{"version":"1.0.0","segments":[{"startTime":0.38,"endTime":2.14,"body":"- Today, I'm going to pull together"},{"startTime":2.14,"endTime":5.75,"body":"the threads of several things"},{"startTime":2.14,"endTime":5.75,"body":"we've been talking about"},{"startTime":5.75,"endTime":8.39,"body":"in the lectures over the last few years,"},{"startTime":8.39,"endTime":13.39,"body":"and look forward to the impact"},{"startTime":8.39,"endTime":13.39,"body":"of these on health globally."},{"startTime":13.77,"endTime":16.89,"body":"I've already talked about"},{"startTime":13.77,"endTime":16.89,"body":"the impact specifically"},{"startTime":16.89,"endTime":19.41,"body":"in the NHS, and by extension,"},{"startTime":19.41,"endTime":21.223,"body":"the high income countries."},{"startTime":23.84,"endTime":25.33,"body":"Health globally is improving"},{"startTime":25.33,"endTime":28.3,"body":"at a really remarkable pace now,"},{"startTime":28.3,"endTime":30.52,"body":"and there's every reason,"},{"startTime":28.3,"endTime":30.52,"body":"as I'll come on to,"},{"startTime":30.52,"endTime":33.12,"body":"to expect that to continue."},{"startTime":33.12,"endTime":36.083,"body":"And this is due to a"},{"startTime":33.12,"endTime":36.083,"body":"combination of medical science,"},{"startTime":37.11,"endTime":39.483,"body":"public health, and development."},{"startTime":41.09,"endTime":43.92,"body":"The biggest change, which"},{"startTime":41.09,"endTime":43.92,"body":"I'm going to talk about"},{"startTime":43.92,"endTime":48.15,"body":"in the first part of this,"},{"startTime":43.92,"endTime":48.15,"body":"is to diseases in childhood."},{"startTime":48.15,"endTime":52.06,"body":"And this is particularly"},{"startTime":48.15,"endTime":52.06,"body":"noticeable in low income countries,"},{"startTime":52.06,"endTime":55.41,"body":"because in those settings,"},{"startTime":52.06,"endTime":55.41,"body":"childhood deaths have been"},{"startTime":55.41,"endTime":58.44,"body":"a very high proportion of"},{"startTime":55.41,"endTime":58.44,"body":"the deaths that are seen."},{"startTime":58.44,"endTime":62.21,"body":"That child mortality is"},{"startTime":58.44,"endTime":62.21,"body":"dropping fast everywhere,"},{"startTime":62.21,"endTime":65.377,"body":"and this is going to lead to significant"},{"startTime":65.377,"endTime":69.883,"body":"and very welcome changes in"},{"startTime":65.377,"endTime":69.883,"body":"global population structure."},{"startTime":71.91,"endTime":74.07,"body":"I'm then going to talk about"},{"startTime":71.91,"endTime":74.07,"body":"slightly older children"},{"startTime":74.07,"endTime":75.2,"body":"and young people,"},{"startTime":75.2,"endTime":78.13,"body":"and then are going to"},{"startTime":75.2,"endTime":78.13,"body":"talk about younger adults,"},{"startTime":78.13,"endTime":82.57,"body":"people under 50, and"},{"startTime":78.13,"endTime":82.57,"body":"then the people who live"},{"startTime":82.57,"endTime":87.57,"body":"through the next 25 years to around 75."},{"startTime":88.02,"endTime":90.94,"body":"In each of these age bands,"},{"startTime":90.94,"endTime":94.44,"body":"the health of people"},{"startTime":90.94,"endTime":94.44,"body":"globally is improving,"},{"startTime":94.44,"endTime":97.13,"body":"but which improvements matter depends"},{"startTime":97.13,"endTime":98.933,"body":"which age we're talking about."},{"startTime":100.28,"endTime":102.44,"body":"And then finally, I'll"},{"startTime":100.28,"endTime":102.44,"body":"talk rather more briefly,"},{"startTime":102.44,"endTime":105.22,"body":"because this has really been"},{"startTime":102.44,"endTime":105.22,"body":"covered more fully in the talk"},{"startTime":105.22,"endTime":108.14,"body":"I gave on the NHS and health in the UK"},{"startTime":108.14,"endTime":111.11,"body":"about some of the issues of health"},{"startTime":111.11,"endTime":115.363,"body":"in older people over 75 around the world."},{"startTime":116.62,"endTime":119.82,"body":"In summary, there are some"},{"startTime":116.62,"endTime":119.82,"body":"significant risk to progress,"},{"startTime":119.82,"endTime":123.29,"body":"and we need to be very"},{"startTime":119.82,"endTime":123.29,"body":"clear viewed about that."},{"startTime":123.29,"endTime":126.55,"body":"And there are some areas"},{"startTime":123.29,"endTime":126.55,"body":"where progress has been"},{"startTime":126.55,"endTime":128.73,"body":"and continues to be slow."},{"startTime":128.73,"endTime":132.113,"body":"But overall, the future"},{"startTime":128.73,"endTime":132.113,"body":"looks very optimistic."},{"startTime":134.81,"endTime":136.79,"body":"Let's start with children under five,"},{"startTime":136.79,"endTime":139.81,"body":"and I'm going to present the data on this"},{"startTime":139.81,"endTime":141.31,"body":"in several different ways,"},{"startTime":141.31,"endTime":144.44,"body":"because this is really"},{"startTime":141.31,"endTime":144.44,"body":"an extraordinary story"},{"startTime":144.44,"endTime":147.843,"body":"and is going to shape the"},{"startTime":144.44,"endTime":147.843,"body":"world from here on in."},{"startTime":148.88,"endTime":153.4,"body":"If you look over the period 1990 to 2020,"},{"startTime":153.4,"endTime":158.4,"body":"so a 30 year period,"},{"startTime":153.4,"endTime":158.4,"body":"there's been a 61% decline"},{"startTime":159.27,"endTime":163.55,"body":"in the number of deaths"},{"startTime":159.27,"endTime":163.55,"body":"per thousand live births."},{"startTime":163.55,"endTime":166.27,"body":"and this is in every continent"},{"startTime":163.55,"endTime":166.27,"body":"we're seeing improvements,"},{"startTime":166.27,"endTime":168.56,"body":"and this improvement, for"},{"startTime":166.27,"endTime":168.56,"body":"reasons I'll come on to,"},{"startTime":168.56,"endTime":170.46,"body":"will continue, 'cause although we've made"},{"startTime":170.46,"endTime":174.02,"body":"really substantial progress,"},{"startTime":170.46,"endTime":174.02,"body":"we have several more things"},{"startTime":174.02,"endTime":176.403,"body":"which we can do to make"},{"startTime":174.02,"endTime":176.403,"body":"things better still."},{"startTime":179.37,"endTime":180.69,"body":"If we look historically,"},{"startTime":180.69,"endTime":183.76,"body":"and this is a nice graphic from Gapminder,"},{"startTime":183.76,"endTime":187.32,"body":"what you can see is that"},{"startTime":183.76,"endTime":187.32,"body":"this real change started"},{"startTime":187.32,"endTime":189.67,"body":"where I've put the arrow around"},{"startTime":189.67,"endTime":194.67,"body":"about the turn of the last"},{"startTime":189.67,"endTime":194.67,"body":"century, so around 1900,"},{"startTime":194.69,"endTime":196.31,"body":"and since that time there's been"},{"startTime":197.561,"endTime":199.06,"body":"a steady decrease in child mortality,"},{"startTime":199.06,"endTime":201.83,"body":"under five mortality around the world,"},{"startTime":201.83,"endTime":203.38,"body":"starting in higher income countries,"},{"startTime":203.38,"endTime":205.853,"body":"moving through to more"},{"startTime":203.38,"endTime":205.853,"body":"middle income countries,"},{"startTime":207.015,"endTime":209.85,"body":"and now in general in"},{"startTime":207.015,"endTime":209.85,"body":"low income countries."},{"startTime":209.85,"endTime":212.55,"body":"Where we are now is where"},{"startTime":209.85,"endTime":212.55,"body":"I put the red arrow,"},{"startTime":212.55,"endTime":215.06,"body":"and you can see that we're still dropping"},{"startTime":216.272,"endTime":218.12,"body":"and there's then a projection forward,"},{"startTime":218.12,"endTime":220.27,"body":"now the exact speed of"},{"startTime":218.12,"endTime":220.27,"body":"the drop from here on"},{"startTime":220.27,"endTime":222.16,"body":"I think you could debate,"},{"startTime":222.16,"endTime":225.11,"body":"but that there will continue"},{"startTime":222.16,"endTime":225.11,"body":"to be dropping child mortality"},{"startTime":225.11,"endTime":227.9,"body":"in this age group, I"},{"startTime":225.11,"endTime":227.9,"body":"think is extremely clear."},{"startTime":227.9,"endTime":229.06,"body":"And as you can see,"},{"startTime":229.06,"endTime":232.72,"body":"we're now at a state where the"},{"startTime":229.06,"endTime":232.72,"body":"probability of children dying"},{"startTime":232.72,"endTime":235.95,"body":"under the age of five is"},{"startTime":232.72,"endTime":235.95,"body":"really remarkably reduced,"},{"startTime":235.95,"endTime":236.85,"body":"compared to where it is,"},{"startTime":236.85,"endTime":240.113,"body":"and generally very low"},{"startTime":236.85,"endTime":240.113,"body":"everywhere in the world."},{"startTime":241.84,"endTime":244.05,"body":"Looking at this geographically,"},{"startTime":244.05,"endTime":248.84,"body":"on the left you got the map of"},{"startTime":244.05,"endTime":248.84,"body":"under five mortality in 1990"},{"startTime":248.84,"endTime":251.16,"body":"and on the right in 2020,"},{"startTime":251.16,"endTime":253.55,"body":"and as you can see in every continent,"},{"startTime":253.55,"endTime":254.86,"body":"this has gone from darker colors"},{"startTime":254.86,"endTime":258.54,"body":"where higher mortality is"},{"startTime":254.86,"endTime":258.54,"body":"seen, to lighter colors."},{"startTime":258.54,"endTime":261.63,"body":"And this is now quite highly concentrated"},{"startTime":261.63,"endTime":263.61,"body":"in particular countries, and in fact,"},{"startTime":263.61,"endTime":267.313,"body":"as I come on to, in particular"},{"startTime":263.61,"endTime":267.313,"body":"parts of those countries."},{"startTime":270.15,"endTime":275.05,"body":"If we look at a graph of"},{"startTime":270.15,"endTime":275.05,"body":"under five mortality rate"},{"startTime":275.05,"endTime":278.84,"body":"per thousand life births in 1990, 2000,"},{"startTime":278.84,"endTime":283.84,"body":"and then in 2020, what you can"},{"startTime":278.84,"endTime":283.84,"body":"see is in each of the regions"},{"startTime":285.76,"endTime":289.23,"body":"and each one of these"},{"startTime":285.76,"endTime":289.23,"body":"stacks of three bar charts,"},{"startTime":289.23,"endTime":292.32,"body":"it is a region that has"},{"startTime":289.23,"endTime":292.32,"body":"been an improvement."},{"startTime":292.32,"endTime":295.3,"body":"So this is an improvement everywhere."},{"startTime":295.3,"endTime":298.33,"body":"The biggest absolute drops are in Africa,"},{"startTime":298.33,"endTime":301.66,"body":"which is the stack on the"},{"startTime":298.33,"endTime":301.66,"body":"far left, comparing 1990,"},{"startTime":301.66,"endTime":304.053,"body":"2000, and 2020 in the dark colors,"},{"startTime":306.52,"endTime":309.65,"body":"but there's also significant"},{"startTime":306.52,"endTime":309.65,"body":"improvements in Asia"},{"startTime":309.65,"endTime":312.72,"body":"and Latin America, but solid"},{"startTime":309.65,"endTime":312.72,"body":"improvements elsewhere."},{"startTime":312.72,"endTime":316.14,"body":"On the right are Europe,"},{"startTime":312.72,"endTime":316.14,"body":"and north America,"},{"startTime":316.14,"endTime":317.37,"body":"and Australia, and New Zealand,"},{"startTime":317.37,"endTime":319.22,"body":"still an improvement,"},{"startTime":319.22,"endTime":322.49,"body":"and that is the place"},{"startTime":319.22,"endTime":322.49,"body":"to which every country"},{"startTime":322.49,"endTime":324.083,"body":"in the world is now heading."},{"startTime":327.5,"endTime":332.5,"body":"Now, I've shown this in a"},{"startTime":327.5,"endTime":332.5,"body":"bit more detail in this map,"},{"startTime":333.83,"endTime":335.66,"body":"because it is important to realize also"},{"startTime":335.66,"endTime":337.34,"body":"that many of the countries,"},{"startTime":337.34,"endTime":340.28,"body":"which have got significant"},{"startTime":337.34,"endTime":340.28,"body":"child mortality still"},{"startTime":341.179,"endTime":343.18,"body":"have quite varied patterns"},{"startTime":341.179,"endTime":343.18,"body":"around the country."},{"startTime":343.18,"endTime":344.97,"body":"So if you look at India, for example,"},{"startTime":344.97,"endTime":348.12,"body":"there are parts of India which have still"},{"startTime":348.12,"endTime":350.86,"body":"some significant child"},{"startTime":348.12,"endTime":350.86,"body":"mortality, other parts,"},{"startTime":350.86,"endTime":352.3,"body":"where it has dropped a very long way."},{"startTime":352.3,"endTime":354.47,"body":"So it's not just by country,"},{"startTime":354.47,"endTime":357.503,"body":"it's also often quite localized."},{"startTime":359.15,"endTime":361.43,"body":"By whichever measure you look at it,"},{"startTime":361.43,"endTime":364.403,"body":"this improvement has occurred everywhere."},{"startTime":367.86,"endTime":370.06,"body":"Now it's important to"},{"startTime":367.86,"endTime":370.06,"body":"think why this is the case,"},{"startTime":370.06,"endTime":371.86,"body":"because it both explains why we've had"},{"startTime":371.86,"endTime":374.44,"body":"this extraordinary turnaround,"},{"startTime":374.44,"endTime":376.03,"body":"but it also gives us some feeling"},{"startTime":376.03,"endTime":379.063,"body":"about is there further still to go?"},{"startTime":380.652,"endTime":382.89,"body":"To start off with two of"},{"startTime":380.652,"endTime":382.89,"body":"the most important things"},{"startTime":382.89,"endTime":386.41,"body":"which drove a lot of child"},{"startTime":382.89,"endTime":386.41,"body":"mortality until recently,"},{"startTime":386.41,"endTime":389.51,"body":"and still do in some areas, sanitation,"},{"startTime":389.51,"endTime":393.77,"body":"clean water, and safe"},{"startTime":389.51,"endTime":393.77,"body":"disposal of the feces,"},{"startTime":393.77,"endTime":395.073,"body":"and malnutrition."},{"startTime":396.13,"endTime":398.7,"body":"Both of these are improving,"},{"startTime":398.7,"endTime":400.41,"body":"if you take the globe as a whole,"},{"startTime":400.41,"endTime":402.23,"body":"but there is still a way to go."},{"startTime":402.23,"endTime":404.92,"body":"So there are still big advances"},{"startTime":404.92,"endTime":406.603,"body":"that we can make in these areas."},{"startTime":407.5,"endTime":409.62,"body":"So starting with clean"},{"startTime":407.5,"endTime":409.62,"body":"water and sanitation,"},{"startTime":409.62,"endTime":413.31,"body":"and this really drove a"},{"startTime":409.62,"endTime":413.31,"body":"lot of, in particular,"},{"startTime":413.31,"endTime":414.95,"body":"the fecal-oral, diarrheal,"},{"startTime":414.95,"endTime":416.523,"body":"and other diseases."},{"startTime":417.557,"endTime":420.61,"body":"The provision of clean"},{"startTime":417.557,"endTime":420.61,"body":"water has been improving"},{"startTime":420.61,"endTime":422.73,"body":"and as has sanitation,"},{"startTime":422.73,"endTime":425.26,"body":"and this has led to a substantial drop"},{"startTime":425.26,"endTime":426.84,"body":"in fecal-oral diseases everywhere,"},{"startTime":426.84,"endTime":429.81,"body":"but there are still over 2 billion people"},{"startTime":429.81,"endTime":432.4,"body":"who lack access to safe drinking water,"},{"startTime":432.4,"endTime":434.45,"body":"and there's still a lot of progress"},{"startTime":434.45,"endTime":436.45,"body":"needs to be made in sanitation."},{"startTime":436.45,"endTime":438.19,"body":"The bad news is that's still the case,"},{"startTime":438.19,"endTime":439.5,"body":"we must do something about that."},{"startTime":439.5,"endTime":442.1,"body":"The good news is that as that happens,"},{"startTime":442.1,"endTime":443.973,"body":"child mortality will drop further."