WEBVTT 1 00:00:00.000 --> 00:00:08.240 Good morning everybody and welcome to one of the first exciting events in the Festival of Ideas. 2 00:00:08.920 --> 00:00:11.060 And thank you for coming on this rainy day. 3 00:00:11.820 --> 00:00:17.500 My name's Robyn McDermott. I'm Pro-Vice-Chancellor of University of South Australia Health Sciences Division. 4 00:00:18.160 --> 00:00:23.700 Just across the road there and we're one of the co-sponsors of the festival. 5 00:00:24.960 --> 00:00:26.820 Just a few housekeeping matters. 6 00:00:26.820 --> 00:00:29.860 There's a microphone in the middle there. 7 00:00:30.460 --> 00:00:37.660 We'll be taking about 15 minutes or so of questions and answers after Norman has finished. 8 00:00:38.160 --> 00:00:44.740 And if you could come up and briefly just identify yourselves and where you are from, 9 00:00:44.840 --> 00:00:48.200 if you are representing anything else other than yourself. 10 00:00:49.400 --> 00:00:55.920 And we need to be out of here strictly before 11 o'clock to make way for the next session. 11 00:00:55.980 --> 00:00:56.360 So. 12 00:00:56.820 --> 00:00:58.600 Thank you for your cooperation in that. 13 00:00:59.300 --> 00:01:06.760 I have to say that being on the Festival of Ideas Committee has been the most fun committee I've ever been on 14 00:01:06.760 --> 00:01:13.560 because we get to sit around and have lunch and dream up who our heroes are, who we can invite to speak. 15 00:01:13.860 --> 00:01:16.400 And one of those heroes of mine was Norman. 16 00:01:16.600 --> 00:01:23.840 And I've been listening to him on Radio National and secretly admiring him for many years. 17 00:01:24.680 --> 00:01:26.800 One thing that Norman is... 18 00:01:27.620 --> 00:01:32.740 uniquely gifted in is the simultaneous translation of medical jargon 19 00:01:32.740 --> 00:01:38.060 coupled with an incredible mumbo-jumbo detector, 20 00:01:38.380 --> 00:01:41.640 particularly for detecting medical mumbo-jumbo. 21 00:01:41.820 --> 00:01:47.220 And there's not many people in the world who can do that very well while simultaneously translating. 22 00:01:48.380 --> 00:01:51.760 So, Norman, thanks for coming and look forward to it. 23 00:01:52.640 --> 00:01:53.420 APPLAUSE 24 00:01:59.460 --> 00:02:00.240 Thanks, Robin. 25 00:02:00.400 --> 00:02:06.260 And Adelaide is very lucky to have Robin, one of our preeminent public health researchers. 26 00:02:07.580 --> 00:02:11.020 I'm impressed that you've got nothing else to do but come and listen to me. 27 00:02:12.100 --> 00:02:15.120 I'm grateful there's more than three people in the audience, so thank you very much. 28 00:02:15.560 --> 00:02:17.200 Adelaide's always a great place to come and talk. 29 00:02:18.060 --> 00:02:25.780 So I've called this talk Survival of the Fittest, Survival of the Thinnest, or Survival of the Richest. 30 00:02:26.880 --> 00:02:30.740 And the story I'm going to talk to you about is about longevity. 31 00:02:32.360 --> 00:02:33.900 Why Survival of the Fittest? 32 00:02:34.600 --> 00:02:36.360 Well, I'm going to talk about genes. 33 00:02:38.540 --> 00:02:41.660 Why Survival of the Thinnest? Well, I'll talk about lifestyle as well. 34 00:02:42.580 --> 00:02:44.380 And why Survival of the Richest? 35 00:02:45.000 --> 00:02:49.900 Well, what you'll discover is that some of the key determinants of how long we live 36 00:02:49.900 --> 00:02:54.100 have got very little to do with lifestyle or indeed our genes. 37 00:02:54.640 --> 00:02:56.780 And in fact, how we organize the 38 00:02:56.820 --> 00:03:01.200 way we live largely determines how long we live. 39 00:03:02.060 --> 00:03:08.200 We're actually living in a unique moment in human history in terms of our survival. 40 00:03:09.240 --> 00:03:12.080 We're surviving longer than we ever have before, 41 00:03:12.880 --> 00:03:18.360 but the nature of survival is changing, and it's changing extremely rapidly. 42 00:03:19.480 --> 00:03:23.020 Very much more rapidly than any other time before in history, 43 00:03:24.260 --> 00:03:26.400 excluding things like influenza, 44 00:03:26.400 --> 00:03:28.800 pandemics, or the black death 45 00:03:28.800 --> 00:03:32.240 and AIDS in Sub-Saharan Africa. 46 00:03:32.920 --> 00:03:37.720 But apart from those issues, in terms of a global pattern, 47 00:03:38.020 --> 00:03:42.000 even in poor countries, our survival is increasing quite rapidly, 48 00:03:42.160 --> 00:03:47.820 but the pattern is changing, and the pattern has changed throughout human history, 49 00:03:47.960 --> 00:03:50.500 and I'm going to describe that to you. 50 00:03:50.660 --> 00:03:55.720 The bottom line, of course, and I don't think Philip Adams is in the audience here, 51 00:03:55.760 --> 00:03:56.380 but Philip is certainly here, 52 00:03:56.380 --> 00:04:01.580 here for the Festival of Ideas. So, you know, is death, one of Philip's, as any of you who 53 00:04:01.580 --> 00:04:06.840 have listened to Late Night Live would know, is one of his great obsessions. It's the obsession 54 00:04:06.840 --> 00:04:10.380 of really anybody in the media, because we're all so egoistical, we can't imagine the world 55 00:04:10.380 --> 00:04:17.200 without us. But of course, we all do have to confront that at one stage. I was actually 56 00:04:17.200 --> 00:04:22.440 starting to read Andrew O'Hagan's book, Be Near Me, and I thought that the poem that 57 00:04:22.440 --> 00:04:27.100 he quotes in the frontispiece is actually probably pretty apt, given that we're actually 58 00:04:27.100 --> 00:04:30.840 all heading in that direction. It's a poem by Alfred Lord Tennyson. 