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Rapid development and urbanisation have led to a complete overturn of mortality in developing countries; people dying from chronic diseases, obesity and smoking now outnumbering those who die from malnutrition and infection. According to an international group of researchers, focus on public health in these developing countries should shift to advocating a healthy lifestyle and fighting chronic diseases in later life, rather than simply addressing communicable diseases that take their toll at younger ages. Lack of time has made citizens of developing countries unable to adapt and they are therefore more susceptible to diseases of affluence. These findings were published on 17 February 2016 in The American Journal of Tropical Medicine and Hygiëne.

Non-communicable diseases have surpassed traditional diseases
With their transition from adverse to affluent environments, developing populations experience a rapid increase in the number of individuals with non-communicable diseases like cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes. In Africa, these diseases already account for more deaths than traditional diseases like malaria and pneumonia. It is expected that the number of deaths due to non-communicable diseases will comprise a staggering 71% of all deaths in developing populations and is more than four times higher as compared with western populations in 2030.

Triple evolutionary mismatch
The researchers argue that developing populations are more susceptible than western populations to suffer from these non-communicable diseases, due to a ‘triple evolutionary mismatch’. Researcher David van Bodegom of Leyden Academy on Vitality and Ageing explains: “Developing populations experience a fast transition from adverse to more affluent environments, often within a single generation. Western populations have experienced this transition over multiple generations, giving them more time to adapt culturally and epigenetically. Developing populations remain not only genetically, but also culturally and epigenetically mismatched with their increasingly affluent environments. Culturally, there is often still an ideal of corpulence and physical inactivity, representing status in men and fertility in women. Epigenetically, many Africans living today were born in poverty. Their bodies were programmed during their youth to maximally store calories in fat reserves for adverse times, now giving rise to obesity, diabetes and cardiovascular disease in rapidly growing urban populations.”

Shift needed in public health
As a result of the triple mismatch, the researchers argue that developing countries will be hit much harder by non-communicable diseases than western populations. Public health organizations should therefore prioritize the prevention and treatment of these diseases. Van Bodegom: “Public health organizations, supported by global collaborative efforts like the Millennium Development Goals, have made tremendous progress in restricting poverty, malnutrition, infectious diseases, and disorders related to pregnancy and childbirth. But we now face a different threat. Only through global collaborative efforts can the environments in developing populations be reorganized in order to stall the emerging explosion of diseases of affluence. Now is the time to act! Smoking, sedentary lifestyles, an abundance of fast food… let’s help prevent what we have neglected for too long in western society.” Organizations like the NCD Alliance and the Lancet NCD Action Group have already endeavoured after the recognition of non-communicable diseases as an urgent threat to global health and development. The researchers now add evolutionary arguments to their plea. The article ‘An Emerging Epidemic of Noncommunicable Diseases in Developing Populations Due to a Triple Evolutionary Mismatch’ by Jacob J.E. Koopman, David van Bodegom, Juventus B. Ziem and Rudi G.J. Westendorp was published by The American Journal of Tropical Medicine and Hygiene on 17 February 2016. An abstract can be found here.

If you have any questions, please contact Niels Bartels (Communications).

How can we ensure that we stay healthy, even as we age? In their new Dutch book ‘A Guide to Growing Older’, professor Rudi Westendorp and David van Bodegom MD PhD present a practical recipe: small changes in your daily environment can make you live longer and healthier.
Many health problems such as cardiovascular disease, type 2 diabetes and osteoporosis seem inevitable, but they result mainly from our lifestyle. And the environment dictates that lifestyle. Due to the mismatch between our ‘old’ genes – our evolutionary legacy – and the modern environment, we are unable to resist the constant temptations around us. That is why blaming and shaming does not work.

We have to let the environment do the work. By making smart changes at home, on the road, at work, at school, and in the neighbourhood, we can – unconsciously – make the easy choice the healthier choice. In A Guide to Growing Older – Let Your Environment do the Work, the practical sequel to the bestseller Growing Older Without Feeling Old, Westendorp and Van Bodegom provide a series of tips for a longer healthy life. Each chapter features a full-colour illustration and the Dutch edition also includes a handy pull-out A3-sized poster, summarizing all the best tips.

