Many more people would avoid "premature death" if governments applied simple, low-cost and targeted health education, particularly for the middle-aged, in developed countries.
"The only two causes of death that are big and getting bigger are HIV and tobacco-related illness," stated Prof Richard Peto of the clinical trials service unit at the University of Oxford.
Addressing the British Association in Cardiff he discussed ways to avoid dying before reaching the age of 70, his biblical interpretation of premature death. The session was chaired by the British Secretary of State for Health, Mr Frank Dobson, and Prof Peto and a selection of noted speakers, including a leading cancer researcher, Sir Walter Bodmer, dealt with the future of medicine.
There had been a profound change in life expectancy since the middle of this century, Prof Peto said, reversing a situation which had existed for all of recorded history. Childhood survival had always been very low and in 1860s Liverpool, up to half the population died before reaching the age of 10, he said.
Yet in modern England fewer than 1 per cent of children now die, from all causes, under the age of 10. This meant that many more people were surviving into middle age (35-69) and beyond into old age.
While childhood and young adult deaths were more often caused by acute illnesses, deaths in middle and old age were usually chronic illnesses such as heart disease, cancer and circulatory diseases.
Many of these diseases were preventable, however, by changes in lifestyle and diet. Success in changing the way people ate, took exercise and getting people to stop smoking could bring many more into old age. "The deaths in middle age are a sustained target for preventive medicine," he said. Tobacco-related deaths in middle age among men in Britain had been halved over the last 30 years, he said, by getting people to stop. The benefits of stopping also seemed to contribute to longevity even for those who quit above the age of 40.
In developing countries the emphasis was needed among children, given the large number of deaths caused by preventable illnesses. Vaccinations, the availability of clean water, providing proper nutrition and improving medical treatments could greatly reduce premature death among children in developing countries.
Earlier, Sir Walter Bodmer outlined how genetic technologies were improving our understanding of disease. They were assisting in early detection of disease and disease occurrence in families and were also helping to identify susceptibility to disease.
These developments in turn raised important questions about access to information about a person's genetic make-up. "Who has a right to know about a person's genetic susceptibilities?" he asked. While there was an argument in favour of warning family members, insurers and employers should never have access to this information. It was also his view, however, that researchers should continue to pursue these studies. "I don't think we need to be afraid about what the genetics will tell us," he concluded.