59 00:04:31.880 --> 00:04:37.820 Be near me when my light is low, when the blood creeps and the nerves prick and tingle, 60 00:04:37.860 --> 00:04:45.080 and the heart is sick, and all the wheels of being slow. Be near me when the sensuous 61 00:04:45.080 --> 00:04:51.740 frame is racked with pangs that conquer trust, and time, a maniac scattering dust. 62 00:04:51.960 --> 00:04:52.420 . 63 00:04:52.420 --> 00:04:59.100 And life, a fury slinging flame. Be near me when my faith is dry, and when the flies 64 00:04:59.100 --> 00:05:04.580 of latter spring that lay their eggs and sting and sing, and weave their petty cells and 65 00:05:04.580 --> 00:05:11.500 die. Be near me when I fade away to point the term of human strife, and on the low dark 66 00:05:11.500 --> 00:05:18.160 verge of life, the twilight of eternal day. So no matter how long we live, we've got to 67 00:05:18.160 --> 00:05:21.160 confront that at the end. That's a really cheery start to a talk, isn't it? 68 00:05:22.780 --> 00:05:26.840 We actually don't really know what life expectancy has been for most of human history since 69 00:05:26.840 --> 00:05:35.460 humans evolved, maybe 60 or 100,000 years ago. A proxy, a reasonable proxy, in terms 70 00:05:35.460 --> 00:05:39.580 of paleontology and just looking through human history, given that bones are largely what 71 00:05:39.580 --> 00:05:47.380 we go by when you go back tens of thousands of years, is height. And paradoxically, Stone 72 00:05:47.380 --> 00:05:50.320 Age Paleolithic humans were reasonably tall. 73 00:05:52.260 --> 00:06:00.780 And when you actually track height, it declined and declined for thousands of years. And we 74 00:06:00.780 --> 00:06:06.460 really only recovered the height of the Stone Age at the beginning of the 20th century. 75 00:06:08.740 --> 00:06:14.200 So what happened? And there is a reason, as I say, there's a reasonable proxy for height. 76 00:06:14.300 --> 00:06:16.820 I mean, you just need to look at what's going on in the Netherlands just now, where height 77 00:06:16.820 --> 00:06:21.140 just keeps on increasing. And you've got this country of giants who are actually, you know, 78 00:06:21.140 --> 00:06:24.900 actually also quite long-lived for lots of different reasons, which we might come back 79 00:06:24.900 --> 00:06:25.220 to later. 80 00:06:26.880 --> 00:06:34.220 When you actually look at the early drawings and paintings of the colonists arriving in 81 00:06:34.220 --> 00:06:39.740 America, some of the earliest were of the Massachusetts tribe, and they showed these 82 00:06:39.740 --> 00:06:48.340 strong long-limbed peoples, true of Aboriginal people in Australia as well. But then that 83 00:06:48.340 --> 00:06:49.760 was just a moment in time. 84 00:06:49.760 --> 00:06:56.420 And then these native peoples, these indigenous peoples became, you know, their lives became, 85 00:06:56.540 --> 00:06:58.580 as Hobbes would say, nasty, brutish, and short. 86 00:07:01.600 --> 00:07:08.100 The late medical historian Roy Porter had an aphorism or an axiom which he said was that 87 00:07:08.100 --> 00:07:14.240 whenever we change the way we live, new diseases arise, new problems arise in terms of the 88 00:07:14.240 --> 00:07:19.740 human condition. And of course, with development beyond Stone Age, we developed agro-economics, 89 00:07:19.740 --> 00:07:28.980 agriculture. With agriculture came dependency on water and climatic changes, much more than 90 00:07:28.980 --> 00:07:34.760 when you were living in small groups and moving around the countryside. So famine became an 91 00:07:34.760 --> 00:07:40.580 issue, and malnutrition probably really hit very strongly at that stage. People gathered 92 00:07:40.580 --> 00:07:46.800 together, and the technology of agriculture allowed cities to develop larger, so there 93 00:07:46.800 --> 00:07:49.640 was population growth because of higher productivity from the land. 94 00:07:49.740 --> 00:07:53.940 Even though there were these ups and downs. And people started gathering together in cities. 