Good afternoon. Just before I introduce for speaker, I welcome you all here.
Can you note that this talk is being filmed and livestreamed, including the questions and answers?
Welcome to the Oxford Martin School. Thanks for joining us here this afternoon for a lecture by Dr. William Bird.
This is a joint lecture between the Oxford Martin School and the Rockefeller Foundation Economic Council on Planetary Health,
which is a mouthful for those who don't know us. The Economic Council on Planche Health launched in 2017.
It's based here at. The Oxford Martin School, is tasked with making the economic and policy case for planetary health with communicating
the links between human health and the natural systems on which they depend.
Our report will be published next year, so keep an eye on our website Planetary Health Dot Dot Dot UK or our Twitter feed.
Ox Planet Health for more details.
More importantly, tonight, the lecture will be followed by a drinks reception next door in the cafe, so please do join us afterwards.
After the talk will be having a 20 minute questions and answers session.
So if you want to leave your questions to the end, that would be fantastic to introduce your speaker, Dr William Bird.
We're glad to have you here today and B he's the CEO and founder of Intelligent Health.
He's a practising doctor who started to get his patients more active by setting up the first Health Walk scheme in 1996.
This led to him creating the green GM a year later as he realised that companionship and
contact with nature were major driving forces in keeping people active and healthy.
You also helped to set up a health forecasting unit at the Met Office, where clinical director for five years,
providing forecasts to help keep health professionals predict and plan for weather related illnesses.
He's an adviser to the World Health Organisation, Public Health England and Sport England.
They set up Intelligent Health eight years ago. With that, companies created the innovative innovative.
Beat the Street and a physical activity intervention programme adopted by cities all over the UK.
Beat the Street has had more than nine hundred and fifty thousand participants to date and has helped to create sustained behaviour change,
making healthier and more active communities. And I'm sure we'll hear more about this later today.
Williams going to talk to us about why we need a fourth revolution in health care.
Thank you very much, sir.
And it is a real pleasure to be here, and it's great to have the inter-disciplinary of where you have everyone in a very different kind of sphere.
When I worked at Natural England, I remember being next to the dormouse specialist.
So everything you need to know about Dormouse was in the man sitting next to me.
And he knew everything about dormice, and I just thought, here I am as a doctor sitting next to a dormouse specialist.
That's brilliant because I'm sure something eventually will connect.
We never did, but it was one of those things, and it started because I was brought up with my father being a doctor.
And when I first started in life,
I was actually born above the surgery and my mother was a naturalist and we used to have stuffed birds in the fridge.
So it was a household where medicine and nature were connected all the way through, and I probably carried on ever since.
So what I want to talk about and I'm borrowing from great people here who have been thinking about this, but in my way,
I've been trying to do the practical side of thinking about how do we actually deliver health care to be sustainable for the future?
And. Let's start with the revolution.
So the first revolution to public health was very much the one we know from the 19th century.
It started with clean water, the sewage being sorted out,
housing being sorted out and air quality first started to be addressed and workplaces were starting to become healthier.
So huge advances in health from that public health, and that's continued all the way through.
However, we still have some of the worst housing in Europe. The damp housing, the coldest housing.
So still some way to go. So a great revolution, one revolution to modern medicine.
So that's the medicine I've been delivering, delivering as a GP for many years antibiotics, surgery, physiotherapy,
all the things that we are completely used to over diagnostics and again, massive inroads on treating cancers that we never thought could be treated.
Hodgkin's lymphoma is now almost 100 percent curable, whereas before it used to be almost 100 percent fatal.
HIV now is almost completely curable or at least contained, and modern medicine has done an incredible amount of good.
So great on that. We're entering and kind of started the third revolution, which is out of personal health,
but we're now actually more in control of our health with internet of actual knowledge.
Wearables that tell us a huge amount about our steps and about our heart rate and
about our fitness and all sorts of apps and other things that we can actually do.
And then you can have your genomes checked to find out what your genetic makeup is.
So you know exactly the ace inhibitor is going to be right for you, but not right for the person next door.
So we start to do this. Precision medicine Precision medicine is where, with your genomics,
we know what would be best for that person with those genes or that lifestyle or that behaviour change.
And actually, that's just remember that precision medicine isn't just genomics and and drugs, it is actually about understanding someone's behaviour.
So you target messages directly to that person. Great.
So that's it sorted. But we can look forward to more disease because what's happening is that our life expectancy increases.
You can see on the right you've got men and women and on a right hand side, he gains in years of multimorbidity.
So over five years for men and about five years for women, but life expectancy is only going to go up to three and a half years or three years.
So you've got those extra two years on average of disease, of living with multimorbidity of two, three, four or even five long term conditions.
And that's going to get worse as we go into the next 20 years.
So although modern medicine is great at saving our lives, the things like Alzheimer's, the things like diabetes,
cardiovascular disease, where there's damage to the heart with heart failure, we're not actually managing to completely cure it.
Well, holding it and we're holding it very well. People don't die, but they don't get completely cured as well.
So this is one factor.
We've got long term conditions and we've got also with all of this, we've got antibiotic resistance that's going to be developing.
Long term conditions will continue.
So another four million people will be having arthritis in 2035, another 1.6 million people will have diabetes in 2035, compared to what we got now.
So as life expectancy goes up, we obviously going to get more diseases, which are an ageing.
So we're living now with more long term conditions and with people with more disability.
So you can say, is that a success? Is that something which is good?
What about health inequalities, they'll be doing well on that. Well, but not so the gap between those who are healthy and for life expectancy of males
and life expectancy in females has remained remarkably stubborn all the way through,
and billions and billions have been spent on trying to narrow that gap of health inequalities.
And as you can see here up to 2016, we're not doing a very good job.
We're indoors, but disconnected from nature. We started to get disconnected from each other, creating isolation and loneliness.
And with all that heat coming out there, we've got some global warming as we actually look in our own houses.
Inactivity because of cars means you've got more pollution and you get more carbon use and global warming again.
The urban heat islands, as we have less vegetation to be able to deal with urban heat, lack of trees and therefore lack of trees.
It all fits with global warming again. So we can see here there are certain conditions and are certain aspects of both human
health and global health that go hand in hand and inflammatory diet deforestation.
And again, global warming. So we know quite clearly the sustainable lifestyle, a lifestyle where we actually having an anti-inflammatory lifestyle.
