Prof. David Jones (Harvard University): The Lost War on Heart Disease? Historical Lessons from a Resurgent Epidemic

Coronary artery disease became the leading cause of death worldwide in the twentieth century. In the 1950s, however, CAD mortality began to fall, first in California, and then throughout the United States and in other high income countries from New Zealand to Norway. Mortality rates fell 50 percent in many countries, one of the great accomplishments of modern public health and medicine. In the 1990s, however, disease surveillance programs began to detect signs that the decline of CAD had slowed or plateaued. In some populations the decline has reversed. Life expectancy in the United States has now decreased for the first time in over a century. Health officials similarly fear an impending epidemic of dementia, despite evidence that the incidence of that disease has recently begun to decline. How should these public health fears be assessed? How should health policy priorities be set? I will trace the history of disease decline and resurgence to identify patterns in how public health officials create data and craft them into powerful narratives of progress or pessimism. This perspective can help us to interpret the narratives that circulate today.