95 00:07:55.560 --> 00:08:03.580 And it's quite likely that human life expectancy declined during that time because new things 96 00:08:03.580 --> 00:08:08.980 started to emerge. When you've got large enough numbers of humans living together, then you 97 00:08:08.980 --> 00:08:14.400 can start to get sustained epidemics. And it's highly unlikely that diseases like infections 98 00:08:14.400 --> 00:08:18.200 like smallpox or indeed measles existed in the Stone Age. 99 00:08:18.400 --> 00:08:19.380 In fact, the 100 00:08:19.740 --> 00:08:26.280 mathematical dynamics of measles, I can't remember the number, but it means you've got 101 00:08:26.280 --> 00:08:31.300 to have a population of around about 300,000 to sustain measles beyond generations. 102 00:08:32.660 --> 00:08:38.840 So new diseases emerged as we consolidated into cities, and almost certainly that caused 103 00:08:38.840 --> 00:08:43.180 a decline in human life expectancy. I should really define terms before I go on much further. 104 00:08:43.460 --> 00:08:48.400 When I say life expectancy, I'm talking about the average number of years you can expect 105 00:08:48.400 --> 00:08:49.340 to live from birth. 106 00:08:50.300 --> 00:08:58.840 Life span is really the maximum time that a human being can live. And I'm going to play 107 00:08:58.840 --> 00:09:03.460 with both of those ideas through this presentation, but most of the time I'm talking about life 108 00:09:03.460 --> 00:09:10.840 expectancy, the average time we have in this mortal coil. So agriculture, consolidation 109 00:09:10.840 --> 00:09:16.420 into cities brought population growth and almost certainly life expectancy decline. 110 00:09:17.260 --> 00:09:19.720 The Industrial Revolution in Britain, the Industrial Revolution in the United States, 111 00:09:19.740 --> 00:09:24.300 the Industrial Revolution in Britain, and then Europe, also was a time of extreme ill 112 00:09:24.300 --> 00:09:29.760 health where you had the countryside being sucked into the cities. These cities were 113 00:09:29.760 --> 00:09:35.300 incredibly unhealthy places, and life expectancy again almost certainly went into decline. 114 00:09:35.660 --> 00:09:39.820 We don't know for sure, but it certainly looks that way from the history. And again, new 115 00:09:39.820 --> 00:09:49.720 diseases arose during the Industrial Revolution. One of them is actually schizophrenia. And 116 00:09:49.740 --> 00:09:55.360 there is no convincing description of schizophrenia before the Industrial Revolution. And another 117 00:09:55.360 --> 00:10:00.900 one of my themes here is we think of coronary heart disease, diabetes, cancer as causes 118 00:10:00.900 --> 00:10:08.480 of shortened life expectancy, but diseases like schizophrenia are also causes of shortened 119 00:10:08.480 --> 00:10:10.480 life expectancy, not just through suicide. 120 00:10:11.600 --> 00:10:18.360 People with schizophrenia in the modern day, and the only data that we have that are reliable 121 00:10:18.360 --> 00:10:19.720 on that are from Western Europe. 122 00:10:19.740 --> 00:10:21.920 The reason why people in Western Australia, because they have hospital linked records, 123 00:10:22.200 --> 00:10:25.960 is that people in Western Australia have no reason to believe it's not true. In South 124 00:10:25.960 --> 00:10:29.860 Australia or other parts of the country, they have life expectancy shorter than indigenous 125 00:10:29.860 --> 00:10:34.660 people in this country. And it's not because of suicide just, it's because they're dying 126 00:10:34.660 --> 00:10:39.160 of coronary heart disease, cancer, and other problems earlier. They're actually sicker 127 00:10:39.160 --> 00:10:41.960 than average because they're actually neglected by the system. 128 00:10:44.900 --> 00:10:48.820 Colonization also was a cause of life expectancy shortening. 129 00:10:49.720 --> 00:10:55.840 So, what happened was that European immune systems turned up in the New World with European 130 00:10:55.840 --> 00:11:00.900 infections and infected the New World and conquered the New World. So, this is part 131 00:11:00.900 --> 00:11:06.100 of that story I was telling you about indigenous peoples and life expectancy reversal. But 132 00:11:06.100 --> 00:11:11.540 interestingly, colonization never worked that well in the tropics because European immune 133 00:11:11.540 --> 00:11:17.240 systems were never very good with malaria and other tropical diseases. So, in fact, 134 00:11:17.300 --> 00:11:18.800 Europeans were never terribly sick. So, they were never very good with malaria and other tropical diseases. So, in fact, Europeans were never terribly 135 00:11:18.820 --> 00:11:19.880 successful in the tropics. 136 00:11:21.020 --> 00:11:29.180 One of the interesting things that occurred was through slavery. The importation of 12 137 00:11:29.180 --> 00:11:38.600 million African slaves to the Caribbean and the American colonies over a fairly short 138 00:11:38.600 --> 00:11:44.740 period of time, what that did was it actually, it was so overwhelming in terms of its numbers 139 00:11:44.740 --> 00:11:48.800 that it actually imported a tropical disease environment into the world. So, it was a very 140 00:11:48.800 --> 00:11:49.640 good environment to the Caribbean. 