Talk about that in a minute actually fits in perfectly with the prevention of global warming.
And we can see here, of course, we don't need any introduction to the global warming side there, so we're left despite these three great revolutions,
we're left with long term conditions that are here to stay and we'll get more and more prevalent as we get long, live longer.
We've got health inequalities that hasn't budged and we've got global warming and not one of those three revolutions.
Unfortunately, save the public health if we can get that right is able to has many managed to bulge this.
In fact, some people feel the actual personalised health care is going to widen health
inequalities because those in the know who've got more knowledge have got
more ability to make a difference will actually find they're going to be better
using that personalised health and health inequalities will get better. So let's go back to find out where it's all gone wrong.
Let's find out how we can address those three big problems that we've got.
So if we go back to being a HUNTER-GATHERER about 100000, 200000 years,
I probably get all sorts of anthropologists here over time exactly how far we go back.
But it's probably about one 100 or 200, and we put a thousand years for one hour.
So that's about 100 hours. That's about four days.
And you can see here that we were hunter-gatherers, and everything in our existence was a brilliant Hunter-Gatherer engine,
and nothing really much changed until we came to about 10 hours ago.
And that's when agriculture came. So it was still outdoors. We were still very good as a outdoors, but we weren't wandering around anymore.
As hunter-gatherers, we were still in those groups.
But all of that time, we have been getting better and better and better as being a hunter gatherer four hours ago,
civilisations in Mesopotamia and in Egypt.
And then big changes for nine minutes to nine minutes ago was the industrial revolution, so that's when the call came along.
So. If you talk to your grandpa or your great grandfather, you could still probably save it in the 1950s and 1960s,
they were still active, still outdoors, are still roaming around the streets. So despite this inactivity creeping in,
there was still a lot of activity in the 50s and 60s as the industrial revolution had well developed and the cars were very much there.
So when did the change come? Well, it's actually a few seconds ago.
So just 80 seconds ago, it was technology and indoor culture.
So I've got a wonderful story of a family in Sheffield and ED.
Who's eight years old and his great grandfather both lived in the same area still.
I have always done for four generations. The great grandfather in 1919 was able to wander six miles with his friends, go out in the morning,
come back when it's dark, as it as all instruction for these eight year olds going out wandering six miles.
Can you imagine now letting your eight year old go out and thin come back when it's dark?
But that was it what it was like in 1919 in the 1950s when Ed's grandfather was out.
He could go about a mile. But in that mile there were woods.
Those valleys. There was an old mine they used to go to. And again, it was go out in the 50s, come back when it's dark.
Then its mother in the 70s, well, she could go to a swimming pool, which is half a mile away,
but come back in an hour, come back in two hours because I want to know where you are.
So we just started to get that feeling that things were right and.
He can't go out. So he is locked. He can go to the parents.
But no way. Eight years old is allowed out of the house. So something's happened.
Something fairly catastrophic has happened in society for us to have this fear
and this anxiety that we cannot let our children can say all sorts of things.
Traffic was obviously completely different than newspapers were different about what the news and the internet and everything else was like.
But basically, now human beings are locked mostly indoors for a lot of the time.
But if we look at our factory settings of what we should be like as a hunter gatherer.
But it's very simple. It's three things people, we should be all connected together place.
We're connected to nature. We're connected to a supportive environment.
And the environment is vibrant and we have purpose.
We've got value. We get up in the morning and we know what we should be doing and who we are and why we're here.
That's pretty much it. And if you do the five ways to wellbeing or understand those that are put on the bottom of connecting to each other,
taking notice of things around you and then being active, giving and keep learning, that's how factory settings, that's where we should be.
This is where we're beginning to go in this last 80 seconds, loneliness.
So we know that loneliness is equivalent for cardiovascular disease, smoking 20 cigarettes a day.
So loneliness is a highly stressful thing. It's not isolation because some people love to be isolated.
We actually think of nothing better than to go out and be completely on your own.
So loneliness is a perception that you're feeling excluded so you can be lonely in the workplace.
You can be lonely, the family, you can be lonely in the school.
The hostile environments we've created, parts of Oxford are absolutely wonderful to walk around.
Parts of Oxford are not good to walk around, and some places are absolutely intimidating.
And that disconnection to nature and lack of control, lack of purpose in our lives.
And because that's so far away from where we've been. That creates a fear.
And chronic stress, because our bodies were designed for this. And said we've got this.
So the human mismatch hypothesis that Lee had started to think about and is now obviously for
many of you will know about it is basically say this is our ideal environment in this circle.
But unfortunately, our new environment has shifted, which means you've got an area of mismatch, an area our bodies are not designed for.
Bay Area and people feel insecure where all our cells and everything that we've done in our life doesn't feel it's quite connected together.
So this fear, chronic stress illness that then leads on to changes in our lifestyle.
So first of all, inactivity. But we'd actually do this, let's do this one first to diet and obesity.
So when you're chronically stressed. And we're talking about chronic stress, acute stress, that's a very different thing, and that's quite normal.
You actually stop eating and you lose weight. You take up all your carbohydrates to cope with this situation.
When you're chronically stressed, you release ghrelin,
which comes from the stomach and it goes up to the brain and goes up to receptors all around the body.
And it's designed to cope with your chronic stress because things are bad, you gentlemen.
The next meal is coming. You don't know if it's going to be a famine or something in the body, saying there's stress, therefore must be a problem.
So the gradient comes up and cortisol, of course, increases your calorie intake and that increases, particularly in mice.
But also, they have done in humans carbohydrate preferring to fat.
So you actually crave the carbohydrates and actually, as you take sucrose of carbohydrates and sugars, the anxiety is allayed.
So you get this wonderful feedback that when you're stressed Greenland is making,
you want to eat more carbohydrates and put on more calories and you get rewarded in your dopamine for actually having it.
So no wonder this comfort eating gets so good when you're stressed, you can feel how you're needing to have this carbohydrate.
But of course, there's no point in having all that carbohydrate is all going to be expended and disappear.
You've got to store it. So where do you store it?
You store in a place that doesn't get in the way of running and doesn't get in the way of throwing a spear in the abdomen.
So that's where visceral fat,
the visceral fat is the storage of the extra load of calories that you've taken because Greenland is saying store as much energy as you possibly can.
We don't know what's going to happen next, and visceral fat is very different from subcutaneous fat.
