Hi students. Like many of the folks here at Duke, I'm taking a break at one of the on-campus coffee houses. Our theme in this module is going to be the future of global health. As we will discover, while we've made progress for many global health problems, others are increasingly on the rise. One of these, in particular, is going to be the challenge of non-communicable diseases. And I thought before we began this module's lessons that it would be important to take you on a little journey around the world, so that you can understand the extent of the problem. [MUSIC] America, like many other highly industrialized countries, has an ever growing issue with non-communicable diseases. In fact, non-communicable diseases, chronic disease, really it counts for most of the healthcare expenditure and healthcare problems in this country. And it's not just in the US as I said. It's in many other industrialized countries and increasingly in the lower and middle income countries as well, what we've called in class the Global South. Since our unit is going to be looking at these non-communicable diseases, both in the global north and the global south, I thought it would be interesting if we spent a little bit of time discussing some of the reasons that non-communicable diseases are on the rise, and actually what some of these diseases might be. But to do that I think instead of being here in Durham, we're going to take a little trip to Europe. Maybe we'll go to hm, I think we're going to go to Austria. I'll see you there. [SOUND] Hi students, I am in Austria in its famous capital, Vienna. And I'm here at the Sacher cafe where I'm about to indulge in the world famous couture. You know, we are about to talk in our class about non-communicable diseases, and it's difficult to talk about those diseases without talking about the risk factors that underlie them. We know that, we have many factors that contribute to noncommunicable disease. We're going to learn that smoking is public enemy number one. But, current lifestyle and nutritional trends are also contributing rapidly. Excess calories, and calories that come from, refined grains, refined sugars, too much fat, especially unhealthy fats, and an increasing lack of physical activity and increased stress. The world all cause an increase not only in body weight, but in lipid and, and sugar levels in your body. Ultimately increasing our risk for conditions like cardiovascular disease and diabetes. Now it doesn't mean that you can't have a little bit of a good thing, but it does mean that we need to pay very careful attention to diet and lifestyle in populations. Because otherwise a little bit of a good thing can be too much. With that being said I am going to dig into this. Oh that is really, really good, and I'll see you in India. [NOISE] Good morning class. I am in southern India, one of the most beautiful parts of this country. Absolutely with the best food, lord knows over the last few days of my work here, I've eaten so much I feel like I need to go on a diet when I get back. But speaking of food, I want to take this opportunity to talk to you about one of the most important and epidemic non-communicable diseases taking place globally right now and that is diabetes. Diabetes, generally, is on the rise because of shifting dietary, and exercise patterns, less exercise, more calories, right? As we talked a lot about this nutritional transition that's taking place across the world. The results of this are that there are over 200 million people with diabetes in the world right now, and that number will shift dramatically to almost 300 by 2035. While that there are a greater proportion of adults with diabetes in the United States, the overall numbers of people with diabetes are primarily in China and in India. Right now, China has about 100 million adults with diabetes, India oh, somewhere around 60. We expect by 2035 that number to rise to the point that there are probably going to be about 150 million, diabetics in China and almost 60, I'm sorry, almost 100 million diabetics in India. This is a particular concern in India for two reasons. One is that because of the poor health infrastructure, especially for the poor, many people are not diagnosed until they become symptomatic, and then they cannot afford the medications necessary for treatment. The second reason is that recent research is indicating that, that Indians, especially South Asians, may actually be genetically predisposed to diabetes. We're still trying to figure out why, but one implication of this is that, Indians who are even just slightly overweight may be at greater risk. And even the way that they metabolize certain foods, including proteins, not just not just carbohydrates or simple sugars, might actually play a role. My friends who've talked a lot about diseases that have an impact in the world and have an impact in productivity and on health, and the relationship between health and economics, and diabetes is one I really want you to keep an eye on. It is, in many ways, a ticking time bomb. [SOUND] Whoa, I just used my super secret global health professor powers to jump to China. Hi students. I am actually in Shanghai, China because I wanted to talk to you a little bit more about non-communicable diseases. As in Austria, it's the same in the US where we're actually beginning to put on lots of weight which leads to a whole set of issues. China not only has some dietary issues, it has another issue as well that is a major problem that needs to be resolved, if China's going to continue its increase in health. And China has actually managed to do that. You know, from 1950, around 1950, to now, China has almost doubled life expectancy. In fact, it's almost, reached the same level of overall life expectancy as Europe and the United States and will continue to do so until 2050. But to talk to you about this little problem, I'm actually going to leave the beautiful place, and I'm actually going to head to a tiny little city of about a million people called Kunshan. [SOUND] No matter where you go in China, one thing is clear. China's got a smoking problem. There are about a billion smokers in the world today, 80% of them in lower and middle income countries. But 300 million of those smokers are here in China. See it all over the place. Even in small cities of oh, a million people like Kunshan where people will be slurping noodles and eating at the same time. Now, smoking as we know is public enemy number one. It's implicated in lung cancer, COPD, chronic obstructive pulmonary disorder, hypertension, multiple things, and we know that if we do not gather some control over smoking, in this world that NCDs are going to increase. But you know in terms of things like lung cancer, heart disease, and other issues in which smoking is implicated, there is one other factor as well that I like to call the, well I used to call it the little sister of smoking, but now I call it the big sister. And that actually is environmental pollution. Especially both indoor and outdoor pollution. But to give you a better sense of that, I think I'm going to hop on the bullet train and head up to Beijing. It's morning in Beijing. I wish I could say that it is a bright and clear morning. There's sunshine, but it's definitely not clear. As happens a lot in major cities like Beijing, particularly in Asia, it's quite cloudy. There's lots of pollution and it makes it difficult to see. I'm going to show you a bit later. But you know, in terms of the air pollution, it's not necessarily the the smogginess, the fogginess, the lack of clarity that's the problem. It's one particular type of pollution that we call that's particulate matter, that's smaller than 2.5 microns. The PM 2.5 levels are very important because, they have a major impact on health. In fact, this particular matter which is composed quite a lot of of organic solids and sometimes heavy metals is so tiny that it actually goes deep into the lungs, can even pass into the circulatory system, increasing inflammation in the arteries and the buildup of plaque. The smallest particulate matter that less than .1 microns can even lodge in the brain, creating inflammation as well. Serious issue in many, many countries. The safe level of PM2.5 is really considered to be under 50. Right now in Beijing today the level is over 300, which, in fact, is so high it's considered very unhealthy. And anyone with weak lungs, children or elderly, should not go outside. A few days ago it was over 400, meaning no one should go outside. This is not only a risk for cardiovascular disease but greatly increases the risk of lung cancer as well. They've already been reported in countries like China, lung cancer in children from this type of, of, pollution. The scary thing, my friends, is that if you look at PM2.5 levels in cities with the major risk, Beijing, where I am right now, is not even on the top ten. Number one, New Delhi, where levels can rise to above 700. This is a major issue in global health, and what this is means, is that environmental pollution has become one of the major risk factors for poor health outcomes. In fact internal air pollution in general actually accounts for over 7 million premature deaths in the world every year. Now what's even scarier? You may think I'm only talking about external air pollution, but I'm not. Indoor air pollution, particulate matter from say, cooking stoves or, burning wood, or cow dung, or other, types of matter for heat or for fire in unventilated houses accounts for over one half of those 7 million deaths. When we think about global health, we can't simply think about human bodies, but we have to think about the world around us and, as importantly, what we breathe. Global health is about many, many determinants and the air in particular is a global problem.