141 00:11:50.560 --> 00:11:56.540 And it started to be logistically extremely difficult for the European overseers to manage 142 00:11:56.540 --> 00:12:02.920 it because they started to have increasing death rates. And, of course, the Caribs, the 143 00:12:02.920 --> 00:12:08.360 indigenous groupings, indigenous peoples of the Caribbean, very quickly died out as well. 144 00:12:10.080 --> 00:12:18.780 The theme here in all this is that our life expectancy is fragile. And, obviously, the 145 00:12:18.800 --> 00:12:21.220 And that people say, well, how long am I going to live? 146 00:12:21.300 --> 00:12:23.320 What are the determinants of how long I live? 147 00:12:24.120 --> 00:12:29.000 And until recently, people have said, well, if your grandparents lived a long time, 148 00:12:29.040 --> 00:12:31.380 your parents lived a long time, you're going to live a long time. 149 00:12:31.440 --> 00:12:32.880 It's your genes, the genes that count. 150 00:12:34.000 --> 00:12:37.660 The story I've just told you has a message in it, 151 00:12:37.700 --> 00:12:43.180 which is that genes are not necessarily as powerful as you think, 152 00:12:43.760 --> 00:12:45.420 and they can be easily overwhelmed. 153 00:12:45.420 --> 00:12:50.380 In our lifetimes, we've seen a dramatic life expectancy reversal. 154 00:12:51.000 --> 00:12:54.120 We've seen problems, obviously, with AIDS in Africa, 155 00:12:54.320 --> 00:12:56.920 but I'm talking about the former Soviet republics. 156 00:12:57.820 --> 00:13:00.680 They have had a dramatic reversal in life expectancy 157 00:13:01.820 --> 00:13:04.640 for lots of different reasons, which we'll come back to. 158 00:13:05.020 --> 00:13:07.420 So if genes were so powerful, 159 00:13:08.420 --> 00:13:12.260 you wouldn't see them being so sensitive to what happens in the environment. 160 00:13:13.660 --> 00:13:15.280 There is an exception to this. 161 00:13:15.420 --> 00:13:16.640 And I'll come back to this again later. 162 00:13:16.880 --> 00:13:18.140 There's people who reach 100. 163 00:13:20.780 --> 00:13:24.200 Centenarians, until recently, are almost certainly freaks. 164 00:13:25.920 --> 00:13:26.800 Nice freaks. 165 00:13:30.100 --> 00:13:32.140 It's a genetic abnormality. 166 00:13:32.420 --> 00:13:35.240 I think it's about 1 in 10,000 people reach 100. 167 00:13:36.440 --> 00:13:39.920 And a lot of people who reach 100 are actually quite young. 168 00:13:40.320 --> 00:13:42.760 For some reason, they're biologically young. 169 00:13:42.980 --> 00:13:44.700 They've got genetic mutations, 170 00:13:44.700 --> 00:13:47.040 which allow them, or they've inherited it, 171 00:13:47.080 --> 00:13:48.220 almost certainly inherited it, 172 00:13:48.260 --> 00:13:49.140 allow them to get to 100. 173 00:13:50.620 --> 00:13:52.660 But we're seeing a change in that, 174 00:13:53.560 --> 00:13:57.720 which is that no longer do you have to be genetically abnormal 175 00:13:58.300 --> 00:14:00.140 to become a centenarian. 176 00:14:01.780 --> 00:14:05.800 So we didn't regain the height of the Stone Age to the 20th century. 177 00:14:06.560 --> 00:14:08.140 And that's significant because 178 00:14:08.140 --> 00:14:10.740 what seems to have been happening from the records 179 00:14:10.740 --> 00:14:13.980 is that from about 1830 or so, 180 00:14:13.980 --> 00:14:16.800 life expectancy seems to have been increasing 181 00:14:16.800 --> 00:14:18.760 by about three weeks per year. 182 00:14:20.400 --> 00:14:22.020 That's a statistic for women, 183 00:14:22.120 --> 00:14:23.920 but it's almost certainly similar for men. 184 00:14:24.200 --> 00:14:26.080 Of course, in the 19th century, 185 00:14:26.300 --> 00:14:29.280 women's life expectancy was shorter than men's. 186 00:14:30.200 --> 00:14:32.860 And that was because of childbirth and pregnancy. 187 00:14:34.160 --> 00:14:36.320 But when we conquered obstetrics 188 00:14:37.060 --> 00:14:39.680 and provided higher quality obstetric care, 189 00:14:39.940 --> 00:14:42.180 where we taught doctors how to wash their hands, 190 00:14:42.260 --> 00:14:43.960 something that they forget from time to time, 191 00:14:43.960 --> 00:14:48.440 but when obstetric care improved, 192 00:14:50.020 --> 00:14:53.360 so women started to survive beyond that. 193 00:14:53.440 --> 00:14:57.140 And so there are multiple causes of this increased life expectancy, 194 00:14:57.360 --> 00:15:00.520 and it's worth examining them because it tells us a lot. 195 00:15:01.080 --> 00:15:02.140 By the way, 196 00:15:03.020 --> 00:15:05.940 there's a lot of rubbish spoken about the obstetric story. 