},{"startTime":445.11,"endTime":447.9,"body":"One of the good things about"},{"startTime":445.11,"endTime":447.9,"body":"improvements in sanitation"},{"startTime":447.9,"endTime":452.9,"body":"and safe water is that,"},{"startTime":447.9,"endTime":452.9,"body":"with a few exceptions,"},{"startTime":452.92,"endTime":457.09,"body":"once progress is made, things"},{"startTime":452.92,"endTime":457.09,"body":"don't tend to go backwards,"},{"startTime":457.09,"endTime":461.863,"body":"except in major disasters,"},{"startTime":457.09,"endTime":461.863,"body":"such an earthquake or a war."},{"startTime":463.37,"endTime":466.93,"body":"Undernutrition, children dying of hunger,"},{"startTime":466.93,"endTime":468.78,"body":"of undernutrition stunting,"},{"startTime":468.78,"endTime":471.16,"body":"undernutrition of a"},{"startTime":468.78,"endTime":471.16,"body":"variety of different types"},{"startTime":471.16,"endTime":473.36,"body":"has also fallen,"},{"startTime":473.36,"endTime":476.62,"body":"but there's still significant"},{"startTime":473.36,"endTime":476.62,"body":"amounts of undernutrition,"},{"startTime":476.62,"endTime":479.44,"body":"and the map on the right shows this,"},{"startTime":479.44,"endTime":483.37,"body":"the steady improvement there's"},{"startTime":479.44,"endTime":483.37,"body":"been in undernutrition."},{"startTime":483.37,"endTime":486.14,"body":"But as you can see, there"},{"startTime":483.37,"endTime":486.14,"body":"is still some way to go,"},{"startTime":486.14,"endTime":489.7,"body":"again, as countries become wealthier,"},{"startTime":489.7,"endTime":491.17,"body":"as families get wealthier,"},{"startTime":491.17,"endTime":494.14,"body":"as food is more widely distributed,"},{"startTime":494.14,"endTime":495.52,"body":"this will continue to improve,"},{"startTime":495.52,"endTime":497.683,"body":"and child mortality will improve further."},{"startTime":499.15,"endTime":500.84,"body":"There are, for this one,"},{"startTime":500.84,"endTime":503.2,"body":"some backward pressures,"},{"startTime":503.2,"endTime":505.7,"body":"of which the most important"},{"startTime":503.2,"endTime":505.7,"body":"in the last two years"},{"startTime":505.7,"endTime":507.61,"body":"has been COVID 19, which has interfered"},{"startTime":507.61,"endTime":511.41,"body":"with many aspects,"},{"startTime":507.61,"endTime":511.41,"body":"ranging from agriculture"},{"startTime":511.41,"endTime":514.24,"body":"through to feeding programs."},{"startTime":514.24,"endTime":519.24,"body":"And very tragically, the war"},{"startTime":514.24,"endTime":519.24,"body":"in Ukraine will exacerbate"},{"startTime":519.85,"endTime":521.0,"body":"some of these problems."},{"startTime":525.51,"endTime":527.69,"body":"So those are two of the major things,"},{"startTime":527.69,"endTime":529.86,"body":"the next large group of diseases,"},{"startTime":529.86,"endTime":531.77,"body":"which have been steadily improving"},{"startTime":531.77,"endTime":534.1,"body":"are the vaccine preventable diseases."},{"startTime":534.1,"endTime":536.65,"body":"So again, these are large"},{"startTime":534.1,"endTime":536.65,"body":"numbers of infections,"},{"startTime":536.65,"endTime":539.3,"body":"and so I've just given two examples"},{"startTime":539.3,"endTime":542.09,"body":"just to demonstrate quite how powerful"},{"startTime":542.09,"endTime":545.02,"body":"these vaccines against"},{"startTime":542.09,"endTime":545.02,"body":"childhood disease are."},{"startTime":545.02,"endTime":547.68,"body":"On the left, Hib,"},{"startTime":547.68,"endTime":551.39,"body":"a vaccine against a form of meningitis"},{"startTime":551.39,"endTime":554.01,"body":"that's common in children, or"},{"startTime":551.39,"endTime":554.01,"body":"used to be common in children,"},{"startTime":554.01,"endTime":557.75,"body":"and on the right, rotavirus vaccine"},{"startTime":557.75,"endTime":559.84,"body":"against diarrheal diseases."},{"startTime":559.84,"endTime":562.11,"body":"In both cases, these are UK data,"},{"startTime":562.11,"endTime":564.02,"body":"it's simply 'cause we got clean data,"},{"startTime":564.02,"endTime":568.44,"body":"it's easy to actually see"},{"startTime":564.02,"endTime":568.44,"body":"how the effect occurred,"},{"startTime":568.44,"endTime":569.99,"body":"where the blue arrow is,"},{"startTime":569.99,"endTime":572.1,"body":"is where the vaccine was introduced,"},{"startTime":572.1,"endTime":574.38,"body":"and you can see an extraordinary drop away"},{"startTime":574.38,"endTime":579.38,"body":"of those diseases, which"},{"startTime":574.38,"endTime":579.38,"body":"are threatening the lives"},{"startTime":579.44,"endTime":584.153,"body":"or the disability rates among children."},{"startTime":586.4,"endTime":587.97,"body":"These started in high income countries,"},{"startTime":587.97,"endTime":590.38,"body":"but are now deployed worldwide,"},{"startTime":590.38,"endTime":591.6,"body":"although of course there are places"},{"startTime":591.6,"endTime":593.453,"body":"where they're not, sadly, available."},{"startTime":595.13,"endTime":597.64,"body":"If you add together all the"},{"startTime":595.13,"endTime":597.64,"body":"vaccine preventable diseases,"},{"startTime":597.64,"endTime":599.52,"body":"and I did a full lecture on vaccine,"},{"startTime":599.52,"endTime":602.73,"body":"so I'm not going to go"},{"startTime":599.52,"endTime":602.73,"body":"through all of them,"},{"startTime":602.73,"endTime":605.11,"body":"you can see that they make up still quite"},{"startTime":605.11,"endTime":608.16,"body":"a significant proportion"},{"startTime":605.11,"endTime":608.16,"body":"of childhood illness."},{"startTime":608.16,"endTime":610.39,"body":"And as vaccines are rolled out to places"},{"startTime":610.39,"endTime":612.72,"body":"where vaccines are still not available,"},{"startTime":612.72,"endTime":616.92,"body":"we will get further gains from vaccines"},{"startTime":616.92,"endTime":619.583,"body":"as a protection of children under five."},{"startTime":622.78,"endTime":626.293,"body":"So if we just take an example, pneumonia,"},{"startTime":627.26,"endTime":628.7,"body":"a infection which is passed on generally"},{"startTime":628.7,"endTime":633.5,"body":"by respiratory transmission"},{"startTime":628.7,"endTime":633.5,"body":"has decreased an estimated 37%"},{"startTime":633.5,"endTime":638.5,"body":"just in the period 10 years"},{"startTime":633.5,"endTime":638.5,"body":"between 2005 and 2015,"},{"startTime":638.69,"endTime":642.56,"body":"and a lot of this can be"},{"startTime":638.69,"endTime":642.56,"body":"explained by vaccines,"},{"startTime":642.56,"endTime":645.33,"body":"particularly pneumococcal"},{"startTime":642.56,"endTime":645.33,"body":"vaccine, but others as well."},{"startTime":645.33,"endTime":649.36,"body":"And in blue, you can see on this graph,"},{"startTime":649.36,"endTime":653.04,"body":"anywhere that's in blue has"},{"startTime":649.36,"endTime":653.04,"body":"had a significant reduction"},{"startTime":653.04,"endTime":656.4,"body":"in their rates of pneumonia,"},{"startTime":653.04,"endTime":656.4,"body":"the darker the color,"},{"startTime":656.4,"endTime":657.66,"body":"the bigger the change."},{"startTime":657.66,"endTime":660.54,"body":"So these changes have"},{"startTime":657.66,"endTime":660.54,"body":"occurred almost everywhere."},{"startTime":660.54,"endTime":661.93,"body":"There are very small number of countries"},{"startTime":661.93,"endTime":663.03,"body":"where that's not true."},{"startTime":668.14,"endTime":670.95,"body":"So those are water and sanitation,"},{"startTime":670.95,"endTime":674.72,"body":"the fecal-oral diseases,"},{"startTime":670.95,"endTime":674.72,"body":"the respiratory diseases,"},{"startTime":674.72,"endTime":677.19,"body":"some of the vaccine preventable diseases."},{"startTime":677.19,"endTime":679.07,"body":"Then there are the vector born diseases"},{"startTime":679.07,"endTime":681.713,"body":"of which the most important"},{"startTime":679.07,"endTime":681.713,"body":"in children is malaria."},{"startTime":682.75,"endTime":684.96,"body":"This is still with us,"},{"startTime":684.96,"endTime":688.32,"body":"it is still killing, sadly,"},{"startTime":688.32,"endTime":693.32,"body":"over 600,000 deaths a year, 77% of which,"},{"startTime":695.77,"endTime":699.163,"body":"so the great majority, are"},{"startTime":695.77,"endTime":699.163,"body":"in children under five."},{"startTime":700.81,"endTime":704.12,"body":"The sort of two bits"},{"startTime":700.81,"endTime":704.12,"body":"of good news, overall,"},{"startTime":704.12,"endTime":707.41,"body":"the geography of malaria"},{"startTime":704.12,"endTime":707.41,"body":"has steadily shrunk"},{"startTime":707.41,"endTime":709.18,"body":"over the last hundred years."},{"startTime":709.18,"endTime":710.7,"body":"So the number of countries where malaria's"},{"startTime":710.7,"endTime":713.91,"body":"a big problem are many fewer."},{"startTime":713.91,"endTime":718.4,"body":"And particularly over the last 20 years,"},{"startTime":718.4,"endTime":720.6,"body":"deaths have over halved,"},{"startTime":720.6,"endTime":723.32,"body":"and there was a really"},{"startTime":720.6,"endTime":723.32,"body":"very steady reduction"},{"startTime":723.32,"endTime":727.61,"body":"over the first two"},{"startTime":723.32,"endTime":727.61,"body":"decades of this century."},{"startTime":727.61,"endTime":729.81,"body":"Unfortunately, a combination"},{"startTime":727.61,"endTime":729.81,"body":"of biological factors,"},{"startTime":729.81,"endTime":732.4,"body":"particularly insecticide resistance,"},{"startTime":732.4,"endTime":736.35,"body":"which reduced some of the"},{"startTime":732.4,"endTime":736.35,"body":"effects against mosquitoes"},{"startTime":736.35,"endTime":741.35,"body":"and some drug resistance"},{"startTime":736.35,"endTime":741.35,"body":"pushed against that,"},{"startTime":741.43,"endTime":745.54,"body":"an improvement, and the"},{"startTime":741.43,"endTime":745.54,"body":"disruption that COVID 19 caused"},{"startTime":745.54,"endTime":750.54,"body":"to control programs has also"},{"startTime":745.54,"endTime":750.54,"body":"led to some backward pressure."},{"startTime":752.58,"endTime":755.81,"body":"So we have in fact seen"},{"startTime":752.58,"endTime":755.81,"body":"some increase in malaria"},{"startTime":755.81,"endTime":758.98,"body":"for the first time for a"},{"startTime":755.81,"endTime":758.98,"body":"while over the last two years,"},{"startTime":758.98,"endTime":762.84,"body":"but hopefully this can be reversed again."},{"startTime":762.84,"endTime":763.73,"body":"But this, again,"},{"startTime":763.73,"endTime":765.31,"body":"is a remarkable achievement"},{"startTime":765.31,"endTime":768.303,"body":"against one of the great"},{"startTime":765.31,"endTime":768.303,"body":"diseases of childhood."},{"startTime":771.56,"endTime":772.48,"body":"And there are many other,"},{"startTime":772.48,"endTime":775.05,"body":"but I'm just giving these"},{"startTime":772.48,"endTime":775.05,"body":"examples of the things"},{"startTime":775.05,"endTime":778.02,"body":"which have, stacked up together,"},{"startTime":778.02,"endTime":781.49,"body":"issues around nutrition,"},{"startTime":778.02,"endTime":781.49,"body":"issues around infection,"},{"startTime":781.49,"endTime":782.5,"body":"in particular,"},{"startTime":782.5,"endTime":787.35,"body":"have led to really"},{"startTime":782.5,"endTime":787.35,"body":"substantial improvements,"},{"startTime":787.35,"endTime":789.11,"body":"and what you can see in this graph,"},{"startTime":789.11,"endTime":791.21,"body":"which just shows a selection of countries,"},{"startTime":791.21,"endTime":793.84,"body":"they happen to be ones with"},{"startTime":791.21,"endTime":793.84,"body":"which I've been associated"},{"startTime":793.84,"endTime":795.37,"body":"with in various points,"},{"startTime":795.37,"endTime":798.46,"body":"that these are countries"},{"startTime":795.37,"endTime":798.46,"body":"which have actually"},{"startTime":798.46,"endTime":802.393,"body":"all had decreases in their"},{"startTime":798.46,"endTime":802.393,"body":"under five mortality,"},{"startTime":803.56,"endTime":807.7,"body":"and they are converging on a"},{"startTime":803.56,"endTime":807.7,"body":"very similar spot over time,"},{"startTime":807.7,"endTime":810.69,"body":"obviously starting from"},{"startTime":807.7,"endTime":810.69,"body":"very different places."},{"startTime":810.69,"endTime":813.84,"body":"So this convergence on"},{"startTime":810.69,"endTime":813.84,"body":"much lower mortality"},{"startTime":813.84,"endTime":817.613,"body":"in children under five is"},{"startTime":813.84,"endTime":817.613,"body":"occurring and occurring still."},{"startTime":822.08,"endTime":825.16,"body":"Now within the childhood diseases,"},{"startTime":825.16,"endTime":828.11,"body":"there's one area in children under five"},{"startTime":828.11,"endTime":832.133,"body":"where the risk is greatest and"},{"startTime":828.11,"endTime":832.133,"body":"the progress has been slower,"},{"startTime":833.13,"endTime":835.45,"body":"and that is in the neonatal period,"},{"startTime":835.45,"endTime":839.5,"body":"which is the first four"},{"startTime":835.45,"endTime":839.5,"body":"weeks after a child is born."},{"startTime":839.5,"endTime":842.84,"body":"And if you look at the"},{"startTime":839.5,"endTime":842.84,"body":"proportion of deaths"},{"startTime":842.84,"endTime":844.983,"body":"in children under five,"},{"startTime":845.83,"endTime":849.16,"body":"a very high proportion are"},{"startTime":845.83,"endTime":849.16,"body":"in the first four weeks,"},{"startTime":849.16,"endTime":850.02,"body":"and those are the ones"},{"startTime":850.02,"endTime":853.213,"body":"that are in yellow in this chart here."},{"startTime":856.89,"endTime":858.97,"body":"Now it's not that neonatal mortality,"},{"startTime":858.97,"endTime":860.763,"body":"which is here shown in yellow,"},{"startTime":861.61,"endTime":866.003,"body":"in some UNICEF data in terms"},{"startTime":861.61,"endTime":866.003,"body":"of mortality since 1990,"},{"startTime":866.003,"endTime":867.65,"body":"it's not that that's not getting better,"},{"startTime":867.65,"endTime":869.34,"body":"it is, it's improving,"},{"startTime":869.34,"endTime":872.0,"body":"but it is falling at a much slower rate"},{"startTime":872.0,"endTime":875.39,"body":"than the other causes that"},{"startTime":872.0,"endTime":875.39,"body":"I've talked about of children"},{"startTime":875.39,"endTime":879.36,"body":"who reach their first four weeks,"},{"startTime":879.36,"endTime":882.413,"body":"and then in the next period"},{"startTime":879.36,"endTime":882.413,"body":"up to their fifth birthday."},{"startTime":883.98,"endTime":887.56,"body":"And therefore, because the"},{"startTime":883.98,"endTime":887.56,"body":"rates of under five children"},{"startTime":887.56,"endTime":890.18,"body":"after the neonatal period"},{"startTime":887.56,"endTime":890.18,"body":"is falling really fast,"},{"startTime":890.18,"endTime":892.59,"body":"neonatal period is falling slower,"},{"startTime":892.59,"endTime":896.42,"body":"neonatal deaths are an"},{"startTime":892.59,"endTime":896.42,"body":"increasing proportion"},{"startTime":896.42,"endTime":901.19,"body":"of the children under five,"},{"startTime":896.42,"endTime":901.19,"body":"who should be alive and well,"},{"startTime":901.19,"endTime":904.32,"body":"but are tragically dying at the moment."},{"startTime":904.32,"endTime":907.18,"body":"Now we know how to"},{"startTime":904.32,"endTime":907.18,"body":"reduce neonatal mortality"},{"startTime":907.18,"endTime":909.2,"body":"very substantially."