A Guide to Growing Older (‘Oud worden in de praktijk’) was published in the Netherlands in September 2015 by Atlas Contact.

About the authors
David van Bodegom (1978) is an ageing researcher at Leyden Academy on Vitality and Ageing. Van Bodegom a medical doctor and historian. He and is convinced that the public environment rather than the consultation room holds the key to healthy ageing.

Rudi Westendorp (1959) is an internationally respected doctor and researcher and former director of Leyden Academy. In the bestseller Growing Older Without Feeling Old (2014, over 50,000 copies sold) he described how the ageing process works, that we will enjoy longer, healthier, and more productive lives, and how we can greet it with confidence. Westendorp now lives in Copenhagen, where he is affiliated with the university as Professor of Medicine at Old Age.

During his public lecture on the 10^th of February at Leyden Academy, prof. Martin van Hees delved into thought-provoking questions around healthcare and more specifically, who is responsible for health?

The first question to answer in this debate that he raised during this lecture was: what is healthcare for? And following, what is justice in the allocation of healthcare? Relying on his extensive background in social justice, he proposed that four perspectives are usually referred to – although at times unconsciously – utilitarian, egalitarian, libertarian and capabilities. For instance, for utilitarians justice in healthcare allocation would be an allocation that maximizes utility, and utility may then be differently operationalized (such as maximum number of healthy life years, maximum number of individuals healthy and so on). For egalitarians, on the other hand, equality is the guiding principle and for instance an equal distribution of health, or equal healthcare access would be considered more important.

During this lecture, he discussed that in the case of healthcare one cannot speak about responsibility in a straightforward way. Responsibility consists of prospective and retrospective assessment of responsibility. In the assessment of responsibility of healthcare these two are often mingled. By way of example he posed the audience with a risk scenario in which a motorcyclist – being fully aware and knowing the higher risk for such an accident – got into an accident. Who is now responsible for the costs of care? The opinions in the audience were mixed. Knowing the risk, some contended that he should pay himself, whereas others contended that a risk is never ultimately the responsibility of the individual. Here on the one hand prospective responsibility comes in by way of things that one should be doing, or should not be doing in case it may happen. Following prospective responsibility, there is a moral duty to take care of your health. At the same time, arguments from a retrospective risk assessment are alluded to, because in how far can we hold individuals responsible for the bad things that happen to them?

Nevertheless, this is complicated since, as prof. Van Hees identified, there are certain issues that obscures this line of reasoning. More particularly, these kinds of responsibility assignments are set in an interactive environment and have an interactive nature. This is particularly important in the context of healthcare. Rather than accountability he proposed that a shift towards retrospective responsibility e.g. through insurance premiums may be an alternative solution. Although here again complications may arise as it may not only be about how you behave, but also how you behave towards others and vice versa.

Particularly interesting in this debate around accountability and responsibility, and perhaps even a way out, is according to prof. Van Hees the concept of quality of life. This may reshape the debate on distribution and social justice. He considers it an interesting starting principle because, accordingly, quality of life is politically neutral and it can draw attention to the budget without running the risk of becoming a polemic debate on justified allocation and individual responsibility.

All in all, the lecture gave a lot of food for thought about one’s own implicit assumptions in how healthcare should be divided. It also made the audience think about taking risks, responsibility and accountability in the context of care. As usual, in these kinds of challenging thought experiments one was left with even more questions. No wonder that the debate during the drinks afterwards was therefore lively and highly animated.

Prof. Martin van Hees is professor of ethics and head of the department of philosophy at the Vrije Universiteit Amsterdam.

 

David van Bodegom was invited to speak at TEDxUtrecht, on Wednesday 27th of January. David is a medical doctor and historian, now working as an ageing researcher at Leyden Academy on Vitality and Ageing. David left a career in medical practice behind, as he believes he can best serve people’s health in the public space. Together with professor Rudi Westendorp he wrote the Dutch bestseller ‘A Guide for Growing Older’ (2015), presenting a unique approach to living longer and staying healthy.

