The handshake that ends the human race

Which brings us back to that handshake. Sir Richard said that while it would be impossible to stop people sneezing in public, abandoning the handshake in favour of the Hindu-style Namaste (palms together, a slight bow) would cut out another route for disease to spread.

Turning to other world health issues, Sir Richard said it was paradoxical that both hunger and obesity were growing at faster rates than at any time in history. “There are 1.6 billion overweight adults in the world and it is estimated that one billion people go to bed hungry every night,” he said.

While the hungry had their condition imposed upon them, it would seem that most overweight and obese people were simply being over-indulgent. However, he said the actual situation was much more complicated.

“A combination of salt, sugar and fat tends to override appetite mechanisms, plugging into primitive man’s desire to feast on these substances when they were available, and known to science as hedonic feeding,” he said.

“The fast food people have picked up on this, so they load their products with these items, which appeals to a primeval need to eat to excess.”

Research has shown that in developing countries overweight and obesity tended to make its appearance in the middle classes. As the country grew richer, the middle classes started to heed health messages, abandon their bad diets and take more exercise. The poorer people, with a little more income to free them from actual hunger, began to feast on junk food.

“India and the United States are classic examples of each case,” he said. “In India, overweight and obesity is still a middle class problem while in the US it is almost exclusively found among poorer, less educated people.”

What he described as the “succession of dietary fads” actually added to the problem.

“There are so many confusing messages that people actually give up,” he said. “Dietary guidelines are impossibly complicated. The big message is simply prefer plants to meat, but this is obscured by all the micro messages.”

Sir Richard said the basic requirements of a good health system were easy access to high quality facilities at an affordable price. Many developing countries had a mirror image of this - poor access, dilapidated facilities and, where they were in reasonable condition, at a price that put them out of reach of all but the richest segment of the population.

“In Africa $16.5 billion is spent on health care, but 60 per cent of that comes directly out of people’s pockets because hardly anywhere has a properly functioning insurance system,” he said. “It means that a serious illness often results in incredible hardship both to the patient and their extended families.

“A typical district hospital is rundown, lacking reliable water, sanitation or electricity, with absent or broken equipment, inadequate supply chains for essential commodities, chronic staff shortages, low service quality and poor clinical outcomes.”

Despite all the bad news Sir Richard remains an optimist, saying organisations such as the Bill and Melinda Gates Living Proof Project point the way forward. However, the United Nations Millennium Development Goals may have to be revised.

“They concentrate on attacking hunger and improving nutrition, with hardly anything on pandemics other than HIV-AIDS and nothing about obesity and health systems,” he said.

“It will be important for new goals to be adopted when they are reviewed in 2015.”