},{"startTime":909.2,"endTime":911.33,"body":"In high income countries,"},{"startTime":911.33,"endTime":914.5,"body":"you would expect to have maybe less"},{"startTime":914.5,"endTime":917.33,"body":"than three per thousand live births."},{"startTime":917.33,"endTime":920.8,"body":"And you can go down from that in places"},{"startTime":920.8,"endTime":925.8,"body":"with high end facilities."},{"startTime":926.19,"endTime":928.66,"body":"In low income countries,"},{"startTime":928.66,"endTime":932.29,"body":"that's closer to 25 or 26 per thousand."},{"startTime":932.29,"endTime":935.33,"body":"And what that means is that"},{"startTime":932.29,"endTime":935.33,"body":"there's a very long way"},{"startTime":935.33,"endTime":937.12,"body":"we could go in terms of improvement,"},{"startTime":937.12,"endTime":939.31,"body":"using existing science and technology."},{"startTime":939.31,"endTime":942.02,"body":"Now a few of these are"},{"startTime":939.31,"endTime":942.02,"body":"really high end things,"},{"startTime":942.02,"endTime":944.14,"body":"but very many of them are things"},{"startTime":944.14,"endTime":946.86,"body":"which are amenable to us improving them,"},{"startTime":946.86,"endTime":949.03,"body":"including pre-term birth,"},{"startTime":949.03,"endTime":951.34,"body":"including caused by some infections."},{"startTime":951.34,"endTime":953.51,"body":"Birth asphyxia, an inability"},{"startTime":951.34,"endTime":953.51,"body":"to breathe at birth."},{"startTime":953.51,"endTime":958.51,"body":"So this is around birthing"},{"startTime":953.51,"endTime":958.51,"body":"processes and infections,"},{"startTime":958.87,"endTime":962.72,"body":"which often occur shortly"},{"startTime":958.87,"endTime":962.72,"body":"after, or at least appear,"},{"startTime":962.72,"endTime":965.99,"body":"shortly after birth,"},{"startTime":962.72,"endTime":965.99,"body":"along with birth defects,"},{"startTime":965.99,"endTime":967.24,"body":"some of which are preventable."},{"startTime":967.24,"endTime":969.34,"body":"These are leading cause"},{"startTime":967.24,"endTime":969.34,"body":"in neonatal deaths,"},{"startTime":969.34,"endTime":971.64,"body":"and we have things we"},{"startTime":969.34,"endTime":971.64,"body":"can do about all of them,"},{"startTime":971.64,"endTime":975.38,"body":"many of which can be used"},{"startTime":971.64,"endTime":975.38,"body":"virtually anywhere in the world."},{"startTime":975.38,"endTime":978.97,"body":"So most of these neonatal"},{"startTime":975.38,"endTime":978.97,"body":"deaths should be seen"},{"startTime":978.97,"endTime":981.07,"body":"as preventable, of course,"},{"startTime":981.07,"endTime":983.983,"body":"it'll never be none at all."},{"startTime":987.21,"endTime":989.09,"body":"Now the reason I've concentrated so much"},{"startTime":989.09,"endTime":993.59,"body":"on children under five is"},{"startTime":989.09,"endTime":993.59,"body":"because they contribute so much"},{"startTime":993.59,"endTime":997.94,"body":"to mortality in people under 60."},{"startTime":997.94,"endTime":1002.63,"body":"And here, what we have is five year bands,"},{"startTime":1002.63,"endTime":1005.0,"body":"under five is the left hand band,"},{"startTime":1005.0,"endTime":1007.16,"body":"and then five year"},{"startTime":1005.0,"endTime":1007.16,"body":"breaks from there on in."},{"startTime":1007.16,"endTime":1009.76,"body":"The first two, first three,"},{"startTime":1009.76,"endTime":1011.89,"body":"rather, children and young people,"},{"startTime":1011.89,"endTime":1015.09,"body":"15 to 19, and then the blue bar,"},{"startTime":1015.09,"endTime":1017.793,"body":"the period 20 to 50."},{"startTime":1019.0,"endTime":1021.55,"body":"What you can see in this is"},{"startTime":1019.0,"endTime":1021.55,"body":"several different things."},{"startTime":1021.55,"endTime":1023.8,"body":"The first of which is the"},{"startTime":1021.55,"endTime":1023.8,"body":"extraordinary predominance"},{"startTime":1023.8,"endTime":1026.33,"body":"of deaths under five."},{"startTime":1026.33,"endTime":1029.71,"body":"If you survive to five,"},{"startTime":1029.71,"endTime":1032.02,"body":"you are not just likely to get to six,"},{"startTime":1032.02,"endTime":1034.86,"body":"it's not just slightly delaying mortality,"},{"startTime":1034.86,"endTime":1037.87,"body":"you have a very high"},{"startTime":1034.86,"endTime":1037.87,"body":"chance of getting to 60."},{"startTime":1037.87,"endTime":1040.62,"body":"So getting people through"},{"startTime":1037.87,"endTime":1040.62,"body":"that first five years"},{"startTime":1040.62,"endTime":1043.74,"body":"is really important because"},{"startTime":1040.62,"endTime":1043.74,"body":"the next period of life,"},{"startTime":1043.74,"endTime":1045.96,"body":"mortality rates really are much,"},{"startTime":1045.96,"endTime":1050.06,"body":"much lower, probability of"},{"startTime":1045.96,"endTime":1050.06,"body":"people dying is very low"},{"startTime":1050.06,"endTime":1052.01,"body":"in virtually all settings."},{"startTime":1052.01,"endTime":1057.01,"body":"And you can see this, that"},{"startTime":1052.01,"endTime":1057.01,"body":"the rates are incredibly low"},{"startTime":1057.6,"endTime":1061.13,"body":"and you really only"},{"startTime":1057.6,"endTime":1061.13,"body":"reach the kinds of rates"},{"startTime":1061.13,"endTime":1063.36,"body":"that you're seeing in the under fives"},{"startTime":1063.36,"endTime":1065.233,"body":"once people get above 65."},{"startTime":1068.03,"endTime":1072.53,"body":"What this has led to is"},{"startTime":1068.03,"endTime":1072.53,"body":"that there's a shift."},{"startTime":1072.53,"endTime":1075.34,"body":"So in this graph, what we've"},{"startTime":1072.53,"endTime":1075.34,"body":"got is a very similar graph"},{"startTime":1075.34,"endTime":1077.4,"body":"to the last one, but in red,"},{"startTime":1077.4,"endTime":1081.26,"body":"we've got the situation in 1970, in blue,"},{"startTime":1081.26,"endTime":1085.63,"body":"the situation in 2000, and in green,"},{"startTime":1085.63,"endTime":1090.51,"body":"the situation in 2016,"},{"startTime":1085.63,"endTime":1090.51,"body":"relatively recently."},{"startTime":1090.51,"endTime":1091.91,"body":"Now what you can see is firstly,"},{"startTime":1091.91,"endTime":1094.76,"body":"the first bit of good"},{"startTime":1091.91,"endTime":1094.76,"body":"news is there has been a,"},{"startTime":1094.76,"endTime":1095.8,"body":"as we've said before,"},{"startTime":1095.8,"endTime":1098.893,"body":"a massive reduction in"},{"startTime":1095.8,"endTime":1098.893,"body":"child deaths under five."},{"startTime":1099.92,"endTime":1103.66,"body":"The second is that we're"},{"startTime":1099.92,"endTime":1103.66,"body":"seeing falls in mortality"},{"startTime":1104.92,"endTime":1109.023,"body":"in children and young"},{"startTime":1104.92,"endTime":1109.023,"body":"people and in young adults."},{"startTime":1110.07,"endTime":1113.33,"body":"And you really are now only"},{"startTime":1110.07,"endTime":1113.33,"body":"seeing significant increases"},{"startTime":1113.33,"endTime":1115.09,"body":"in the later stage of life."},{"startTime":1115.09,"endTime":1118.84,"body":"So if people survive"},{"startTime":1115.09,"endTime":1118.84,"body":"their first five years,"},{"startTime":1118.84,"endTime":1123.84,"body":"they will usually live through"},{"startTime":1118.84,"endTime":1123.84,"body":"to much later in their life,"},{"startTime":1124.86,"endTime":1126.093,"body":"generally past 60."},{"startTime":1128.09,"endTime":1130.69,"body":"So we're therefore seeing"},{"startTime":1128.09,"endTime":1130.69,"body":"quite a significant shift"},{"startTime":1130.69,"endTime":1132.82,"body":"in the pattern of"},{"startTime":1130.69,"endTime":1132.82,"body":"mortality around the world,"},{"startTime":1132.82,"endTime":1134.62,"body":"and this is not going to reverse."},{"startTime":1134.62,"endTime":1137.32,"body":"So this change, now it's been made,"},{"startTime":1137.32,"endTime":1139.42,"body":"is a one way door, and a very welcome one."},{"startTime":1140.43,"endTime":1144.58,"body":"And towards the far end,"},{"startTime":1140.43,"endTime":1144.58,"body":"you've got people in their 90s,"},{"startTime":1144.58,"endTime":1146.63,"body":"and here is where you are starting"},{"startTime":1146.63,"endTime":1148.305,"body":"to see increases in mortality."},{"startTime":1148.305,"endTime":1149.138,"body":"But that's because these are people"},{"startTime":1149.138,"endTime":1151.423,"body":"who would've died earlier in other places."},{"startTime":1153.89,"endTime":1154.86,"body":"So that's good news."},{"startTime":1154.86,"endTime":1159.63,"body":"And I think an important"},{"startTime":1154.86,"endTime":1159.63,"body":"secondary bit of good news on this"},{"startTime":1159.63,"endTime":1161.16,"body":"is that there used to be a real worry,"},{"startTime":1161.16,"endTime":1163.06,"body":"and a perfectly rational worry,"},{"startTime":1163.06,"endTime":1165.93,"body":"that if children survived"},{"startTime":1165.93,"endTime":1169.68,"body":"and there were large numbers"},{"startTime":1165.93,"endTime":1169.68,"body":"of children surviving,"},{"startTime":1169.68,"endTime":1172.76,"body":"this would lead to just"},{"startTime":1169.68,"endTime":1172.76,"body":"some extraordinary expansion"},{"startTime":1172.76,"endTime":1174.49,"body":"in the world population,"},{"startTime":1174.49,"endTime":1177.32,"body":"and this would essentially carry on until"},{"startTime":1177.32,"endTime":1178.44,"body":"it was limited by resources."},{"startTime":1178.44,"endTime":1180.1,"body":"This was an idea first put forward"},{"startTime":1180.1,"endTime":1183.57,"body":"by the Reverend Thomas"},{"startTime":1180.1,"endTime":1183.57,"body":"Malthus, Malthusianism,"},{"startTime":1183.57,"endTime":1186.523,"body":"and perfectly respectable argument."},{"startTime":1187.37,"endTime":1191.62,"body":"But the data demonstrates that"},{"startTime":1187.37,"endTime":1191.62,"body":"in reality, this is wrong."},{"startTime":1191.62,"endTime":1193.88,"body":"And although many people"},{"startTime":1191.62,"endTime":1193.88,"body":"still actually believe this,"},{"startTime":1193.88,"endTime":1197.27,"body":"that children not dying is a good thing,"},{"startTime":1197.27,"endTime":1199.51,"body":"but it'll lead to massive problems."},{"startTime":1199.51,"endTime":1202.74,"body":"I think this is a"},{"startTime":1199.51,"endTime":1202.74,"body":"misunderstanding of the data."},{"startTime":1202.74,"endTime":1204.63,"body":"It's now pretty clear that in places"},{"startTime":1204.63,"endTime":1206.93,"body":"where there's reduced child mortality,"},{"startTime":1206.93,"endTime":1208.56,"body":"widely available contraception,"},{"startTime":1208.56,"endTime":1211.91,"body":"the second thing which the"},{"startTime":1208.56,"endTime":1211.91,"body":"medical side can contribute,"},{"startTime":1211.91,"endTime":1215.34,"body":"female education, and reduced poverty,"},{"startTime":1215.34,"endTime":1219.69,"body":"really important, the result"},{"startTime":1215.34,"endTime":1219.69,"body":"has been a very rapid drop"},{"startTime":1219.69,"endTime":1221.023,"body":"in global fertility."},{"startTime":1222.08,"endTime":1223.4,"body":"So to maintain the population"},{"startTime":1223.4,"endTime":1226.123,"body":"at a stable rate in any"},{"startTime":1223.4,"endTime":1226.123,"body":"country, in any society,"},{"startTime":1227.21,"endTime":1230.49,"body":"if you have a rate of 2.1 children"},{"startTime":1230.49,"endTime":1233.91,"body":"per woman of childbearing age,"},{"startTime":1233.91,"endTime":1236.67,"body":"that will lead to broadly"},{"startTime":1233.91,"endTime":1236.67,"body":"stable population,"},{"startTime":1236.67,"endTime":1237.54,"body":"anything more than that,"},{"startTime":1237.54,"endTime":1238.99,"body":"the population will increase,"},{"startTime":1241.807,"endTime":1242.68,"body":"well at least the numbers will increase,"},{"startTime":1242.68,"endTime":1245.48,"body":"and anything less than that,"},{"startTime":1242.68,"endTime":1245.48,"body":"numbers start to fall away."},{"startTime":1245.48,"endTime":1248.14,"body":"Global fertility around"},{"startTime":1245.48,"endTime":1248.14,"body":"the world as a whole"},{"startTime":1248.14,"endTime":1253.14,"body":"is now down to 2.5, so it's"},{"startTime":1248.14,"endTime":1253.14,"body":"still a bit above that 2.1."},{"startTime":1253.39,"endTime":1255.87,"body":"In high income countries,"},{"startTime":1253.39,"endTime":1255.87,"body":"I'll come on to this,"},{"startTime":1255.87,"endTime":1258.37,"body":"it's now dropped below"},{"startTime":1255.87,"endTime":1258.37,"body":"that replacement level,"},{"startTime":1258.37,"endTime":1260.43,"body":"in Europe it's around about 1.5,"},{"startTime":1260.43,"endTime":1262.683,"body":"depends which country"},{"startTime":1260.43,"endTime":1262.683,"body":"you're talking about."},{"startTime":1264.15,"endTime":1266.78,"body":"And so we've seen this real transformation"},{"startTime":1266.78,"endTime":1271.78,"body":"as a result of children"},{"startTime":1266.78,"endTime":1271.78,"body":"not dying, contraception,"},{"startTime":1271.88,"endTime":1274.52,"body":"female education development."},{"startTime":1274.52,"endTime":1276.9,"body":"From the situation on the left,"},{"startTime":1276.9,"endTime":1280.0,"body":"where everything in red or orange,"},{"startTime":1280.0,"endTime":1283.37,"body":"populations were increasing in the 1950s,"},{"startTime":1283.37,"endTime":1287.873,"body":"to the situation on the right,"},{"startTime":1283.37,"endTime":1287.873,"body":"with the same color scale,"},{"startTime":1289.25,"endTime":1292.91,"body":"everything in yellow, pale or dark,"},{"startTime":1292.91,"endTime":1295.7,"body":"then populations are stable or falling."},{"startTime":1295.7,"endTime":1297.91,"body":"And the number of parts of the world"},{"startTime":1297.91,"endTime":1300.33,"body":"where populations are still"},{"startTime":1297.91,"endTime":1300.33,"body":"increasing is now becoming"},{"startTime":1300.33,"endTime":1301.94,"body":"more and more concentrated"},{"startTime":1301.94,"endTime":1304.08,"body":"in these small number of countries."},{"startTime":1304.08,"endTime":1308.15,"body":"But in east Asia,"},{"startTime":1304.08,"endTime":1308.15,"body":"increasingly in south Asia,"},{"startTime":1308.15,"endTime":1311.32,"body":"in Latin America, north Africa,"},{"startTime":1311.32,"endTime":1312.153,"body":"a variety of other places,"},{"startTime":1312.153,"endTime":1315.38,"body":"rates have really come down"},{"startTime":1312.153,"endTime":1315.38,"body":"very substantially, and in fact,"},{"startTime":1315.38,"endTime":1319.613,"body":"come down in many parts of Africa as well."},{"startTime":1320.95,"endTime":1323.05,"body":"And the result of this is that if we look"},{"startTime":1323.05,"endTime":1326.02,"body":"over the next few decades,"},{"startTime":1326.02,"endTime":1328.43,"body":"the UN Population Division projects"},{"startTime":1328.43,"endTime":1332.16,"body":"that global fertility will drop"},{"startTime":1328.43,"endTime":1332.16,"body":"below the replacement level"},{"startTime":1332.16,"endTime":1333.97,"body":"sometime in the next few decades."},{"startTime":1333.97,"endTime":1336.51,"body":"Exactly when will depend on a"},{"startTime":1333.97,"endTime":1336.51,"body":"number of different factors."},{"startTime":1336.51,"endTime":1340.49,"body":"Once that's happened, it is"},{"startTime":1336.51,"endTime":1340.49,"body":"very unlikely to reverse."