Transcript HEALTH PROMOTION AND DISEASE PREVENTION

HEALTH PROMOTION AND
DISEASE PREVENTION
Christine M. Zammit, RPA-C
HEALTH
Health is not only the absence of illness
Described as a state of complete physical,
mental and social well being
Determinants of Health
Biology
Genetic makeup, family history and health
problems acquired during life
Behaviors
Individual responses to internal or external
stimuli
Personal choices and physical and social
environment can affect behaviors
Social environment
Interactions with family, friends, coworkers
and others in the community
Physical environment
That which can be seen, touched, smelled or
tasted
Invisible agents such as radiation, carbon
monoxide, etc.
Policies and interventions
Stop smoking campaign
Back to sleep campaign
Child restraints
Immunizations
Access to Health Care
Expanding access to healthcare will
increase quality years of life for all
Americans
Healthy People 2010
Goal # 1
To help individuals of all ages increase life
expectancy and improve their quality of life
Life expectancy
The number of years persons born in a given
year are expected to live based on age specific
death rates
Today life expectancy is about 77 years
Quality of life
General sense of happiness and satisfaction
with life and our environment
Leading Causes of Mortality for
All Ages in the United States
Diseases of the heart
Malignant neoplasms
Cerebrovascular disease
Chronic lower respiratory diseases
Accidents
Diabetes
Influenza and pneumonia
Alzheimer’s disease
Nephritis, nephrotic syndrome and
nephrosis
Septicemia
Suicide
Chronic liver disease and cirrhosis
Essential hypertension and renovascular
hypertension
Parkinson’s disease
Pneumonitis
Leading Causes of Mortality
from Ages 1-4
Accidents
Congenital malformations, chromosomal
abnormalities
Malignant neoplasms
Homicide
Diseases of the heart
Leading Causes of Mortality
from Ages 5-14
Accidents
Malignant neoplasms
Congenital malformations, chromosomal
abnormalities
Homicide
Suicide
Leading Causes of Mortality
from Ages 15-24
Accidents
Malignant neoplasms
Congenital malformations, chromosomal
abnormality
Homicide
Suicide
Leading Causes of Mortality
from Ages 25-44
Accidents
Malignant neoplasms
Disease of the heart
Suicide
Homicide
Leading Causes of Mortality
from Ages 45-64
Malignant neoplasms
Disease of the heart
Accidents
Diabetes mellitus
Cerebrovascular disease
Leading Causes of Mortality
Ages 65 and older
Disease of the heart
Malignant neoplasms
Cerebrovascular disease
Chronic lower respiratory disease
Alzheimer’s disease
Leading Health Indicators
Healthy People 2010
Exercise
Mental health
Obesity
Environmental quality
Smoking/Substance abuse
Sexual behavior
Immunization
Access to health care
Leading Health Indicators
Reflect the major public health concerns in
the United States
Specific indicators used to track progress
Motivate action
Goal is to help everyone understand the
importance of health promotion and
disease prevention
Physical Activity
Regular physical activity can
Decrease the risk of CHD, colon cancer, CVA,
DM, HTN
Promotes healthy bones, muscles and joints
Prevents obesity
Decrease the prevalence of falls in adults and
arthritis pain
Decrease LDL, increase HDL
Increase lean muscle mass and decrease body
fat
Enhance psychological well being and decrease
incidence of depression
The following populations have low levels of
physical activity
Women
African Americans and Hispanics
Low socioeconomic class on lower education
Persons with disabilities
Those who live in northeastern and southern US
Barrier to physical activity
Time constraints
Motivation
Environment
Those who find exercise boring
Recommendations
Adults
30 minutes of moderate intensity physical
activity at least 5 times/week
Children and adolescents
60 minutes of moderate intensity physical
activity most days of the week
Overweight and Obesity
Major contributor to causes of preventable
deaths in the US
2/3 of the population in the US are
overweight
30.5% of the US population is obese
Prevalence has increased in all age groups,
genders, races
Increased prevalence in African Americans
and Hispanics
67% of patients with Type 2 DM have a
BMI >27
Overweight and Obesity
Overweight and obese persons are at
increased risk for morbidity and mortality
from
CHD
CVA
DM
Gallbladder disease
Osteoarthritis
Breast/endometrial/prostate and colon cancer
Obesity is the result multiple factors
including genetics, environment, social,
culture and behavior
Efforts to maintain a healthy weight
should begin in early childhood and persist
through adulthood
Increasing physical activity is also
important to attain this goal
Goals
Increase number of adults at a healthy
weight
Decrease the number of obese children