197 00:15:06.660 --> 00:15:09.200 The feminist analysis of obstetrics was 198 00:15:09.200 --> 00:15:12.260 that these patriarchal male obstetricians who hate women 199 00:15:12.260 --> 00:15:13.940 have technologized the obstetric system, 200 00:15:13.960 --> 00:15:15.040 and they have to do it in a way that's in line with child care, 201 00:15:15.260 --> 00:15:16.360 and isn't that terrible? 202 00:15:16.640 --> 00:15:19.180 And really we can all go off into the bush and have our babies. 203 00:15:19.780 --> 00:15:23.020 That pervaded the World Health Organization in that ideology. 204 00:15:24.680 --> 00:15:30.780 Every country in the developing world which has taken that approach, 205 00:15:31.100 --> 00:15:34.880 that feminist, if you like, analysis of obstetrics, 206 00:15:35.120 --> 00:15:39.880 has failed to improve their child and maternal mortality statistics. 207 00:15:40.600 --> 00:15:43.120 The countries in the developing world, 208 00:15:43.160 --> 00:15:43.940 much as you like to think about them, 209 00:15:43.940 --> 00:15:49.200 hold to this idea of patriarchal obstetrics. The countries which have in the developing 210 00:15:49.200 --> 00:15:55.740 world which have invested in technology where women have their babies in a clean environment 211 00:15:55.740 --> 00:16:01.580 in a hospital with proper health care from a midwife at minimum, their child and maternal 212 00:16:01.580 --> 00:16:07.400 mortality rates are declining faster. Women for safe childbirth, particularly in the developing 213 00:16:07.400 --> 00:16:15.040 world, need hospitals, sterility, and trained attendance. And that's of course what started 214 00:16:15.040 --> 00:16:21.160 to be introduced in Europe in the 19th century. There's a great debate amongst gerontologists 215 00:16:21.160 --> 00:16:27.100 about whether or not we're maxing out in terms of life expectancy. Are we reaching our limits? 216 00:16:27.940 --> 00:16:32.400 And some people say the limits of life expectancy are around about 85. Remember, I'm talking 217 00:16:32.400 --> 00:16:34.400 about life expectancy, not lifespan. 218 00:16:36.620 --> 00:16:37.380 By and large, the limits of life expectancy are around about 85. And some people say the 219 00:16:37.380 --> 00:16:47.100 fact 220 00:16:59.900 --> 00:17:04.740 just keeps on going up. In Japan, where they're much better off than we are in terms of life 221 00:17:04.740 --> 00:17:12.800 expectancy, not a sign of tailing off. We just keep on increasing. Interestingly, there hasn't 222 00:17:12.800 --> 00:17:17.200 been, despite the fact we talk about aging all the time, there hasn't been a lot of research into 223 00:17:17.200 --> 00:17:22.900 aging itself. Most of the research that's gone on around the world into aging has really been into 224 00:17:22.900 --> 00:17:27.360 the diseases of aging. So, obviously, we get more cancer, we get coronary heart disease, diabetes, 225 00:17:27.360 --> 00:17:31.720 and it's what those diseases do to us as we age that a lot of the researchers have been looking 226 00:17:31.720 --> 00:17:36.580 at. It's really only quite recently that people have tried to look at what fundamentally goes on 227 00:17:36.580 --> 00:17:42.080 in the body as we age. They still don't really know, but there's a story coming together that 228 00:17:42.080 --> 00:17:48.080 looks plausible. One of the things is that we have a background level of inflammation 229 00:17:48.560 --> 00:17:53.320 in our bodies. Same sort of inflammation when you get a rash, when a wound heals, 230 00:17:53.420 --> 00:17:56.620 but it happens on the inside. It's an activated immune system. 231 00:17:59.040 --> 00:18:05.600 It's part of how you develop atherosclerosis. You need inflammation. You need immune cells to take 232 00:18:05.600 --> 00:18:10.380 the cholesterol in, a bit of irritation, and laying down the cholesterol causing that constriction. 233 00:18:10.540 --> 00:18:16.260 And that inflammation causes fibrosis, thickening of tissues, stiffening of tissues, 234 00:18:16.520 --> 00:18:22.640 and the aging of tissues. Free radicals, highly active oxygen species are also involved in that 235 00:18:22.640 --> 00:18:27.180 process, as are how we utilize and metabolize 236 00:18:27.180 --> 00:18:27.340 enzymes. 237 00:18:32.380 --> 00:18:44.160 We're starting to realize that when you actually have a lot of fat cells, a lot of fat on board, you have an increased level of inflammation in your body, and therefore you age more rapidly. 238 00:18:45.780 --> 00:18:56.260 And other, other, coronary heart disease does it. So there seems, it's a bit of a fad at the moment in research, but it looks as though there's a story there about inflammation. 239 00:18:56.720 --> 00:18:57.120 Unfortunately, 240 00:18:57.260 --> 00:18:57.340 it's not. 241 00:18:57.340 --> 00:18:58.980 They're taking anti-inflammatory agents. 242 00:18:59.780 --> 00:19:07.740 Doesn't seem to affect this process, nor indeed do antioxidants, which are supposed to mop up these free radicals. 