Transcript Document

Actual problem of prevention
Northern-West State Medical University named after I.I. Mechnikov
Department of Public Health and Health Care
Elena A. Abumuslimova
Ph.D., Associate Professor
Health is a state of complete Physical, Mental, and Social
well-being and not merely the absence of disease or
infirmity.
The Metaphysical
Context of the Universe
Physical
Mental
Social
The Secular Dimensions of
Health
WHO, 1947
Two Major Aspects of Health
 Feeling Well
 Ability to Function
Determinants of Health
 the complex inter-relationships of
 genetics
 social environment
 physical environment
 behavior
 health/illness services
that determine the level of health and sense of wellbeing in an individual
Lifestyle Factors are maximally
conducive to good health
 “Genes load the gun.
Lifestyle pulls the trigger”
Dr. Elliot Joslin
Lifestyle Factors
 Since 90th time, there is more and more concrete
evidence indicating that practicing healthy habits
can significantly decrease our chances of
developing chronic disease.
 Therefore, of all the health determinants that we
have discussed, lifestyle factors are among the most
controllable and influential factors influencing our
health.
Lifestyle Factors & The Prevention Movement
 Lifestyle factors and healthy habits can decrease risk of
chronic disease.
 Some 60% of chronic diseases are considered
preventable.
 Practicing healthy habits is one of the best strategies to
stay healthy longer and to enhance the quality of life.
Choices made in regard to:
 Smoking
 Nutrition
 Exercise
 Substance Abuse
 Rest
 Stress
 Sexual behavior
 Other Life-style Factors
Lifestyle Factors: Smoking
 Tobacco use in the form of smoking and the effects of
second hand smoke kill more people each year in the
World than alcohol, cocaine, heroin, homicide, suicide,
firearms, and AIDS.
 Tobacco is a leading risk factor for mortality
responsible for 5.1 million deaths a year. Almost 1in 8
deaths of adults over the age of 30 is due to smoking.
 Upwards of 87% of lung cancer deaths are among
individuals who have smoked.
 There has been an increase in teenage smoking rates.
Percentage of deaths over age 30 caused by
tobacco, 2004
Lifestyle Factors: Nutrition
 Being overweight or suffering from obesity is the fifth
leading risk for death.
 It responsible for 7 per cent of deaths globally – 8 per
cent in high income countries and 7 per cent in middle
income countries.
 Too much food intake, high fat diets, larger portion
sizes, and lack of exercise are all contributors to the
obesity epidemic.
Lifestyle Factors: Exercises
 Being physically active is one of the most
positive things we can do for our health.
 Recently, studies have documented the
benefits of exercise to psychological wellbeing.
 Experts agree that both weight bearing
resistance training and aerobic training are
important for optimal fitness. However, it
takes aerobic exercise to burn fat tissue
because oxygen must be present for this
metabolic process to occur.
Lifestyle Factors:
Substance Abuse – Alcohol
 Alcohol is in third position in terms of lifestyle factors that
contribute to death from disease and accidents.
 Drinking too much alcohol is highly associated with
cirrhosis of the liver and increased risk of certain types of
cancer, that of the mouth, esophagus, and throat.
 Alcohol is interesting because moderate intake is known to
have health benefits whereas over-consumption contributes
to serious disease. A glass of wine daily is associated with
improved cardiovascular health, particularly with lowering
cholesterol. Red wine has been shown to have the most
positive association.
Lifestyle Factors: Sleep Deprivation
 Studies show that individuals who sleep less than 6 or
more than 10 hours on a regular basis, have a lower life
expectancy that those who get between 6-10 hours
nightly.
 Consequences of being sleep-deprived include:
- Daytime sleepiness
- Irritability
- Difficulty dealing with stress and conflict
- Reduced productivity
- Drowsy driving
Lifestyle Factors: Stress
 Continual stress in life sets off chemical
reactions in the body that can eventually lead
to illness.
 Individuals constantly under stress are at
greater risk for heart disease and other
conditions.
 Practicing healthy habits can help alleviate
stress.
Lifestyle Factors: Sexual Behavior
 Unsafe sex that leads to transmission of human
papilomavirus is responsible for virtually all death
due to cervical cancer.
 Cervical cancer is responsible for 11 per cent of
global unsafe sex deaths and is leading cause of
cancer death in Africa.
Genetics
 Body Size
 Special Abilities
 Disease Resistance
 Disease Susceptibility
 Genetic Diseases
 General Robustness
Physical Environment
 Macro-environment
 Food and Water
 Air Pollution
 Micro-environment
 Home
 Workplace
Social Environment
 Religion
 Race/Gender
 Socioeconomic Status
 Education
 Occupation
 Family Composition
1
Social Environment
2
 "Over time… socially designed systems have
become more important than the physical
environment to individual survival because they
control the distribution of and access to those
very factors that now determine mortality
levels".
John Ratcliffe, 1980
Social Environment 3:
Socioeconomic Status, Income and Health
 As GDP increases, the health of a nation
increases
 In times of economic hardship, the incidence
of disease increases
Health Care



Quality
Availability
“Health has improved NOT because of steps
taken while we are ill, but because we are ill less
often.”
Thomas McKeown, 1978
Health Promotion


