1. 2 anticipatory care & health promotion prof. sulaiman al-shammari department of family &...

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Anticipatory Care & health promotionAnticipatory Care & health promotion

Prof. Sulaiman Al-Shammari

Department of Family & Community Medicine , College of Medicine King Saud University , Riyadh, Saudi Arabia

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Anticipatory CareAnticipatory Care

Learning ObjectivesLearning Objectives

At the end of this session students would be able At the end of this session students would be able to:to: Define anticipatory careDefine anticipatory care Recognize its importance.Recognize its importance.Recall levels of prevention with appropriate examples.Recall levels of prevention with appropriate examples. Define screening.Define screening. Recognize its principles.Recognize its principles. Recall criteria of screening.Recall criteria of screening.

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ContentContent Introduction.Introduction. Definition.Definition. PHC and anticipatory care.PHC and anticipatory care. Level of preventive intervention.Level of preventive intervention. Screening:Screening:

- Definition- Definition

- Principles - Principles

- Ethics- Ethics

Conclusion.Conclusion.

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CaseCase A 45-year-old man is presented to A 45-year-old man is presented to

the clinic with C/O mild cough, the clinic with C/O mild cough, fever & general body ache of one fever & general body ache of one day duration. O/E :day duration. O/E :

Temp 39C, congested throat, & he is Temp 39C, congested throat, & he is obese.obese.

Possibility of flue like viral infectionPossibility of flue like viral infectionWhat should be done for this man?What should be done for this man?

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CaseCase

A 40-year-old A 40-year-old healthyhealthy man on man on routine checkup he found to have:routine checkup he found to have:

BMI: 31BMI: 31FBS: 6.2FBS: 6.2

What should be done for this What should be done for this healthy man?man?

BMI Categories:

Underweight = <18.5 Normal weight = 18.5–24.9 Overweight = 25–29.9 Obesity = BMI of 30 or greater

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Awareness:Awareness:Women and Heart DiseaseWomen and Heart Disease

1 in 2-3 women die of CHD, but only 4% 1 in 2-3 women die of CHD, but only 4% fear of dying of CHDfear of dying of CHD

1 in 27 women die of breast cancer, but 1 in 27 women die of breast cancer, but 40% fear of dying of breast cancer40% fear of dying of breast cancer

2/3 of women have at least 1 CHD risk 2/3 of women have at least 1 CHD risk factor, factor,

52% over age 45 have hypertension,52% over age 45 have hypertension, 40% over age 55 have high cholesterol40% over age 55 have high cholesterol

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Some EBM FactsSome EBM Facts Changing pattern of mortality and morbidity.Changing pattern of mortality and morbidity. Geographical variation in disease occurrence.Geographical variation in disease occurrence. Migrants and development of diseases.Migrants and development of diseases.

Stopping of smoking:Stopping of smoking:• Decreasing death due to all types of Ca-33%.Decreasing death due to all types of Ca-33%.• Decreasing death due to all types of IHD 25%.Decreasing death due to all types of IHD 25%.• etc. etc.

Early detection of hypertensionEarly detection of hypertension• Helps in 50% of stroke prevention.Helps in 50% of stroke prevention.

Prevention of DM ??Prevention of DM ??

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50% of patients with “ImpairedFasting Glucose” will go on to

becomediabetic within 10 years

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Does Treating The Metabolic Syndrome Does Treating The Metabolic Syndrome Make a DifferenceMake a Difference??

• Design– 522 middle-aged overweight/obese patients (mean

BMI 31 kg/m2)

– 172 men and 350 women

– Mean duration 3.2 years

• Intervention group: individualized counseling– Reducing weight, total intake of fat and saturated fat

– Increasing intake of fiber, physical activity

Tuomilehto J et al. N Engl J Med 2001;344:1343-1350

Finnish Diabetes Prevention Study

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Benefit of Treating The Metabolic Syndrome:Benefit of Treating The Metabolic Syndrome:Finnish Diabetes Prevention StudyFinnish Diabetes Prevention Study

After 4 years, After 4 years, risk of diabetes risk of diabetes

reduced by 58%reduced by 58%

Tuomilehto J, et al. N Engl J Med. 2001;344:1343-1350.

