Diseases of Modern Life

Question 1

A. Kleinman: disease vs illness

Timmermann, C., ‘Chronic Disease and Illness History

Answer 1

‘illness’ is the experience

‘disease’ is an ‘identifiable entity’

Question 2

Chronic diseases in the longue duree

Timmermann, C., ‘Chronic Disease and Illness History

Answer 2

• ‘chronic, incurable illness, leading to slow but apparently inevitable deaths, has a history that long precedes the twentieth century and has been blamed on civilisation by many past commentators’

Question 3

How were chronic diseases viewed in the immediate post-war?

Timmermann, C., ‘Chronic Disease and Illness History

Answer 3

• synonymous with non-communicable
• preceded by long, symptom free periods, even dormancy, and triggered by various forms of stress
• similar to consumption

Question 4

Susan Sontag on parallels between consumption, TB and cancer?

Timmermann, C., ‘Chronic Disease and Illness History

Answer 4

• Consumption ‘not a distinct disease entity’ as it was not exclusively TB, and sometimes other conditions were labelled consumption, too. Sometimes scurvy, cancer
• Susan Sontag, Illness as Metaphor

Question 5

Parallels between consumption ajd AIDS?

Timmermann, C., ‘Chronic Disease and Illness History

Answer 5

‘Chronic illness signalled a weak constitution irreparably damaged by a life lived
carelessly or under unfavourable conditions’

Question 6

Case study: Dropsy

Evidence of changing diagnosis

Timmermann, C., ‘Chronic Disease and Illness History

Answer 6

• associated with cold and heavy drinking, caused fluid buildup
• like consumption, diagnosis based on symptom manifestation, causes found in biography/lifestyle
• Richard Bright (1789-1858)’s urine test meant patients could be diagnosed with ‘Bright’s Disease’ with no symptoms
• Triumph for pathological anatomy

Question 7

Case Study: Diabetes

A Modern disease, but why?

Timmermann, C., ‘Chronic Disease and Illness History

Answer 7

• outlook for Diabetes patients changed with isolation of the insulin hormone in 1921 - a triumph for experimental physiology
• Insulin was isolated in Toronto in 1921, and was medically available in Britain in 1923
• not a cure, but made diabetes manageable
• became ‘a model for the long-term management of other conditions being identified as chronic diseases.’

Question 8

TB in the 20th century

Timmermann, C., ‘Chronic Disease and Illness History

Answer 8

• ‘remained a chronic, incurable disease until the mid 20th century’
• Had declined in incidence by 1950s (Mckeown controversy)

Question 9

Mortality and morbidity in 20th century Britain

Timmermann, C., ‘Chronic Disease and Illness History

Answer 9

• Deaths in childhood/adolescence had declined rapidly
• More people living past middle age, so cancer, heart disease, stroke, become far more visible
• By 1950s, mortality rates for TB lower than cancer
• New fears (lung cancer, cardiovascular disease, hypertension, blood cholesterol)
• lung cancer sole contributor to increase in cancer deaths: work by R. Doll (1912-2005) and A. B. Hill (1897-1991)
• Development of geriatrics as a specialism

Question 10

New conceptions of epidemiologic transitions in the modern world

Timmermann, C., ‘Chronic Disease and Illness History

Answer 10

J. Michael Gaziano, ‘Fifth Phase of the Epidemiologic Transition: The Age of Obesity and Inactivity

J. Olshansky and A. B. Ault, ‘The Fourth Stage of the Epidemiologic Transition:
The Age of Delayed Degenerative Diseases’

Question 11

‘Diseases of civilisation’ - Roy Porter

Porter, R., ‘Diseases of Civilisation’

Answer 11

• ‘it has been a fact of history - at least until recent times -
  that disease incidence runs in direct ratio to settlement density.’
• Excessive consumption of fine foods and alcohol, and lack of exercise combined to obstruct the nervous fibres, impeding communications between the brain, the vital organs, and the extremities, and leading to pains, inflammation, stoppage , and habitual sensations of lethargy and lassitude unknown
  to strapping peasants.