243 00:19:08.720 --> 00:19:09.240 In fact, 244 00:19:10.640 --> 00:19:16.260 the randomized controlled trials of antioxidant supplements show, that's vitamin C, E, beta-carotene, 245 00:19:17.000 --> 00:19:21.060 those taking those antioxidant vitamins have an increased mortality rate. 246 00:19:22.140 --> 00:19:22.740 Increased. 247 00:19:24.620 --> 00:19:25.560 Save your money. 248 00:19:27.940 --> 00:19:31.340 And that's correcting for the background level of illness that these people have. 249 00:19:32.680 --> 00:19:38.580 But I want to talk about this changing pattern of mortality a bit more, and go back to the 19th century. 250 00:19:39.160 --> 00:19:46.600 There was a debate in the medical profession after the war, Second World War, looking at the dramatic decline in tuberculosis. 251 00:19:47.200 --> 00:19:54.160 And people said, fantastic, this is proof that these new antibiotics we've got, the one for tuberculosis was called streptomycin, 252 00:19:54.980 --> 00:19:56.800 is causing the decline of TB. 253 00:19:56.920 --> 00:19:57.320 Try it. 254 00:19:57.320 --> 00:19:58.520 It's time for medical technology. 255 00:20:00.200 --> 00:20:07.720 And the public health people, like Robin, said, no, because people like Robin don't like curative medicine, they like preventive medicine, except when they're sick. 256 00:20:12.540 --> 00:20:19.140 The public health people said, no, no, no, if you look at the statistics, and they were right, if you look at the statistics, tuberculosis was declining from the late 19th century. 257 00:20:19.940 --> 00:20:27.020 And the reason for tuberculosis declining is actually improved nutrition, improved housing, improved urban environments. 258 00:20:27.020 --> 00:20:30.520 Because tuberculosis is the quintessential social disease. 259 00:20:33.420 --> 00:20:38.200 And Barry Smith, a historian at the Australian National University, said, no, the public health people are wrong. 260 00:20:39.260 --> 00:20:43.920 Because he and a colleague in Germany had looked at parish records in Europe. 261 00:20:44.860 --> 00:20:54.580 And they found parishes next to each other equally poor, equally bad housing, equally exposed to famine. 262 00:20:55.200 --> 00:20:57.000 And there seemed to be lower rates of death. 263 00:20:57.000 --> 00:20:57.540 There seemed to be higher rates of tuberculosis. 264 00:20:57.840 --> 00:21:03.980 And there seemed to be higher life expectancies in one village compared to another, almost side by side. 265 00:21:04.900 --> 00:21:07.120 And they tried to look for the correlates. 266 00:21:08.040 --> 00:21:10.440 Very hard research to do, full of inaccuracies. 267 00:21:10.600 --> 00:21:16.140 But they tried to look for the correlates of what determined the healthier looking village from the one that was unhealthier. 268 00:21:17.120 --> 00:21:24.440 And the one thing they came up with again and again was that parishes that taught their girls to read and write 269 00:21:25.300 --> 00:21:26.980 were the ones which... 270 00:21:27.000 --> 00:21:29.880 Which had lower rates of TB and seemed to have higher rates of life... 271 00:21:29.880 --> 00:21:30.900 Higher life expectancies. 272 00:21:31.980 --> 00:21:32.900 Female literacy. 273 00:21:34.260 --> 00:21:43.560 This has now been shown in the modern world, in the developing world, a close correlation with female literacy and the health of a community. 274 00:21:44.980 --> 00:21:46.040 What's going on there? 275 00:21:47.720 --> 00:21:48.240 Education. 276 00:21:49.300 --> 00:21:56.220 Well, let me tell you that when you look at the risk factors, the things that shorten life expectancy, 277 00:21:57.100 --> 00:21:59.280 education cuts across the lot. 278 00:22:00.360 --> 00:22:05.200 So if you're a smoker, and you compare two smokers smoking 20 a day, 279 00:22:05.580 --> 00:22:10.260 the person who has not had a university education versus the one who has, 280 00:22:10.460 --> 00:22:13.220 the person who's not will die sooner from their smoking. 281 00:22:14.080 --> 00:22:19.020 So for risk factors, you're much less likely to smoke if you've got a higher education. 282 00:22:19.240 --> 00:22:22.040 But if you are, you're still less likely to die. 283 00:22:22.140 --> 00:22:24.620 Education cuts across all this. 284 00:22:24.860 --> 00:22:26.760 You will live a shorter life, 285 00:22:26.760 --> 00:22:28.820 if you've not been well educated, 286 00:22:29.120 --> 00:22:31.040 by and large, on average. 287 00:22:31.340 --> 00:22:32.420 There's always exceptions. 288 00:22:33.200 --> 00:22:35.260 So education cuts across the lot. 289 00:22:35.680 --> 00:22:38.300 Probably what's going on with female literacy, 290 00:22:39.100 --> 00:22:40.600 is the notion of control. 291 00:22:41.480 --> 00:22:45.800 Is that women who are the gatekeepers traditionally of health and family and in the community, 292 00:22:46.020 --> 00:22:51.440 are less liable to be listening to mumbo jumbo, to use Robin's phrase, 293 00:22:52.380 --> 00:22:55.500 and more likely to be able to have the confidence to... 294 00:22:55.500 --> 00:22:56.100 People... 