Many diseases of old age, such as cardiovascular disease and diabetes, seem inevitable but originate mostly from our lifestyles. For many years, we have been blaming individuals for these lifestyles, telling them it is their own fault. Well, it is not says David van Bodegom. The constant temptations in our environment seduce our ancient genes to make unhealthy choices. A radically different approach is needed: re-shaping environments where all people are nudged to automatically make healthier choices.

Click here to view David’s TEDx Talk in Utrecht.

How does it feel, when can’t move your body as fast and flexible as you would want it to? When your vision is blurred, your hands slightly shaking, and you can’t hear so well? For most young people, this is hard to imagine. Ishani Mukerji, a 24-year old creative assistant at Aegon, decided to accept the challenge and try on Leyden Academy’s old age suit. It turned out to be quite an experience for Ishani: “The suit is putting my life into perspective.” Watch the video here.

Making smart, healthier choices at work
The good news is that many of the ‘diseases of old age’ that the suit simulates, can be postponed or even prevented by a healthier life style. As explained by David van Bodegom and professor Rudi Westendorp in their recent book A Guide for Growing Older, your environment plays a key role in unconsciously making healthier choices. At home, in the neighborhood, and also at work where we spend many hours every week. In a second video, Ishani showed David around the Aegon head office in The Hague, to see what practical steps she can take in her workplace to make the easy choice the healthier choice. Watch the video here.

New report: The New Flexible Retirement
The videos are a combined initiative of Leyden Academy on Vitality and Ageing and the Aegon Center for Longevity and Retirement, and were launched together with the new report The New Flexible Retirement. The report shows that the concept of retirement is changing rapidly. As people live longer, retirement will become a more active life stage, with more people looking to blend work and leisure. Today’s workers are expecting to gradually transition into retirement, but a significant obstacle is that only few employers offer employment practices to support this. But maintaining a healthy body and mind are also key, which Ishani demonstrated vividly in the videos.

Many countries are on the threshold of a major demographic shift: an aging population. This is often associated with a higher pressure on the collective budget, mainly due to a higher demand for medical and long-term care. However, economic studies show that the ageing population probably will have a marginal impact on rising health care expenditures, when compared to medical innovations, increasing inefficiency of labour in the health care sector, and restructuring of the health care market. In addition, the rise in health care expenditures due to aging will possibly be moderated by other developments. This is the subject of the PhD thesis Population ageing and health care expenditure by Herbert Rolden, which he will publicly defend on Tuesday February 2nd in Leiden.
Rolden describes that population aging can roughly be divided into three dynamics: a higher life expectancy, a growing proportion of older persons and a higher average mortality risk in the overall population.

Life expectancy
Life expectancy has risen consistently in many countries throughout the last centuries, mainly due to rising prosperity and better care, nutrition and hygiene. Whether this rise in life expectancy will cause an increase in health care expenditure depends on the development of ‘healthy life expectancy’. If healthy life expectancy rises in a parallel fashion to life expectancy, then the ‘expensive years’ of old age will be postponed rather than expanded.

Number of older persons
As health care expenditure rises with age in each individual, a larger share of older people will increase the total level of health care expenditure. However, there are several developments that can moderate the impact of a larger share of older persons on health care expenditures. An example: As women live longer than men, there are more widows than widowers. However, the number of widows in the future will likely decrease because the life expectancy of men is rising faster than that of women, in turn reducing the pressure on long-term care.

Mortality risk
The individual level of health care expenditure peaks in the months before death. These ‘cost of dying’ make up a large share in the total level of health care expenditure. Since the cost of dying decreases with age, an increasing overall mortality risk in the population can partly be offset by another component of population ageing: increasing life expectancy.

The promotion of Herbert Rolden took place on Tuesday, 2 February 2016 in Leiden. Supervisors were Prof. Dr. Rudi Westendorp (Copenhagen University) and Dr. David van Bodegom (Leyden Academy).