Actually, we don't care about subcutaneous fat. It's actually not very harmful the visceral fat in your stomach.
That is harmful for cells, just get bigger because it's only a temporary measure in subcutaneous fat,
you get more fat cells in visceral fat, they just get bigger. So you get lots of bigger, bigger,
bigger cells of adipose tissue and those adipose cells get too big so they don't get enough nutrients and oxygen in the middle,
and therefore it creates an inflammatory reaction because they become hypoxic.
And as you get these large cells, you start to get unsustainable and visceral fat is an incredible source of inflammation.
So it's not a great thing to have. It's only meant to be dead temporarily.
When you become stressed, you also become inactive again, possibly because you're just trying to conserve energy.
But your motivation drops and you find you can't go to the gym and you can't do the runs.
You can't even go for the walk anymore. When you're chronically stressed, physical inactivity is encouraged.
So what is chronic stress that's come in and fear releases stress hormones?
Also, smoking, drinking alcohol, why is that because you're inhibitory fibres are diminished and your inhibitory fibres,
obviously, if you're about to be, have a line jump at you.
You don't get a spreadsheet and talk about a cost benefit analysis of which way you're going to go.
You jump. Whichever way you're going to go, you leap.
So your brain takes away the inhibitory, which means that smoking drinking alcohol can start to become much more of an issue when you're under stress.
So you think of places where there's chronic stress. It's not surprising that we've got these behaviour changes and then that leads
on to something else because the immune system gets in the in the game now.
So you think if you are going to be in a family, we're going to be in a war or you're going to be attacked by animals?
You've got to make sure your immune system is raised up.
So chronic inflammation is one of the consequences of the chronic stress, and that's going to be a big thing I want to talk about.
It's a chronic inflammation is when the immune system rises above its baseline and starts purring away.
Think of your computer when it's trying to do some background stuff, a viral check or whatever it is.
You Typekit you type something into the computer. Nothing changes because it's doing some background when your immune system is raised up.
It takes all the energy from every other part of the body. It's king.
The immune system takes more energy from anything else. It takes it away from the brain.
So the brain actually is unable to do complication things and think differently.
So when you've got this chronic inflammation, your brain starts to diminish. You get tired, you can't concentrate so much.
But the big thing about chronic inflammation is unfortunately.
It is the source of all of those diseases or supportive of those diseases, if not the cause.
Cardiovascular disease is probably the first one. Cardiovascular disease is entirely an inflammatory condition.
You've got your little fatty streaks on the artery and they create inflammation.
Macrophages pass through immune system. Start to come to it.
Increasingly, you get more and more inflammation until eventually it ruptures, and all the therapeutic stuff comes out and you get a clot.
So all through the immune system or through the cardiovascular system, you've got inflammation.
And if you measure just CERP, it would be raised. It's an inflammatory disease.
And now we start to look at diabetes as an inflammatory disease and cancers as inflammatory diseases,
even anxiety and depression are now thought to be inflammation of the brain.
You create inflammation of the brain and anxiety will come through. Arthritis, of course, is inflammatory.
So our bodies, when our immune system is purring away and going up and up, seem to respond in a particularly bad way.
Originally, it was to help us to survive, but unfortunately that's no longer.
So we have a new problem problems, chronic stress and inflammation, and these are the conditions you find in the more deprived communities.
So it's not surprising that health inequalities hasn't shifted if we don't get
to the root problem of dealing with chronic stress and chronic inflammation.
CSI. OK, so that's how you can remember chronic stress, chronic inflammation.
So we've got three conditions here. Long term conditions, health inequalities, global warming, which haven't been sorted out.
We now know about the reason and some of it.
So let's have a look at the fourth revolution. We'll call it total health.
You can call it one health. You can call it planetary health. We can call it a way which identifies where you have the person, the individual health.
But instead of being in modern medicine where that is isolated,
that has to be totally connected to health of a place where they live and totally connected to the health of the community.
Out of a three come together as one and is slightly more than public health, which is behaviour change,
although obviously green space is now which is part of public health is a bit of social prescribing is lots of things.
But what we have to do is make sure there's three central parts all connected together.
Hypocrisy is, of course, as always, gets always gets all the glory because he felt environmental causes and natural treatments of
diseases and the need for harmony between the individual and the social and the natural environment.
How about that? Absolutely. Spot on. And we've kind of forgotten about the nature.
We've kind of forgotten about the natural environment around us.
They've even probably forgotten about the community aspect of health as I've been sitting in my GP practise doling out antibiotics when needed.
I have to show is I do that only when I need it. But also things thinking about the person thinking about their social setup.
But I wouldn't be thinking so much about the parks around, but now I do, and this is where we have to to go.
So let's have a look at the person. Oh, I forgot to mention my sponsor feature.
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That's Fitch rates going for a walk.
Going for a walk sounds really dull. It sounds really nice.
And when I tell a patient to go for a walk, they can say, my granny could tell me that you're meant to be a qualified doctor,
give me those tablets, send me to the hospital and I want to see the top specialists.
I don't want this to be told to go for a walk. OK, well, let's have a look see what all can do.
Major fault immune system. That is what the datasheet of a dream drug would be.
And we got to get really excited by that. We would be so excited if one drug did all of those things, it would just sort out the world.
And yet, because it's wrapped up in a walk is kind of lost interest.
And yet it outcome is identical to about 15 polypharmacy, drugs and an older person to be taking to get that exact result.
And you want to tell me why that's four times strength, that particular walk.
What's going on there? What else is going on? I that sunshine.
Yes, thank you. So how many times we're being told to wrap up completely and not ever go in the sun?
And now suddenly we get rickets? We think, Oh, actually, the vitamin D is quite important.
So yes, we don't get burnt, we don't get calluses. But sunshine is important.
Social to people, loneliness, similar to 20 cigarettes a day for cardiovascular disease companionship,
we are designed to be but depends who the companion, of course, is.
Some companions you might not want to go with, but companionship is important and the last one is.
Greenspace, yeah. So I can promote a book, The Oxford Textbook of Nature and Public Health at £42, which we mean helping to edit.
So it brings all the evidence about green space, which is extraordinary now about how it improves and impacts the brain health.
So here we have four times the strength of a drug of the dream, and it's a walk.
That's all it is. That is where health should be.
That's how we should be doing it. Let's have a look a little bit more about the walking and the inflammatory response, how it helps the inflammation.