},{"startTime":1340.49,"endTime":1342.66,"body":"Now of course, populations"},{"startTime":1340.49,"endTime":1342.66,"body":"then continue to grow,"},{"startTime":1342.66,"endTime":1346.267,"body":"'cause people are living longer,"},{"startTime":1342.66,"endTime":1346.267,"body":"those people who would've,"},{"startTime":1346.267,"endTime":1349.28,"body":"you know, many people are"},{"startTime":1346.267,"endTime":1349.28,"body":"living for a longer period,"},{"startTime":1349.28,"endTime":1350.39,"body":"but there's a limit,"},{"startTime":1350.39,"endTime":1352.48,"body":"and once you get to the point"},{"startTime":1350.39,"endTime":1352.48,"body":"where the number of children"},{"startTime":1352.48,"endTime":1356.74,"body":"being born per mother is"},{"startTime":1352.48,"endTime":1356.74,"body":"dropped below 2 or 2.1,"},{"startTime":1356.74,"endTime":1358.21,"body":"then you're going to get to a situation"},{"startTime":1358.21,"endTime":1359.92,"body":"where the population stabilizes"},{"startTime":1359.92,"endTime":1361.5,"body":"and probably then starts to fall."},{"startTime":1361.5,"endTime":1364.36,"body":"So people being born today may well"},{"startTime":1364.36,"endTime":1365.96,"body":"for the first time in history, see,"},{"startTime":1365.96,"endTime":1369.74,"body":"not only the rate of fertility dropping"},{"startTime":1369.74,"endTime":1371.1,"body":"below replacement levels,"},{"startTime":1371.1,"endTime":1374.77,"body":"but actually the human population"},{"startTime":1371.1,"endTime":1374.77,"body":"of the globe stabilizing,"},{"startTime":1374.77,"endTime":1376.883,"body":"and then probably beginning to fall."},{"startTime":1380.45,"endTime":1382.63,"body":"This is an extraordinary transformation."},{"startTime":1382.63,"endTime":1385.85,"body":"And alongside this has been a real change"},{"startTime":1385.85,"endTime":1388.62,"body":"in the geography of ill"},{"startTime":1385.85,"endTime":1388.62,"body":"health as you go through"},{"startTime":1388.62,"endTime":1393.39,"body":"the later part of life for adults."},{"startTime":1393.39,"endTime":1396.38,"body":"And if you look at life"},{"startTime":1393.39,"endTime":1396.38,"body":"expectancy at birth,"},{"startTime":1396.38,"endTime":1400.13,"body":"again in 1950, on the left,"},{"startTime":1400.13,"endTime":1404.517,"body":"and in yellow or orange"},{"startTime":1400.13,"endTime":1404.517,"body":"are the life expectancy"},{"startTime":1405.81,"endTime":1406.92,"body":"being under 50."},{"startTime":1406.92,"endTime":1409.47,"body":"In green, it's 60 to 65."},{"startTime":1409.47,"endTime":1412.64,"body":"In blue, 75 to 90."},{"startTime":1412.64,"endTime":1417.0,"body":"And if you compare 1950s to 2020s,"},{"startTime":1417.0,"endTime":1419.9,"body":"what you can see is"},{"startTime":1417.0,"endTime":1419.9,"body":"everywhere in the world"},{"startTime":1419.9,"endTime":1421.923,"body":"has really transformed."},{"startTime":1423.01,"endTime":1425.41,"body":"And much of, for example,"},{"startTime":1425.41,"endTime":1429.02,"body":"Africa, or resource poor parts of Asia,"},{"startTime":1429.02,"endTime":1431.93,"body":"or Latin America have rates of mortality,"},{"startTime":1431.93,"endTime":1435.14,"body":"or more accurately, life expectancy,"},{"startTime":1435.14,"endTime":1440.14,"body":"which is as good as or"},{"startTime":1435.14,"endTime":1440.14,"body":"better than north America,"},{"startTime":1440.36,"endTime":1443.36,"body":"Europe did back in the 1950s."},{"startTime":1443.36,"endTime":1445.64,"body":"So there have been"},{"startTime":1443.36,"endTime":1445.64,"body":"improvements everywhere,"},{"startTime":1445.64,"endTime":1448.64,"body":"obviously people are starting"},{"startTime":1445.64,"endTime":1448.64,"body":"from slightly different bases."},{"startTime":1452.813,"endTime":1454.96,"body":"So I talked about children"},{"startTime":1452.813,"endTime":1454.96,"body":"and that the big change"},{"startTime":1454.96,"endTime":1456.92,"body":"I've just shown there is largely"},{"startTime":1456.92,"endTime":1458.883,"body":"because children are not dying."},{"startTime":1459.75,"endTime":1460.88,"body":"As I said, once people have got"},{"startTime":1460.88,"endTime":1462.545,"body":"through their first five years,"},{"startTime":1462.545,"endTime":1463.54,"body":"there's a very high chance they will get"},{"startTime":1463.54,"endTime":1467.063,"body":"through to their 60s or later."},{"startTime":1468.71,"endTime":1471.583,"body":"Now of course there are"},{"startTime":1468.71,"endTime":1471.583,"body":"risks in young adulthood,"},{"startTime":1472.5,"endTime":1475.068,"body":"but the physical health"},{"startTime":1472.5,"endTime":1475.068,"body":"outlook for young people"},{"startTime":1475.068,"endTime":1476.95,"body":"and younger adults is,"},{"startTime":1476.95,"endTime":1479.6,"body":"which I'm classifying for"},{"startTime":1476.95,"endTime":1479.6,"body":"this purpose as under 50,"},{"startTime":1479.6,"endTime":1481.98,"body":"medically that's what"},{"startTime":1479.6,"endTime":1481.98,"body":"I would see as younger,"},{"startTime":1481.98,"endTime":1483.853,"body":"is getting better almost everywhere."},{"startTime":1485.33,"endTime":1488.44,"body":"So in the period between 5 and 50,"},{"startTime":1488.44,"endTime":1491.793,"body":"chances of dying for most"},{"startTime":1488.44,"endTime":1491.793,"body":"people are extremely low."},{"startTime":1492.83,"endTime":1496.17,"body":"Historically, infections"},{"startTime":1492.83,"endTime":1496.17,"body":"would've had a big impact,"},{"startTime":1496.17,"endTime":1497.003,"body":"things like TB,"},{"startTime":1497.003,"endTime":1499.81,"body":"cholera would've killed"},{"startTime":1497.003,"endTime":1499.81,"body":"quite significant numbers."},{"startTime":1499.81,"endTime":1502.48,"body":"These have largely gone away"},{"startTime":1499.81,"endTime":1502.48,"body":"due to better sanitation,"},{"startTime":1502.48,"endTime":1504.793,"body":"nutrition, and medical treatment."},{"startTime":1506.05,"endTime":1508.88,"body":"HIV and a number of other infections,"},{"startTime":1508.88,"endTime":1511.42,"body":"which are required after sexual debut,"},{"startTime":1511.42,"endTime":1512.83,"body":"sexually transmitted infections,"},{"startTime":1512.83,"endTime":1515.16,"body":"like the virus causes cervical cancer,"},{"startTime":1515.16,"endTime":1517.77,"body":"viruses can cause some"},{"startTime":1515.16,"endTime":1517.77,"body":"forms of liver cancer,"},{"startTime":1517.77,"endTime":1521.0,"body":"acquired an early adulthood,"},{"startTime":1517.77,"endTime":1521.0,"body":"but HIV being the big one,"},{"startTime":1521.0,"endTime":1522.5,"body":"are now improving."},{"startTime":1522.5,"endTime":1525.343,"body":"HIV mortality rates are"},{"startTime":1522.5,"endTime":1525.343,"body":"dropping due to treatment,"},{"startTime":1526.52,"endTime":1530.43,"body":"hepatitis B and cervical cancer rates"},{"startTime":1530.43,"endTime":1533.06,"body":"are going to fall due to vaccination."},{"startTime":1533.06,"endTime":1536.86,"body":"But we've seen a situation"},{"startTime":1533.06,"endTime":1536.86,"body":"really transformed,"},{"startTime":1536.86,"endTime":1539.95,"body":"and the chances of young"},{"startTime":1536.86,"endTime":1539.95,"body":"adults dying of infections"},{"startTime":1539.95,"endTime":1543.313,"body":"are really substantially reduced"},{"startTime":1539.95,"endTime":1543.313,"body":"over the last few decades."},{"startTime":1545.79,"endTime":1548.58,"body":"In terms of the classic,"},{"startTime":1545.79,"endTime":1548.58,"body":"non-communicable diseases,"},{"startTime":1548.58,"endTime":1551.08,"body":"cancers, cardiovascular"},{"startTime":1548.58,"endTime":1551.08,"body":"disease in particular,"},{"startTime":1551.08,"endTime":1553.76,"body":"that can kill people,"},{"startTime":1551.08,"endTime":1553.76,"body":"with a few exceptions,"},{"startTime":1553.76,"endTime":1557.7,"body":"such as the very earlier"},{"startTime":1553.76,"endTime":1557.7,"body":"cases of breast cancer,"},{"startTime":1557.7,"endTime":1560.188,"body":"which usually peaks later in life,"},{"startTime":1560.188,"endTime":1561.021,"body":"some of the lymphomas,"},{"startTime":1561.021,"endTime":1562.87,"body":"cancers are pretty rare in this age group"},{"startTime":1562.87,"endTime":1564.54,"body":"or very rare in this age group,"},{"startTime":1564.54,"endTime":1568.07,"body":"as our fatal heart disease, strokes,"},{"startTime":1568.07,"endTime":1569.15,"body":"it's not that they don't occur,"},{"startTime":1569.15,"endTime":1572.083,"body":"but they're extremely"},{"startTime":1569.15,"endTime":1572.083,"body":"rare in people under 50."},{"startTime":1573.368,"endTime":1574.201,"body":"There are, of course,"},{"startTime":1574.201,"endTime":1577.9,"body":"some important diseases that"},{"startTime":1574.201,"endTime":1577.9,"body":"can have an impact on life"},{"startTime":1577.9,"endTime":1580.17,"body":"without necessarily causing mortality."},{"startTime":1580.17,"endTime":1583.94,"body":"Diabetes is an example, and"},{"startTime":1580.17,"endTime":1583.94,"body":"that's an increasing problem,"},{"startTime":1583.94,"endTime":1586.52,"body":"which I'll come back"},{"startTime":1583.94,"endTime":1586.52,"body":"to, driven by obesity,"},{"startTime":1586.52,"endTime":1587.69,"body":"asthma, for example,"},{"startTime":1587.69,"endTime":1588.73,"body":"maybe going up in some areas."},{"startTime":1588.73,"endTime":1591.3,"body":"So I don't want to imply that"},{"startTime":1588.73,"endTime":1591.3,"body":"everything is getting better,"},{"startTime":1591.3,"endTime":1594.79,"body":"absolutely everywhere, but overall,"},{"startTime":1594.79,"endTime":1598.53,"body":"the fatality rates are"},{"startTime":1594.79,"endTime":1598.53,"body":"already naturally very low"},{"startTime":1598.53,"endTime":1601.16,"body":"in young adults and are falling."},{"startTime":1604.86,"endTime":1608.96,"body":"The big risks in this age"},{"startTime":1604.86,"endTime":1608.96,"body":"period tend to be accidents"},{"startTime":1608.96,"endTime":1609.933,"body":"and injuries."},{"startTime":1610.85,"endTime":1613.468,"body":"And the leading causes of"},{"startTime":1610.85,"endTime":1613.468,"body":"mortality in this age group"},{"startTime":1613.468,"endTime":1617.26,"body":"include road traffic accidents,"},{"startTime":1613.468,"endTime":1617.26,"body":"accidents at work where,"},{"startTime":1617.26,"endTime":1618.6,"body":"you know, for example,"},{"startTime":1618.6,"endTime":1620.28,"body":"scaffolding falls on people,"},{"startTime":1620.28,"endTime":1621.37,"body":"accidental poisonings,"},{"startTime":1621.37,"endTime":1623.71,"body":"suicide, and homicide."},{"startTime":1623.71,"endTime":1626.1,"body":"Now the first two of those,"},{"startTime":1623.71,"endTime":1626.1,"body":"road traffic accidents"},{"startTime":1626.1,"endTime":1629.72,"body":"and accidents at work can"},{"startTime":1626.1,"endTime":1629.72,"body":"be significantly reduced"},{"startTime":1629.72,"endTime":1633.61,"body":"by state action to ensure"},{"startTime":1629.72,"endTime":1633.61,"body":"that there are safer cars,"},{"startTime":1633.61,"endTime":1636.16,"body":"safer roads, in the case"},{"startTime":1633.61,"endTime":1636.16,"body":"of road traffic accidents,"},{"startTime":1638.49,"endTime":1640.14,"body":"driving tests, for example,"},{"startTime":1640.14,"endTime":1643.92,"body":"and also that there's legislation"},{"startTime":1640.14,"endTime":1643.92,"body":"to ensure safety at work."},{"startTime":1643.92,"endTime":1645.77,"body":"And in high income countries,"},{"startTime":1645.77,"endTime":1648.58,"body":"rates of deaths on the road"},{"startTime":1645.77,"endTime":1648.58,"body":"and rates of deaths at work"},{"startTime":1648.58,"endTime":1652.4,"body":"have fallen steadily"},{"startTime":1648.58,"endTime":1652.4,"body":"over the last decades."},{"startTime":1652.4,"endTime":1654.18,"body":"But therefore a gap is, and on the top,"},{"startTime":1654.18,"endTime":1656.64,"body":"what you can see for example"},{"startTime":1654.18,"endTime":1656.64,"body":"is the number of deaths caused"},{"startTime":1656.64,"endTime":1661.177,"body":"by road accidents in the"},{"startTime":1656.64,"endTime":1661.177,"body":"UK, right back to the 1920s."},{"startTime":1661.177,"endTime":1664.748,"body":"And as you can see, there's"},{"startTime":1661.177,"endTime":1664.748,"body":"been with some ups and downs,"},{"startTime":1664.748,"endTime":1667.54,"body":"a steady decline over"},{"startTime":1664.748,"endTime":1667.54,"body":"the last few decades."},{"startTime":1667.54,"endTime":1669.77,"body":"And what we now have is a situation,"},{"startTime":1669.77,"endTime":1672.67,"body":"rather nice graphic from \"The Economist\""},{"startTime":1672.67,"endTime":1674.51,"body":"using data from elsewhere."},{"startTime":1674.51,"endTime":1677.31,"body":"What you have is in very"},{"startTime":1674.51,"endTime":1677.31,"body":"low income settings,"},{"startTime":1677.31,"endTime":1678.73,"body":"road traffic accidents tend to be lower,"},{"startTime":1678.73,"endTime":1681.11,"body":"'cause there are many"},{"startTime":1678.73,"endTime":1681.11,"body":"fewer people who got access"},{"startTime":1681.11,"endTime":1685.92,"body":"to road transport, and"},{"startTime":1681.11,"endTime":1685.92,"body":"in high income countries,"},{"startTime":1685.92,"endTime":1687.57,"body":"road traffic accidents tend to be low"},{"startTime":1687.57,"endTime":1690.55,"body":"because of a combination of"},{"startTime":1687.57,"endTime":1690.55,"body":"safety features both in the car,"},{"startTime":1690.55,"endTime":1692.96,"body":"the road, and the regulations."},{"startTime":1692.96,"endTime":1696.493,"body":"So the big risks here are"},{"startTime":1692.96,"endTime":1696.493,"body":"in middle income countries."},{"startTime":1701.26,"endTime":1703.65,"body":"One important area of health, however,"},{"startTime":1703.65,"endTime":1705.62,"body":"is a particular risk in this period,"},{"startTime":1705.62,"endTime":1708.8,"body":"and that is the first arrival"},{"startTime":1708.8,"endTime":1711.22,"body":"of significant mental health disorders."},{"startTime":1711.22,"endTime":1714.09,"body":"People may have them lifelong,"},{"startTime":1714.09,"endTime":1717.25,"body":"but young people and young adults"},{"startTime":1717.25,"endTime":1720.893,"body":"is where the first"},{"startTime":1717.25,"endTime":1720.893,"body":"presentations very often occur."},{"startTime":1722.528,"endTime":1725.11,"body":"And this is already important"},{"startTime":1725.11,"endTime":1727.85,"body":"and becoming increasingly important."},{"startTime":1727.85,"endTime":1730.15,"body":"As physical causes of"},{"startTime":1727.85,"endTime":1730.15,"body":"illness have decreased,"},{"startTime":1730.15,"endTime":1732.86,"body":"the relative importance"},{"startTime":1730.15,"endTime":1732.86,"body":"of mental health illness"},{"startTime":1732.86,"endTime":1737.57,"body":"is increasing and we've"},{"startTime":1732.86,"endTime":1737.57,"body":"had much less progress"},{"startTime":1737.57,"endTime":1739.46,"body":"in turning around either preventing"},{"startTime":1739.46,"endTime":1741.99,"body":"or treating quite large amount numbers"},{"startTime":1741.99,"endTime":1743.99,"body":"of mental health disorders"},{"startTime":1741.99,"endTime":1743.99,"body":"than physical ones."