Intervention Control

With Diabetes (%)

0%

5%

10%

15%

20%

25%

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Levels of Risk Associated with Smoking, Levels of Risk Associated with Smoking, Hypertension and HypercholesterolaemiaHypertension and HypercholesterolaemiaLevels of Risk Associated with Smoking, Levels of Risk Associated with Smoking,

Hypertension and HypercholesterolaemiaHypertension and Hypercholesterolaemia

x1.6 x4

x3

x6

x16

x4.5 x9

Hypertension(SBP 195 mmHg)

Serum cholesterol level(8.5 mmol/L, 330 mg/dL)

Smoking

Poulter N et al., 1993

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The Rule of Halves in HypertensionThe Rule of Halves in Hypertension

½ Known treatedand controlled

½ of thoseTreatedNot controlled

½ not known

½ of those known Not treated

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•Cost ?Cost ?

Less attention on Less attention on prevention??prevention??

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About six cents of every health dollar in the U.S. is spent on medical and health research.

Source: America Speaks: Poll Data, Vol. 5, Research!America, 2003.

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Less than one cent of every health care dollar in the U.S. is spent on prevention research.

Source: America Speaks: Poll Data, Vol. 5, Research!America, 2003.

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““There I am standing by the shore of a swiftly flowing-river and I There I am standing by the shore of a swiftly flowing-river and I hear a cry of a drowning man. So I jump into the river, put my hear a cry of a drowning man. So I jump into the river, put my arms around him, pull him to shore and apply artificial respiration. arms around him, pull him to shore and apply artificial respiration. Just when he begins to breathe, there is another cry for help. So I Just when he begins to breathe, there is another cry for help. So I jump into the river, reach him, pull him to shore, apply artificial jump into the river, reach him, pull him to shore, apply artificial respiration, and then, just as he begins to breathe, another cry for respiration, and then, just as he begins to breathe, another cry for help. So back in the river again, reaching, pulling, applying, help. So back in the river again, reaching, pulling, applying, breathing and then another yell. Again and again, without end, breathing and then another yell. Again and again, without end, goes the sequence. You know, I am so busy jumping in, pulling goes the sequence. You know, I am so busy jumping in, pulling them to shore, applying artificial respiration, that I have no time to them to shore, applying artificial respiration, that I have no time to see who the hell is upstream pushing them all insee who the hell is upstream pushing them all in””..

Zola, I.K. Zola, I.K. ““Helping Helping –– does it matter? The problems and prospects does it matter? The problems and prospects of mutual aid groupsof mutual aid groups””..

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What is anticipatory care?What is anticipatory care? It include all measures which promote good It include all measures which promote good health health and prevent or delay the onset of and prevent or delay the onset of diseases or their diseases or their complications.complications. This care aims to:This care aims to:

Improve the quality of lifeImprove the quality of life Reduce the premature disabilityReduce the premature disability Increased life expectancyIncreased life expectancy

So it denotes So it denotes ““the essential union of the essential union of prevention with prevention with care and curvecare and curve””

(RCGP-1981).(RCGP-1981).

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Level of preventionLevel of prevention

Primordial prevention. Primordial prevention. Primary prevention.Primary prevention. Secondary prevention.Secondary prevention. Tertiary prevention.Tertiary prevention.

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Table 6.1.Table 6.1.Levels of preventionLevels of prevention..

Level of Level of preventionprevention

Phase of diseasePhase of diseaseTargetTarget

PrimordialPrimordialUnderlying conditions Underlying conditions leading to causationleading to causation

Total population and Total population and selected groupsselected groups

PrimaryPrimarySpecific causal factorsSpecific causal factorsTotal population, Total population, selected groups and selected groups and healthy individualshealthy individuals

SecondarySecondaryEarly stage of diseaseEarly stage of diseasePatientsPatients

TertiaryTertiaryLate stage of disease Late stage of disease (treatment, (treatment, rehabilitation)rehabilitation)

PatientsPatients

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Routine V/S PreventiveRoutine V/S Preventive

Care CareCare Care

Patient-initiativePatient-initiativeDoctor-initiativeDoctor-initiative

Immediate-typeImmediate-typeNon-urgentNon-urgent

Usually involve the doctorUsually involve the doctorEasily delegated to other PHC teamEasily delegated to other PHC team

Focused on individualFocused on individualFocused on high-risk groupsFocused on high-risk groups

Good record are a help but audit is Good record are a help but audit is difficultdifficult

Good record are essential, audit is Good record are essential, audit is straightforwardstraightforward

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Special groups•Pregnancy

•* oral contraception.

