Transcript Health Crisis in the United States: The Good News and the

Physical Activity &
Tobacco Prevention
as the Keys for Health Promotion
Mohammad R. Torabi, PhD, MPH, CHES
Interim Dean & Chancellor’s Professor
School of Health, Physical Education, and Recreation
Indiana University – Bloomington
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Outline

Leading Causes of Death

Paradigm Shift

Economics of Prevention

Actual Causes

Opportunities

Conclusions
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Leading Causes of Death
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3 Leading Causes of Death, 1900
(Transmissible Diseases)
Pneumonia
11.8
Tuberculosis
11.3
Diarrhea/Enteritis
8.3
0
5
10
% of all deaths
Source: Centers for Disease Control Prevention, National Center for Health
Statistics, National Vital Statistics System and unpublished
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4
3 Leading Causes of Death, 2000
(Non-Transmissible Diseases)
29.6
Heart Disease
23
Cancer
7
Stroke
0
10
20
30
% of all deaths
Source: Minino et al. Deaths: final data for 2000. Natl Vital Stat Rep. 2002; 50:1-120.
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5
Top 3 Actual Causes of Death,
2000
(Lifestyle Related)
435,000 18.1
Tobacco
400,000
Poor Diet /
Inactivity
Alcohol
Consumption
16.6
85,000 3.5
0
5
10
15
20
% of all deaths
(Numbers of Death Shown in Red)
Source: JAMA, March 10, 2004; 291(10): 1238-1246
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Mortality rates due to major causes of
death, Thailand, 1967-2006
Diseases and risk factors among
Thai males, 2004
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Source: Working Group on Burden of Disease and Risk Factors
in Thailand, International Health Policy Programme, 2006.
Diseases and risk factors among
Thai females, 2006
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Source: Working Group on Burden of Disease and Risk Factors
in Thailand, International Health Policy Programme, 2006.
Joseph A. Califano:
(former secretary of the US Department of Health and Human Service)

We are killing ourselves by...

our own careless habits,

carelessly polluting the environment, &


permitting harmful social conditions to persist –
conditions like poverty, hunger, and ignorance which
destroy health.
You, the individual, can do more for your own health
and well being than any doctor, any hospital, any
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drug, or any exotic medical device.
Paradigm Shift
Control of infectious disease paralleling
the emergence of chronic disease
Percentage of causes of disabilityadjusted life years (DALY) lost of
Thai people by age group, 2004
Source: Working Group on Burden of Disease and Risk Factors, Thailand.
International Health Policy Programme, 2006.
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Paradigm Shift
Treatment
+
Quarantine
+
Hygiene
Lifestyle
+
Health
Education/
Promotion
+
Environment
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Economics of Prevention
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Annual Economic & Health Burden of Chronic Disease
Disease/
Risk Factors
Morbidity
(Illness)
Mortality
(Death)
Direct Cost/
Indirect Cost
Diabetes
20.8 million
200,000
$174 billion
Heart Disease &
Stroke
80 million
870,000
$448 billion
Cancer
1.3 million new
cases /year
45.3 million
adults
553,000
$219 billion
438,000
$193 billion
400,000.
$117 billion
Tobacco
Obesity/
64% of adults
Physical Activity/ are overweight
Nutrition
or obese
Source: http://www.cdc.gov/NCCdphp/press/index.htm
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During the Past 30 Years the Percentage of
the GDP Consumed by Health Care Doubled
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The Cost of Health Care Threatens the Ability of the
U.S. to Compete Economically with Other Nations
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Is This a Rational Investment Strategy?

Proportion of health
expenditure going to the
population-wide core
functions of public health
vs. medical treatment

