DISRUPTING AGEING
Longevity and good health no longer have to be mutually exclusive, says China-born Victor Dzau, head of the US National Academy of Medicine.
In a world where just about every sector is facing disruption, ageing has not been spared. After all, if the possibility exists that we can be healthier for longer, surely it’s a goal worth pursuing. Victor Dzau certainly agrees. “Ageing is a process of getting older and biologically, your tissues have degeneration and you get disease,” says the president of the US National Academy of Medicine (NAM).
“Disruption would be to create health as you age. What we want is to achieve healthy longevity, not just ageing alone.”
The professor was in Singapore in early February to attend a two-day workshop on the Global Roadmap for Healthy Longevity initiative. It was the early stages of the Covid19 outbreak, just over a week after the first cases of infection were reported in the citystate, but more of that later.
Singapore was chosen for the workshop because the international commission appointed by the NAM was looking for places where “there’s a lot of attention” and where there are good public health programmes in place, Prof Dzau says.
Over 200 participants, including more than 70 health experts from 16 countries, turned up for the workshop, which was co-hosted by the National University Health System, the Office for Healthcare Transformation, the National University of Singapore and the National Research Foundation Singapore.
Over two days, health experts and leaders from multi-disciplinary backgrounds discussed the nature of ageing as they worked through a “global roadmap” — a blueprint of sorts on best practices that countries can refer to in shaping policies on health and longevity.
“The whole idea is to not think about it when you’re older but throughout the course of your life, so that you are healthier when you are getting to an older age,” says Prof Dzau.
Healthy longevity means improving people’s physical, mental and social well-being as they age, he points out. It’s about moving away from the idea of “disease to disease” to achieve health, a better quality of life and better productivity.
LIVING FOREVER?
In that case, as technology advances, can we then ever see our lives extended such that we can one day live forever?
Prof Dzau chuckles at the suggestion, but ultimately doesn’t think it is possible.
As a baby boomer, he says, his generation has been able to live healthier and longer lives because their parents created a better environment for them.
“I think the worry is the new generation, especially in America; there’s more obesity, diabetes, and maybe you won’t see that kind of life expectancy increase,” he says.
And that’s because the human body and genes are adapted to a time when people had less food but today we have a society living in abundance, he says.
This means that our modern lifestyle and resulting diseases may have instead created a new set of limitations for ourselves.
“Even though I’m very optimistic about the next generation because people are smart, they’re multi-faceted, at the same time, they’re very challenged by many issues,” he says.
“I do know that if everything continues in a positive way, biologically, you can live past 100,” he says.
There are already more centenarians living today than ever before, with the number projected by the United Nations to increase to a new high of some 573,000 this year.
But many factors are at play that could influence biology, he adds, among which are climate change, mental health problems and stress.
Perhaps the question is — do people necessarily want to live longer lives?
While people already are living longer, the twilight years tend to be spent in ill health. Life expectancy in Singapore has risen steadily to now 84.8 years.
But the last 10 years of an average Singaporean’s life are spent in disease, according to a report titled “The Burden of Disease in Singapore 1990-2017” released in June 2019.
“We’re making an assumption because of the statistics that people are living longer,” says Prof Dzau. “So perhaps the more important issue is that people want to live longer if they’re healthier and happier.”
Prof Dzau, who will turn 75 in October, is the epitome of healthy ageing. Retirement is far from his mind as long as he feels a sense of purpose.
“Every chance I have an opportunity to make a difference, to feel that I’m doing something useful for society and to use what I’ve been trained and educated to do, I feel that’s worthwhile,” he says.
The alternatives are just as attractive — improving his golf game and spending time with his grandchildren — but making a difference and having a good purpose are what he considers most important.
He has been imbued with this sense of duty since a young age.
He recalls his earliest memory — that of leaving Shanghai for Hong Kong, to escape the Chinese Communist Revolution in the 1950s — describing the border crossing with hundreds of other people like “what you see on television”.
“As a family of five, we lived in a single room for a period of time until my father was able to find a job. I also remember the poverty, the disease — tuberculosis (TB) was rampant,” he recalls.