},{"startTime":1743.99,"endTime":1745.36,"body":"That's not to say there"},{"startTime":1743.99,"endTime":1745.36,"body":"haven't been improvements,"},{"startTime":1745.36,"endTime":1746.44,"body":"there definitely have,"},{"startTime":1746.44,"endTime":1748.63,"body":"there have been some quite"},{"startTime":1746.44,"endTime":1748.63,"body":"significant improvements,"},{"startTime":1748.63,"endTime":1751.27,"body":"but they have been much"},{"startTime":1748.63,"endTime":1751.27,"body":"slower, and therefore"},{"startTime":1751.27,"endTime":1755.5,"body":"the relative importance"},{"startTime":1751.27,"endTime":1755.5,"body":"of mental health disorders"},{"startTime":1755.5,"endTime":1757.4,"body":"has increased."},{"startTime":1757.4,"endTime":1758.87,"body":"And if you look on the right,"},{"startTime":1758.87,"endTime":1762.09,"body":"what we've got here is the"},{"startTime":1758.87,"endTime":1762.09,"body":"peak age at which people"},{"startTime":1762.09,"endTime":1765.58,"body":"are first diagnosed or first present"},{"startTime":1765.58,"endTime":1770.19,"body":"with mental health disorders."},{"startTime":1770.19,"endTime":1772.69,"body":"On the left, these are"},{"startTime":1770.19,"endTime":1772.69,"body":"things which tend to peak"},{"startTime":1772.69,"endTime":1775.25,"body":"in mid-teens, for example,"},{"startTime":1775.25,"endTime":1777.01,"body":"anxiety and fear related disorders,"},{"startTime":1777.01,"endTime":1779.89,"body":"feeding or eating"},{"startTime":1777.01,"endTime":1779.89,"body":"disorders, and on the right,"},{"startTime":1779.89,"endTime":1781.92,"body":"personality disorders on the top,"},{"startTime":1781.92,"endTime":1786.13,"body":"schizophrenia and psychotic"},{"startTime":1781.92,"endTime":1786.13,"body":"disease on the bottom."},{"startTime":1786.13,"endTime":1787.74,"body":"And what this demonstrates"},{"startTime":1787.74,"endTime":1792.74,"body":"is that these tend to first"},{"startTime":1787.74,"endTime":1792.74,"body":"present in young adults."},{"startTime":1792.88,"endTime":1795.88,"body":"So this is a period of"},{"startTime":1792.88,"endTime":1795.88,"body":"life where we need to think"},{"startTime":1795.88,"endTime":1798.32,"body":"really seriously about how we can prevent"},{"startTime":1798.32,"endTime":1801.623,"body":"and treat mental health disorders."},{"startTime":1805.5,"endTime":1809.95,"body":"Moving back to things which"},{"startTime":1805.5,"endTime":1809.95,"body":"actually cause physical illness"},{"startTime":1809.95,"endTime":1813.723,"body":"and deaths in large numbers."},{"startTime":1814.56,"endTime":1818.57,"body":"If you look over time, and this I think"},{"startTime":1818.57,"endTime":1822.52,"body":"is probably obvious to people,"},{"startTime":1818.57,"endTime":1822.52,"body":"but it's worth stressing,"},{"startTime":1822.52,"endTime":1826.85,"body":"in red here, what we have"},{"startTime":1822.52,"endTime":1826.85,"body":"is this is an age chart"},{"startTime":1826.85,"endTime":1830.24,"body":"of when people die and what they die of."},{"startTime":1830.24,"endTime":1832.52,"body":"In red are infections, neonatal,"},{"startTime":1832.52,"endTime":1833.92,"body":"and nutritional disorders."},{"startTime":1833.92,"endTime":1838.66,"body":"And deaths in red,"},{"startTime":1833.92,"endTime":1838.66,"body":"which go up to about 10,"},{"startTime":1838.66,"endTime":1843.563,"body":"are heavily dominated by"},{"startTime":1838.66,"endTime":1843.563,"body":"infections and nutritional issues."},{"startTime":1844.69,"endTime":1847.6,"body":"In young adults, really the"},{"startTime":1844.69,"endTime":1847.6,"body":"number of deaths is very small,"},{"startTime":1847.6,"endTime":1849.22,"body":"there are contributions"},{"startTime":1847.6,"endTime":1849.22,"body":"from various areas,"},{"startTime":1849.22,"endTime":1852.56,"body":"as I've said, including accidents."},{"startTime":1852.56,"endTime":1854.74,"body":"But then once you get to middle age,"},{"startTime":1854.74,"endTime":1856.823,"body":"which I'm going to define as over 50,"},{"startTime":1857.85,"endTime":1861.23,"body":"you start to get cardiovascular"},{"startTime":1857.85,"endTime":1861.23,"body":"diseases, strokes,"},{"startTime":1861.23,"endTime":1865.56,"body":"and heart attacks, and cancers"},{"startTime":1861.23,"endTime":1865.56,"body":"increasingly are an issue,"},{"startTime":1865.56,"endTime":1867.95,"body":"and they get a greater and greater issue"},{"startTime":1867.95,"endTime":1870.653,"body":"till you get right into your late 80s."},{"startTime":1874.24,"endTime":1876.54,"body":"Now, if you look at the world,"},{"startTime":1876.54,"endTime":1877.71,"body":"roughly as it is at the moment,"},{"startTime":1877.71,"endTime":1882.71,"body":"and these are data from Hans"},{"startTime":1877.71,"endTime":1882.71,"body":"Rosling's group, Gapminder,"},{"startTime":1883.32,"endTime":1885.36,"body":"this is every country on the world"},{"startTime":1885.36,"endTime":1888.89,"body":"with its income along the bottom axis,"},{"startTime":1888.89,"endTime":1893.87,"body":"and life expectancy in years"},{"startTime":1888.89,"endTime":1893.87,"body":"along the left hand axis."},{"startTime":1895.11,"endTime":1899.38,"body":"The ones in blue are from"},{"startTime":1895.11,"endTime":1899.38,"body":"Africa, from red are in Asia,"},{"startTime":1899.38,"endTime":1904.38,"body":"and yellow are from Europe,"},{"startTime":1899.38,"endTime":1904.38,"body":"green, the Americas."},{"startTime":1906.14,"endTime":1909.07,"body":"And what is extraordinary"},{"startTime":1906.14,"endTime":1909.07,"body":"about this is firstly"},{"startTime":1909.07,"endTime":1913.72,"body":"that these all line up"},{"startTime":1909.07,"endTime":1913.72,"body":"along a straight line,"},{"startTime":1913.72,"endTime":1917.27,"body":"demonstrating that as"},{"startTime":1913.72,"endTime":1917.27,"body":"countries get wealthier"},{"startTime":1917.27,"endTime":1921.74,"body":"and almost every country not"},{"startTime":1917.27,"endTime":1921.74,"body":"actively at war is, over time,"},{"startTime":1921.74,"endTime":1924.13,"body":"not in any given year, but over decades,"},{"startTime":1924.13,"endTime":1928.16,"body":"getting wealthier, mortality rates go down"},{"startTime":1928.16,"endTime":1931.24,"body":"or more accurately,"},{"startTime":1928.16,"endTime":1931.24,"body":"life expectancy goes up,"},{"startTime":1931.24,"endTime":1935.04,"body":"and countries are all moving"},{"startTime":1931.24,"endTime":1935.04,"body":"from bottom left to top right."},{"startTime":1935.04,"endTime":1936.99,"body":"Now I've put two arrows on this."},{"startTime":1936.99,"endTime":1941.53,"body":"Under 50, really very few"},{"startTime":1936.99,"endTime":1941.53,"body":"countries got life expectancies"},{"startTime":1941.53,"endTime":1945.203,"body":"now are under 15, basically almost none."},{"startTime":1946.41,"endTime":1950.76,"body":"Then you've got the range 50"},{"startTime":1946.41,"endTime":1950.76,"body":"to 75, and in this age range,"},{"startTime":1950.76,"endTime":1953.04,"body":"cardiovascular diseases tend to play"},{"startTime":1953.04,"endTime":1956.16,"body":"a very large part in mortality."},{"startTime":1956.16,"endTime":1958.07,"body":"And then towards the"},{"startTime":1956.16,"endTime":1958.07,"body":"upper end range of this,"},{"startTime":1958.07,"endTime":1961.89,"body":"so 70s onwards, you continue"},{"startTime":1958.07,"endTime":1961.89,"body":"to get cardiovascular diseases,"},{"startTime":1961.89,"endTime":1964.62,"body":"but cancers become increasingly dominant"},{"startTime":1964.62,"endTime":1965.77,"body":"in terms of mortality,"},{"startTime":1965.77,"endTime":1969.0,"body":"but cancer and cardiovascular"},{"startTime":1965.77,"endTime":1969.0,"body":"diseases in some combination."},{"startTime":1969.0,"endTime":1970.59,"body":"And right at the top,"},{"startTime":1970.59,"endTime":1974.433,"body":"we tend to get mixtures of"},{"startTime":1970.59,"endTime":1974.433,"body":"diseases, which I'll come on to."},{"startTime":1975.66,"endTime":1978.7,"body":"If we look over time, and"},{"startTime":1975.66,"endTime":1978.7,"body":"this is an obvious point"},{"startTime":1978.7,"endTime":1981.81,"body":"in a sense, there's been an"},{"startTime":1978.7,"endTime":1981.81,"body":"improvement across the world."},{"startTime":1981.81,"endTime":1983.82,"body":"This is the same graph,"},{"startTime":1981.81,"endTime":1983.82,"body":"slightly different axis,"},{"startTime":1983.82,"endTime":1987.78,"body":"1922, so 100 years ago,"},{"startTime":1987.78,"endTime":1990.68,"body":"and 2021, last year."},{"startTime":1990.68,"endTime":1993.01,"body":"What you can see with both of these is"},{"startTime":1993.01,"endTime":1995.963,"body":"in a hundred years ago,"},{"startTime":1993.01,"endTime":1995.963,"body":"most countries in the world,"},{"startTime":1996.928,"endTime":1999.01,"body":"under 50, dominated by infections,"},{"startTime":1999.01,"endTime":2002.21,"body":"and richer countries, 50 to 75,"},{"startTime":2002.21,"endTime":2004.53,"body":"would've had a loss of"},{"startTime":2002.21,"endTime":2004.53,"body":"cardiovascular disease,"},{"startTime":2004.53,"endTime":2006.64,"body":"some infection, and cancers."},{"startTime":2006.64,"endTime":2009.43,"body":"We're now in a situation where infections"},{"startTime":2009.43,"endTime":2011.78,"body":"are much less important"},{"startTime":2009.43,"endTime":2011.78,"body":"as a cause of mortality"},{"startTime":2012.75,"endTime":2015.09,"body":"or every country in the world,"},{"startTime":2015.09,"endTime":2016.74,"body":"pretty well, is over 50."},{"startTime":2016.74,"endTime":2019.23,"body":"And the wealthiest countries are over 75"},{"startTime":2019.23,"endTime":2021.75,"body":"and have a combination"},{"startTime":2019.23,"endTime":2021.75,"body":"of different diseases,"},{"startTime":2021.75,"endTime":2023.63,"body":"which can be problematic."},{"startTime":2023.63,"endTime":2026.1,"body":"But cardiovascular"},{"startTime":2023.63,"endTime":2026.1,"body":"disease tends to dominate"},{"startTime":2026.1,"endTime":2027.513,"body":"in that middle period."},{"startTime":2028.56,"endTime":2029.71,"body":"And you can see this here,"},{"startTime":2029.71,"endTime":2032.62,"body":"just taking the UK as"},{"startTime":2029.71,"endTime":2032.62,"body":"an example of a country"},{"startTime":2032.62,"endTime":2037.5,"body":"that went through a transition"},{"startTime":2032.62,"endTime":2037.5,"body":"between 1911 and 2012."},{"startTime":2037.5,"endTime":2040.3,"body":"So this is again, is a 100"},{"startTime":2037.5,"endTime":2040.3,"body":"years of data from the ONS,"},{"startTime":2040.3,"endTime":2044.01,"body":"and in the solid line"},{"startTime":2040.3,"endTime":2044.01,"body":"is circulator diseases,"},{"startTime":2044.01,"endTime":2046.69,"body":"heart disease and stroke."},{"startTime":2046.69,"endTime":2050.57,"body":"And blue is in men, red is in women."},{"startTime":2050.57,"endTime":2052.79,"body":"Dotted line is infections."},{"startTime":2052.79,"endTime":2055.35,"body":"Infections really fell away as a cause"},{"startTime":2055.35,"endTime":2057.38,"body":"as the country became wealthier."},{"startTime":2057.38,"endTime":2060.46,"body":"Cancers have gone at a fairly"},{"startTime":2057.38,"endTime":2060.46,"body":"steady rate over that time,"},{"startTime":2060.46,"endTime":2062.69,"body":"and they're mainly in oldest people,"},{"startTime":2062.69,"endTime":2066.44,"body":"But circulation diseases,"},{"startTime":2062.69,"endTime":2066.44,"body":"heart disease and stroke,"},{"startTime":2066.44,"endTime":2070.79,"body":"steadily increased, really"},{"startTime":2066.44,"endTime":2070.79,"body":"through to the 1950s and 60s,"},{"startTime":2070.79,"endTime":2073.28,"body":"and then started to improve."},{"startTime":2073.28,"endTime":2076.45,"body":"This pattern is likely to be"},{"startTime":2073.28,"endTime":2076.45,"body":"followed for many countries"},{"startTime":2076.45,"endTime":2077.713,"body":"as they industrialize."},{"startTime":2079.46,"endTime":2081.12,"body":"And we're now in a situation in the UK"},{"startTime":2081.12,"endTime":2084.82,"body":"as a high income country"},{"startTime":2081.12,"endTime":2084.82,"body":"where rates of heart disease"},{"startTime":2084.82,"endTime":2086.99,"body":"and stroke have fallen very far."},{"startTime":2086.99,"endTime":2091.29,"body":"So this is data from the 1970s"},{"startTime":2086.99,"endTime":2091.29,"body":"through to very recently,"},{"startTime":2091.29,"endTime":2093.17,"body":"British Heart Foundation data,"},{"startTime":2093.17,"endTime":2096.69,"body":"there's been around a 73%"},{"startTime":2093.17,"endTime":2096.69,"body":"reduction in that time."},{"startTime":2096.69,"endTime":2098.02,"body":"Men more than women,"},{"startTime":2098.02,"endTime":2101.283,"body":"some of the difference"},{"startTime":2098.02,"endTime":2101.283,"body":"explained simply by smoking."},{"startTime":2103.28,"endTime":2105.29,"body":"This has been even more marked"},{"startTime":2105.29,"endTime":2107.92,"body":"if we talk about people under 75."},{"startTime":2107.92,"endTime":2110.91,"body":"So this is people in their first 75 years,"},{"startTime":2110.91,"endTime":2112.92,"body":"the chance of dying in"},{"startTime":2110.91,"endTime":2112.92,"body":"a high income country"},{"startTime":2112.92,"endTime":2115.71,"body":"from heart disease are"},{"startTime":2112.92,"endTime":2115.71,"body":"now very low, not zero,"},{"startTime":2115.71,"endTime":2118.053,"body":"and even lower in women."},{"startTime":2121.86,"endTime":2124.43,"body":"And there's also been a"},{"startTime":2121.86,"endTime":2124.43,"body":"significant improvement in strokes."},{"startTime":2124.43,"endTime":2126.24,"body":"So circulatory diseases,"},{"startTime":2126.24,"endTime":2129.5,"body":"which go up as infectious"},{"startTime":2126.24,"endTime":2129.5,"body":"diseases go away,"},{"startTime":2129.5,"endTime":2133.137,"body":"as a cause of mortality,"},{"startTime":2129.5,"endTime":2133.137,"body":"have then come down."},{"startTime":2133.137,"endTime":2135.29,"body":"And this pattern has been repeated"},{"startTime":2135.29,"endTime":2137.71,"body":"in many other highly"},{"startTime":2135.29,"endTime":2137.71,"body":"industrialized countries"},{"startTime":2137.71,"endTime":2139.203,"body":"over the last few decades."},{"startTime":2141.03,"endTime":2143.1,"body":"Other countries are still"},{"startTime":2141.03,"endTime":2143.1,"body":"going through this transition."},{"startTime":2143.1,"endTime":2143.96,"body":"So here, for example,"},{"startTime":2143.96,"endTime":2145.805,"body":"is India, of course,"},{"startTime":2145.805,"endTime":2147.68,"body":"there's very wide varieties."},{"startTime":2147.68,"endTime":2151.64,"body":"India's a very large country,"},{"startTime":2147.68,"endTime":2151.64,"body":"a very large population,"},{"startTime":2151.64,"endTime":2154.04,"body":"but what you can see is in blue and red,"},{"startTime":2154.04,"endTime":2158.67,"body":"the trend line for ischemic"},{"startTime":2154.04,"endTime":2158.67,"body":"heart disease in the UK,"},{"startTime":2158.67,"endTime":2160.08,"body":"from an academic study,"},{"startTime":2160.08,"endTime":2162.75,"body":"and in green to measure"},{"startTime":2160.08,"endTime":2162.75,"body":"two different ways,"},{"startTime":2162.75,"endTime":2166.4,"body":"but the trends weren't important,"},{"startTime":2162.75,"endTime":2166.4,"body":"what we've seen in India."},{"startTime":2166.4,"endTime":2168.2,"body":"And India has not yet got to the point"},{"startTime":2168.2,"endTime":2169.5,"body":"where there's steady improvement"},{"startTime":2169.5,"endTime":2173.363,"body":"in heart disease is yet"},{"startTime":2169.5,"endTime":2173.363,"body":"occurring, but it will."