Question 12

The development of theories of ‘modern’ diseases in the 19th century

A Socio-pathological view?

Porter, R., ‘Diseases of Civilisation’

Answer 12

The manifestations of insanity had traditionally been understood to be either supernatural in origin (visitations of God or the Devil) or essentially organic, provoked by an excess of black bile (melancholy), or yellow bile (choler), or by some brain defect. Now a socio-pathological account achieved popularity. Madness was increasingly seen as in the mind,
a disorder of the imagination or understanding.

It was, in other words,
psychological, and the realm of the psyche was viewed as being significantly
programmed by the ensemble of linguistic, literary, and intellectual signals in
cultural circulation (for example Methodism, Romanticism)

Question 13

Social Medicine

Porter, R., ‘Diseases of Civilisation’

Answer 13

• Epidemiology had to move
  beyond the pathology laboratory and into society as a whole.
• sickness trends were functions of social variables
  such as class, income, status, occupation (or, commonly, unemployment),
  family size, housing standards, educational achievement, and so forth.
• life-styles and environments
  (in one case, the pressures upon the business person; in the other, the
  alienation of the young mother in run-down inner-city accommodation or on
  the council estate).
  —> what was psycho-socially triggered could not
  adequately be treated by pharmaceutical or surgical interventions alone.

Question 14

Have infectious diseases been superseded by ‘modern diseases’?

Porter, R., ‘Diseases of Civilisation’

Answer 14

• as the airborne and water-home infections
  classically associated with high-density living (typhoid, diphtheria, tuberculosis,
  etc.) have been vanquished, new classes of diseases have gained in prominence:

cardiovascular disorders, 
degenerative conditions of the nervous system,
hypertension, 
diabetes mellitus, 
cirrhosis of the liver,
 the cancers, 
Alzheimer's disease,  depression,
chronic fatigue syndrome

Question 15

Questions to challenge the notion of ‘diseases of modern life’

Porter, R., ‘Diseases of Civilisation’

Answer 15

Might not the apparent escalation of
these complaints largely be, in reality, an optical illusion?

Are not more
people dying today of disorders that their forebears never lived long enough to
contract?

Are not superior diagnostic techniques and more intense screening resulting in the showing-up of a far higher proportion of cancers and degenerative neurological conditions than could have been identified in earlier centuries?

Question 16

A few causes of diseases of modern life?

Porter, R., ‘Diseases of Civilisation’

Answer 16

atmospheric carcinogens, obesity,

cigarette moking, addictions,

Question 17

Diseases of modern life and class?

Porter, R., ‘Diseases of Civilisation’

Answer 17

it appears likely that today’s so-called diseases of civilization are not in any
straightforward sense the products of affluence, but rather diseases disproportionately afflicting the less privileged members of advanced societies. In
this light, it is highly significant that cancers, heart conditions, respiratory diseases, and so forth are rapidly worsening amongst the masses of the
Third World, evidently spread by industrial toxins, dietary dislocation, and by
cigarette smoking.

Question 18

Modern medicine as a ‘disease of modern life’ (?!)

Porter, R., ‘Diseases of Civilisation’

Answer 18

Ivan Illich, argues that modem medicine is one
of the prime diseases of civilization, not only spreading iatrogenic disorders,
but orchestrating a disabling ‘expropriation of health’. Illich has commended
the health and disease cultures of simpler times and peoples.

Question 19

Berridge on chronic diseases in modern Britain

Answer 19

‘The key to the new post-war public health would be a revised epidemiology which dealt with chronic rather than infectious disease’

Question 20

Berridge on ‘changing patterns of disease’

Answer 20

• The traditional focus on public health had been the outbreak of epidemic…but this pattern of disease and disease-related mortality began to change in the middle of the twentieth century.
• As the population lived longer, so non-infectious causes of death such as heart disease, strokes and cancer grew in importance.