His grandparents and parents all had TB, and his grandmother later died from it.
But the family setback turned into a motivation for Prof Dzau to become the eminent physician, researcher and leader that he is today.
The whole idea is to not think about it when you’re older but throughout the course of your life, so that you are healthier when you are getting to an older age
We’re making an assumption because of the statistics that people are living longer. So perhaps the more important issue is that people want to live longer if they’re healthier and happier
SCIENCE BEHIND MEDICINE
He moved to Canada to study medicine at 18 and became very interested in the science behind medicine — a passion that took him through research programmes and eventually to various leadership positions in Stanford University and Harvard University.
As chancellor for health affairs at Duke University and living in the diverse 250,000strong community of Durham, North Carolina, he had a realisation.
“You begin to realise that of course, as somebody in health and healthcare, I’m responsible for the health of all the people in the community,” Prof Dzau says.
“So I became very actively involved with the community and quickly realised that social determinants are so important — education, housing and all those things.”
His work in the community goes beyond healthcare to education-related fields and other areas.
In 2014, Prof Dzau was appointed president of the NAM (then called the Institute of Medicine). It’s a position he considers pivotal in bringing everything together.
“As the US National Academy of Medicine, we are very powerful in our voice,” he says.
“Our reports can influence a lot of things, and the US government, Congress and the administration listen to us as this global (healthcare) government.
“So my feeling is this is my opportunity to bring all the experience that we have and all the great brain power to see how we can make a difference globally.”
But being a leader does not simply mean being a boss, he says. Instead, it’s about understanding what people need and mobilising the organisation with the same vision.
“That’s where you can contribute most. All the other skill sets can be acquired, or you have good people around you – very good finance people, very good human resource persons — but I think the most important thing for anyone is a sense of having the values, the principles and the sense of leadership as well,” he says.
PROUDEST ACHIEVEMENT
As an established cardiovascular and genetics researcher, Prof Dzau has had countless accolades, but one of his proudest achievements is setting up Duke-NUS Medical School in Singapore.
In 2005, Duke University and the National University of Singapore signed a deal to establish a graduate-entry medical school to build up Singapore’s supply of doctors who would be exposed to clinical research and help increase the nation’s capacity to develop a biomedical hub.
“We were very fortunate to be chosen, and I feel that if Singapore asks us to do this, it’s so important that we must do a good job,” Prof Dzau says.
“Today, if you look at the results of the school and the students and the research, we’re very proud of them.
“And of course, it’s important for me to have the relationship with so many friends in Singapore; I feel like this is my home as well.”
Prof Dzau is certainly no stranger to Singapore, having been a SingHealth board member from 2008 to 2018 and then being made an Honorary Singaporean in 2019.
His good faith in Singapore’s public health system is also what brought him to the republic at a time when people are avoiding travel due to the coronavirus outbreak.
Prof Dzau’s illustrious career in medicine spans more than five decades, during which he has seen his fair share of pandemics — from Ebola to Sars to H1N1, and now Covid-19.
“The difference so far is that the case fatality is much lower but transmission may be much more rapid. Why? Because it seems that you can transmit the coronavirus without symptoms,” Prof Dzau says of Covid-19.
“So there may be a lot more people exposed, and you can see how fast it is.”
Most estimates put the fatality rate at about 2%, although Chinese officials say the death toll at ground zero is about 4%. In comparison, Sars had a 10% fatality rate.
Asked if the world is adequately prepared to contain the Covid-19 outbreak, Prof Dzau was tight-lipped, saying it is too early to tell. (This was early February and the situation was still very fluid and unclear.)
“The only measures we have for a condition like this without any medication or cures right now is public health, which is what Singapore does so well,” he said at the time.
The good news, though, is that work on vaccines has already begun, with vaccine platforms that are much faster and RNAbased. He estimates it could take about four months for a vaccine to emerge. But even so, Prof Dzau would not go so far as to say he is optimistic about the situation.
“I’m feeling better (about this) than previous outbreaks because man can only control that much, so we need to know more about the virus.
“But I think the overall response has been more expedited, more prepared, and that’s what we want.”