},{"startTime":2175.6,"endTime":2176.433,"body":"And the reason it will,"},{"startTime":2176.433,"endTime":2180.35,"body":"and thinking particularly"},{"startTime":2176.433,"endTime":2180.35,"body":"about those under 75 happen,"},{"startTime":2180.35,"endTime":2183.16,"body":"is it's due to multiple incremental steps."},{"startTime":2183.16,"endTime":2185.12,"body":"And most of these are widely available"},{"startTime":2185.12,"endTime":2186.42,"body":"to middle income countries"},{"startTime":2186.42,"endTime":2188.71,"body":"and certainly to high income countries."},{"startTime":2188.71,"endTime":2190.12,"body":"They include reductions in smoking,"},{"startTime":2190.12,"endTime":2192.4,"body":"smoking drives a lot of"},{"startTime":2190.12,"endTime":2192.4,"body":"this cardiovascular disease,"},{"startTime":2192.4,"endTime":2194.93,"body":"unfortunately, wholly preventable."},{"startTime":2194.93,"endTime":2195.763,"body":"Air pollution,"},{"startTime":2195.763,"endTime":2198.633,"body":"which is a significant risk"},{"startTime":2195.763,"endTime":2198.633,"body":"for heart disease and stroke."},{"startTime":2199.87,"endTime":2202.22,"body":"A range of drugs, statins,"},{"startTime":2202.22,"endTime":2203.67,"body":"antihypertensives, beta blockers,"},{"startTime":2203.67,"endTime":2206.03,"body":"ACE inhibitors, aspirin,"},{"startTime":2206.03,"endTime":2208.2,"body":"these drugs are now all very cheap"},{"startTime":2208.2,"endTime":2209.7,"body":"and are available everywhere."},{"startTime":2209.7,"endTime":2211.684,"body":"So for middle income countries,"},{"startTime":2211.684,"endTime":2214.24,"body":"these are available, provided"},{"startTime":2211.684,"endTime":2214.24,"body":"people can be screened"},{"startTime":2214.24,"endTime":2218.993,"body":"or can be detected as"},{"startTime":2214.24,"endTime":2218.993,"body":"being at risk and treated."},{"startTime":2220.1,"endTime":2221.75,"body":"Then slightly more expensive,"},{"startTime":2221.75,"endTime":2223.88,"body":"but actually still manageable,"},{"startTime":2221.75,"endTime":2223.88,"body":"clot-busting drugs,"},{"startTime":2223.88,"endTime":2226.1,"body":"drugs used when people"},{"startTime":2223.88,"endTime":2226.1,"body":"have had a heart attack."},{"startTime":2226.1,"endTime":2229.84,"body":"And the first one really"},{"startTime":2226.1,"endTime":2229.84,"body":"that moves into a situation"},{"startTime":2229.84,"endTime":2234.33,"body":"that needs a relatively"},{"startTime":2229.84,"endTime":2234.33,"body":"well resourced health system"},{"startTime":2235.33,"endTime":2237.8,"body":"is cardiac stenting and cardiac surgery,"},{"startTime":2237.8,"endTime":2239.66,"body":"something I'll actually be talking about"},{"startTime":2239.66,"endTime":2242.083,"body":"in the next years lectures."},{"startTime":2243.36,"endTime":2245.02,"body":"So all of these will improve,"},{"startTime":2245.02,"endTime":2247.43,"body":"they'll improve either because"},{"startTime":2245.02,"endTime":2247.43,"body":"the risk factor goes down,"},{"startTime":2247.43,"endTime":2249.07,"body":"we will see reductions in air pollution"},{"startTime":2249.07,"endTime":2252.53,"body":"and hopefully in smoking"},{"startTime":2249.07,"endTime":2252.53,"body":"in most countries,"},{"startTime":2252.53,"endTime":2255.21,"body":"or because the health service can start"},{"startTime":2255.21,"endTime":2256.9,"body":"to use them effectively."},{"startTime":2256.9,"endTime":2259.9,"body":"And as the country develops,"},{"startTime":2256.9,"endTime":2259.9,"body":"that will be increasingly true."},{"startTime":2260.85,"endTime":2264.49,"body":"Working against this, so"},{"startTime":2260.85,"endTime":2264.49,"body":"slowing this progress down,"},{"startTime":2264.49,"endTime":2268.5,"body":"rising obesity, really"},{"startTime":2264.49,"endTime":2268.5,"body":"significant problem,"},{"startTime":2268.5,"endTime":2271.28,"body":"and consequence diabetes, and sadly,"},{"startTime":2271.28,"endTime":2274.603,"body":"in some countries, still"},{"startTime":2271.28,"endTime":2274.603,"body":"increasing in smoking."},{"startTime":2276.09,"endTime":2279.32,"body":"So those are drivers of"},{"startTime":2276.09,"endTime":2279.32,"body":"cardiovascular disease."},{"startTime":2279.32,"endTime":2282.38,"body":"When it come to cancers,"},{"startTime":2279.32,"endTime":2282.38,"body":"if people get cancer,"},{"startTime":2282.38,"endTime":2284.71,"body":"mortality has dropped very significant"},{"startTime":2284.71,"endTime":2288.12,"body":"in high income countries now"},{"startTime":2284.71,"endTime":2288.12,"body":"for very many of the cancers."},{"startTime":2288.12,"endTime":2290.45,"body":"And on this, what you"},{"startTime":2288.12,"endTime":2290.45,"body":"can see is the change"},{"startTime":2290.45,"endTime":2292.93,"body":"from the left hand to the"},{"startTime":2290.45,"endTime":2292.93,"body":"right end of this arrow,"},{"startTime":2292.93,"endTime":2296.21,"body":"for multiple cancers in 10 year survival,"},{"startTime":2296.21,"endTime":2299.11,"body":"using the UK as an example"},{"startTime":2296.21,"endTime":2299.11,"body":"of a high income country."},{"startTime":2299.11,"endTime":2302.03,"body":"So really significant improvements"},{"startTime":2299.11,"endTime":2302.03,"body":"in many of these cancers."},{"startTime":2302.03,"endTime":2303.85,"body":"As countries get richer,"},{"startTime":2303.85,"endTime":2305.33,"body":"they will have access to this science"},{"startTime":2305.33,"endTime":2307.23,"body":"and we will improve on the science."},{"startTime":2307.23,"endTime":2311.923,"body":"So the ability to actually"},{"startTime":2307.23,"endTime":2311.923,"body":"treat cancer will spread."},{"startTime":2313.83,"endTime":2317.67,"body":"And cancer treatment is"},{"startTime":2313.83,"endTime":2317.67,"body":"continuing to improve"},{"startTime":2317.67,"endTime":2318.58,"body":"for the great majority."},{"startTime":2318.58,"endTime":2320.87,"body":"So just taking in the UK,"},{"startTime":2320.87,"endTime":2325.37,"body":"the commonest cancers in men and women,"},{"startTime":2325.37,"endTime":2328.72,"body":"as examples of these, on the left,"},{"startTime":2328.72,"endTime":2330.29,"body":"prostate cancer, on the right,"},{"startTime":2330.29,"endTime":2333.7,"body":"breast cancer, survival has"},{"startTime":2330.29,"endTime":2333.7,"body":"been steadily improving,"},{"startTime":2333.7,"endTime":2334.92,"body":"till we get to the point"},{"startTime":2334.92,"endTime":2336.87,"body":"where the great majority of people"},{"startTime":2336.87,"endTime":2341.413,"body":"with both of these cancers"},{"startTime":2336.87,"endTime":2341.413,"body":"will survive 10 years and more,"},{"startTime":2343.23,"endTime":2344.8,"body":"and have a good quality of life."},{"startTime":2344.8,"endTime":2348.43,"body":"So the outlook for cancer,"},{"startTime":2344.8,"endTime":2348.43,"body":"really transformed."},{"startTime":2348.43,"endTime":2350.66,"body":"These sciences will be transferred,"},{"startTime":2350.66,"endTime":2352.42,"body":"are already being used in some settings,"},{"startTime":2352.42,"endTime":2354.943,"body":"but will increasingly"},{"startTime":2352.42,"endTime":2354.943,"body":"become the norm everywhere."},{"startTime":2356.45,"endTime":2357.8,"body":"There are, sadly,"},{"startTime":2357.8,"endTime":2359.81,"body":"some exceptions, of which"},{"startTime":2357.8,"endTime":2359.81,"body":"by far the most important"},{"startTime":2359.81,"endTime":2364.13,"body":"is lung cancer and a"},{"startTime":2359.81,"endTime":2364.13,"body":"number of other cancers"},{"startTime":2364.13,"endTime":2365.453,"body":"and diseases of smoking."},{"startTime":2366.37,"endTime":2367.54,"body":"The long term outlook"},{"startTime":2367.54,"endTime":2370.18,"body":"for lung cancer remains extremely poor,"},{"startTime":2370.18,"endTime":2372.17,"body":"even in high income settings."},{"startTime":2372.17,"endTime":2377.11,"body":"And sadly, smoking contributes"},{"startTime":2372.17,"endTime":2377.11,"body":"massively to this avoidable,"},{"startTime":2377.11,"endTime":2378.54,"body":"mortality and morbidity,"},{"startTime":2378.54,"endTime":2380.02,"body":"lung cancer, virtually all of it,"},{"startTime":2380.02,"endTime":2382.066,"body":"not absolutely all of it,"},{"startTime":2382.066,"endTime":2385.04,"body":"and a very high proportion"},{"startTime":2382.066,"endTime":2385.04,"body":"of heart disease,"},{"startTime":2385.04,"endTime":2387.453,"body":"stroke, and other cancers."},{"startTime":2389.02,"endTime":2391.77,"body":"And as people are living beyond 50,"},{"startTime":2391.77,"endTime":2395.89,"body":"because outlooks look a lot better,"},{"startTime":2395.89,"endTime":2399.599,"body":"the impact of this public"},{"startTime":2395.89,"endTime":2399.599,"body":"health disaster of smoking"},{"startTime":2399.599,"endTime":2402.033,"body":"will become increasingly clear."},{"startTime":2403.53,"endTime":2405.48,"body":"Now in many countries in Asia,"},{"startTime":2405.48,"endTime":2409.02,"body":"as in Europe and north"},{"startTime":2405.48,"endTime":2409.02,"body":"America, smoking is falling,"},{"startTime":2409.02,"endTime":2411.05,"body":"but there are some in Asia where it's not,"},{"startTime":2411.05,"endTime":2412.65,"body":"I've highlighted here, for example,"},{"startTime":2412.65,"endTime":2415.47,"body":"Indonesia, and there are"},{"startTime":2412.65,"endTime":2415.47,"body":"certainly some countries,"},{"startTime":2415.47,"endTime":2417.53,"body":"particularly in Sub-Saharan Africa"},{"startTime":2417.53,"endTime":2420.46,"body":"where smoking rates"},{"startTime":2417.53,"endTime":2420.46,"body":"are in fact increasing."},{"startTime":2420.46,"endTime":2422.68,"body":"So pushing back on the tide of smoking"},{"startTime":2422.68,"endTime":2426.24,"body":"is one of the simplest and"},{"startTime":2422.68,"endTime":2426.24,"body":"most cost effective ways"},{"startTime":2426.24,"endTime":2429.43,"body":"we can help to ensure"},{"startTime":2426.24,"endTime":2429.43,"body":"that the health gains"},{"startTime":2429.43,"endTime":2431.7,"body":"that we've had in the"},{"startTime":2429.43,"endTime":2431.7,"body":"high income countries"},{"startTime":2431.7,"endTime":2436.36,"body":"can be more quickly realized"},{"startTime":2431.7,"endTime":2436.36,"body":"in low income countries,"},{"startTime":2436.36,"endTime":2437.41,"body":"and it costs nothing."},{"startTime":2439.53,"endTime":2443.26,"body":"So smoking is one very, very"},{"startTime":2439.53,"endTime":2443.26,"body":"big and preventable risk."},{"startTime":2443.26,"endTime":2446.04,"body":"The second more difficult issue,"},{"startTime":2446.04,"endTime":2448.25,"body":"but important to tackle is obesity."},{"startTime":2448.25,"endTime":2450.85,"body":"This is going up everywhere"},{"startTime":2448.25,"endTime":2450.85,"body":"in every country,"},{"startTime":2450.85,"endTime":2453.12,"body":"pretty well, certainly in"},{"startTime":2450.85,"endTime":2453.12,"body":"every region of the world."},{"startTime":2453.12,"endTime":2458.12,"body":"These are global statistics"},{"startTime":2453.12,"endTime":2458.12,"body":"from the mid '70s to recently,"},{"startTime":2458.19,"endTime":2460.77,"body":"looking at all the different continents."},{"startTime":2460.77,"endTime":2462.0,"body":"So this is an increasing problem"},{"startTime":2462.0,"endTime":2464.46,"body":"in both men and women everywhere."},{"startTime":2464.46,"endTime":2467.55,"body":"And if you look at a map on"},{"startTime":2464.46,"endTime":2467.55,"body":"the left of those classified"},{"startTime":2467.55,"endTime":2470.093,"body":"as obese, that's a BMI of over 30,"},{"startTime":2471.1,"endTime":2473.66,"body":"you can see a really substantial change"},{"startTime":2473.66,"endTime":2475.74,"body":"in every country of the world."},{"startTime":2475.74,"endTime":2477.44,"body":"In general, the higher the income,"},{"startTime":2478.836,"endTime":2480.2,"body":"the more that the obesity happens,"},{"startTime":2480.2,"endTime":2484.44,"body":"and as countries get"},{"startTime":2480.2,"endTime":2484.44,"body":"wealthier, obesity rates go up,"},{"startTime":2484.44,"endTime":2485.94,"body":"and that's certainly what"},{"startTime":2484.44,"endTime":2485.94,"body":"we've seen in Europe,"},{"startTime":2485.94,"endTime":2488.42,"body":"north America, north Africa,"},{"startTime":2488.42,"endTime":2491.96,"body":"quite large parts of the"},{"startTime":2488.42,"endTime":2491.96,"body":"middle east, and worryingly,"},{"startTime":2491.96,"endTime":2494.93,"body":"we're increasingly likely"},{"startTime":2491.96,"endTime":2494.93,"body":"to see in south Asia,"},{"startTime":2494.93,"endTime":2497.363,"body":"Latin America, and Africa."},{"startTime":2498.23,"endTime":2500.19,"body":"So this is something which"},{"startTime":2498.23,"endTime":2500.19,"body":"we really need to work out"},{"startTime":2500.19,"endTime":2502.77,"body":"how we can move to a situation"},{"startTime":2502.77,"endTime":2506.84,"body":"where improving development,"},{"startTime":2502.77,"endTime":2506.84,"body":"incredibly important to happen,"},{"startTime":2506.84,"endTime":2510.213,"body":"doesn't inevitably lead to"},{"startTime":2506.84,"endTime":2510.213,"body":"significant increases in obesity."},{"startTime":2512.48,"endTime":2515.66,"body":"Infections, there are also some"},{"startTime":2512.48,"endTime":2515.66,"body":"potential backward pressures"},{"startTime":2515.66,"endTime":2518.13,"body":"on these improvements we've seen."},{"startTime":2518.13,"endTime":2521.79,"body":"So antimicrobial resistance"},{"startTime":2518.13,"endTime":2521.79,"body":"against bacteria,"},{"startTime":2521.79,"endTime":2523.85,"body":"against parasites, against viruses,"},{"startTime":2523.85,"endTime":2525.8,"body":"indeed against fungi,"},{"startTime":2525.8,"endTime":2527.78,"body":"threaten some of the advances we've made,"},{"startTime":2527.78,"endTime":2530.92,"body":"'cause a lot of the improvements"},{"startTime":2527.78,"endTime":2530.92,"body":"we've seen in infections"},{"startTime":2530.92,"endTime":2534.869,"body":"have been caused by good access to these,"},{"startTime":2534.869,"endTime":2535.702,"body":"and insecticide are important"},{"startTime":2535.702,"endTime":2539.63,"body":"for insect transmitted"},{"startTime":2535.702,"endTime":2539.63,"body":"infections, such as malaria,"},{"startTime":2540.87,"endTime":2544.42,"body":"and we're getting insecticide resistance,"},{"startTime":2544.42,"endTime":2545.41,"body":"which threaten our gains."},{"startTime":2545.41,"endTime":2549.89,"body":"So resistance threatens some"},{"startTime":2545.41,"endTime":2549.89,"body":"of the gains we're seeing,"},{"startTime":2549.89,"endTime":2554.89,"body":"but again, science and"},{"startTime":2549.89,"endTime":2554.89,"body":"rational use of these"},{"startTime":2555.19,"endTime":2558.623,"body":"can slow down this risk and"},{"startTime":2555.19,"endTime":2558.623,"body":"find us countermeasures."},{"startTime":2561.04,"endTime":2563.4,"body":"And I think it's important to acknowledge"},{"startTime":2563.4,"endTime":2565.21,"body":"the very significant long term effect,"},{"startTime":2565.21,"endTime":2566.8,"body":"and in some parts of the world,"},{"startTime":2566.8,"endTime":2569.66,"body":"already quite significant"},{"startTime":2566.8,"endTime":2569.66,"body":"short term effects,"},{"startTime":2569.66,"endTime":2574.1,"body":"climate change is having as"},{"startTime":2569.66,"endTime":2574.1,"body":"a backward impact on health."