Increase physical activity
Working together with school system to
encourage healthy lifestyle
Making environment more accessible to
those who engage in outdoor physical
activity
Healthy foods
Fruits and vegetables
Low fat milk and dairy products
Fish
Lean meat
Poultry
Beans
Whole grains
Tobacco Use
Cigarette smoking is the most preventable
cause of death in the US
430,000 tobacco related deaths in the US
per year
Main goals of this objective are to reduce
the number of adolescent and adult
tobacco smokers
Smoking is a risk factor for major cardiac
events as well as stroke and lung cancer
Smoking during pregnancy can result in
preterm labor, STOP, SIDS
Environmental tobacco smoke increases the
risk of asthma and bronchitis
Also responsible for lung cancer
Groups at risk
Adolescent smoking is on the rise
White high school students have the highest
incidence
American Indians, Alaskan natives, blue collar
workers and military personnel have highest
rate
Men are slightly more likely to smoke than
women
Persons with low income are more likely to
smoke than those with higher income
Goals
Decrease adult and adolescent tobacco
smokers
Increase number of physicians and doctors
who counsel their patients about smoking
cessation
Increase number of schools that provide
information on tobacco use
Increase average age of first use of
tobacco
Eliminate tobacco advertising
Increase federal and state tax on tobacco
products
Promote smoke free indoor areas
Reduce illegal buy rate among minors
Substance Abuse
Alcohol and illicit drug use are associated
with all of the following
accidents, injury, homicide, suicide, assault,
HIV transmission
child and spousal abuse
Leads to low worker productivity, and
homelessness
Disrupt family, personal and social life
Alcohol abuse alone can lead to cirrhosis,
pancreatitis
Reduce illegal sale of alcohol to minors
Education in schools about the dangers of
alcohol and drug abuse
Support groups
Responsible Sexual Behavior
Unsafe sexual practices can lead to
unplanned pregnancies, transmission of
STD’s
Abstinence is the only method of complete
protection
Condoms can help in the prevention of
STD’s and unplanned pregnancies if used
correctly
Half of all pregnancies in US are
unintended
Rates have been declining
Highest prevalence in teenagers, women over 40
and low income African American women
STD’s
15 million new cases of STD’s per year
4 million of these are in adolescents
Women have higher complication rates than
men
African Americans and Hispanics have a higher
rate
800,000-900,000 people infected with
HIV/AIDS in the US
½ of newly diagnosed patients are under
the age of 25 years old
Leading cause of death for African
American men aged 25-44
Goals
Decrease number of unintended
pregnancies
Decrease transmission of HIV and other
STD’s
Encourage abstinence
Encourage safe sexual behaviors
Safe sex education in schools and at home
Condom distribution in high schools and on
college campuses
Mental Health – Focus on
Depression
20% of people in the US are afflicted with
a mental illness
Mental health is the state of successful
mental functioning, resulting in productive
activities, fulfilling relationships, ability to
adapt to change and cope with adversity
Depression is the most common mental
disorder with over 19 million patients
affected
Depression causes high degree of disability
and is the cause of 2/3 of suicides
Depression is under diagnosed and under
treated
Affects all ages, races, and genders
however
Older adults have a higher rate of depression
Women are affected 2 times as often as men
Poor, uneducated women are more commonly
affected
More common among those with coexisting
medical conditions
Depression
Patients with depressive disorder are
often unable to fulfill the daily
responsibilities of being a spouse, partner
or parent
People often do not seek help, because of
the stigmata associated with mental
illnesses
One of main goals for the mental illness
indicator is that people with recognized
depression be treated appropriately
Environmental Quality
25% of preventable illnesses worldwide can
be attributed to poor environmental quality
Two indicators being looked at are ozone
and environmental tobacco smoke
Physical and social environment play major
roles in the health of individuals and
communities
Environmental quality is a global concern
Poor air quality contributes to respiratory
disease, cardiovascular disease and cancer
Although air pollutants have decreased
steadily in last few decades, it is still a
major concern
Environmental tobacco smoke is a major
problem, with home and the workplace
being major sources
Goals
Continue to
ensure clean drinking water
Safe waste management
Provide safe food
