to control tobacco is a policy and the policy is to
tobacco is a policy and the policy is to
tobacco is a policy and the policy is to have laws that reduce the use of tobacco
have laws that reduce the use of tobacco
have laws that reduce the use of tobacco and of those the most important one is
and of those the most important one is
and of those the most important one is increasing the prices in the UK they had
increasing the prices in the UK they had
increasing the prices in the UK they had two big price increases one in 1947 and
two big price increases one in 1947 and
two big price increases one in 1947 and in one in 1981 and during that time
in one in 1981 and during that time
in one in 1981 and during that time immediately the rates of tobacco smoking
immediately the rates of tobacco smoking
immediately the rates of tobacco smoking came down now there is now remember
came down now there is now remember
came down now there is now remember government’s make a ton of money from
government’s make a ton of money from
government’s make a ton of money from the taxes on tobacco and one of the
the taxes on tobacco and one of the
the taxes on tobacco and one of the reasons they are reluctant to increase
reasons they are reluctant to increase
reasons they are reluctant to increase the price of tobacco too much because
the price of tobacco too much because
the price of tobacco too much because they are concerned what will happen to
they are concerned what will happen to
they are concerned what will happen to their revenues so in South African
their revenues so in South African
their revenues so in South African France the experiences suggest if you
France the experiences suggest if you
France the experiences suggest if you triple the price of cigarettes smoking
triple the price of cigarettes smoking
triple the price of cigarettes smoking rates were high but despite having it
rates were high but despite having it
rates were high but despite having it government revenues will still be
government revenues will still be
government revenues will still be doubled so now this can obviously go on
doubled so now this can obviously go on
doubled so now this can obviously go on indefinitely because at some stage the
indefinitely because at some stage the
indefinitely because at some stage the numbers of people smoking will be very
numbers of people smoking will be very
numbers of people smoking will be very low
low
low so I’ll stop here by reminding you that
so I’ll stop here by reminding you that
so I’ll stop here by reminding you that are really five main causes worldwide or
are really five main causes worldwide or
are really five main causes worldwide or premature death
premature death
premature death these are tobacco HIV which I didn’t
these are tobacco HIV which I didn’t
these are tobacco HIV which I didn’t talk about it has nothing to do with
talk about it has nothing to do with
talk about it has nothing to do with heart disease alcohol adiposity that is
heart disease alcohol adiposity that is
heart disease alcohol adiposity that is obesity and war and of this alcohol
obesity and war and of this alcohol
obesity and war and of this alcohol tobacco and adiposity that is obesity
tobacco and adiposity that is obesity
tobacco and adiposity that is obesity affects heart disease so remember death
affects heart disease so remember death
affects heart disease so remember death in old age is inevitable but that before
in old age is inevitable but that before
in old age is inevitable but that before old age is not thank you
old age is not thank you
old age is not thank you [Applause]
”
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