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Forming a picture of health

As life expectancy increases how can stakeholders ensure the last decades of life are healthy ones?

Puzzle

We often speak of an ageing population and its concomitant rise in chronic health problems, but the issue was thrown into sharp relief earlier this year by new research from the Economist Intelligence Unit (EIU).

On the one hand it suggests today’s children are likely to become the first generation to live 100 years, but on the other children are currently set to be less healthy than today’s adults overs 65 when they reach that age.

The EIUs Kids and Old Age: Taking the Long View of Children’s Health and Well-Being report pinned the blame for this on lifestyle-related problems, saying they’re not only likely to contribute to chronic disease in later life, but are already causing health problems among children.

Kids and Old Age was sponsored by Merck and released at Merck Consumer Health’s annual debate, which this year tackled the question of ‘100 Healthy Years: Are Kids Prepared?’. It saw a distinguished panel of experts gather in May at the German healthcare company’s Darmstadt home, where representatives from the likes of UNAIDS, the World Obesity Federation and the United Nations debated questions of long-term health and longevity.

Determining life expectancy

One of those experts was Dr Marc Luy. The head of the Health and Longevity research group at the Vienna Institute of Demography within the Austrian Academy of Sciences, Marc’s research focuses on differentials in health and longevity, particularly those between different subpopulations such as men and women.

One of Marc’s notable pieces of work is what’s know as the ‘cloister study’. Gathering long-term data from a Benedictine monastery and two Franciscan nunneries in Bavaria, he sought to answer the question of why women live longer than men. Studying changes in life expectancy over the 120 years to 2000, he concluded the increase seen in gender-specific mortality differences in the religious communities could be traced solely to behavioural and environmental causes, and not to biological factors.

“From this study we learned two very important things. The first is that it turns out that the gender gap in life expectancy is primarily due to non-biological factors, so factors that can be influenced by your own action. The second is that [the difference] is caused by the high mortality of men, not so much the low mortality of women,” Marc explained as he talked the audience through the cloister study, setting the scene for the debate.

“What we know about healthy ageing is that it looks like a very, very big jigsaw puzzle, for which we have most pieces at hand, if not quite all of them.”

However, and given that biology is not itself the most important thing, the risk factors - and their impact on mortality - are actually pretty simple: smoking is the biggest of them, closely followed by physical activity. And then as life expectancy increases, so too does the risk of chronic diseases.

Managing diseases

One such manageable chronic disease is HIV, thanks to a decade of progress that has seen it transformed from a devastating epidemic that prompted the WHO to declare it in 2006 “an unprecedented human catastrophe”. By 2015 the global HIV epidemic claimed fewer lives than at any point in almost two decades, and fewer people became newly infected with HIV than in any year since 1991.

“Who’d have thought with HIV that we’d be talking about 100 healthy years?” Dr Erasmus Morah, UNAIDS country director for South Africa acknowledged.

Erasmus spent 12 years working for UNICEF in the Philippines, Somalia, Kenya and Pakistan, before joining UNAIDS in 2002. Serving as country coordinator for first Malawi and then Kenya, where he initiated the world’s first ever mass HIV testing week, beginning one of Kenya’s largest ever testing drives that saw more than three million people tested over two years.

“We have people who were afraid of dying of AIDS, who are now perhaps worrying about dying of diabetes or heart disease, the dying of the very things that may be triggered by obesity. To me it’s an interesting transformation, people who were worried about dying of AIDS are now worried about dying from other chronic lifestyle-triggered conditions,” Erasmus noted.

Many of these are caused by obesity, which was itself classed as a chronic disease by the American Medical Assocation in 2013.

Around the world 220 million school-age children are overweight or obese. “If governments don’t act soon that statistic is due to rise to 268 million by 2025,” said Ellie Needs, head of communications and business development at the World Obesity Federation. “One of the things that we’re working towards is the WHO target to halt the rise in obesity and achieve a 25% reduction in mortality from non-communicable diseases.”

The knock-on effects of this rise are well known, but bear repeating. “If we don’t address obesity we’ll be treating the consequences of obesity,” Ellie said. Noting it’s an “overarching issue” that can cause cancer, type II diabetes, fatty liver disease and many additional health problems, which “ultimately will cost more to treat if obesity isn’t tackled”.

Achieving behaviour change

Just as the pharmaceutical industry has been looking to behavioural change theories for issues such as improving patients’ adherence to their treatment, so too are organisations such as the United Nations.

Another of the panellists at Merck Consumer Health’s annual debate was Etienne Franca, who is communications officer at the United Nations’ Every Woman Every Child team. Every Woman Every Child works with governments and the private sector to ensure women, children and adolescents are at the heart of development.

“Behaviour change is one of the most difficult things to address, both from a conceptual way but also from a practical way,” Etienne noted. “So how can we measure change in behaviour, how can we have the quantitative data to say that this is really working?

“The leap between having the information and actually changing the behaviour can only be made if we have the parents, the caregivers and the school together with the community pushing the behaviour.”

Moving from simply having the right information available to translating that into action has been an issue within HIV, where UNAIDS’ Erasmus said that while “HIV prevention is something that most people now know… you need the right environment to translate what you know into action”.

“One of the things that we found with HIV was that you can have the best evidence, the best programme data and you go nowhere. We’ve gone the furthest in South Africa when we’ve been able to bridge the science and the politics, and then the two work together.”

Moving the needle

As for how the debate fits with Merck Consumer Health, its chief marketing officer Atilla Cansun explained. “The dream, the vision of my company is that everybody around the world should have the right and get the support to live 100 fantastic years. So for that purpose we have created a neutral, iconic brand, WE100 - it’s a brand specific for services and education.”

Under this flagship initiative Merck earlier this year began pilots in South Africa of its GEN100 programme to support school-age children and help them live longer and healthier lives. A school-based education programme, GEN100 covers nutrition, obesity, diabetes, skincare and exercise within the school curriculum. “I’m very hopeful with GEN100 that it’s going to move the needle,” Atilla concluded.

Article by
Dominic Tyer

is PMGroup's director of editorial

11th August 2017

From: Healthcare

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