Proportion of early deaths
that could be prevented
by population – wide
public health approaches
vs. medical treatment
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Actual Causes
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Major Causes of Morbidity & Mortality
#1 Tobacco Use
- Cigarette: the Gateway Drug -
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Dose-Response Relationship Between
Cigarette Smoking and Other Drug Use
By Indiana Students in Grades 5-12
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Source: Torabi et al.
Dose-Response Relationship Between
Cigarette Smoking and Other Drug Use
By Indiana Students in Grades 5-12
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Source: Torabi et al.
Cigarette Smoking Among US Men, Women, High School
Students, and Mothers during Pregnancy, 1965 – 2003
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Source: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group
If you are a smoker, your life…
80
74.4
79.8
61.2
70
65.3
60
-14.5 yrs
-13.2 yrs
50
40
30
20
10
0
US Mean
Smokers
Males
Females
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Source: MMWR 1997;46:444-51
If smoking relaxes you, then don’t quit.
Being dead is very relaxing.
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Major Causes of Morbidity & Mortality
#2 Overweight/Obesity
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Obesity Trends Among U.S. Adults
BRFSS, 1985
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
Source: Behavioral Risk Factor Surveillance System, CDC
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Obesity Trends Among U.S. Adults
BRFSS, 1990
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
Source: Behavioral Risk Factor Surveillance System, CDC
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Obesity Trends Among U.S. Adults
BRFSS, 1995
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14
15%–19%
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Source: Behavioral Risk Factor Surveillance System, CDC
Obesity Trends Among U.S. Adults
BRFSS, 2000
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
≥20
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Source: Behavioral Risk Factor Surveillance System, CDC
Obesity Trends Among U.S. Adults
BRFSS, 2005
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
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Source: Behavioral Risk Factor Surveillance System, CDC
Obesity Trends Among U.S. Adults
BRFSS, 2009
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
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Source: Behavioral Risk Factor Surveillance System, CDC
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Source: National Health and Nutrition Examination Survey, 2004
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Source: National Health and Nutrition Examination Survey, 2004
Why Has Caloric Intake Increased?
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More food available

Cheaper
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Greater variety
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Easier to acquire

Heavily marketed by more effective media
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More calorie dense foods

High-fructose corn syrup
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Super-sized
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More people who model increased caloric intake
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Why Has Caloric Output Decreased?
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Fewer occupations require physical labor

Fewer physical household chores
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Less need and opportunities for manual
transportation (walking, biking)

More attractive sedentary leisure-time activities
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Less physical education and other physical activity

More people who model decreased caloric output
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Why does it take six weeks to lose five pounds,
but only one day to gain it all back?
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Major Causes of Morbidity & Mortality
#3 Lack of Physical Activity
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Benefits of Physical Activity
Physical activity can lower the risk of:

Coronary heart disease

Stroke

Type II diabetes mellitus

High blood pressure

Colon cancer by 30–50%

Active people have lower premature death rates
than people who are the least active
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Adults with 30+ minutes of moderate
physical activity 5 or more days per week
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Source: Behavioral Risk Factor Surveillance System, 2007
Adults with 20+ minutes of vigorous
physical activity 3 or more days per week
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Source: Behavioral Risk Factor Surveillance System, 2007
2007 National Average:
Recommended Physical Activity by Age
Age
18-24
25-34
35-44
45-64
65+
Recommended
59.0
53.2
49.6
46.6
39.3
Insufficient
31.9
36.9
39.8
39.6
36.9
Inactive
9.1
9.9
10.7
13.8
23.7
No Leisure-Time
Physical Activity
18.4
20.8
22.3
24.8
32.7
Source: Centers for Disease Control and Prevention, 2007
Opportunities
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Progress



Slowly prevention getting attention of
policy makers
Funding for tobacco settlements
New funding for nutrition and physical
activities
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Smoking Prevention in Thailand
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What fits your busy schedule better,
exercising one hour a day or
being dead 24 hours a day?
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Conclusions
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What Does Prevention Do for Us?
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10 to 20 years of extended life
Improved quality of life
Reduced chronic disease
Less medications/hospital visit/surgery
Postponed disability
Save money
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Recommendations





Building infrastructure,
academic units,
service units,
community agencies,
pilot projects,
Providing wellness services
Developing and offering a wellness course
as a core course for all students
Advancing research
Leading by examples
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Ultimately

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

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Do not start smoking
If you smoke, quit
Adopt an active lifestyle
Limit time spent in front of TV & computer
Stay intellectually active
Sleep between 6 to 8 hours a day
Have balanced variety of foods
Reduce stress
Count your blessings
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“It is health that is real wealth and
not pieces of gold and silver.”
- Mahatma Gandhi
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Thank You!
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