We know the inflammation. That's a cause of many of these chronic diseases. Let's go back to this bit.
That's not actually visceral fat. That's visceral fat.
The stuff inside the white you can see inside the halo around the outside is subcutaneous fat.
You may not like that subcutaneous fat. Actually, I didn't mind it too much. I really, really mind you having that visceral fat in the middle.
And what's so unfair about this one is that between the two top and the bottom,
one's got 4.3 litres of visceral fat and the other one's got 4.5 litres of visceral fat and you've got the same waist circumference.
How unfair is that? Voice circumference is a good proxy measure of visceral fat, but as you can see here, it's not perfect at all.
And I should explain why visceral fat so such a problem because of the inflammatory response it gives.
Bring back the Fisher Rex Patrick's sorts of visceral fat, just like that.
You can see the orange there is the amount of visceral fat is reduced just by walking for 13 weeks.
The subcutaneous fat is the dark blue, and the more you have in diabetes, the more the visceral fat, which is one of the big components of diabetes.
It disappears, so you can imagine a patient. Obese patients didn't lose any weight, either.
So he did all that walking. And for this study, that's a little bit more in order to not lose weight, but still a visceral fat plummeted.
So they are much healthier now. Are they going to tell me that no way they're going to come back and said, Stop that walking is an absolute nonsense.
Still can't get my genes on. I still can't get myself together. I'm still way exactly the same as I did.
It's nonsense. I only go for diets with physical activity, as I said, Well, look inside you look inside you.
That visceral fats disappeared. Well, we haven't got a CT scanner in the surgery, so we can't do that.
But that's where physical activity specifically can attack that part.
Let's have a look at the other things you can do. Just get walking. Contract your muscles.
You get your kinds of kinds of interleukins.
And then you get an anti-inflammatory bath in every part of your organ for a few hours after every exercise you do.
So it calms down immune system, just as it's meant to do, because obviously when you're exercising, everything's good and all fine and dandy.
And then let's get back into the nitty gritty of the cells. So here's a cell.
Sure, you've heard of the mitochondria. And whenever the mitochondria came from.
Yeah, thank you very much. About a billion years ago, as life was working itself out, a little bacteria fused with another bacteria and life began to,
you carry it, life began and we've kept those mitochondria as little bacteria ever since.
And they don't need power. Everything that we have. But they also power trees and slugs and snails are not actually very special people.
We just use exactly the same batteries as pretty much the whole of life.
So let's have a look inside that mitochondria. You've got antioxidants.
You've got its own DNA and you've got results for oxidative phosphorylation.
Here's a sedentary, high calorie, probably high rather than high fat and stress.
So this is a bad place to be. Battery charges up every battery has to charge up.
OK, so your batteries are all charged up now because you been sitting. OK.
You're not moving very much. So what is about to happen in your bodies and billions and billions of little cells,
is you going to start to leak out free radicals because of all that heavy lunch?
You had a bit of a stress you've got because cortisol makes it worse and you're not moving
around means you start getting free radicals because it can't hold that charge anymore.
The outer membrane of mitochondria is absolutely at full capacity.
And it just can't hold it. So just like overcharging your mobile phone, it gets warm.
The battery gets warm. That's electrons leaking out, also known as free radicals in the human body.
So these free, free radicals, the leaking out, not because we're energised, moving around because we're sitting down doing nothing.
And the antioxidants aren't able to cope because they haven't been stimulated enough.
So get moving, start to walk around, start to be active, perhaps have less calories on board and reduce stress.
And now the mitochondria purrs way. Of mitochondrial health in Cambridge, he says it's like a dynamo.
It just needs to be moving all the time. You've got to keep your mitochondria going the whole time and then free radicals
fade away because the pressure would destroy the potential difference as reduced.
Antioxidants lift up, more mitochondria come through, cleans out all the debris in the cell.
The cell becomes much happier. Healthier. Well, let's have a look and see why those free radicals ended up.
Because they didn't just stay in the mitochondria, those free radicals of oxidative stress ones come out.
And they hit the chromosome again to the nucleus.
So what sort is telomere business? Okay. Well, the telomeres were discovered or the purpose of them?
Elizabeth Blackwell at University of California,
for which she got the Nobel prise and she got the Nobel prise because people knew the end of every chromosome as a repetitive genomic structure,
which meant nothing and it didn't programme any genes or proteins at all.
It was just sitting there and nobody quite knew what it was.
And then she realised that telomeres at the end, as she called them for longer than people did better.
They had less disease and they were healthier and actually following some of the people through, they got less diseases.
And it's like a cap like a shoelace at the end of a but little plastic bits at the end of a shoe laces stop that chromosome unravelling,
but also stopping chromosomes joining together.
But its big thing is every time a cell divides, the telomere gets a bit shorter until it gets so short that cell can no longer divide.
And when that cell can no longer divide, it doesn't get replaced.
And when that cell doesn't get replaced. You will want to sell short.
Which could be a bit of your brain, a bit of your muscle, but if your bone all shrinking and that tipping point is 28 years old,
so everyone piles to it, I'm afraid are sliding down, I've been sliding down for a long time.
And but if you've got very long telomeres, that 28 year old actually can be longer.
And if you've got very short, telomeres get shorter. And what we know now when we think about the fourth revolution of health care is not
only the physical activity actually helping protect us from those free radicals.
But if you're a child and it's had a very difficult upbringing, the adverse childhood events, then you'll cramp.
Your telomeres will start off shortly before you've even started your adult life.
So the chances of living in a very deprived area,
having had a very difficult childhood with lots of perhaps abuse or nutritional problems or stress as a child,
the chance of you living longer is going to be very small because those telomeres are already short, so.
We've got this whole light course to actually think about.
But there's only one thing that releases something called Tumblr and Tumblr rays can make those telomeres go longer again,
and that's physical activity. I can assure you there are lots of laboratories in the world trying to work out, how do we make Tumblr res?
Because you can imagine if you took two batteries and it hit those telomeres and made them grow longer.
Hey, presto, you've got a picture of life and nowhere near nowhere near.
It's probably been more complicated, but walking a simple thing we just talked about can do that.
That cell, when he can't divide anymore, goes into the licence,
sends out massive explosion like a supernova of inflammatory markers so that the immune system can destroy it and apoptosis, it disappears.
So every time cells get to the end of their life, they're creating more and more inflammation.