Question 21

Decline of infectious diseases and its impact on death rates

Answer 21

1840s-1971, 75% of mortality rate reduction due to decline of infectious disease

Question 22

NEURASTHENIA

NEURASTHENIA: Who invented the term ‘neurasthenia’?

Answer 22

• George Beard, Boston Medical and Surgical Journal 1869
• ## Van Deusen also used the term that year

Question 23

NEURASTHENIA

Primary source: the fashionability of neurasthenia

Answer 23

• ‘everything could be explained by neurasthenia: suicide, decadent art, dress and adultery’

Question 24

NEURASTHENIA

What was neurasthenia?

Answer 24

• ‘a disease of the nervous system…characterised by enfeeblement of the nervous force.’
• ‘nervous exhaustion, characterised by undue fatigue and muscular weakness’

An exceptionally broad church:

1) male hysteria
2) chronic fatigue
3) depression
4) prototype and foundational for other diseases

Question 25

NEURASTHENIA

The Social Paradigm of Neurasthenia

Answer 25

• overwork, nervous exhaustion

- ‘modern civilisation’: ‘wireless telegraphy, science, steam power, newspapers, the education of women’

Question 26

NEURASTHENIA

Problems of measuring fatigue?

Answer 26

• ‘It was doubted if neurasthenia really was ‘a disease of modern life (Schofield, 1908)
• we had become more tender in our ills - Dubois, 1909

Question 27

OBESITY

Why does obesity occur in the 21st century?

GILMAN

Answer 27

• we live longer, have less physically stressful occupations, and have easier access to food
• a mental illness on the spectrum with anorexia nervosa
• access to poor food
• addiction
• genetic: an ‘ob-gene’

Question 28

OBESITY?

Counter argument to premise that obesity is a disease of modern life: the ob-gene

GILMAN

Answer 28

Jeffrey M. Friedman discovered the ob-gene,

Working with a special strain of mice, he set out to identify the hormone that normal animals use to control their appetite - a molecule that was missing in the plump rodents. After eight years he found it

The OB gene encodes leptin, a hormone that inhibits hunger

Question 29

OBESITY?

Counter argument to premise that obesity is a disease of modern life: anti-medicalisation

GILMAN

Answer 29

‘One social product of the stigmatisation of the obese by the 1960s was the appearance of advocacy groups of overweight individuals who argued not only that their bodily status should not be stigmatised but also that they were happy and proud to be fat.’

NAAFA (1969): to ‘eliminate discrimination based on body size’. Later splintered into offshoot groups

–> obesity ‘a natural state or a disease process’?

Question 30

OBESITY

Statistics on OBESITY in the uk now

GILMAN

Answer 30

• As of 2013, UK had the highest obesity level in Europe
• 24.5% of uk obesity
• By 2050, could be 50%

SOURCE: NHS Live well

• more commonly lower socioeconomic and socially disadvantaged
  groups

Question 31

OBESITY

Infectious obesity?

GILMAN

Answer 31

For all of the desire to stop the image of the obese being at fault for their own misery, the idea of infectobesity provided yet one more level to the anxiety about the obesity epidemic.

Question 32

OBESITY:

Longue-duree perspective on Obesity:

A. V. Cornaro, Discorsa della vita sobria (1558)

GILMAN

Answer 32

• claims his gluttony ‘kills every year’
• physicians encourage Cornaro to diet

was certainly ill with many of the diseases attributed to obesity in the Galenic tradition: “I had pains in the stomach, frequent pains in the side, symptoms of gout, and, still worse, a low fever that was almost continuous; but I suffered especially from disorder of the stomach, and from an unquenchable thirst.”3 But he also lost his ability to reject temp- tation, having become addicted to eating and drinking.