•* developmental screening of infants and children.

•*elderly

•*known family history of IHD, cancer, glaucoma

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The optimum setting for anticipatory care:The optimum setting for anticipatory care:

Primary Health Care.Primary Health Care.

Frequent contacts.Frequent contacts. Defined population.Defined population. Primary-care team.Primary-care team. Dr.-Pt. relationship.Dr.-Pt. relationship. Holistic approach.Holistic approach.

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ScreeningScreening

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ScreeningScreeningThe iceberg of diseaseThe iceberg of disease

Self care andSelf care and

Medical treatmentMedical treatment

SymptomaticSymptomatic

diseasedisease

The surfaceThe surface

ScreeningScreening Pre-symptomaticPre-symptomatic

diseasedisease

HealthHealth

(Last 1963)(Last 1963)

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ScreeningScreeningDefinition:Definition:It is broadly defined as the questioning, It is broadly defined as the questioning, examination, or investigation of an asymptomatic examination, or investigation of an asymptomatic individual to determine the presence or absence individual to determine the presence or absence of disease.of disease.

Is it diagnostic??Is it diagnostic?? Screening is not usually diagnostic and it Screening is not usually diagnostic and it requires requires appropriate investigative follow-up appropriate investigative follow-up and treatment.and treatment.

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ScreeningScreening

Types:Types: Mass screening.Mass screening. Multiple or multi-phasic screening.Multiple or multi-phasic screening. Targeted screening.Targeted screening. Case-finding ??Case-finding ??

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Case Case –– Finding Finding

Case-findingCase-finding or or opportunistic screening:opportunistic screening:

It is the term used when it is undertaken It is the term used when it is undertaken opportunistically for patients who consult their opportunistically for patients who consult their doctors for some other purpose.doctors for some other purpose.

Example??Example??

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II.II. Criteria for Assessment of a Criteria for Assessment of a screening test.screening test.

Validity -Validity - SensitivitySensitivity

SpecificitySpecificity

ReliabilityReliability Predictive ValuePredictive Value

predictive value

a measure used by clinicians to interpret diagnostic test results. (The likelihood that a positive test result indicates disease or that a negative test result excludes disease..)

positive predictive value the probability that a patient with a positive test result really does have the condition for which the test was conducted.

negative predictive value the probability that a patient with a negative test result really is free of the condition for which the test was conducted.

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Principles of ScreeningPrinciples of Screening

The criteria for screening:The criteria for screening:

(Wilson 1976)(Wilson 1976)

A.A. The disease:The disease: An important problemAn important problem Recognized latent or early symptomatic stage.Recognized latent or early symptomatic stage. Natural history of disease adequately understood.Natural history of disease adequately understood. Facilities for Dx. And treatment available.Facilities for Dx. And treatment available.

B.B. The treatment:The treatment: Agreed policy on whom to treat.Agreed policy on whom to treat. Acceptable treatment for patients recognized.Acceptable treatment for patients recognized.

C.C. The test:The test: Suitable test or exam.Suitable test or exam. Acceptable to population.Acceptable to population. The cost should be economically balanced.The cost should be economically balanced. Continuous process and not a Continuous process and not a ““once for allonce for all”” project. project.

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Principles of ScreeningPrinciples of ScreeningThe criteria for screening:The criteria for screening:

(Wilson 1976)(Wilson 1976)

A.A. The disease:The disease: An important problemAn important problem Recognized latent or early symptomatic stage.Recognized latent or early symptomatic stage. Natural history of disease adequately understood.Natural history of disease adequately understood. Facilities for dgx. And treatment available.Facilities for dgx. And treatment available.



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(Wilson 1976)(Wilson 1976)A.A. The disease:The disease:

An important problemAn important problem Recognized latent or early symptomatic stage.Recognized latent or early symptomatic stage. Natural history of disease adequately understood.Natural history of disease adequately understood. Facilities for dgx. And treatment available.Facilities for dgx. And treatment available.



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(Wilson 1976)(Wilson 1976)A.A. The disease:The disease:

An important problemAn important problem Recognized latent or early symptomatic stage.Recognized latent or early symptomatic stage. Natural history of disease adequately understood.Natural history of disease adequately understood. Facilities for dgx. And treatment available.Facilities for dgx. And treatment available.

B.B. The treatment:The treatment: Agreed policy on whom to treat.Agreed policy on whom to treat.

