Now, I want to play a guessing game. So I need your participation here. Everybody at home, please also try to guess along. So I'm going to start a little bit, see if you can think in your head leading causes of death worldwide. So now I'm going to actually do interactive graphs. So let's just start with COPD. Can you guess for me roughly how many millions of deaths you think? These are the most recent data available. How many millions, and we're talking like 1-8. It's not going to exceed 10. So this is annual. I'm going to go with seven. Say, seven? I'd say a little bit lower than that. Maybe, four. Okay. So now I'm just going to do higher or lower. Instead of having to actually give me a number, just do you think that diabetes is higher or lower? High. Higher? I'd say high. All right. Heart disease? Higher. Much higher. HIV AIDS? Than COPD or than ischemic heart disease? Either. You know what? Let's do heart disease. High or lower? Lower. Really low. What about lung and associated cancers? Lung, trachea, bronchial? I'd say higher than COPD. Okay. TB? Higher. Higher. Lower respiratory infections? Higher. Good. Alzheimer's? Lower. Diarrhoeal diseases? Higher. That's lower, actually. I can barely even tell. Almost a flat one. [inaudible]. Stroke? Higher. Preterm birth? Higher. It's actually not even getting into that. This one, so I put it there for a reason. I'm going to give that away in a second. Birth trauma and asphyxiation? Lower. Also, not making in there. Malaria? Road injury? I would say it's a relatively high one. Okay. Now, I actually want to compare these data to the 2000 data. So that was the reason why some of these were falling out. I'm already giving you. These are actually the 2000 data and I want to compare that to the 2015 data. So we have the preterm birth, for example, and birth trauma didn't make it into the top leading causes in 2015. So there have been some shifts even in this very narrow time frame. I had them loosely categorized on the previous slide as to those that could be more directly seen as being social behavioral. Things like heart disease, COPD, lung cancer, all of which are traceable to smoking outcomes, dietary or dietary behaviors, in part. Of course, these are all complex in terms of etiology. But you can see that we've actually seen a relative worsening of some of these, but we've gotten better in some other domains. So preterm birth and the birth-related causes have actually improved considerably in just this 15-year span, whereas road injury, for example, has gotten significantly worse worldwide. Any theories as to why road injury, given all of our, well, even just thinking about US briefly. United States, it's also, road injuries are a leading cause of death. But, we've gotten safer vehicles, we have airbags, we have various policies in place to try to facilitate safer driving, we have car seats for children, regulation and so on. Any ideas as to what's going on with road injury? Well, we've got better cellphones now. We do have better cellphones now. I think, partly too, a lot of those technologies are user-dependent. You have to buckle your child into the car seat appropriately to have a seat belt work properly, or to have an airbag be protective. They're all dependent on the user. Yes. They boil down to behavior. Absolutely true. I mean, if your car is strapped to you and the car seat is self-adjusted so that it was perfect, there might be a drop. They're human-dependent. Certainly, human dependence boils down to the actual behavior or uptake of it. I do think that the most powerful change over the past 15 years in these outcomes is the cellphone use, the smartphone usage and so on. A topic of a different class, but I've been digging into that literature a good bit lately. The cellphone stays in the trunk now when you're driving. It's unbelievably powerful effect. You know what? As another supplemental tangent, I'm famous for my tangents, I will upload a bunch of those studies as well, just in a supplemental readings folder. So thank you for that game. I know it's very hard. That's why I'd like to do these little guessing games because there are some striking patterns. I think, what we're seeing are some shifts, but again, underscoring that point of a lot of this comes down to the sorts of personal level behavior either uptake, or somehow we're potentially getting it wrong as a field and that we're not equipping people with the proper forms of primary prevention. This is another repeat slide on this, but this is just to let you see the causes for the United States specifically as opposed to worldwide. Many of the topics in this class have been chosen specifically because of the extent to which they map onto these causes. I also want to point out some of the basic risk factors. So taking heart disease as one of the leading causes of death in the United States and globally, what are some of the risk factors? [inaudible] one of this? Some of them. Risk factors is poor lifestyle. Yeah. Smoking. Smoking, yeah. Any others? Sanitary. Sanitary activity or lack of physical activity. So some of these coming to nutrition, some going to smoking, some going to physical inactivity or sanitary lifestyle. All of these are significant risk factors and some of them relate to each other. Some of them though are things that are out of control. These are things like genetic loading, and age, and various other kinds of demographic factors. But you can see though that a lot of them are in fact in the more behavioral domain. I'd like to bring these up to have a very specific point here, which is that even though we know these things, like we can rattle off, even just starting the program before getting into all of the science of it all, like yeah, okay. So poor nutrition, inactivity, high blood pressure. These are all the risk factors. So even though this might be a baseline knowledge from many people, and in fact, the research does show that many people understand the risks of heart disease pretty clearly, this doesn't necessarily translate to behavior. So people know, yes, proper nutrition is something that reduces my risk, very few people are actually able to achieve what is considered to be a healthy diet. In fact, you can barely even see the ideal band. So the healthy diet score is, well, these are all the behavioral factors. So we've got 25 percent of the population still smoking. A full, almost greater than a third who is not able to achieve a healthy body weight. Not getting enough physical activity. Healthy diet of course is related to these other factors. But we can see pretty significant proportion of the population that is not achieving a healthy diet. What's not able to be seen here is that the ideal should be at the top band of the diet score, but it is so narrow that the number isn't even visible at the very top there. I can't do it with my pointer, but that's the very top band, the 22.9 percent above that. We don't even have anybody achieving the range of the ideal diet to prevent heart disease. So this is just simply a graphic of how these variables are all interrelated and actually begin to have an interactive component among themselves so that we know that smoking is a risk factor, smoking is also related to demographic factors as well as things like chronic strain, chronic stress, stressors, alcohol consumption, and so on. So all of these things really form a very complex causal model. But also part of what these start to point out is that intervening at any one of these components has the potential to reduce risk. So these are the kinds of things that we'll be trying to present over the course of the semester, and we'll actually be learning specific ways to intervene in a variety of ways across multiple domains of health behavior. So there you go. The model of heart disease. Not a simple question, certainly no simple answers. Now, the final piece of what I want to talk about in this segment is that we get a lot of, well, there's a lot of developing science and a lot of research dedicated toward trying to identify the most helpful diet. We know that as all of those, as two slides ago demonstrated, it's been pretty difficult for people to follow various types of health advice. The conclusion of this study is that what's really important across comparisons of all of these complex diets is the ability for people to adhere to them. It doesn't matter if there's a specific carbohydrate formula, or if it's x number of grams of protein, and however many Omega fatty 3 acids or whatever else. What's actually the most important thing is that the diet is something that people can follow. So the adherence piece, helping people learn to change their behaviors is the piece that gives us, I think, the most power for our efforts. So in the segments that follow, we're going to be teaching and learning very specific health behavior change techniques. These are things that draw from the clinical arena of health behavior change and things that we can potentially employ at a population level, what we've learned about how behaviors consolidate and how we can intervene and change them as we can potentially employ in larger public health efforts. So when we return, we will learn specifics of health behavior change and those techniques.