Question 33

OBESITY

A history of weight monitoring from the renaissance to BMI

GILMAN

Answer 33

• S. Sanctorius (1561-1636): weigh body to promote losing excess weight
• 19th Century: Adolphe Quelet, ‘l’homme moyen’—average man—by the mean values of
  measured variables having a normal distribution!
• Keys proposed in this 1972 article that the index
  devised by Quetelet, the ratio of weight over height
  squared, now be called the ‘body mass index’ (BMI)

Question 34

Keys (BMI guy)’s attitudes to obesity

Commentary: Origins
and evolution of body mass
index (BMI): continuing saga
Henry Blackburn* and David Jacobs Jr†

GILMAN

Answer 34

He maintained that obesity was ‘ugly but does not itself cause CHD’,12 and was not necessarily dangerous
for mortality risk in the average working man in the
traditional populations we studied in mid century

• Writing around 1949-1950, aware of potential for obesity epidemic in affluent societies

Question 35

OBESITY

Victorian attitudes to Obese women

GILMAN

Answer 35

In his 1897 book, The Female Offender, author Cesare Lombroso

“This greater weight among prostitutes is confirmed by the notorious fact of the obesity of those who grow old in their vile trade, and who gradually become positive monsters of adipose tissue.”

Question 36

OBESITY

Victorian psychological attitudes to obesity

GILMAN

Answer 36

“Obesity always carries with it physical and often mental weakness…”

Question 37

Obesity as a disease, or as a contributor to disease?

Obesity as a disease
Roland T Jung
The Diabetic Centre, Nineusells Hospital, Dundee, UK

Answer 37

Obesity is not just a health risk but a disease. Estimates of the genetic
contribution to weight gain in susceptible families range from 25—40%

Obviously there is a major environmental effect but this genetic susceptibility alone removes this condition from a social stigma to the
disease category

Mortality rates affected, link with CHD

Associated with 45 diseases inc. gout, several cancers, heart disease, t2 diabetes

Question 38

Etiology of obesity

Rippe, Crossley, Ringer, ‘Obesity as a Chronic Disease’

Answer 38

‘Obesity is a chronic disease with a multifactorial etiology including genetics, environment, metabolism, lifestyle, and behavioural components’

Treatments include lifestyle changes and medical interventions

Question 39

How is obesity a chronic disease?

Rippe, Crossley, Ringer, ‘Obesity as a Chronic Disease’

Answer 39

• Many cannot easily return/shift to a healthy weight
• For many the transition to being obese is very slow, over several years
• Many go through cycles, returning to a healthy weight before relapsing into obesity again
• Most effectively managed not just with intervention but with management: pharmaceutical, surgical, lifestyle changes

Question 40

Lifestyle vs heredity?

Answer 40

• Probably 30-40% hereditability
• ‘Clearly, genetic shifts represent an implausible argument for the recent dramatic surge in the prevelance of obesity. Lifestyle factors such as overconsumption of energy and decreases in physical activity offer more reasonable explanations.’
• food intake, esp. high fat, does contribute
• plentiful energy-dense food

Question 41

Petrie, Wesseley, Modern worries, new technology, and medicine New technologies mean new health complaints

Modernity and illness?

Answer 41

Normal everyday
symptoms such as headache and fatigue are now
more easily interpreted as signs of disease or ill health.
Attributions made by patients about the cause of their
illness often involve environmental pollution, and they see the effects of modern life as undermining the effectiveness
of their immune system.

The rapid introduction of new technologies,
while improving the quality of life of millions of
people, has been accompanied by important adverse effects in the way people make sense of illness and present with health complaints.

Question 42

Obesity: historical development of scientific and cultural ideas.

Author(s) : Bray, G. A.

Obesity as a modern idea?

Answer 42

It is concluded that most of the concepts which are the basis for research in obesity had their origin in the 19th century and often earlier.