295 00:22:56.100 --> 00:22:57.400 The answer is people don't really know. 296 00:22:57.820 --> 00:22:59.120 But it's so... 297 00:22:59.120 --> 00:23:05.240 Such a solid factor that it became a health goal for the World Health Organization under Haftan Mala. 298 00:23:05.620 --> 00:23:08.360 Female literacy was a health goal. 299 00:23:08.500 --> 00:23:09.660 So potent was it. 300 00:23:10.080 --> 00:23:17.480 So that's my other message, which is that you tend to think in narrow terms of cholesterol, smoking, blood pressure. 301 00:23:18.180 --> 00:23:25.240 But the things that determine our longevity and well-being are sometimes surprising and outside the box. 302 00:23:27.720 --> 00:23:31.140 So life expectancy improved, obstetric care and so on. 303 00:23:31.260 --> 00:23:32.000 But what... 304 00:23:32.000 --> 00:23:33.300 And what... 305 00:23:33.300 --> 00:23:35.600 But if you were walking... 306 00:23:35.600 --> 00:23:41.340 Let's say you were walking down North Terrace in 1880, 1890, 307 00:23:42.280 --> 00:23:46.020 when life expectancy in Australia, which was one of the highest in the time New Zealand was higher, 308 00:23:46.140 --> 00:23:51.340 but probably about 40 was the life expectancy, something like that, in Australia at that time. 309 00:23:52.320 --> 00:23:56.080 Of course, you, without your convict heritage, would like to think you're 40. 310 00:23:56.100 --> 00:23:57.120 You'd probably have a longer life expectancy. 311 00:23:59.440 --> 00:24:04.840 But there would have been plenty of elderly people walking down the streets, through the streets of Adelaide in 1880. 312 00:24:05.380 --> 00:24:07.280 Yet life expectancy was 40. 313 00:24:07.840 --> 00:24:09.020 What's the story here? 314 00:24:10.640 --> 00:24:13.620 Well, 40 was life expectancy at birth. 315 00:24:14.520 --> 00:24:21.400 And of course, you had these massive numbers of babies and indeed women dying around time of childbirth. 316 00:24:21.580 --> 00:24:25.460 You had massive numbers of children dying and not getting to the age of 15. 317 00:24:26.340 --> 00:24:30.680 What happened in the late 19th century and through the big early 20th century, 318 00:24:30.820 --> 00:24:35.100 through indeed better education, better housing, better nutrition, immunization, 319 00:24:35.340 --> 00:24:39.180 the beginnings of antibacterial compounds and other things, 320 00:24:39.360 --> 00:24:43.720 probably the getting rid of congenital syphilis was very important as well, 321 00:24:45.580 --> 00:24:49.780 is that you had a better chance of getting through childhood to adulthood. 322 00:24:50.440 --> 00:24:56.080 And that's what increased the life expectancy through the first half of the 20th century. 323 00:24:56.100 --> 00:25:07.200 But a statistic that did not change from 1880 to 1950 in Australia, Britain or the United States, 324 00:25:07.440 --> 00:25:09.600 was life expectancy at 50. 325 00:25:10.640 --> 00:25:15.700 If you were 50 in 1880, your chances of getting to 70 were exactly the same, roughly, 326 00:25:15.820 --> 00:25:18.680 as they were in 1950 after World War II. 327 00:25:20.280 --> 00:25:26.000 What has changed in developed countries like ours since the Second World War, 328 00:25:26.000 --> 00:25:27.980 is life expectancy at 50. 329 00:25:29.600 --> 00:25:33.640 Apart from the shameful statistics we have in Aboriginal communities in Australia, 330 00:25:34.660 --> 00:25:42.380 for the rest of us, we're kind of doing as well as we can with perinatal infant and child mortality. 331 00:25:43.920 --> 00:25:46.820 The gains are coming from life expectancy at 50. 332 00:25:47.320 --> 00:25:49.580 So the story constantly changes. 333 00:25:50.080 --> 00:25:55.580 But it's now changing so quickly that there are some statisticians who are saying, 334 00:25:55.580 --> 00:25:59.340 we're maxing out already at life expectancy at 50. 335 00:26:00.520 --> 00:26:03.720 Now what's booming is life expectancy at 75. 336 00:26:05.880 --> 00:26:09.220 So what are the causes, what is changing now, 337 00:26:10.040 --> 00:26:14.300 because this has enormous social and political consequences. 338 00:26:14.420 --> 00:26:16.620 And we're not just talking about an aging population here. 339 00:26:17.100 --> 00:26:20.120 Because there's a lot of stuff talked about the aging population. 340 00:26:20.980 --> 00:26:25.120 Because people say, well, why would you bother living to 90 341 00:26:25.580 --> 00:26:26.420 if it's going to be crap? 342 00:26:28.780 --> 00:26:32.100 So a word of warning about this crap business, 343 00:26:32.440 --> 00:26:36.400 because it depends how old you are and who you ask what crap means. 344 00:26:39.820 --> 00:26:44.580 Dan Kahneman, who won the Nobel Prize in Economics, I think about four years ago, 345 00:26:44.800 --> 00:26:46.660 who in fact is not an economist. 