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4
This reduced mortality from infectious disease together
with the associated decline in maternal and infant mortality and advances in
treatment has produced an overall increased expectation of life. Whereas
in 1929 the expectation at birth was 58 years for males and 62 years for
females, in 1968 this was 68.6 and 74.8 respectively. Inevitably this
has led to an increase in deaths from malignant and degenerative diseases
such as:-
1929 1968
Cancer 56,896 102,531
Cerebral haemorrhage 25,215 80,352
Heart diseases 96,467 138,617
Even so, many of these diseases are preventable - e.g.
those due to lung cancer and cervical cancer. In fact, there are still
tens of thousands of deaths very largely preventible - deaths from the
following causes:-
1968
Lung Cancer 28,836
Bronehit is 29,864
Alcoholism 80*
Road Traffic Accidents 6,349
Home Accidents 6,6l4*
Drug Addiction 30*
Suicide 4,586
There are also large numbers of deaths from cardiac
disease and other causes predisposed to by overweight. There is also much
avoidable illness - venereal disease, urethritis, abortions and their
consequences, and unwanted pregnancies.
Over the years the emphasis in preventive medicine has
changed from "them" to "us". As Sir George Godber, the Chief Medical
Officer of the Department of Health and Social Security pointed out in his
Inaugural Address to the Royal Society of Health Congress in April, 1970:
"A hundred years ago it was pollution - of water supplies, of rivers
the insanitation of urban environments, typhoid fever, and the aftermath
of the great cholera epidemics. Today the wheel has turned full circle
and we are again looking at environmental hazards. This time, however, the
principal accent is on the dangers of long-term exposure to chemicals which we
ourselves have added to our surroundings." Whereas prevention in byegone
days was largely a matter for authority to intervene by such action as
environmental and sanitary improvements, disinfection, isolation, quarantine
and immunisation, we are now concerned with such man-made hazards as
pollution of the air by smoke, flue gases and motor vehicle fumes; pollution
of water by factories, pesticides, chemical fertilisers, sewage effluents
and toxic substances; pollution of food by pesticides, food additives and
antibiotics in animal feeding; and pollution of the lungs by cigarette smoke.
As Sir George Godber has written:- "It is a fantastic situation that we
promote by our own voluntary - and surely no longer ignorant - actions by
far the largest single avoidable cause of death and disability in Britain
today. There is no other agent in our environment that approaches the cigarette
in menace to health and life."
Preventive medicine has now very largely become a matter
for the individual's own efforts, directed against cigarette smoking, drugs,
over-eating, under-exercising, over-drinking, dangerous driving, and
pollution of the atmosphere.
There has also been a great alteration in social
conditions. I well recall the Depression of the 1920's and early 1930's
with the extreme poverty in industrial areas - shoeless, ragged and undernourished
children, clinics issuing free milk vouchers for mothers and