},{"startTime":2574.1,"endTime":2575.72,"body":"So all these improvements in other areas,"},{"startTime":2575.72,"endTime":2577.71,"body":"but this is definitely"},{"startTime":2575.72,"endTime":2577.71,"body":"going to go backwards."},{"startTime":2577.71,"endTime":2581.491,"body":"They range from very direct"},{"startTime":2577.71,"endTime":2581.491,"body":"things, such as heat stress,"},{"startTime":2581.491,"endTime":2583.75,"body":"slightly more indirect things,"},{"startTime":2583.75,"endTime":2587.62,"body":"such as flooding through"},{"startTime":2583.75,"endTime":2587.62,"body":"vector borne diseases,"},{"startTime":2587.62,"endTime":2591.18,"body":"and then issues such as"},{"startTime":2587.62,"endTime":2591.18,"body":"changes in agriculture"},{"startTime":2591.18,"endTime":2596.18,"body":"and economy of more marginal societies."},{"startTime":2598.81,"endTime":2602.77,"body":"So this is another backward"},{"startTime":2598.81,"endTime":2602.77,"body":"pressure, but nevertheless,"},{"startTime":2602.77,"endTime":2603.83,"body":"despite these,"},{"startTime":2603.83,"endTime":2607.85,"body":"the outlook for the health"},{"startTime":2603.83,"endTime":2607.85,"body":"of people aged 50 to 75"},{"startTime":2609.76,"endTime":2613.79,"body":"and indeed, from childhood through to 50,"},{"startTime":2613.79,"endTime":2616.683,"body":"is going to improve in the"},{"startTime":2613.79,"endTime":2616.683,"body":"great majority of countries."},{"startTime":2618.7,"endTime":2620.85,"body":"Now, the result of this is that mortality"},{"startTime":2620.85,"endTime":2623.96,"body":"is increasingly concentrated by age."},{"startTime":2623.96,"endTime":2627.55,"body":"And just taking the UK as"},{"startTime":2623.96,"endTime":2627.55,"body":"an example of a country,"},{"startTime":2627.55,"endTime":2630.64,"body":"which has evolved from low"},{"startTime":2627.55,"endTime":2630.64,"body":"income, to middle income,"},{"startTime":2630.64,"endTime":2633.85,"body":"to high income by current nomenclature,"},{"startTime":2633.85,"endTime":2638.68,"body":"this shows over a period since the 1850s,"},{"startTime":2638.68,"endTime":2641.92,"body":"when in someone's life"},{"startTime":2638.68,"endTime":2641.92,"body":"they were likely to die."},{"startTime":2641.92,"endTime":2644.54,"body":"And what you can see in this graph"},{"startTime":2644.54,"endTime":2646.81,"body":"is that on the left hand side,"},{"startTime":2646.81,"endTime":2650.82,"body":"the lower ones are the 1850s, 1870s,"},{"startTime":2650.82,"endTime":2652.673,"body":"and in red, 1900,"},{"startTime":2653.97,"endTime":2657.73,"body":"obviously a very significant"},{"startTime":2653.97,"endTime":2657.73,"body":"number of children would die"},{"startTime":2657.73,"endTime":2659.21,"body":"before they reached their fifth birthday,"},{"startTime":2659.21,"endTime":2662.34,"body":"in fact, in the neonatal period."},{"startTime":2662.34,"endTime":2664.28,"body":"But there was still a high chance of dying"},{"startTime":2664.28,"endTime":2667.67,"body":"all the way through"},{"startTime":2664.28,"endTime":2667.67,"body":"adulthood due to infections,"},{"startTime":2667.67,"endTime":2668.94,"body":"accidents, and so on."},{"startTime":2668.94,"endTime":2672.92,"body":"As those have reduced,"},{"startTime":2668.94,"endTime":2672.92,"body":"the probability of someone"},{"startTime":2672.92,"endTime":2675.25,"body":"who gets through their first four weeks,"},{"startTime":2675.25,"endTime":2678.34,"body":"surviving through to their 60s,"},{"startTime":2678.34,"endTime":2679.837,"body":"and then subsequently 70s,"},{"startTime":2680.99,"endTime":2683.05,"body":"has gone up really very substantially,"},{"startTime":2683.05,"endTime":2686.6,"body":"very few people will die now"},{"startTime":2686.6,"endTime":2691.6,"body":"between their 4th week birthday"},{"startTime":2686.6,"endTime":2691.6,"body":"and their 75th birthday."},{"startTime":2693.5,"endTime":2697.68,"body":"And so the age at which people"},{"startTime":2693.5,"endTime":2697.68,"body":"are dying in our society"},{"startTime":2697.68,"endTime":2701.297,"body":"is increasingly concentrated"},{"startTime":2697.68,"endTime":2701.297,"body":"in the period 75 to 100,"},{"startTime":2703.68,"endTime":2707.18,"body":"and actually really in quite"},{"startTime":2703.68,"endTime":2707.18,"body":"a narrow range of that,"},{"startTime":2707.18,"endTime":2708.853,"body":"mainly after 80."},{"startTime":2711.306,"endTime":2713.29,"body":"And this is my final section, really,"},{"startTime":2713.29,"endTime":2716.08,"body":"having talked about really"},{"startTime":2713.29,"endTime":2716.08,"body":"very clear good news"},{"startTime":2716.08,"endTime":2720.12,"body":"in children under five, really clear,"},{"startTime":2720.12,"endTime":2724.12,"body":"low risk in children and"},{"startTime":2720.12,"endTime":2724.12,"body":"young people under 18,"},{"startTime":2724.12,"endTime":2725.91,"body":"also improving,"},{"startTime":2725.91,"endTime":2730.91,"body":"low risk and improving in"},{"startTime":2725.91,"endTime":2730.91,"body":"the young adults up to 50,"},{"startTime":2731.053,"endTime":2735.3,"body":"and in what I would"},{"startTime":2731.053,"endTime":2735.3,"body":"consider medical middle age,"},{"startTime":2735.3,"endTime":2737.49,"body":"from 50 to 75, significant improvements"},{"startTime":2737.49,"endTime":2740.6,"body":"in cardiovascular and"},{"startTime":2737.49,"endTime":2740.6,"body":"cancer deaths in particular,"},{"startTime":2740.6,"endTime":2742.36,"body":"but many other things."},{"startTime":2742.36,"endTime":2747.36,"body":"We now reach older age, which"},{"startTime":2742.36,"endTime":2747.36,"body":"we hope everyone will reach,"},{"startTime":2747.444,"endTime":2749.96,"body":"as a result of the improvements"},{"startTime":2747.444,"endTime":2749.96,"body":"in the younger stages"},{"startTime":2749.96,"endTime":2751.16,"body":"everywhere in the world."},{"startTime":2752.35,"endTime":2755.84,"body":"And I want to start off"},{"startTime":2752.35,"endTime":2755.84,"body":"with a very clear statement"},{"startTime":2755.84,"endTime":2757.53,"body":"that the outlook for"},{"startTime":2755.84,"endTime":2757.53,"body":"individual conditions,"},{"startTime":2757.53,"endTime":2760.97,"body":"such as heart disease and"},{"startTime":2757.53,"endTime":2760.97,"body":"cancer is really improving"},{"startTime":2760.97,"endTime":2764.15,"body":"in people over 75 and"},{"startTime":2760.97,"endTime":2764.15,"body":"will continue to improve."},{"startTime":2764.15,"endTime":2767.41,"body":"So the outlook for health"},{"startTime":2764.15,"endTime":2767.41,"body":"for individual diseases"},{"startTime":2767.41,"endTime":2769.163,"body":"is really good."},{"startTime":2770.25,"endTime":2772.55,"body":"And because older people"},{"startTime":2770.25,"endTime":2772.55,"body":"are at higher risk, in fact,"},{"startTime":2772.55,"endTime":2774.97,"body":"many of the biggest"},{"startTime":2772.55,"endTime":2774.97,"body":"benefits of the improvements"},{"startTime":2774.97,"endTime":2778.333,"body":"we've seen in medical science"},{"startTime":2774.97,"endTime":2778.333,"body":"are in this age group."},{"startTime":2779.97,"endTime":2782.57,"body":"We also have a number of"},{"startTime":2779.97,"endTime":2782.57,"body":"degenerative conditions,"},{"startTime":2782.57,"endTime":2784.61,"body":"they may not kill people, but"},{"startTime":2782.57,"endTime":2784.61,"body":"they're very debilitating,"},{"startTime":2784.61,"endTime":2786.26,"body":"such as hip arthritis,"},{"startTime":2786.26,"endTime":2787.65,"body":"which we have very good treatments for."},{"startTime":2787.65,"endTime":2789.323,"body":"So things like hip replacements,"},{"startTime":2790.21,"endTime":2793.11,"body":"just as a relatively"},{"startTime":2790.21,"endTime":2793.11,"body":"straightforward example"},{"startTime":2793.11,"endTime":2794.413,"body":"can be transformational."},{"startTime":2795.63,"endTime":2797.06,"body":"And these improvements,"},{"startTime":2797.06,"endTime":2799.95,"body":"which are currently quite concentrated"},{"startTime":2799.95,"endTime":2803.502,"body":"in high income countries or high, middle,"},{"startTime":2803.502,"endTime":2806.68,"body":"or high or richer people"},{"startTime":2803.502,"endTime":2806.68,"body":"in other countries,"},{"startTime":2806.68,"endTime":2807.96,"body":"are going to steadily disseminate"},{"startTime":2807.96,"endTime":2809.41,"body":"as countries become wealthier."},{"startTime":2809.41,"endTime":2812.113,"body":"So these are all really positive trends."},{"startTime":2814.14,"endTime":2816.13,"body":"This improvement would"},{"startTime":2814.14,"endTime":2816.13,"body":"be a lot faster, in fact,"},{"startTime":2816.13,"endTime":2818.87,"body":"than it was in the currently"},{"startTime":2816.13,"endTime":2818.87,"body":"high income countries,"},{"startTime":2818.87,"endTime":2821.49,"body":"because a lot of the medical"},{"startTime":2818.87,"endTime":2821.49,"body":"science can now be banked."},{"startTime":2821.49,"endTime":2824.31,"body":"It's already there, we'll"},{"startTime":2821.49,"endTime":2824.31,"body":"continue to improve on it,"},{"startTime":2824.31,"endTime":2827.722,"body":"but what's really limiting many countries"},{"startTime":2827.722,"endTime":2832.03,"body":"is their ability to afford"},{"startTime":2827.722,"endTime":2832.03,"body":"some of the changes,"},{"startTime":2832.03,"endTime":2833.93,"body":"not whether the science is"},{"startTime":2832.03,"endTime":2833.93,"body":"there in the first place."},{"startTime":2833.93,"endTime":2835.92,"body":"So as development occurs,"},{"startTime":2835.92,"endTime":2839.36,"body":"they will to move very"},{"startTime":2835.92,"endTime":2839.36,"body":"rapidly through to getting"},{"startTime":2839.36,"endTime":2842.723,"body":"the medical benefits of these"},{"startTime":2839.36,"endTime":2842.723,"body":"scientific improvements."},{"startTime":2845.54,"endTime":2846.373,"body":"But there are, however,"},{"startTime":2846.373,"endTime":2848.24,"body":"some diseases of old age"},{"startTime":2846.373,"endTime":2848.24,"body":"for which we currently"},{"startTime":2848.24,"endTime":2852.14,"body":"do not have good treatments,"},{"startTime":2848.24,"endTime":2852.14,"body":"and an important example,"},{"startTime":2852.14,"endTime":2855.29,"body":"one of the most important ones"},{"startTime":2852.14,"endTime":2855.29,"body":"are the dementia of old age,"},{"startTime":2855.29,"endTime":2857.51,"body":"Alzheimer's disease, Lewy body dementia,"},{"startTime":2857.51,"endTime":2859.21,"body":"vascular dementia."},{"startTime":2859.21,"endTime":2861.23,"body":"And because people are"},{"startTime":2859.21,"endTime":2861.23,"body":"not dying of other things,"},{"startTime":2861.23,"endTime":2863.29,"body":"heart disease, strokes,"},{"startTime":2863.29,"endTime":2865.82,"body":"cancers, infections in earlier life,"},{"startTime":2865.82,"endTime":2867.996,"body":"people are living long"},{"startTime":2865.82,"endTime":2867.996,"body":"enough to get these."},{"startTime":2867.996,"endTime":2869.75,"body":"It's not that the rates"},{"startTime":2867.996,"endTime":2869.75,"body":"themselves are going up, in fact,"},{"startTime":2869.75,"endTime":2871.12,"body":"if anything in the UK,"},{"startTime":2871.12,"endTime":2873.67,"body":"the actual rate is probably going down,"},{"startTime":2873.67,"endTime":2875.7,"body":"but the number of people"},{"startTime":2873.67,"endTime":2875.7,"body":"who are living to the point"},{"startTime":2875.7,"endTime":2879.95,"body":"where they get dementias"},{"startTime":2875.7,"endTime":2879.95,"body":"are steadily increasing,"},{"startTime":2879.95,"endTime":2881.27,"body":"and therefore the number of people living"},{"startTime":2881.27,"endTime":2883.93,"body":"with dementia will increase in the UK."},{"startTime":2883.93,"endTime":2885.963,"body":"And this is therefore likely to occur,"},{"startTime":2886.816,"endTime":2890.44,"body":"it is already occurring"},{"startTime":2886.816,"endTime":2890.44,"body":"in high income countries,"},{"startTime":2890.44,"endTime":2894.33,"body":"and it's likely to occur in"},{"startTime":2890.44,"endTime":2894.33,"body":"all countries as they develop,"},{"startTime":2894.33,"endTime":2897.23,"body":"and fortunately citizens can live"},{"startTime":2897.23,"endTime":2900.803,"body":"to what would historically"},{"startTime":2897.23,"endTime":2900.803,"body":"be seen as a good old age."},{"startTime":2904.228,"endTime":2905.85,"body":"There is also a problem"},{"startTime":2904.228,"endTime":2905.85,"body":"which medical science"},{"startTime":2905.85,"endTime":2908.85,"body":"is not adequately really addressing,"},{"startTime":2908.85,"endTime":2910.863,"body":"and that is in old age,"},{"startTime":2911.89,"endTime":2914.1,"body":"individual chronic conditions accumulate."},{"startTime":2914.1,"endTime":2915.52,"body":"So this is a graph on the right,"},{"startTime":2915.52,"endTime":2917.183,"body":"it's well known one from the UK."},{"startTime":2922.658,"endTime":2924.01,"body":"People live fortunately"},{"startTime":2922.658,"endTime":2924.01,"body":"for much of their life,"},{"startTime":2924.01,"endTime":2926.45,"body":"usually disease free or"},{"startTime":2924.01,"endTime":2926.45,"body":"with very trivial diseases"},{"startTime":2926.45,"endTime":2928.458,"body":"that don't interfere with their life,"},{"startTime":2928.458,"endTime":2930.182,"body":"but they then start to accumulate them."},{"startTime":2930.182,"endTime":2934.01,"body":"So they may only have one"},{"startTime":2930.182,"endTime":2934.01,"body":"disease or chronic condition"},{"startTime":2934.01,"endTime":2935.68,"body":"at the age of, let's say,"},{"startTime":2935.68,"endTime":2940.68,"body":"65, but they might have"},{"startTime":2935.68,"endTime":2940.68,"body":"6 at the age of 85."},{"startTime":2942.07,"endTime":2944.51,"body":"So increasingly we are"},{"startTime":2942.07,"endTime":2944.51,"body":"going to have populations"},{"startTime":2944.51,"endTime":2945.84,"body":"with preponderance of older people"},{"startTime":2945.84,"endTime":2947.87,"body":"with multiple conditions simultaneously,"},{"startTime":2947.87,"endTime":2949.37,"body":"which may on the first site,"},{"startTime":2949.37,"endTime":2952.12,"body":"at least, look as if they're"},{"startTime":2949.37,"endTime":2952.12,"body":"unrelated to one another."},{"startTime":2952.12,"endTime":2954.01,"body":"And this is a problem,"},{"startTime":2952.12,"endTime":2954.01,"body":"because medical science"},{"startTime":2954.01,"endTime":2956.59,"body":"and organization is basically designed"},{"startTime":2956.59,"endTime":2957.61,"body":"around single diseases."},{"startTime":2957.61,"endTime":2959.62,"body":"We're very good at treating heart disease,"},{"startTime":2959.62,"endTime":2962.405,"body":"or a particular cancer,"},{"startTime":2959.62,"endTime":2962.405,"body":"or a particular infection."},{"startTime":2962.405,"endTime":2966.08,"body":"What we're now having to help is maximize"},{"startTime":2966.08,"endTime":2967.23,"body":"the quality of life for people"},{"startTime":2967.23,"endTime":2972.14,"body":"with potentially multiple"},{"startTime":2967.23,"endTime":2972.14,"body":"simultaneous chronic conditions."},{"startTime":2972.14,"endTime":2975.24,"body":"And then this moves further"},{"startTime":2972.14,"endTime":2975.24,"body":"down from several diseases"},{"startTime":2975.24,"endTime":2977.32,"body":"to people being very frail"},{"startTime":2977.32,"endTime":2982.143,"body":"and eventually often"},{"startTime":2977.32,"endTime":2982.143,"body":"becoming quite dependent."