Acceptable treatment for patients recognized.Acceptable treatment for patients recognized.


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Ethics of ScreeningEthics of ScreeningSafe?Safe? Beneficial?Beneficial?

The The ““costcost”” to patient of screening: Disadvantages? to patient of screening: Disadvantages?

InconvenienceInconvenience

AnxietyAnxiety

DiscomfortDiscomfort

Risk that screening Procedure may be harmfulRisk that screening Procedure may be harmful

Risk of labeling as Risk of labeling as ““sicksick”” or or ““at riskat risk””..

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Conclusion:Conclusion:

Anticipatory care is the integration of Anticipatory care is the integration of prevention and cure.prevention and cure. PHC service is the optimal place to PHC service is the optimal place to apply this care and observe.apply this care and observe. Every opportunity to be utilize to deliver Every opportunity to be utilize to deliver

this care.this care. Case finding V/S formal screening.Case finding V/S formal screening.

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Health PromotionHealth Promotion

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What is Health Promotion1What is Health Promotion1??

Concept wConcept was first introduced in USA 1979as first introduced in USA 1979 Has evolved to include the educational, Has evolved to include the educational,

organizational, procedural, environmental, organizational, procedural, environmental, social, and financial supports that help social, and financial supports that help individuals and groups reduce negative health individuals and groups reduce negative health behaviors and promote positive change among behaviors and promote positive change among various population groups in a variety of various population groups in a variety of settings settings

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What Is Health Promotion2What Is Health Promotion2??

Health promotion programs are designed to Health promotion programs are designed to help people who are healthy, but engaging inhelp people who are healthy, but engaging in risky behaviors (i.e., smoking, drinking, risky risky behaviors (i.e., smoking, drinking, risky

sexual behaviors)sexual behaviors) or actions that increase their susceptibility to or actions that increase their susceptibility to

negative health consequences (i.e., physical negative health consequences (i.e., physical inactivity, unhealthy diets)inactivity, unhealthy diets)

to change their behaviorsto change their behaviors

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Behavior ChangeBehavior Change– Is It An Easy Task– Is It An Easy Task??

Can we expect people to adopt a healthy lifestyle Can we expect people to adopt a healthy lifestyle after they have been exposed to a health promotion after they have been exposed to a health promotion program?program?

Can we force people to participate in sport and Can we force people to participate in sport and physical activities because we believe they are good physical activities because we believe they are good for their health and soul?for their health and soul?

No … Getting people to engage in health behavior No … Getting people to engage in health behavior change is a complex process that is very difficult change is a complex process that is very difficult even under the best of conditions..even under the best of conditions..

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Effective Health Promotion1Effective Health Promotion1

Does saying, “Just do it!” work?Does saying, “Just do it!” work? No … Health promotion is not simply an information No … Health promotion is not simply an information

campaign or just providing opportunities.campaign or just providing opportunities. Information campaign is the easiest and most Information campaign is the easiest and most

common form of program, yet least effectivecommon form of program, yet least effective ““Just do it!” sounds ‘good’, but doesn’t work.Just do it!” sounds ‘good’, but doesn’t work.

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Effective Health Promotion2Effective Health Promotion2

Effective health promotion programsEffective health promotion programshelp peoplehelp people::

modify behaviors, increase skills, change attitudes, modify behaviors, increase skills, change attitudes, increase knowledge, influence values, and improve increase knowledge, influence values, and improve

health decision makinghealth decision makingmaintain healthy lifestylesmaintain healthy lifestyles

provideprovide::educational, organizational, environmental, financial, educational, organizational, environmental, financial,

and social supportand social supporte.g., worksite smoke cessation programe.g., worksite smoke cessation program

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Need for Health Promotion1Need for Health Promotion1

Physical Inactivity is a Global ProblemPhysical Inactivity is a Global ProblemIn developed countriesIn developed countries::

Industrialization, modern technologies, automation, and a global Industrialization, modern technologies, automation, and a global food market have taken away the need and opportunity for physical food market have taken away the need and opportunity for physical

exertionexertion

In developing countriesIn developing countries::Over crowding, poverty, crime, traffic, low air quality, plus lack of Over crowding, poverty, crime, traffic, low air quality, plus lack of

parks, sports and recreation facilities, and sidewalks make physical parks, sports and recreation facilities, and sidewalks make physical activity a difficult choiceactivity a difficult choice