An intervention that seeks to eliminate or reduce
exposures to harmful factors by modifying human
behaviors; or any combination of health education and
related organizational, political and economic
interventions designed to facilitate behavioral and
environmental adaptations that will improve or protect
health
Concerned specifically with sociobehavorial processes.
Targets of Health Promotion
 Individuals at risk of a health problem
 Those who influence individuals at risk
 Those who set policy
 Foster the adoption of healthful changes in the
environment
 Improve health services
 Encourage healthful personal behavior change
Health Promotion Objectives
 Individual
 Community
 Knowledge
 Policies
 Attitudes
 Practices
 Behaviors
 Programs
 Physiology
 Facilities
 Organization
 Policies
 Resources
 Government
 Practices
 Policies/Programs
 Programs
 Facilities/Resources
 Facilities
 Legislation/Ordinances
 Resources
 Regulation/Enforcement
Examples of several national health programs:
HEALTHY PEOPLE 2000 (USA);
HEALTH 2020 (Russia).
Priority Areas
 Health Promotion
 Physical Activity and Nutrition
 Tobacco
 Alcohol Consumption
 Preventive Services
 Heart Disease and Stroke
 Cancer
 Health Screenings
HEALTHY PEOPLE 2000 (USA)
HEALTH 2020 (Russia)
 2 Broad Goals
 Increase quality and years of healthy life
 Eliminate health disparities
 4 Primary Objectives
 Promote healthy behaviors
 Promote healthy and safe communities
 Improve systems for personal and public health
 Prevent and reduce diseases and disorders
Disease Prevention1
“Actions aimed at eradicating, eliminating, or
minimizing the impact of disease and disability. The
concept of prevention is best defined in the context
of levels, traditionally called primary, secondary,
and tertiary prevention”
A Dictionary of Epidemiology, Fourth Edition
Edited by John M. Last
Disease Prevention2
 any intervention that seeks to reduce or eliminate
diagnosable conditions; it may be applied at the
individual level, as in immunization, or the community
level, as in chlorination of the water supply
 Disease prevention incorporates known strategies to
help prevent disease. It includes measures beyond
lifestyle factors.
Interrelated Domains
Disease Prevention
Behavioral
science
Health
Education
Public health
Disease Prevention2: levels
 Primary prevention
 Secondary prevention
 Tertiary prevention
Primary Prevention
 Measures taken to prevent the disease from
occurring such as:
 healthy lifestyle habits
 Immunizations
Secondary Prevention
 Measures undertaken to facilitate early detection
 Screenings
 Diagnostic tests
Leading causes of attributable global
mortality and burden of disease, WHO
Attributable Mortality
Attributable DALYs
%
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
High blood pressure
Tobacco use
High blood glucose
Physical inactivity
Overweight and obesity
High cholesterol
Unsafe sex
Alcohol use
Childhood underweight
Indoor smoke from
solid fuels
59 million total global deaths in 2004
%
12.8
8.7
5.8
5.5
4.8
4.5
4.0
3.8
3.8
1.
2.
3.
4.
1.
2.
3.
4.
5.
3.3
6.
Childhood underweight
5.9
Unsafe sex
4.6
Alcohol use
4.5
Unsafe water, sanitation,
hygiene
4.2
High blood pressure
3.7
Tobacco use
3.7
Suboptimal breastfeeding
2.9
High blood glucose
2.7
Indoor smoke from solid fuels
2.7
Overweight and obesity
2.3
1.5 billion total global DALYs in 2004
Tertiary Prevention
 Measures to minimize complications or
exacerbation of injury or disease.
 Rehabilitation Therapy
 Patient counseling
Public Health and Sanitation
Achievements of the 20th century:
 Improvements in hygiene practices
 Improvements in food handling (refrigeration)
 Improvement in Water and sewage treatment
 Vaccination practices
Rising Life Expectancy
Source: United Nations (U.N.) Population Division, Demographic
Indicators, 1950-2050 (The 1996 Revision) (U.N., New York, 1996).
•
Death rate for Tuberculosis, 1860-1960,
United States, Source: US Bureau of the
Census, Historical Statictics of the United
States; Colonial Times to 1970
(Washington, D.C.:Government Printing
Office, 1975), Part 1 pp58,63. Note:
Data between 1860 and 1900 for
Massachusetts only.
Preventive Concept
 Preventive (preventive measures) is a main
component of medicine.
 Creation of system of the prevention of diseases
and elimination of risk factors is the major social,
economic and medical tasks of the state.
Levels of health promotion objectives
 Individual
 Organization
 Community
 Government
Summary
 Unhealthy lifestyle factors are major
contributors to cause of death in the World.
 The top factors of concern are:
 Smoking, diet/ exercise, and alcohol abuse
• The “Prevention” trend has become an
important part of healthcare.
Medical activity and a healthy way of life
 Activity of people in the field of protection,
improvement of individual and public health in the
certain social and economic conditions.
Medical-social activity includes:
 presence of hygienic skills,
 fulfillment of medical recommendations,
 participation in lifestyle improvement and an
environment,
 skill to render the first pre-medical help to itself
and relatives,
 using means of national, traditional medicine, etc.
Healthy way of life (HWL)
 HWL is the hygienic behavior basing on scientifically
proved sanitary-and-hygienic specifications, directed
on strengthening and preservation of health, activation
of protective recourses of an organism, maintenance of
a high level of work capacity, achievement of active
long life.
 It is a basis for preventive prophylaxis of diseases and is
directed on elimination of risk factors of illness.
The basic directions and methods of
propagation healthy way of life
 The verbal propaganda is the most effective. It is the
most popular, economic, simple and accessible
method.
 The printed propaganda covers wide groups of the
population.
 The visual teaching method is the most multiform
one. It can be divided into two groups: natural
objects and graphic means (volumetric and plane).
 The combined method.