},{"startTime":2983.12,"endTime":2984.84,"body":"And there is much less clarity"},{"startTime":2984.84,"endTime":2987.09,"body":"about how science will"},{"startTime":2984.84,"endTime":2987.09,"body":"develop in this area."},{"startTime":2987.09,"endTime":2989.44,"body":"I am confident that science"},{"startTime":2987.09,"endTime":2989.44,"body":"will improve in this area,"},{"startTime":2989.44,"endTime":2991.62,"body":"I'm absolutely confident about that,"},{"startTime":2991.62,"endTime":2994.18,"body":"but whereas there's a"},{"startTime":2991.62,"endTime":2994.18,"body":"really clear line of sight"},{"startTime":2994.18,"endTime":2997.49,"body":"about how things are going"},{"startTime":2994.18,"endTime":2997.49,"body":"rapidly better in many cancers,"},{"startTime":2997.49,"endTime":3000.04,"body":"cardiovascular disease, and infections,"},{"startTime":3000.04,"endTime":3003.053,"body":"in this area, I think"},{"startTime":3000.04,"endTime":3003.053,"body":"the future is less clear."},{"startTime":3006.38,"endTime":3008.27,"body":"And finally, there is a societal question,"},{"startTime":3008.27,"endTime":3009.77,"body":"this is not a medical question,"},{"startTime":3009.77,"endTime":3011.66,"body":"how we support people in older age,"},{"startTime":3011.66,"endTime":3013.62,"body":"because in every society now,"},{"startTime":3013.62,"endTime":3016.75,"body":"the great majority of"},{"startTime":3013.62,"endTime":3016.75,"body":"people will reach older age"},{"startTime":3016.75,"endTime":3018.39,"body":"where they become frailer."},{"startTime":3018.39,"endTime":3020.86,"body":"This is a societal question,"},{"startTime":3020.86,"endTime":3022.84,"body":"at least as much as is a medical question."},{"startTime":3022.84,"endTime":3026.75,"body":"And the answer to that"},{"startTime":3022.84,"endTime":3026.75,"body":"may well vary by society,"},{"startTime":3026.75,"endTime":3029.05,"body":"but every society is going"},{"startTime":3026.75,"endTime":3029.05,"body":"to have to wrestle with this,"},{"startTime":3029.05,"endTime":3030.38,"body":"and fairly soon."},{"startTime":3030.38,"endTime":3032.76,"body":"Almost every country is now moving"},{"startTime":3032.76,"endTime":3035.83,"body":"to a situation where the"},{"startTime":3032.76,"endTime":3035.83,"body":"majority of their population"},{"startTime":3035.83,"endTime":3038.75,"body":"will reach older age"},{"startTime":3035.83,"endTime":3038.75,"body":"and an age where frailty"},{"startTime":3038.75,"endTime":3040.95,"body":"or more degenerative"},{"startTime":3038.75,"endTime":3040.95,"body":"diseases become common."},{"startTime":3045.12,"endTime":3046.41,"body":"But I'd like to return, really,"},{"startTime":3046.41,"endTime":3050.33,"body":"to my optimistic starting point."},{"startTime":3050.33,"endTime":3053.86,"body":"Global health is improving"},{"startTime":3050.33,"endTime":3053.86,"body":"at a really remarkable pace,"},{"startTime":3053.86,"endTime":3055.79,"body":"due to the combination of medical science,"},{"startTime":3055.79,"endTime":3058.3,"body":"gradually accumulating,"},{"startTime":3055.79,"endTime":3058.3,"body":"don't go backwards on that,"},{"startTime":3058.3,"endTime":3059.81,"body":"and development."},{"startTime":3059.81,"endTime":3062.96,"body":"Child mortality, which I talked"},{"startTime":3059.81,"endTime":3062.96,"body":"about a lot at the beginning"},{"startTime":3062.96,"endTime":3065.153,"body":"is dropping very fast."},{"startTime":3066.17,"endTime":3068.04,"body":"Slower improvements in"},{"startTime":3066.17,"endTime":3068.04,"body":"the neonatal period,"},{"startTime":3068.04,"endTime":3069.28,"body":"but they are improving,"},{"startTime":3069.28,"endTime":3071.46,"body":"but we need to concentrate"},{"startTime":3069.28,"endTime":3071.46,"body":"very heavily on that."},{"startTime":3071.46,"endTime":3073.83,"body":"If people get through"},{"startTime":3071.46,"endTime":3073.83,"body":"their first five years,"},{"startTime":3073.83,"endTime":3078.83,"body":"their chance of living"},{"startTime":3073.83,"endTime":3078.83,"body":"through to beyond 50"},{"startTime":3079.41,"endTime":3083.29,"body":"are incredibly good in virtually"},{"startTime":3079.41,"endTime":3083.29,"body":"all parts of the world."},{"startTime":3083.29,"endTime":3086.06,"body":"Health of adults under"},{"startTime":3083.29,"endTime":3086.06,"body":"50 is already very good,"},{"startTime":3086.06,"endTime":3088.053,"body":"and steadily improving everywhere."},{"startTime":3089.33,"endTime":3092.65,"body":"The health of those in"},{"startTime":3089.33,"endTime":3092.65,"body":"the 50 to 75 kind of band"},{"startTime":3092.65,"endTime":3095.11,"body":"is also improving, but"},{"startTime":3092.65,"endTime":3095.11,"body":"there are some risks"},{"startTime":3095.11,"endTime":3096.76,"body":"that we really need to counteract,"},{"startTime":3096.76,"endTime":3099.41,"body":"such as smoking and obesity."},{"startTime":3099.41,"endTime":3100.79,"body":"And these are predictable problems,"},{"startTime":3100.79,"endTime":3102.97,"body":"and for countries that"},{"startTime":3100.79,"endTime":3102.97,"body":"don't have large amounts"},{"startTime":3102.97,"endTime":3106.02,"body":"of either of those, the key"},{"startTime":3102.97,"endTime":3106.02,"body":"thing is to stop them acquiring"},{"startTime":3106.02,"endTime":3110.08,"body":"them as they transition through"},{"startTime":3106.02,"endTime":3110.08,"body":"to the high income future,"},{"startTime":3110.08,"endTime":3111.803,"body":"which we hope they have."},{"startTime":3113.97,"endTime":3116.78,"body":"More complicated areas,"},{"startTime":3113.97,"endTime":3116.78,"body":"longevity in older people over 75"},{"startTime":3116.78,"endTime":3118.55,"body":"is improving, that's excellent."},{"startTime":3118.55,"endTime":3120.18,"body":"We're dealing with many diseases"},{"startTime":3120.18,"endTime":3123.94,"body":"and allowing people to live,"},{"startTime":3120.18,"endTime":3123.94,"body":"which all of us want to,"},{"startTime":3123.94,"endTime":3127.37,"body":"to a good old age, free"},{"startTime":3123.94,"endTime":3127.37,"body":"from many major diseases,"},{"startTime":3127.37,"endTime":3129.52,"body":"but disability, frailty,"},{"startTime":3129.52,"endTime":3132.37,"body":"are still things that I"},{"startTime":3129.52,"endTime":3132.37,"body":"think we have some way to go"},{"startTime":3132.37,"endTime":3135.123,"body":"to be clear what the future holds."},{"startTime":3136.02,"endTime":3138.73,"body":"So we should recognize the"},{"startTime":3136.02,"endTime":3138.73,"body":"extraordinary triumphs,"},{"startTime":3138.73,"endTime":3142.02,"body":"the fact that this is irreversibly changed"},{"startTime":3142.02,"endTime":3144.66,"body":"the shape of the world,"},{"startTime":3142.02,"endTime":3144.66,"body":"that what our grandparents"},{"startTime":3144.66,"endTime":3146.88,"body":"were born to will be completely different"},{"startTime":3146.88,"endTime":3149.513,"body":"to what our grandchildren will be born to."},{"startTime":3151.1,"endTime":3154.3,"body":"But there are also limits"},{"startTime":3151.1,"endTime":3154.3,"body":"to medical science,"},{"startTime":3154.3,"endTime":3157.28,"body":"and we need to think very"},{"startTime":3154.3,"endTime":3157.28,"body":"seriously about how we support"},{"startTime":3157.28,"endTime":3159.2,"body":"the oldest, which is where,"},{"startTime":3159.2,"endTime":3161.746,"body":"in every society, we are going."},{"startTime":3161.746,"endTime":3162.746,"body":"Thank you very much."},{"startTime":3165.02,"endTime":3166.44,"body":"- Well, this is,"},{"startTime":3166.44,"endTime":3170.27,"body":"very sadly, professor"},{"startTime":3166.44,"endTime":3170.27,"body":"Whitty's final lecture"},{"startTime":3170.27,"endTime":3174.6,"body":"as the 38th Gresham Professor of Physics."},{"startTime":3174.6,"endTime":3177.24,"body":"He will be returning to"},{"startTime":3174.6,"endTime":3177.24,"body":"the college next year"},{"startTime":3177.24,"endTime":3178.57,"body":"as a visiting professor,"},{"startTime":3178.57,"endTime":3181.76,"body":"but I just wanted to say"},{"startTime":3178.57,"endTime":3181.76,"body":"a few words of thanks"},{"startTime":3181.76,"endTime":3186.76,"body":"at the end of his tenure"},{"startTime":3181.76,"endTime":3186.76,"body":"of the professorship."},{"startTime":3187.54,"endTime":3192.54,"body":"I think it's safe to say"},{"startTime":3187.54,"endTime":3192.54,"body":"that no Professor of Physics"},{"startTime":3192.6,"endTime":3196.41,"body":"in the last 426 years since"},{"startTime":3196.41,"endTime":3199.01,"body":"the first Gresham Professor of Physics"},{"startTime":3199.01,"endTime":3202.31,"body":"has had to contend with the challenges"},{"startTime":3202.31,"endTime":3204.91,"body":"that professor Whitty has."},{"startTime":3204.91,"endTime":3209.13,"body":"He continued with his"},{"startTime":3204.91,"endTime":3209.13,"body":"Gresham lectures alongside"},{"startTime":3209.13,"endTime":3213.36,"body":"his considerable duties"},{"startTime":3209.13,"endTime":3213.36,"body":"as Chief Medical Officer"},{"startTime":3213.36,"endTime":3216.32,"body":"during the COVID 19 pandemic."},{"startTime":3216.32,"endTime":3220.79,"body":"His commitment to public"},{"startTime":3216.32,"endTime":3220.79,"body":"education and outreach is such"},{"startTime":3220.79,"endTime":3224.73,"body":"that he even provided an"},{"startTime":3220.79,"endTime":3224.73,"body":"additional special lecture"},{"startTime":3224.73,"endTime":3227.503,"body":"on COVID in April, 2020,"},{"startTime":3228.8,"endTime":3233.473,"body":"and this has had nearly 200,000 views."},{"startTime":3234.58,"endTime":3239.58,"body":"He still practices as an"},{"startTime":3234.58,"endTime":3239.58,"body":"NHS consultant physician"},{"startTime":3239.59,"endTime":3244.59,"body":"at UCLA and at the Hospital"},{"startTime":3239.59,"endTime":3244.59,"body":"for Tropical Diseases."},{"startTime":3245.96,"endTime":3249.29,"body":"And before coming Chief Medical Officer,"},{"startTime":3249.29,"endTime":3252.85,"body":"he was Professor of Public"},{"startTime":3249.29,"endTime":3252.85,"body":"and International Health"},{"startTime":3252.85,"endTime":3257.74,"body":"at the London School of"},{"startTime":3252.85,"endTime":3257.74,"body":"Hygiene and Tropical Medicine."},{"startTime":3257.74,"endTime":3261.19,"body":"Professor Whitty's tenure"},{"startTime":3257.74,"endTime":3261.19,"body":"as Professor of Physics"},{"startTime":3261.19,"endTime":3264.26,"body":"at Gresham College began in 2018."},{"startTime":3264.26,"endTime":3268.75,"body":"His first series of lectures"},{"startTime":3264.26,"endTime":3268.75,"body":"was on Infectious Diseases:"},{"startTime":3268.75,"endTime":3270.73,"body":"The Oldest Enemy."},{"startTime":3270.73,"endTime":3274.43,"body":"This provided an overview"},{"startTime":3270.73,"endTime":3274.43,"body":"of how these diseases"},{"startTime":3274.43,"endTime":3278.6,"body":"have dominated medicine"},{"startTime":3274.43,"endTime":3278.6,"body":"and mortality in the UK,"},{"startTime":3278.6,"endTime":3281.16,"body":"and how they remain a threat"},{"startTime":3281.16,"endTime":3283.9,"body":"as a result of widespread travel,"},{"startTime":3283.9,"endTime":3286.83,"body":"antimicrobial resistance to drugs,"},{"startTime":3286.83,"endTime":3289.65,"body":"and changing demographics."},{"startTime":3289.65,"endTime":3294.65,"body":"The series began with a lecture"},{"startTime":3289.65,"endTime":3294.65,"body":"on epidemics and pandemics"},{"startTime":3295.3,"endTime":3296.96,"body":"in October, 2018,"},{"startTime":3296.96,"endTime":3301.29,"body":"and this has now been"},{"startTime":3296.96,"endTime":3301.29,"body":"viewed over 150,000 times."},{"startTime":3304.3,"endTime":3307.45,"body":"His second series began in 2019,"},{"speaker":"this was Cancer","startTime":3307.45,"endTime":3311.44,"body":"A Fight"},{"speaker":"this was Cancer","startTime":3307.45,"endTime":3311.44,"body":"We Are Steadily Winning,"},{"speaker":"this was Cancer","startTime":3311.44,"endTime":3314.61,"body":"with accounts of various types of cancers"},{"speaker":"this was Cancer","startTime":3314.61,"endTime":3318.16,"body":"and the developments in their treatment."},{"speaker":"this was Cancer","startTime":3318.16,"endTime":3319.99,"body":"In 2020 to '21,"},{"speaker":"this was Cancer","startTime":3319.99,"endTime":3324.44,"body":"he presented lectures on major"},{"speaker":"this was Cancer","startTime":3319.99,"endTime":3324.44,"body":"debates in public health,"},{"speaker":"this was Cancer","startTime":3324.44,"endTime":3327.21,"body":"including talks on the role of the state,"},{"speaker":"this was Cancer","startTime":3327.21,"endTime":3330.95,"body":"vaccination, obesity, and screening."},{"speaker":"this was Cancer","startTime":3330.95,"endTime":3335.95,"body":"And this was followed by his"},{"speaker":"this was Cancer","startTime":3330.95,"endTime":3335.95,"body":"current series on infections"},{"speaker":"this was Cancer","startTime":3337.02,"endTime":3339.73,"body":"and their roots of transmission,"},{"speaker":"this was Cancer","startTime":3339.73,"endTime":3344.39,"body":"including accounts of respiratory"},{"speaker":"this was Cancer","startTime":3339.73,"endTime":3344.39,"body":"roots, insect vectors,"},{"speaker":"this was Cancer","startTime":3344.39,"endTime":3349.12,"body":"sexual transmission, food"},{"speaker":"this was Cancer","startTime":3344.39,"endTime":3349.12,"body":"and drink, and touch."},{"speaker":"this was Cancer","startTime":3349.12,"endTime":3354.12,"body":"Well, we are so grateful to"},{"speaker":"this was Cancer","startTime":3349.12,"endTime":3354.12,"body":"you for your incredible efforts"},{"speaker":"this was Cancer","startTime":3354.16,"endTime":3357.51,"body":"to communicate the science of medicine"},{"speaker":"this was Cancer","startTime":3357.51,"endTime":3361.4,"body":"to a wide and diverse audience,"},{"speaker":"this was Cancer","startTime":3361.4,"endTime":3364.75,"body":"particularly at a time when misinformation"},{"speaker":"this was Cancer","startTime":3364.75,"endTime":3367.683,"body":"and disinformation were proliferating."},{"speaker":"this was Cancer","startTime":3368.64,"endTime":3371.6,"body":"Professor, your lectures have provided"},{"speaker":"this was Cancer","startTime":3371.6,"endTime":3373.08,"body":"and continue to provide"},{"speaker":"this was Cancer","startTime":3373.08,"endTime":3376.16,"body":"an authoritative source of information."},{"speaker":"this was Cancer","startTime":3376.16,"endTime":3380.08,"body":"We at the college are most grateful to you"},{"speaker":"this was Cancer","startTime":3380.08,"endTime":3381.98,"body":"for everything you have done,"},{"speaker":"this was Cancer","startTime":3381.98,"endTime":3386.01,"body":"and we look forward to"},{"speaker":"this was Cancer","startTime":3381.98,"endTime":3386.01,"body":"welcoming you back next year"},{"speaker":"this was Cancer","startTime":3386.01,"endTime":3390.26,"body":"as a visiting professor for"},{"speaker":"this was Cancer","startTime":3386.01,"endTime":3390.26,"body":"your series of lectures,"},{"speaker":"this was Cancer","startTime":3390.26,"endTime":3394.55,"body":"being on the subject of"},{"speaker":"this was Cancer","startTime":3390.26,"endTime":3394.55,"body":"diseases of the heart."},{"speaker":"this was Cancer","startTime":3394.55,"endTime":3395.883,"body":"Thank you very much."}]}