ResultResult: 60% ~ 85% global population fails to achieve 30 minute : 60% ~ 85% global population fails to achieve 30 minute moderate intense physical activity dailymoderate intense physical activity daily

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Physical movement and activity are essential Physical movement and activity are essential for the human organism to grow, develop, and for the human organism to grow, develop, and

maintain healthmaintain health . .Consequences of physical inactivityConsequences of physical inactivity

increased levels of obesity, diabetes, increased levels of obesity, diabetes, cardiovascular disease (the leading cause of cardiovascular disease (the leading cause of

death in most countries)death in most countries)

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Physical inactivityPhysical inactivity::second greatest threat to U.S. public healthsecond greatest threat to U.S. public healtha major public health problem affecting huge a major public health problem affecting huge

numbers of people in all regions of the worldnumbers of people in all regions of the worldEffective health promotion programs are urgently Effective health promotion programs are urgently

needed to promote physical activity and improve needed to promote physical activity and improve public health around the worldpublic health around the world..

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Physical activityPhysical activityA sedentary lifestyle increases the risk ofA sedentary lifestyle increases the risk of

•overall mortality (2 to 3-fold)overall mortality (2 to 3-fold)•cardiovascular disease (3 to 5-fold)cardiovascular disease (3 to 5-fold)

The effect of low physical fitness is comparable The effect of low physical fitness is comparable to that of hypertension, high cholesterol, diabetes, to that of hypertension, high cholesterol, diabetes,

and even smokingand even smoking..

Sources: Wei et al., JAMA 1999; Blair et al., JAMA

1996

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Chronic diseases associated with unhealthy behaviors, such as Chronic diseases associated with unhealthy behaviors, such as unhealthy diets, caloric excess, inactivity, and obesity are the unhealthy diets, caloric excess, inactivity, and obesity are the

greatest public health problems in most countries of the worldgreatest public health problems in most countries of the worldThe increasing incidence of chronic diseasesThe increasing incidence of chronic diseases

causing ~60% of the 56.5 million reported deaths causing ~60% of the 56.5 million reported deaths globallyglobally

contributing ~46% to the spread of disease worldwidecontributing ~46% to the spread of disease worldwideThese estimates are expected to rise to 73% and 60%, These estimates are expected to rise to 73% and 60%,

respectively, by 2020respectively, by 2020

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Deaths by broad cause groupDeaths by broad cause group

Cardiovascular disease – heart disease, stroke

CancerChronic respiratory diseases

Diabetes

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60% of all deaths are due to chronic diseases

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What Has Been Done3What Has Been Done3??

In the past three decadesIn the past three decades::widespread interest in good health, wellness, and health widespread interest in good health, wellness, and health

behaviorsbehaviors,,recognized for its potential to improve quality of recognized for its potential to improve quality of

lives,longevity & adaptation healthy lifestylelives,longevity & adaptation healthy lifestyle , ,programs to promote good health among general programs to promote good health among general

populationpopulation..

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WHO Annual Global Move for Health initiativeWHO Annual Global Move for Health initiativeto promote healthy diets and physical activity to promote healthy diets and physical activity

among the world population, both male and among the world population, both male and female, of all ages and conditions including female, of all ages and conditions including

disabilities worldwidedisabilities worldwide..WHO Global Strategy on Diet, Physical Activity and WHO Global Strategy on Diet, Physical Activity and

HealthHealth

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In the United States, physical activity, overweight and obesityIn the United States, physical activity, overweight and obesity::are the top two leading health indicators listed in the are the top two leading health indicators listed in the

government document, Healthy People 2010 - the U.S. government document, Healthy People 2010 - the U.S. National Goals and Objectives in Health Promotion and National Goals and Objectives in Health Promotion and

Disease PreventionDisease Preventionare two of the six priority health behaviors used by the U.S. are two of the six priority health behaviors used by the U.S.

Centers for Disease Control and Prevention to monitor the Centers for Disease Control and Prevention to monitor the population risk behaviors in the U.Spopulation risk behaviors in the U.S..

will lower life expectancy by 5 years unless obesity rate is will lower life expectancy by 5 years unless obesity rate is reduced significantly by 2010reduced significantly by 2010..