Decrease environmental tobacco smoke
Improve air quality
Immunizations
Help prevent disability and death from
infectious disease
Help to avoid the spread of disease within
a community
Coverage levels for immunizations in
children are high, but need to be higher
Coverage levels for adults is less than
children
Goals include to increase the proportion of
children who receive all vaccinations that
have been recommended for universal
administration for at least 5 years
Increase the proportion of noninstitutionalized adults who are vaccinated
yearly against influenza and ever against
pneumococcal disease
Access to Health Care
Predictors of access to health care
Health insurance
Higher income
Primary care provider
Health insurance
Provides access to healthcare
More likely to have primary care provider
More likely to have immunizations and screening
tests
44 million people in the US do not have health
insurance
Primary care provider
40 million Americans do not have a regular
doctor, clinic or healthcare center they go to
for healthcare
Barriers
Financial
Cultural
Spiritual
Lack of healthcare providers/specialists
Language barriers
Poor education
Goals
Increase the proportion of patients with
health insurance
Increase the proportion of persons who
have a specific source of ongoing primary
care
Increase the proportion of pregnant women
who begin prenatal care in the first
trimester
Health Disparities
2nd goal of Healthy People 2010 is to
eliminate health disparities
Gender
Some disparities are a result of biological
difference
Men have life expectancy 6 years less than
women
Men have higher death rates for 10 leading
causes of death
Race
Biologic differences between African
Americans, Pacific Islanders, Hispanics, Native
American Indians do not explain the
differences when these groups are compared
with non-Hispanic Caucasians
African Americans
Infant mortality rate double Caucasians
Increased death rate from all cancers and HIV/AIDS
when compared to Caucasians
Hispanics
More likely to die from DM
Increased prevalence of TB
Higher prevalence of HTN and obesity
American Indians and Alaska natives
Increased infant death rate
Prevalence of DM 2x that in the Caucasian population
Asians and Pacific Islanders
One of healthiest groups in the US
Vietnamese women suffer from cervical cancer 5
times more than white women
Health Disparities
Income and education
Populations with worst health status, are those
most poverty stricken and those with the least
education
Higher income groups have better access to
health care
Disability
21% of US
More complaints of anxiety, pain, restlessness
and sleeplessness
Increased prevalence of obesity
Geographic location
25% of Americans live in rural areas
Injury related deaths 40% higher in these
areas
Less likely to use screening measures, wear
seatbelts or use helmets
Sexual orientation
Gay, male adolescents are 2-3 times more likely
to attempt suicide than their peers
Prevention
Primary Prevention
Measures provided to individuals to prevent
onset of a targeted condition
I.e.. Immunization, bicycle helmets, safety belts
Most cost effective
Secondary Prevention
Identify and treat asymptomatic persons who
have already developed risk factor or preclinical disease but in whom the condition is not
apparent
Screening tests
Tertiary Prevention
Involves care of established disease
Attempt to restore highest function
Prevent disease related complications
Recommended Screening
Guidelines
Breast Cancer
Clinical breast exam every 3 years for women in
20’s -30’s and every year after 40
Mammogram yearly after age 40
Follow doctor’s recommendation for those
considered to be at high risk
Cervical Cancer
PAP test within 3 years of beginning vaginal
intercourse but definitely by age 21
Yearly PAP with old method, every 2 years with
new liquid based PAP
At 30 years old, with 3 normal PAP smears, may
get screened every 2-3 years
At 70 years old, with 3 normal PAP smears, may
choose to discontinue screening
Colorectal cancer (one of these)
Yearly fecal occult blood test (FOBT)
Sigmoidoscopy every 5 years
Yearly FOBT plus sigmoidoscopy every 5 years
Double contrast barium enema every 5 years
Colonoscopy every 10 years
Recommended Screening
Guidelines
Prostate Cancer
Digital rectal exam and serum PSA yearly for
men older than 50
May begin screening earlier for high risk
patients
Diabetes screening
Every 3 years for those with risk factors
After age 50, every 3 years
Melanoma screening
At least every 5 years
No more than once/year for those with risk
factors
Chlamydia and STD screening
Once a year for sexually active men and women
until age 26
Cholesterol screening
At least every 5 years
More frequently if high, or with risk factors