Which is why as you get older and older, inflammatory markers go up a little bit.
OK, let's have a look and see what are settings are for health, for green space.
So we said it's people place and purpose the place bets.
Here's some pictures of a pretty horrible outlook.
I think this is in South Korea, but these students were divided into four groups and one lot saw these pictures and loads of others.
A lot, a lot of students, so of CGI thrown in some trees, exactly the same pictures as above,
but with trees and green space and flowers and other things on it.
Another group has exactly the same bottom, but the green trees were just a little bit microsecond released.
Subliminal. So they weren't aware in the cortex that it was happening,
but subliminally they had the trees released and the fourth group had the trees
explained to them by someone sitting next to them as they were looking on the screen.
So all of these were done on screens. They did some complicated, backward digital Dhubri thinking, I can't remember,
but you have to subtract 13 from a big number and keep subtracting 13 until you make a mistake.
Probably the most stressful thing you could possibly imagine.
And then they did the experiment, and then they did exactly the same experiment on those four groups.
So what happened? How's our brain wired? Does it really make a difference if you look at a screen with those?
Or should we have to be outside in nature and should things make any difference at all?
Well, the first one, those who looked to grey urban landscapes with no greenery at all.
They did worse.
And every study that's been done has shown exactly the same thing after mean looking green or grey infrastructure with no water and no trees,
we actually get stressed and therefore our brain gets less effective.
The two who looked at trees both subliminally and in real birds in exactly the same,
which indicates that this is deep in our brain, is deep in our limbic system.
This is our reptilian brain and where a lot of this is happening.
And then the other group has someone next to them, of course, did very well because we like to have a social.
We like to learn. We like to feel there was something about it. So if that is so good, they can start to reduce stress.
And depression and surely the inequalities will get better because it will reach those people who are.
Most needy.
So if you can look here is a study done quite a long time ago by Popcom and Rich Mitchell, so you can see here the lowest income is the dark blue.
The middle income and the middle one and the highest income is the light blue. On the left is the ratio of death and case of death.
The higher that is, the more death is happening.
So the first thing you can see is if you look at each of those segments, the inequalities is horrendous.
Those in the very poor areas are dying much as how much greater rate than those who are affluent.
But as you go across the green spectrum, but the little hiccup at the beginning bit towards the end, there is a very green environment around them.
That gap has really shrunk. And that's because the green space and the greenery and nature is a way of making our brains feel comforted.
It feels that we're not under pressure anymore. There's no famine to being.
We can see trees. Therefore there must be life. There must be water, there must be shade, there must be animals, there must be food.
So the more we see water biodiversity, the friendliness not to, you know, not too thick undergrowth, we actually start to feel better and our brain.
And you can see here the gap between the rich and the poor is diminished hugely.
Well, an incredible thing to be able to do just by being able to change the landscape of a city.
So we've mentioned about loneliness.
And I think we can probably all experience that part of stress where you've got a sleep disturbance, engage in less physical activity,
increase pain, depression, fatigue, poor health is all the things that happen when you're stressed or when you're lonely.
And inflammation count goes up, inflammation count also goes up,
and telomeres get shorter in carers and carers who are looking after patients of Alzheimer's have a spouse
of Alzheimer's or a child of severe autism have some of the highest stress levels that we can measure.
They've got the equivalent of soldiers coming back from Afghanistan.
And when a patient when their spouse dies after three months, all inflammatory markers go down again.
So we've got this stress built into society in all sorts of ways.
The loneliness, the carers, those who feel left out, those who feel in a in a difficult relationships are whole aspects and children in particular.
So let's have a look and see what we've got in the people.
So we got this people purpose place chronic stress and poor health behaviours, mitochondrial damage,
telomere shortening, chronic inflammation and that creates our long term conditions.
That's my world. But actually, it's more than that.
Because if you look at this. Chronic stress and inactivity, poor concentration, tiredness, irritability, addiction,
depression, weakness, chronic inflammation of all consequences of this mismatch.
And as a society, you get less people out of doors.
Therefore, the streets become less safe because there's less vigilance, poor air quality because people are in their cars, reduced learning in school.
Because children do worse, they're stressed or they've got no inactive,
very inactive productivity at work goes down because people are inactive or eating the wrong things,
and therefore the brain is being devoured of energy dependence of elderly because people who
haven't been active for their lives therefore are more prone to false sarcopenia and other things,
less volunteering because they're less people outdoors, less people connected to each other.
Isolation. Obesity. This activity was walking, this very simple thing starts to completely, if it's not there, destroy society.
An inactive. Community is a dying community.
It can't function as it should be.
There's no interaction, there's no interaction with the place, there's no interaction with people, get it right and everything points.
Everything spirals upwards and feeds on itself.
Because the more people are out in the park, the more people want to go in the park because it feels safe,
the more people talking to each other, the more people want to go out to talk to each other.
Because it becomes the norm, it becomes a cultural norm. So our focus in health has kind of gone from let's build tennis courts, swimming pools.
And football pitches. That's how I used to when I was in the 1990s. That's what I was told as a doctor.
That's how you get patients active. And I saw my diabetic patients.
They said, I hate sport, I hate swimming pools. I can't bear the gym.
I was tough. You can't do anything. And then of course, I went for a walk with my dog.
I went past all the houses, the GP and everyone where they all live.
And I was a single patient out walking on a lovely July evening.
And I thought, Hang on a sec, you tell me you can't do all these fancy things like gym and go swimming and all of that, but you go for a walk.
And actually, that's how the health folks I see because we realise the men,
the men were worried they wouldn't be able to get back because they were about to climb every style bit.
And they worried about getting lost. And the women are worried about fear of being alone.
So hence we got the walking groups together. But this is how we were meant to be.
And this is the exercise referral decommissioned by Nice because it had no evidence.
But after 12 weeks, it made the job a difference to your physical activity.
So now it's been asked not to commission it.
It can work in a few isolated places, but they've got it right. Then we went to the community based services.
The park runs, the health, walks, green gyms, the salsa classes, all of those things which we can see in a community thriving,
brilliant, fantastic, got people all in groups, and that's where we start to democratise physical activity.
And that's what we're doing now, which is social prescribing. Social prescribing is where people can actually lead a walk or go for salsa or do
art therapy or do dance or do whatever it is to be able to get people engaged.
But we're not going into our fourth revolution like that. That's still where we are now.