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OverweightOverweight

Increasing weight associated withIncreasing weight associated with:: risk of overall mortality (up to 2.5-fold in the risk of overall mortality (up to 2.5-fold in the

30-44 age group, less at older ages)30-44 age group, less at older ages) risk of cardiovascular mortality (up to 4-fold in risk of cardiovascular mortality (up to 4-fold in

the 30-44 age group, less at older ages)the 30-44 age group, less at older ages) risk of diabetes (up to 5-fold)risk of diabetes (up to 5-fold) risk of hypertensionrisk of hypertension risk of some cancersrisk of some cancers risk of gall bladder diseaserisk of gall bladder disease

Source: Willett et al., Source: Willett et al., New Eng J MedNew Eng J Med, 1999, 1999

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Why Aren’t We EffectiveWhy Aren’t We Effective??

Programs not based on sound health behavior theories or Programs not based on sound health behavior theories or outcomes assessmentoutcomes assessment

The program planners mayThe program planners may::not have the necessary knowledge of health promotion not have the necessary knowledge of health promotion

program planning, implementation, evaluation, andprogram planning, implementation, evaluation, andlack adequate training in health behavior theorieslack adequate training in health behavior theories..

Having good intentions and the knowledge in exercise and Having good intentions and the knowledge in exercise and sports are not enoughsports are not enough..

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What Can Sport Do to Promote What Can Sport Do to Promote Health1Health1

Competitive sports events inspire and motivate Competitive sports events inspire and motivate people to participatepeople to participate..

Non-competitive sports activities provide Non-competitive sports activities provide opportunities for mass participation and opportunities for mass participation and

involvementinvolvement..

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What can Sport do to Promote Health2What can Sport do to Promote Health2??

Participation help people become more physically Participation help people become more physically active and develop healthier lifestyle habits, thus active and develop healthier lifestyle habits, thus

reducereduce: : obesity, BP ,cholesterolobesity, BP ,cholesterolburden illness and premature deathburden illness and premature death..

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What Can Sport Do to Promote Health3What Can Sport Do to Promote Health3??

build social bonds and social supportbuild social bonds and social support,,reduce feelings of depression and anxietyreduce feelings of depression and anxiety,,promote psychological well-being, andpromote psychological well-being, and prevent risky behaviors, especially among children prevent risky behaviors, especially among children

and young peopleand young peopletobacco, alcohol or other substance abusetobacco, alcohol or other substance abuseunhealthy diet or violenceunhealthy diet or violence

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What Can Sport Do to Promote What Can Sport Do to Promote Health5Health5??

Detailed sport plans provide procedural support for Detailed sport plans provide procedural support for behavioral changebehavioral change..

Incentives eg discounted,free gym, reduced insurance Incentives eg discounted,free gym, reduced insurance premiums for regular exercise and healthy body weight = premiums for regular exercise and healthy body weight =

provide financial support for behavioral changeprovide financial support for behavioral change..

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What Can Sport Do to Promote What Can Sport Do to Promote Health6Health6??

Building fields, sidewalks, bike lanes, and Building fields, sidewalks, bike lanes, and organize events = environmental support for organize events = environmental support for

behavioral changebehavioral change . .

Participating in sport, instill the value of sport in Participating in sport, instill the value of sport in all aspect of our lives, and involve families, all aspect of our lives, and involve families, friends, and coworkers = social support for friends, and coworkers = social support for

behavioral changebehavioral change..

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Plan Sport-Related Plan Sport-Related Health Promotion Programs1Health Promotion Programs1

Practitioners and scholars in sport fieldPractitioners and scholars in sport field::are experts in theories and skills of sportsare experts in theories and skills of sports,,have a desire to help people live a healthier life, have a desire to help people live a healthier life,

andandalready possess the basic program planning and already possess the basic program planning and

implementation skillsimplementation skills..

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Procedures that are similar to health promotion Procedures that are similar to health promotion programmingprogramming::

identifying a planning committeeidentifying a planning committee,,obtain support of decision makersobtain support of decision makers,,develop goals and objectivesdevelop goals and objectives,,design or select health intervention activitiesdesign or select health intervention activities,,identify and allocate resourcesidentify and allocate resources,,market the program, andmarket the program, andimplement the programimplement the program..

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Health promotionsHealth promotions::conduct various forms of evaluations conduct various forms of evaluations

throughout the implementation phase to ensure throughout the implementation phase to ensure that the program is carried out as plannedthat the program is carried out as planned..

