Day 253 - 21 May 96 - Page 23


     
     1   MR. JUSTICE BELL: I have found it, thank you.
     2
     3   MR. RAMPTON: "Table 5 shows that obesity in adults is not
     4        confined to industrialised countries.  Obesity is already
     5        prevalent to the developing world, particularly in women,
     6        with very high rates in some places, eg in Trinidad.  The
     7        prevalence of obesity is surprisingly variable but in some
     8        developing countries high rates are already evident in
     9        children as well as in adults" and there is a reference to
    10        figure.
    11
    12        "As life expectancy" -- and here I would ask you to read it
    13        carefully, Professor, please -- "increases in many
    14        developing countries, new problems of cardio-vascular
    15        disorders and cancers are emerging.  These reflect the
    16        co-existing effects of the demographic ageing of the
    17        population and of newly acquired risks relating to the
    18        diets and lifestyles that have accompanied economic
    19        development.  On current trends, such diseases will present
    20        a huge health care burden for less affluent communities in
    21        the near future.
    22
    23        The stage at which cardio-vascular disease emerges as a
    24        significant cause of death corresponds to a life expectancy
    25        level between 50 and 60 years and at this level
    26        cardio-vascular disease mortality accounts for 15 to 25 per
    27        cent of all deaths."
    28
    29        That reflects, in large parts, something which you told us
    30        yesterday I think?
    31        A.  Yes, one is to live long enough to develop heart
    32        disease.
    33
    34   Q.   Can you tell us, please, what, in your view, are the
    35        factors which lead to increasing life expectancy in
    36        developing countries?
    37        A.  I think the first factor is living to the age of 5 and
    38        the major problem by far in most developing countries is
    39        the protein energy malnutrition.  This is a shortage of
    40        both calories and protein in the diet.  In other words, it
    41        is a lack of food.  This is by far the major problem in the
    42        world, it is not heart disease or stroke, and it affects
    43        millions and millions of people.
    44
    45        Now, if one can start off with changing the very high
    46        levels of infant mortality, particularly in under 1 year
    47        from thyroid diseases, then people have a chance of living
    48        to the age of 50, but in between there are many stages of
    49        infection, environmental conditions and so on, which are
    50        going to affect it and all of these have to be tackled 
    51        before one can start thinking about increasing life 
    52        expectancy.  These are all non-nutritional factors we are 
    53        talking about.
    54
    55   Q.   Then I think you went on yesterday as part of the same
    56        answer and I can see why.  You said:
    57
    58        "In other words, since heart disease is something that on
    59        average, certainly in this country, the average man has his
    60        heart attack at the age of around 70.  This may surprise

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