Lecture 30. NCD trends and burden Flashcards
epidemiologic transition
Characteristic shift in common causes of death and disability
from perinatal and communicable (infectious) diseases to
non-communicable (chronic) diseases
Key factors influencing the risk burden
• How strong is the ‘causal’ association between the risk factor and health
condition(s)? (e.g., relative risk)
• How common is the exposure to this risk in the population of interest?
(e.g., the prevalence of the risk factor in the population)
what measures are used to identify the leading risk factors for GBD?
PAR
• The amount of “extra” disease burden attributable to a particular risk factor in a population
• If the association is causal, this is the amount of the disease burden that we could theoretically prevent if we removed that risk factor from the population
DALY
The amount of “extra” disease or DALYs attributable to a particular risk factor in a population
DALY enables:
comparison of risk factors
risk transition
Changes in risks factor profiles as countries shift from low- to higher income countries, where common risks for perinatal and communicable diseases (e.g., unhygienic water) are replaced by risks for non-communicable diseases (e.g., tobacco)
Increasing socioeconomic status of country:
increasing risks for NCDs
Decreasing risks for perinatal and communicable diseases
double burden of disease
- In many middle-income countries previously common risks for
perinatal and communicable diseases co-exist with increasing risks for
non-communicable diseases
NCDs+ communicable diseases
requires double response from the government- major challenge for health policy
where do self-harm, mental health and suicide fit in the GBD?
mental health and self-harm- non-communicable disease
suicide- injury
the realities of NCD
- 80% in LMIC( low-middle income countries)
- concentrated among the poor
- LMIC require double response
- not just old people
- can be prevented
population groups most affected by NCDs
- Populations living in poverty
* Those living in LMICs
determinants of the determinants for NCD
smoking trends
- reduction in smoking
- increase of smoking prevalence with deprivation
Why have inequalities in tobacco use persisted or increased in
some populations in NZ despite overall falls in smoking?
unequal distribution of risk factors
trend in alcohol attributable health events
even at the same alcohol consumption the more deprived populations are at a higher risk
what disease risks are influenced by the commercial sector
- smoking
- high fasting plasma glucose
- high BMI
- high total cholesterol
- alcohol use
- high sodium
role of commercial sector in NCD epidemic
upstream determinant
creates unequal distribution of risks –> unequal NCD epidemic
how have commercially driven epidemics happen?
(1) Change to Social norms and shaping preferences:
- not just the rich people smoking now
- social norms changed as smoking became popular among other social groups
- target more deprived communities, women, children
- changing physical and social environments
- > concentrate outlets in low socioeconomic areas
(2) A greater emphasis on downstream (compared with upstream) strategies has put equity in public health at risk
• Public health measures have focussed on behaviour change (downstream) interventions
• Difficulties with behaviour change are actively exploited by industries
− Frame education as the most effective solution
− Offer choice and pleasure
− Emphasis on moderation
how are tobacco companies targeting teenagers?
- offer cigarettes to youth
- exposure to smoking in movies
Frequency of outlets
-more dense in more deprived areas
industrial epidemics
- Diseases arising from
over-consumption of unhealthy commercial products
(e.g. tobacco, alcohol, processed food, sugar-sweetened beverages)
how to address the commercial determinants of NCDs and health inequalities?
- Shift focus from individual behaviours to broader environment and upstream drivers of unhealthy product consumption
- Tackle the broader determinants of health (i.e., upstream determinants)
- Develop effective health policy recognising the tension between commercial and health objectives
Tobacco control strategies. The 6 MPOWER measures
- Monitor tobacco use and prevention policies
- Protect people from tobacco use (smoke free legislations)
- Offer help to quit tobacco use (downstream option) – targeted programmes
- Warn about the dangers of tobacco
- Enforce bans on tobacco advertising, promotion and sponsorship
- Raise taxes on tobacco
Right to Health- respect, protect, fulfil
Tobacco control strategies. The 6 MPOWER measures
- Monitor tobacco use and prevention policies
- Protect people from tobacco use (smoke free legislations)
- Offer help to quit tobacco use (downstream option) – targeted programmes
- Warn about the dangers of tobacco
- Enforce bans on tobacco advertising, promotion and sponsorship
- Raise taxes on tobacco
Right to Health- respect, protect, fulfil