The fourth revolution. Actually relies on the entire community taking ownership.
Everyone becomes a fitness instructor, the doctor for his patients, the teacher first for the pupils,
the shopkeeper for their customers, the workplace manager for the employees.
Receptionists, everybody starts to take control of the health and those around us, and we start to share it together.
And that's a social movement. So that is a social movement where we start to own the problem of health,
and that's where walking and all these other things connexion to nature arts,
and all of those things start to help to narrow the gap between health inequalities, to help the climate change.
Because we know that obviously is going to be everything we do. There is going to be helpful for that and long term conditions can be allayed.
We shouldn't have diabetes, we shouldn't have as existing.
A few people might be able to get it, but everyone was active. And if everyone ate a very normal, reasonable diet, we wouldn't have diabetes.
Not near. We have it now. It is a disease that could almost be obliterated.
Just imagine having no diabetes in a community because everyone has taken on the health themselves,
working with each other and using what's around them as medicine.
The fisheries medicine they're taking. So let's have a look and just see how it can work, how you can motivate if this is a green gym.
So that's conservation work. Here's a lady who's been doing the green gym and she went to aerobics as well, and we monitor her heart.
And we looked at her and said, OK, you've been doing step aerobics. What did you do?
Well, 20, 10 minutes, 15 minutes. We did the warm ups and everything like that.
And then we did the real hard workout, got my abs sorted out, my pecs and everything like that,
and I got my heart rate up to here and I was training out of breath and marine breathing rate went to this and it was really exciting.
Remember just to calm down and we did 20 minutes. Really hard work as a brain.
That's fantastic. All about herself and her body, which is OK, but she had a good time.
She loved it. She went and she had some people.
She then went to the green gym and you can see that is a tool to tell you how to work out an X in a post or at the beginning.
Then the heart rate goes up if you notice that heart rate goes up more than 20 minutes more than an hour.
In fact, it went on for two and a half hours in the cardiovascular training zone.
So she was doing conservation work for two and a half solid hours at a training level.
So we asked her what she did, how she said it was amazing.
I went down and we just looked at the Bank of the river and apparently the waterfall was coming back.
So we cleared some of that, this or that other stuff there and cleared that bank and be able to take some of the mooring ropes away.
We'll be able to get them back again. And then we learnt how to get the butterflies back for this area here.
And I love all the trees were and I realise there's an otter which is up there.
I had no idea about that. I met some fantastic people. We are big cake and we went down and had a cup of tea.
But you did two and a half hours cardiovascular training, and you haven't mentioned that at all.
Why, why should she mention it? Why do we have to do health as an extra thing?
Health should be as part of normal things, health as a means to an end.
The end is fulfilment and happiness. Health should never be the target end.
It shouldn't be the end itself. It should always be the means to an end.
Physical activity is definitely a means to an end because that lady has done more for her health, but she hasn't realised it for health by stealth.
If you want to call it that way. And Sarah mentioned about being street, we've been doing,
but we've now got over a million people who from the most deprived communities who've taken part and we make it a game.
That thing is little RFID beatbox. We put those all around a city or town,
and we give every single child in that area with all the schools a little RFID for if take it home and give it to their parents,
our aunts and uncles and neighbours and workplaces get them.
And before we know we have up to anything between 10 and 25 percent of the entire population playing a game, which I think How am I doing this game?
This is great fun. And I say, go out and meet each other and talking to other people, they're exploring areas.
We can bonus point so that people can go to the parks and green spaces and for six weeks.
The world is transformed in that place. So Barnsley, thirty seven thousand people were playing in Hounslow.
We've just finished there, twenty six thousand people playing, and we know that all sorts of things have taken place.
But the most important thing is the most deprived communities are the ones that benefit the most.
Because it's not health. We don't mention health. Public health pass,
actually for them is about a game and opportunity for the future of going to the parks they just discovered and learning new things.
And here in Hounslow, how's the traffic?
People put a camera up for street to find out what happened before and after street for six weeks.
You can see the gradual decline of House of Cars and vans as more people want to walk to school because
that's becomes the norm because everyone's trying to get more points for their school and gaming is a game.
Now at the bottom, we've seen even after a year that you sustain that behaviour because now the mum
or dad has actually had quality time with their child and it's worked very well.
So what started off as prises becomes looking at the environment, meeting up with friends, feeling good about yourself?
The prises were there just to get it going. Let's put those away now, so let's have a quick recap of his fourth revolution.
We've got resilience down the left hand side of strong social networks that place feeling secure, connexion type of purpose.
If that's weak, then stressful events create chronic stress, and chronic stress has that horrible effect on poor diet,
inactivity, alcohol, drugs, stress hormones and come out visceral fat forms.
We haven't talked about the because then you've got that triad of disaster, of chronic inflammation, telomere shortening,
mitochondrial damage leading in to all the health problems that we know in society, which will continue even if we've got the best medicine.
Because as people live longer, we can have three or four of them and we'll have more and more and more people with diabetes improve that resilience.
Strong social networks, beautiful place, connecting people together,
giving people that sense of purpose and control over their own health and their life.
Strong resilience, stressful events and now better off.
And if we could do that, we'd get more satisfaction, happiness and healthy diet.
So thank you very much. I'll leave that with you. But the fourth revolution?
Is where human beings in the communities, in groups just like where we were in our origins of a hunter gatherer, take control of our health.
Thank you very much. Thank you very much.
It's fantastic and a lot of food for thought there. Do we have any questions?
We've got a microphone, so if you want to put your hand up will weigh about you and then bring the microphone over and shout into them.
Thank you very much. That was really amazing to see how well you could express something that we all kind of know, but not that well expressed.
If I understood your weight right you, you are one of the main things you use as gamification in order to spread this.
How do you spread this by itself, from community to community without having somebody like you have to be there and instil it?
How do you make this so it spreads like a virus across the world?
That's a great question, and I think we've used streets as an experimental to really learn what it is that drives people to makes their life change.
So from that, I wouldn't expect you have beat the streets in every place on the planet so that we can try and get people to do it.
But I think the example of the green gym is you go to where people are in that,
what they believe in, what their values are and trying to understand that.
And what we found for most people doing street is that they want to do something for their children.
They didn't care about themselves. They want to do something for their children.
They want to do something for their community. And they want to keep learning and understanding things.
And by making something very local, ultra local. So there's no bus ride, but they can do something there.