346 00:26:47.060 --> 00:26:48.100 He's a psychologist. 347 00:26:50.100 --> 00:26:53.660 He's an Israeli who worked at the University of California, Berkeley. 348 00:26:54.100 --> 00:26:55.560 And he worked with his late colleagues. 349 00:26:55.580 --> 00:26:57.720 He's a colleague who would have also won the Nobel Prize had he survived. 350 00:26:57.960 --> 00:26:59.760 Amos Tversky, who was at Stanford. 351 00:27:00.820 --> 00:27:05.540 And they pioneered, along with others, the science of risk perception. 352 00:27:06.660 --> 00:27:09.560 How our minds operate when we're faced with risk. 353 00:27:09.940 --> 00:27:15.740 And the reason he won the Nobel Prize was that he did the psychological analysis 354 00:27:16.580 --> 00:27:19.140 which really underpins what's called contrarian investment. 355 00:27:19.840 --> 00:27:22.040 This is what Kerry Packard knew intuitively, 356 00:27:22.040 --> 00:27:27.300 is that you buy on a falling market and you sell on a rising market. 357 00:27:30.000 --> 00:27:33.120 But Dan Kahneman and Amos Tversky were really interested in it 358 00:27:33.120 --> 00:27:36.520 because the notion of loss is really quite potent. 359 00:27:36.660 --> 00:27:38.120 Some of you have heard me talking about this before. 360 00:27:38.360 --> 00:27:42.060 It's that we react more emotionally to the sense of loss than the sense of gain. 361 00:27:42.160 --> 00:27:45.400 That's why when the market's dropping, we all want to sell our shares. 362 00:27:46.100 --> 00:27:49.180 And what Dan Kahneman taught us was you don't do that. 363 00:27:49.260 --> 00:27:50.140 You hold on. 364 00:27:50.380 --> 00:27:51.900 Because you only lose money when you sell. 365 00:27:51.900 --> 00:27:52.280 You wait. 366 00:27:53.940 --> 00:27:58.120 But this notion of loss really is very powerful. 367 00:27:58.720 --> 00:28:04.440 So what they did was they did an experiment which was they asked two groups of people. 368 00:28:04.520 --> 00:28:07.640 One in their 40s and one in their 70s. 369 00:28:07.700 --> 00:28:10.640 And they said, I can't remember exactly what the details were, 370 00:28:10.760 --> 00:28:14.440 but roughly, here's this healthcare intervention. 371 00:28:15.360 --> 00:28:21.120 It costs $50,000 and it will give you, when you're 75, 372 00:28:21.120 --> 00:28:22.760 two years of extra life. 373 00:28:23.840 --> 00:28:27.820 But the cost, not only the financial cost, there'll be extra disability. 374 00:28:28.500 --> 00:28:30.240 Would you buy that healthcare intervention? 375 00:28:31.680 --> 00:28:33.800 The 40-year-old said, not on your Nelly. 376 00:28:35.160 --> 00:28:37.720 And the 75-year-old said, thank you very much, I'll have it. 377 00:28:40.640 --> 00:28:43.500 And it's because at 40, you don't, unless you're unlucky, 378 00:28:43.620 --> 00:28:44.620 you don't really have any disabilities. 379 00:28:45.480 --> 00:28:48.520 When you're 75, you've probably got a little sugar, 380 00:28:49.020 --> 00:28:50.380 your blood pressure's up a little bit, 381 00:28:50.380 --> 00:28:51.820 you're probably on two or three medications, 382 00:28:52.220 --> 00:28:53.780 you're feeling sore from arthritis. 383 00:28:54.320 --> 00:28:56.760 What's a couple of extra disabilities when, you know, 384 00:28:58.520 --> 00:29:01.120 unless you have enormous faith, this is all you've got. 385 00:29:01.320 --> 00:29:03.400 So we'll have another two years of it, thank you very much. 386 00:29:04.680 --> 00:29:06.580 So it depends on who you ask. 387 00:29:07.120 --> 00:29:11.220 But by and large, the causes of extra years of life 388 00:29:11.220 --> 00:29:15.480 are also the causes of extra years of disability-free life. 389 00:29:16.100 --> 00:29:19.060 So it's true, we accumulate disabilities as we get older, 390 00:29:19.060 --> 00:29:23.460 but we are actually accumulating them later. 391 00:29:24.380 --> 00:29:27.100 And there was an enormous debate about this, 392 00:29:27.180 --> 00:29:31.320 but by and large, it seems clear that we are staying healthier longer. 393 00:29:32.240 --> 00:29:37.260 But at the moment, we do have a problem of frailty in a very aged group. 394 00:29:37.480 --> 00:29:42.200 But what we have is a surge of people heading towards their 90s. 395 00:29:43.060 --> 00:29:45.240 I was in Western Australia recently doing something, 396 00:29:45.300 --> 00:29:49.040 and the head of the emergency department of the Royal Perth arrived late, 397 00:29:50.060 --> 00:29:52.760 because he had a busy ward round, people waiting to get into the wards. 398 00:29:52.840 --> 00:29:55.700 He was doing a ward round of the people lying in beds waiting to get into the wards. 399 00:29:55.800 --> 00:30:01.880 The average age, average age, he calculated was 92 of those people. 400 00:30:02.920 --> 00:30:07.380 When I was training in medicine, you know, those people would have been in their 60s. 401 00:30:08.520 --> 00:30:10.680