Question 43

Obesity in Ancient History

D. Haslam, The treatment of obesity: Past, present
and future

Answer 43

Obesity has existed ever since civilisation has
been recorded.
- The Venus of Hohle Fels, a crude statuette of a naked obese woman, is estimated
to be 35 000 years old

in 500 bc, the
ancient Indian surgeon Sushruta described
“obesity, voracity, gloss of the body, increased
soporific tendency and inclination for lounging
in bed or on cushion”

Avicenna, the great Persian physician, prescribed
an appetite suppressant for his obese patients

Hippocrates said, “Men who
are constitutionally very fat are more likely to
die quickly than those who are thin.” Galen of
Pergamon, physician to several Roman Emperors,
described the polysarkos phenotype, who “cannot
walk without sweating, cannot reach when sitting
at the table because of the mass of his stomach,
cannot breathe easily, cannot give birth, cannot
clean himself”

Question 44

Early modern ideas of Obesity as an issue of willpower

Answer 44

Jean Anthelme Brillat-Savarin (1755–1826), The Physiology of Taste or, Meditations on Transcendental Gastronomy (1825)

“(Obesity) is not actually a disease, it is at least a most unpleasant state of ill health, and one into which we almost always fall because of our own fault.”

Question 45

Railway spine: diseases of modern technology

Caplan, E. ‘Trains, Brains, and Sprains: Railway Spine and the Origins of Psychoneuroses’

Answer 45

• Railway spine: paralysis, headaches, other ailments, following traumatic high-speed rail crash
• First materialistic (spine)
• Psychological (hysteria/neurasthenia)

Erichsen (1866): ‘concussion of the spine’: must be organic disturbance, as ‘couldn’t fathom’ that men could fall victim to hysteria, too.

Jean-Martin Charcot and Herbert Page, insisted that some symptoms could be caused by hysteria (now known as conversion disorder).

Question 46

1980, the American Psychiatric Association, post-traumatic stress disorder
(PTSD) in the third edition of its Diagnostic and
Statistical Manual, the DSM III (APA, 1980).

Bracken, P. J., ‘Post-Modernity and Post-Traumatic Stress Disorder’, Social Science & Medicine 53 (2001), 733-43

Answer 46

The
condition is defined in terms of intrusive symptoms
(such as nightmares, flashbacks and persistent memories),
avoidance symptoms (such as emotional numbing,
withdrawal from the world and avoidance of
reminders) and symptoms of overarousal (such as
insomnia and irritability). There have been a number
of changes to the syndrome in subsequent versions of the
DSM but its basic structure remains the same

– parallels with Royal College of Psychiatrists’ definition in the UK

Question 47

Does PTSD have a universal validity?

Bracken, P. J., ‘Post-Modernity and Post-Traumatic Stress Disorder’, Social Science & Medicine 53 (2001), 733-43

Answer 47

assumed to across cultures and time by Diagnosis and Statistics Manual (DSM, US), WHO

Question 48

PTSD - invented or discovered?

What, according to OBrein, do lots of ppl think?

Answer 48

PTSD is merely the renaming or the synthesis of an

age-old condition (O’Brien, 1998, p. 5).

Question 49

Is PTSD a particularly modern, new, disease?

Bracken, P. J., ‘Post-Modernity and Post-Traumatic Stress Disorder’, Social Science & Medicine 53 (2001), 733-43

Answer 49

While historically there is considerable evidence of
physical and psychological reactions to terrifying events
in the medical and non-medical literature, most of these reports point to symptom complexes which are not
co-terminus with the defined symptoms of PTSD

US Civil War: ‘soldiers heart’ (withdrawn)
WW1: ‘shell shock’ (nerve damage, organic)

–> the
symptoms of these military syndromes were simply not
the same as those of PTSD

Question 50

The Counstruction of PTSD

Young, 1995,

Answer 50

The disorder is not timeless, nor does it possess an
intrinsic unity. Rather, it is glued together by the
practices, technologies, and narratives with which it
is diagnosed, studied, treated, and represented and by
the various interests, institutions, and moral arguments
that mobilized these efforts and resources

Question 51

PTSD as a Post Modern Disease?

Bracken, P. J., ‘Post-Modernity and Post-Traumatic Stress Disorder’, Social Science & Medicine 53 (2001), 733-43

Answer 51

Modernity and Self-Identity: Self and Society in the Late
Modern Age (Giddens, 1991)

• In the move from modernity to the condition of postmodernity,
  disorder becomes an integral part of life. In
  the post-modern cultural arena ‘meaning’ itself is
  systematically undermined and reality is experienced as
  fleeting and unstable.