And then whether it's learning some craft or doing the conservation work or going for a short walk
on a lead walk that is enough to get them out of their cycle of being indoors the whole time.
And the thing that will get them going will be something which is not health,
which is not physical activity, which is not one hundred and fifty minutes is not 10000 steps,
but it's something because my grandchild told me to do it because I want to go back to the old place I used to work.
I want to go to a football stadium where I support. So you're trying to make those things back to normal, so health gets lost.
And what we've lost is that we put health centre stage and that we put health at the centre stage will always have the health inequalities,
but instead, what do people want? How do they want their communities to work?
Peter St. We've learnt a lot. The people want something very simple. They want a nice place to live.
They want it to be comfortable. They want it to be good for their children.
They want to be able to have green space around and they want to be able to walk without fear of cars.
If we can try and get those values into people, then I think we can actually spread the understanding without having to be a game.
I love the speech. Fantastic. Thank you. Oh, hello.
Fantastic talk, I really enjoyed it. And like the other gentleman said, tell us a lot of interesting facts and things.
One thing I was interested in is your your particular graph that demonstrated that as green space increased around where people lived,
whether they were medium income or low income, their health increased.
But I personally don't know of many places that are very green or pretty high green,
where low income families are even able to live because by the time somewhere becomes very green at prices,
low income families out, just that's the way our society works.
If you look at inner city London, I can't think of a single area that is classed as low income that looks green.
The moment it becomes green, it gentrified and those people can't live there anymore.
So apart from gamification, which sounds fantastic and there have been attempts at it before, you know, and how do we how do we address that problem?
So honestly, what's going on here on this study?
They did, they did make sure that there was that accountability,
but it was actually it wasn't just where the gentrification comes in actually goes up.
So they allowed for that.
Interesting when they did this in the states, it didn't show that relationship because in the states where you had green space,
actually it meant you were in a suburban area and everyone was in the car.
So there was no physical activity whatsoever. So there's zero physical activity.
So that actually was a much, much flatter line. I think this is just been a new study is been done of of this and many other studies that was done,
I think in The Lancet right last year where they actually took all the studies together to work out.
And they did show that if you do plant up or you have what's perceived to be a safer area of green space, it does reduce inequalities.
It does help many things on the on the health front. So it's just by increasing the greenery in a way that people understand it.
So you don't want to have shades of people or people hiding behind hedges and things like that by intervening, it does make a difference.
So I think there is a better part of understanding what greenery counts,
what it is, and obviously a lot of studies and people have been working on that.
But there does seem to be that you can make it as an intervention and you don't need to gentrify it just by having a greenery,
because this can be a big housing estates where you can actually increase the
greenery incredible edible who've been doing in vegetable work or around Tadcaster,
etc. They've shown that you can actually improve a housing estate with greenery and keep the people there and keep those benefits.
So I think it's understanding what part of greenery is, what value to what the dose is, how it's planned, how it's marked.
I think we're still a long way away from knowing exactly what the prescription is in a way to a place where people live to make it better.
But I do believe from what we've seen and the evidence, and I get that study up, but it is some value we can do that.
Hello, thank you. And I was wondering what the evaluation showed from using these plant gardens or these green gyms to increase dietary,
you know, productive dietary outcomes of dietary changes over the long term after they had partaking in these activities.
And if there were sort of measurable circumstances that you saw through using that method that led people to actually choose better options available?
No, we haven't done any any of that research.
So two things about the diet and it's slightly out of my area because of dietary side is not my my strong point physical activity much more.
But I do know that when you are active and reduce when you're stressed and inactive and obese,
the grilling and the hormones of change make you choose the wrong foods.
You tend to go for the high calories and refined carbohydrates, and that that's is well known.
So just by taking people's stress away, you can start to actually undo that and they can choose a slightly better diet.
We've never done any studies on the green gym, on physical activity, and we don't know stress levels, but we obviously haven't chosen that.
We haven't done anything about their dietary behaviour. I'd love to think that it changes, but we haven't got any evidence.
But certainly, choice of foods is the thing that seems to change a lot when when physical activity starts and stress comes down.
I'm afraid I can't answer that question. It's not been done as far as I know.
That's one of the. I am.
So my question and it has just been touched on a bit, is we know that you took about people place and purpose as central to inflammation in the body.
But we do know that the food that you eat is also central to that.
So I also wondered, I know you sort of just answered it, but within that, we know that across the UK there are food deserts,
nutrition deserts where people can't access fresh, healthy foods that would help with the inflammation in their body.
So I just wondered what your thoughts were around addressing that?
Yeah, I mean, I didn't go into the the food side because it would have taken it too long.
And this was not my strongest point that you saw on the on this one here.
Is. The unhealthy gut microbial and obviously we now know that the gut brain axis and how the microbes.
Forty five percent of our cells in our body belong to bacteria, as we know from the gut.
So it is a hugely important site and what we eat makes a vast difference,
but also how that gut bacteria is laid down really from in utero and when we have when we're born.
And so even if you're having a caesarian section, your gut microbiome will be different than if you had a normal vaginal delivery.
So we should be going right back there for dietary changes of understanding antibiotics under the age of six months probably has major bigger effects,
and you've ever thought through the dietary side is in a way starts before we've even eaten anything because of getting a gut bacteria, right?
Because you become better resilience when you got the gut bacteria all healthy.
But you're absolutely right.
There is a real problem in nutrition, and I think to have the holiday hunger programmes across Britain is absolutely disgraceful.
I just find it most horrific thing that people don't have enough money to be able to have a normal good diet for their children during the holidays.
And we have to have these holiday hunger programmes. Otherwise it will just be refined carbohydrates and that's all they be eating.
So it is important growing, I think, as always, have to be a perception as this whole thing about growing your own food.
I would be very surprised that people would be able to continue with that in some of the very deprived areas.
We just have to ensure that good food is much easier to get.
But actually getting people's choice and making sure that they don't have to crave for the refined carbohydrates is probably as important as well.
A gentleman in the red jacket in the middle. Thank you.
Can we go virtual and it's going to be relevant, in other words, should my screensaver be a tree, should it come on every 10 minutes?
And should I have a tree picture on my on my office wall of cities?
Not to be trees all the time,
but I'm just wondering whether virtual actually could be a difference and whether that could be a way of scaling up really dramatically.
Yeah. Well, I hate to say this, but the evidence is it's very, very effective.
