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Chronic Disease Prevention: The Power of Public Health

Chronic Disease Prevention: The Power of Public Health. 11 th World Congress on Public Health Conference August 2006. By Dr. John Frank, Scientific Director, CIHR-Institute of Population & Public Health. Presentation at a Glance. Chronic Disease Prevention Challenges Selected examples

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Chronic Disease Prevention: The Power of Public Health

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  1. Chronic Disease Prevention:The Power of Public Health 11th World Congress on Public Health Conference August 2006 ByDr. John Frank, Scientific Director, CIHR-Institute of Population & Public Health

  2. Presentation at a Glance • Chronic Disease Prevention Challenges • Selected examples • What does the evidence tell us? • Need for a population and public health approach

  3. Global Mortality From Chronic Diseases Yach, D. et al. JAMA 2004;291:2616-2622.

  4. Deaths Attributable to 16 Leading Causes in Developing Countries, 2001 Yach, D. et al. JAMA 2004;291:2616-2622.

  5. 20-Year Trends in Smoking: Current smokers by age, Canada, 1981-2001 A Canadian Success Story but….

  6. Age-Standardized Mortality Rates for Cardiovascular Diseases, Canadian Males and Females, 1950-1999. Source: Health Canada, 2003. Age-standardized to the 1991 Canadian population.

  7. Source: 2004 CPHI report, Improving the Health of Canadians.

  8. Source: 2004 CPHI report, Improving the Health of Canadians.

  9. Renewing our Public Health Principles • Seek the root causes of disease and disability - a focus on determinants • Consider and deal with whole populations • Understand and apply the principles of social change, over the life course

  10. Population Health Framework Political Social Cultural Economic Spiritual Ecological Technological Health Outcomes Forces Nation-States Regions (Urban Entities) Neighborhoods / Communities Most Health Care Families / Couples / Households Lifecourse of Individuals Biological Endowment Physical & Social Environmental Exposures Gene-Environment Interactions Most Public Health Interventions 10

  11. The Bell-Curve Shift in Industrial Populations In Western industrialized populations, the entire bell-curve of risk-factor levels is shifted due to dietary and other ‘lifestyle’ factors, so even “low levels” within the population confer CHD risk. Thus a large number of people at small risk give rise to more cases of disease than the small number who are at high risk.. % of Population Individual (largely genetic for CHD) Population – level factors (largely environmental)   Increasing Serum LDL Cholesterol & CHD Risk Source: Rose G. Sick Individuals and sick populations. 1985; Int J Epid 12:32-38.

  12. The Importance of Population Distributions of Exposure Source: The World Health Report : 2002. Reducing Risks, Promoting Healthy Life. Chapter 2, Figure 2.3 27

  13. Population-oriented Individually-oriented Environmental and Policy Approaches Educational, High Risk and Clinical Preventive Services Approaches Treatment Downstream Upstream Action on Obesity: Three Different Paradigms Compliments of PHRED program

  14. Community-based interventions – Hype or Hope? • Usually suffer from methodological and conceptual limitations - poor study design, lack of evaluation, theoretical basis is limited given complexity of interactions • Small or modest effect sizes at the individual level vs. what was expected, especially given other social trends Source: Sorensen G., Emmons K, Hunt MK, Johnston D., 2003. Implications of the results of community intervention trials. Annu. Rev. Public Health,19:379-416.

  15. Community-based interventions – Hype or Hope?(cont’d) • Interventions targeted only at individual-level knowledge, attitude and behaviour cannot succeed alone • Should therefore not be seen as the “panacea” to solving complex societal problems, especially given duration and intensity of such interventions and the countervailing forces arraigned against them Source: Sorensen G., Emmons K, Hunt MK, Johnston D., 2003. Implications of the results of community intervention trials. Annu. Rev. Public Health,19:379-416.

  16. BUT THERE IS HOPE…. • Impacts can be realized if community-based interventions: • Are properly resourced and sustained over time • Community-led, addressing the social and cultural context in which individual behaviours are manifested • Are complemented by comprehensive population-level interventions that address: • Environmental supports/controls • Economic levers • Enforcement (regulations / legislation) • Research funding agencies need to put more emphasis on supporting policy and program intervention research Source: Smedley BD and Syme SL (eds.). Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington: National Academy of Sciences, 2000.

  17. “Calling for Sustainable Investmentsin the Public Health System – the Champion for “Upstream Thinking” • Our focus on the (sick-)care system problems needing urgent attention should not detract us from our responsibility to invest in public health. • More is needed to strengthen the front-line where most of public health takes place • Community-level creativity must be tapped to change social norms – local public health professionals working in intersectoral coalitions

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