—> . If the post-modern condition does involve an undermining
of meaning, order and coherence, perhaps this goes
some way towards explaining the current level of interest
in PTSD, a syndrome said to be the result of a
breakdown in the meaningfullness of the victim’s world.

Question 52

Supposed evidence of PTSD being a timeless condition

Jones et al., Flashbacks and post-traumatic stress disorder:
the genesis of a 20th-century diagnosis

Answer 52

Shay (1991) suggested that elements
of the disorder could be identified in
Homer’s Iliad.

Samuel Pepys, who lived
through the plague and Great Fire of London,
is said to have recorded the features
of PTSD in his diary (Daly, 1983),

Question 53

Testing hypothesis: the
symptom clustering associated with PTSD
existed before psychiatrists recognised it
as a formal disorder.

Jones et al., Flashbacks and post-traumatic stress disorder:
the genesis of a 20th-century diagnosis

Answer 53

• Tested cases of disordered action of the heart/shellshock/psychoneurosis from Boer to Persian Gulf
• Had to accommodate for changing language (eg ‘flashback’ wasn’t a word in WW2, so included ‘visual hallucinations instead)

–>
- Although we did find cases from the First and Second World Wars which would meet today’s criteria for PTSD, their incidence was significantly lower than for the Gulf conflict. Previous historical investigations have relied on single
case studies to make the point that PTSD is a timeless disorder. However, such studies
lack a denominator and are instead
based on an active search through historical literature for descriptions that resemble modern formulations of PTSD, while presumably
discarding presentations that
appear different.

——> Our
findings imply that the psychopathology
of trauma is not static and that culture has an impact on the expression of distressing
memories. There is no single way for human beings to respond to the terrifying events of war, and the concept of a ‘universal
trauma reaction’ appears flawed. We suggest that PTSD is one more phase in the continually evolving picture of human reaction to adversity (Young, 1995)

Question 54

Look After Yourself! Campaign

Answer 54

‘Do you hold your breath when a man looks at you?
‘You’ll be in better shape all round if you lose a few pounds. And you’ll feel better, too.’

Is your body coming between you and the opposite sex?

Question 55

Early concern for Modern Life

Answer 55

George Cheyne, The English Malady (1733).
Immoderate and luxurious modern lifestyle was bad for health.
Advocate of vegetarianism.

Diseases of Modern Life, B. W. Richardson, 1876

‘Diseases from Worry and Mental Strain…Influence of the Passions…Impurity of Air’

Discusses dangers of smoking for changes to the blood, but denies smoking causes cancer as ‘Cancer was present for ages before tobacco was introduced as a luxury’

Question 56

Quote from B. W. Richardson that perfectly captures the debate over ‘modern diseases’

Answer 56

Smoking does not cause cancer: ‘Cancer was present for ages before tobacco was introduced as a luxury’

– Disease is not ‘modern’, but new causes are modern: entertains the idea that cancer may ‘excite, locally…the disease cancer?’

Question 57

Berridge, ‘Introduction’, ‘Marketing Health’

SMOKING: systematic gradualism and coercive permissiveness

Answer 57

Systematic gradualism was a strategy particularly important in the 1950s and 1960s when smoking as an activity was deeply embedded in society, in cultural and social practices

Coercive permissiveness, on the other hand, was the strategy which emerged in the 1960s and 1970s and grew in importance for public health both nationally and internationally as the cultural significance of smoking began to wane. It argued for individual self‐determination—but within a framework of behaviour increasingly defined by the state.

Question 58

Berridge, ‘Introduction’, ‘Marketing Health’

SMOKING:

Early attitudes to smoking

Answer 58

Nineteenth‐century public health paid little attention to smoking as a health hazard, and its health dangers were little discussed

Its health benefits were more central and were recognized to include alleviation of stress. Manufacturers submitted cigarettes to the Lancet for medical approval

the smoker might be weak willed but he was not diseased.

