This topic discused at Mortality,Morbidity in the Population and Sudden Infant Death Syndrome by Dr Professor Michael Dunne QUT School of Public Health Director, International Health Program.

1. Mortality and Morbidity in the Population Professor Michael Dunne QUT School of Public Health Director, International Health Program Hue University of Medicine and Pharmacy (no official position, but a good friend)

17. Deaths from all causes throughout the 20 th century in Australia Source: CSIRO, 2001

18. Why has life expectancy improved so much?

19. 20 th century decline in deaths from infectious disease, Australia (Includes Polio, Diptheria, Whooping Cough, Measles)

20. These trends are similar throughout most of the world (eg USA)

21. Source: University of Wisconsin, USA; www.uwmc.uwc.edu

22. Significant rise, then decline, in coronary heart disease in Australia, 1940 - 2005 Note: Rates are age-standardised to the Australian population. Source: AIHW National Mortality Database

26. Australian epidemiological data on road deaths

27. Risk of death on the roads is now at its lowest level

29. Year Road Rail Marine Aviation 1997 1767 68 46 37 1998 1755 59 46 55 1999 1764 47 51 46 2000 1817 46 42 43 2001 1737 56 59 42 2002 1715 59 48 34 2003 1621 48 41 44 2004 1583 47 41 33 2005 1627 38 39 43 2006 1599 40 na 40 The Aust Transport Safety Bureau records, investigates and helps to prevent transport-related death and injury (see Bills, 2007)

30. But recently, there has been a slight increase…. ATSB, Road Deaths Bulletin, January 2009 There was a total of 120 road deaths throughout Australia in January 2009. - this is a 7.1 per cent increase over the January 2008 figure This increase unfortunately comes after many years of a trend for decreasing road deaths. Clearly, we need to sustain our national efforts and think of new ways to prevent accidents

33. In Australia, we also see patterns for improvement in relatively rare causes of death and injury For example, deaths caused by guns

34. Decline in deaths by firearms over a decade (1991-2001) Source: Australian Institute of Criminology, 2004

35. So how long is human life in Australia compared to the rest of the world?

41. HIV/AIDS In Africa Life expectancy can be calculated for people with, or without, HIV/AIDS

42. Source: United Nations Development Program

45. LE varies WITHIN countries Differences in life expectancy within Australia

50. Health in Western Countries What may happen in the future?

54. Epidemiologists study the problem and try to find solutions

57. Other indicators of population health

65. Males: Healthy Life Expectancy Source: World Health Organisation Australian men (est=70.1y) are ranked number 3

66. Females: Healthy Life Expectancy Source: World Health Organisation Australian women (est. 73.2y) are also ranked number 3

67. You are a student in Public Health, and study within a medical school How does the science of PUBLIC HEALTH save lives?

68. Case study: Control of Sepsis One of the first times epidemiology was used to improve the practice of medicine

70. Sepsis: external signs

71. Triptych of a European hospital in the 16 th Century

74. Dr Oliver Wendell Holmes, American physician Investigated sepsis after a doctor and a med student died of blood poisoning after performing an autospy on a dead mother. In 1842, he proposed rigorous hand-washing after each medical procedure to prevent contagion

75. The idea that the infection was acquired in hospital, and transmitted by doctors was ridiculed by some, including an obstetrician Charles Meigs, who said: “ Doctors are gentlemen, and gentlemen’s hands are clean” Source: De Costa, 2002. Medical Journal of Australia

76. Meanwhile, in Austria, a Hungarian doctor Ignaz Semmelweis , devoted many years to prove a link between hospital hygiene and sepsis deaths

77. Semmelweis and the control of maternal sepsis My doctrine is produced in order to banish the terror from lying-in hospitals, to preserve the wife to the husband, and the mother to the child... Ignaz Semmelweis, 1861

86. Public health researchers examined the social and behavioural factors influencing SIDS … To provide the evidence needed for prevention campaigns

87. Age distributions of SIDS and explained sudden and unexpected deaths in infancy infants Source: LEACH, C.E.A. et al (1999) Epidemiology of SIDS and Explained Sudden Infant Deaths. Pediatrics 104:43

88. At about three months, SIDS can equal all other causes

89. Mother’s Age by Risk of Sudden Infant Death 0.7 35+ 0.6 30-34 0.7 25-29 1.3 20-24 1.8 Under 20 Relative Risk of SIDS

90. Sudden Infant Death by Mother’s Age and Birth Order (Relative Risk Of Death)

91. Sudden Infant Death by Mother’s Age and Birth Order (Relative Risk Of Death)

93. Seasonal Incidence of SIDS (Southern Hemisphere)

96. Remember one essential thing about your profession

97. Public Health It is about understanding, then changing , the social conditions that affect diseases, heath care and well-being of individuals, families and society as a whole

98. Health Promotion and Disease Prevention in Action Design, Implementation and and Evaluation the effectiveness of SIDS prevention

99. “ BACK TO SLEEP”: A Better Way to Make Up Baby’s Cot to Reduce the Risks http://raisingchildren.net.au/articles/preventing_sids.html

102. Decline in SIDS deaths over a 15 yr period (USA, similar in Aust)