So I have the motivation. Yeah, and and I know a lot of the exciting work going on for older people who are doing virtual walks with VR,
virtual reality and the little thing they do have to get their feet off the ground.
They just shuffle back to the forwards and they can do walks with friends and they can go to places they used to go as a child.
And it's all done in virtual reality from our sitting room. So if they can't go out.
So I, you know, there's one part of you says, well, as dreadful because they should be out.
But if they can't get out right, because they're getting some activity and they're reliving an experience you used to have.
But having green pictures in operating theatres makes a difference in recovery.
Having your screensaver makes Microsoft have obviously done it well with the screen savers that they've got that.
Yeah. All the virtual stuff. It does work, but the real stuff is better.
I think I've got a microphone, so to speak. I'm part of the deprivation that you were talking about a few moments ago.
Holiday hunger, food banks and all the rest of it is a political choice that's been made in this country over the past 10 years or so.
So how are you taking your programme to government, both national government and local government?
Because there's a lot of persuading to do that. I mean, we've been sponsored by Sport England,
and some of the Sport England have got a very high target of reaching the most deprived communities and getting more active.
And they're really struggling.
They're really struggling to get sport and physical activity and get the people in a very deprived communities to be able to take take part.
Luckily, the chief executive now banning the words hard to reach because it's our problem, not their problem.
And I think we have to realise that way. We've been doing things in the past been quite patronising and wrong.
When we come into a place, we get them with all the schools on board.
We get a huge amount of ownership.
What we're struggling to do is to get the government and the NHS, particularly to show that actually it can be done.
You can actually invest is quite a bit is quite the ability to get people engaged in healthy living and healthy activities.
But we can't do it in the way we used to do it, which is probably more of a top down and little scheme.
This has got to be come from a community upwards, community owning it,
community enjoying it, not mentioning health, not mentioning some of the things,
but just to get people to do to just bring out their own ingenuity and understanding and doing
things to their children and doing things in their local area so we can start to build it up.
We go away and we know as some sustainability that lasts for over a year because we've gone there,
but we're all trying to get the dietary side into it. We're trying to get some of the other things.
We find the public health, sometimes just not quite getting it.
I can understand that, but I think in some areas the public health is still struggling to know how to deal with it.
And I I think I think we're still struggling to do it.
But you're right. Politically, it has been a problem, but there's still a lot of people who don't,
I don't think understand that this is a this is possible and you can make it happen,
but you have to invest in these places to make infrastructure better and get people to own the problem themselves and build it up.
I'm not sure that's a very good answer.
A lot of great politicians on that, but that helps the big Jones just feedback on anything that looks like Lady Health.
My question was going to be someone that was actually what is the role for Public Health England from a policy perspective.
But linked to that, obviously Public Health England and its policies trickle down to the GP surgery.
Is there not a critical role for GP surgeries and the practise of GP's and the surgery environment somehow in actually generating this process?
I think there's massive change. I mean, I think GP's roles are going to have to change dramatically if we're going to make any headway at all.
They're going to have to become we are going to have to become public health consultants as well and take
the role of the surgery now in our facility and make that area an area which we have to look after,
not just the people in it, but actually have an infrastructure change around it.
KPMG's the patient groups are now beginning to get more teeth and some of them are starting to really understand how they can look after that area.
And GP's started to say, No, you can't got to build a crossing, you've got to you can't build on that green space over there.
So I think GP's are going to be vital for taking part, but of course, we're not trained.
But I do think the moment that public health sits over their GP sit over here and we still haven't got that connexion.
And I think it's way overdue that we get that right.
And I think we're going to have to we're going to be forced to because otherwise we're unsustainable in our job.
I, of course, the last few people have sort of taken the questions are going to ask.
The last one was on the politics and we've got an election coming up and politicians of our money into the National Health Service.
They even invent that they're going to build lots of hospitals and all this sort of stuff.
So my spin on all this is how do you deal with all the vested interests that are vested in doing it differently from this?
And also, can you have a little bit of explanation about the stress thing? I mean, there are lots and lots of things driving stress in modern living,
whether it's people stuck on computers all day or it could be their jobs or their contracts,
which kind of policies would you enact to sort of make modern living less stressful as it were?
I invested interest in the health system in the TV and lots of places that are trying to drive us away from, you know,
healthy living by since I said we'd be doing some work in a big bank,
a very successful bank, it's money orientated and you've got all the commercial managers.
And I started to talk about kindness in the office and started to talk about values and sympathy and understanding
people where they're coming from and trying to make a place which is actually going to be much kinder.
But for them to do tough work, really tough work where the pressure is still there, but they feel secure and they have.
These top managers were talking about the girl who comes every mall, every Monday morning,
and she talks and talks and talks about the television the night before and over the weekend.
And what happened. I said, Oh my God, she's on again. And everyone was kind of, you know, eye rolling.
And many realised that she never saw anyone all weekend. She had no friends, no family.
And as a manager of an office where you're trying to get the best out of people, you're starting to see a shift.
They're putting plants in there. They're doing birdsong in some of these managers.
But I mean, these are things you'd never have heard of five years ago, 10 years ago.
So I think we're starting to see the corporate sector beginning to take this and saying, look, stress is destroying our bottom line.
How can we make people perform and be happier at work? So I think there's a line.
I don't think you can actually impose it, I think. But I work at the NHS as an awful lot of catching up to do from the NHS.
It's a very stressful environment and I think that we've got a long way to go on that.
And then I think it's the infrastructure.
I think the biggest thing we can do is to make places a better place to live, and that will be a vast amount of infrastructure change.
A lot of money needs to do that, but a little bit how Liverpool was transformed when Hazeltine went up there made something.
Yeah, I think every housing estate and everywhere where there's real danger, air quality is awful, where the roads are right by schools,
we've just got to change it bit by bit with a 30 year plan to change our infrastructure of where those people who are struggling with stress leave.
And I think that's probably the the easiest way we can. Well, not easiest, but the clearest way we can make a difference.
And then I think the workplaces, the other. I think we're we're out of time for questions, obviously, we'll be going next door for drinks reception,
so if you've got more questions, feel free to talk to him. Then if you've enjoyed this talk, please keep an eye on the Oxford Martin School website.
We've got talks from Paul Nurse and Chris Whitty being announced imminently,
and all that remains is for me to thank William for an excellent talk and lots to think about.