Question 59

Berridge, ‘Introduction’, ‘Marketing Health’

SMOKING: Increased opposition and the situation in Britain?

Answer 59

The main period of concern came in the early 1900s when a number of anti‐smoking organizations were founded to oppose smoking in children.

British Lads Anti‐Smoking Union

Work linking Smoking to Cancer in US/Germany

BUT

In Britain in these interwar years, there was little connection between formal public health and opposition to smoking…MoHs worked to contain infectious disease, ….Changing individual habits like smoking were not part of this mindset at all.

Later banned advertising on TV in 1965

Public smoking ban in 2005

Question 60

Diseases of modern life: Killer Chairs?

Answer 60

This grim conclusion may surprise you, but 18 studies reported during the past 16 years, covering 800,000 people overall, back it up. In 2010, for example, the journal Circulation published an investigation following 8,800 adults for seven years. Those who sat for more than four hours a day while watching television had a 46 percent increase in deaths from any cause when compared with people who sat in front of the tube for less than two hours.

https://www.scientificamerican.com/article/killer-chairs-how-desk-jobs-ruin-your-health/

Question 61

Berridge, ‘Introduction’, ‘Marketing Health’

Smoking: Establishing the link between smoking and lung cancer

Answer 61

Concern was roused by the gradual increase in the incidence of cancer

This was the origin of the work carried out in the Statistical Research Unit at the London School of Hygiene and Tropical Medicine (LSHTM) by Professor Bradford Hill and Dr Richard Doll. The results, published in the British Medical Journal (BMJ) in 1950, concluded that there was a ‘real association’ between carcinoma of the lung and smoking and that smoking was a factor, and an important one, in the production of carcinoma of the lung.

In the UK context, the work of Doll and Hill was the watershed.

The Parliamentary Secretary to the MH on 27 June 1957 expressed for the first time unambiguous support for the conclusions reached by Doll and Hill in 1950.

–> MH circular encouraging local authorities to develop health education campaigns on smoking

Question 62

Berridge, ‘Introduction’, ‘Marketing Health’

SMOKING: Economic issues with anti-smoking in UK: Evidence

Answer 62

Macmillan commented about the statement to be made in 1956 by the minister of Health, ‘Cabinet approved a statement to be made by the minister of Health about Tobacco and cancer of the lung. It was a much better draft than the original one. I only hope it won’t stop people smoking!’62

Question 63

Berridge, ‘Introduction’, ‘Marketing Health’

SMOKING: not perceived as a disease?

Answer 63

Smoking, it argued, was not a ‘disease’ in the way cancer, or indeed infectious disease was. It might lead to disease, but not for many years. The notion of long‐term ‘risk’, as we have seen, was not yet central to public health in the 1950s.

Question 64

The Fourth Stage of the Epidemiologic Transition: The Age of Delayed Degenerative
Diseases

Ault

`Thesis?

Answer 64

• Since 1960s, death rates for cancer, heart disease falling, population aging rapidly
• Mortality patterns remain the same as in Omran’s third stage (age of manmade and degenerative conditions), but occurs later in life

Question 65

Fifth Phase of the Epidemiologic Transition
The Age of Obesity and Inactivity

J. Michael Gaziano,

Thesis?

Answer 65

The steady gains made in both quality of life and longevity by addressing risk factors such as smoking, hypertension, and dyslipidemia are threatened by the obesity epidemic.

4th stage (Ault) of delayed degenerative diseases to be superceded by 5th stage of obesity and inactivity

deleterious health effects strongly linked to excess weight. These include increased risk of coronary heart disease, ischemic stroke, hypertension, dyslipidemia,
type 2 diabetes, joint disease, cancer, sleep apnea,
asthma, and a host of other chronic conditions

Question 66

Richardson, diseases of modern life (1876)

Answer 66

Disease from worry and mental strain, in people engaged in ‘arts, science and literature, political life’ due to failure of nervous system

Dementia caused by ‘excessive mental strain’