1 / 17

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

kiley
Download Presentation

Chronic Disease Prevention: The Power of Public Health

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  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

More Related