Process evaluation - to control, assure, or Process evaluation - to control, assure, or improve the quality of program activitiesimprove the quality of program activities

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Impact evaluation - to judge the immediate Impact evaluation - to judge the immediate impact of the programimpact of the program::

awareness of consequences of physical awareness of consequences of physical inactivityinactivity,,

knowledge of benefits of healthy body knowledge of benefits of healthy body weightweight,,

attitudes toward exerciseattitudes toward exercise,,skills of certain sports, andskills of certain sports, andbehaviors of healthy dietbehaviors of healthy diet..

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Outcome evaluation - to assess the ultimate goal of Outcome evaluation - to assess the ultimate goal of the program is achievedthe program is achieved::

improved BMIimproved BMI,,reduced CVDreduced CVD , ,reduced deaths due to chronic diseasereduced deaths due to chronic disease..

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How Do We Change CultureHow Do We Change Culture??

In some culture, “plump” used to be a sign of In some culture, “plump” used to be a sign of health and wealthhealth and wealth..

In the Middle East, “round” is seen as In the Middle East, “round” is seen as successfulsuccessful..

Some Africans view “heavy” women as a sign Some Africans view “heavy” women as a sign of having rich husbandsof having rich husbands??

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WHO Global Strategy on Diet, Physical WHO Global Strategy on Diet, Physical Activity and Health (DPAS) GoalActivity and Health (DPAS) Goal

""Promote and protect health by guiding the Promote and protect health by guiding the development of an enabling environmentdevelopment of an enabling environment for for

sustainable actions at individual, community, sustainable actions at individual, community, national and global levels, that, when taken national and global levels, that, when taken

together, will lead to reduced disease and together, will lead to reduced disease and death rates related to unhealthy diets and death rates related to unhealthy diets and

physical inactivityphysical inactivity""

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Objectives of DPASObjectives of DPAS

Reduce risk factors through essential public action Reduce risk factors through essential public action actions, health-promoting and disease prevention actions, health-promoting and disease prevention

measuresmeasuresIncrease awareness and understanding of importance Increase awareness and understanding of importance

of diet and physical activity and healthof diet and physical activity and healthDevelop, strengthen, implement global, regional, Develop, strengthen, implement global, regional,

national policies, plans etc to improve diets, physical national policies, plans etc to improve diets, physical activityactivity

Monitor science and promote researchMonitor science and promote research

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Foundations of WHO Global Strategy on Foundations of WHO Global Strategy on Diet, Physical Activity and HealthDiet, Physical Activity and Health

Prevention of chronic, noncommunicable Prevention of chronic, noncommunicable diseases (NCDs)diseases (NCDs)

Multisectoral actionMultisectoral action

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1.Integrated healthy lifestyle guide on healthy diet, PA and tobacco

2.Directed at the public in general

3.Transmitted by the health and education sectors

Activities in CHILEActivities in CHILE

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Activities in SpainActivities in Spain

Spanish Strategy for Nutrition, Physical Activity and the Spanish Strategy for Nutrition, Physical Activity and the Prevention of Obesity (NAOS)Prevention of Obesity (NAOS)

AIMAIM::To improve the diet and encourageTo improve the diet and encourage

the regular practice of physicalthe regular practice of physical activity by all citizens, with specialactivity by all citizens, with special emphasis on childrenemphasis on children

Produced byProduced by::Spanish Ministry of Health andSpanish Ministry of Health and

Consumer Affairs (General DirectorateConsumer Affairs (General Directorate of Public Healthof Public Health((

Coordinated by the Spanish Food Safety AgencyCoordinated by the Spanish Food Safety Agency

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Activities in SwedenActivities in Sweden

The Action Plan for Healthy Dietary Habits and Increased The Action Plan for Healthy Dietary Habits and Increased Physical activityPhysical activity

AimAim : :To introduce measures to improve the prerequisites for healthy dietary To introduce measures to improve the prerequisites for healthy dietary

habits and physical activity in order to contribute to the overall public habits and physical activity in order to contribute to the overall public health aimhealth aim

To create societal conditions which ensure good health on equal terms To create societal conditions which ensure good health on equal terms for the entire populationfor the entire population

Produced byProduced by : :The Swedish Government commissioned the National Food The Swedish Government commissioned the National Food

Administration and the National Institute of Public Health to develop Administration and the National Institute of Public Health to develop the national action planthe national action plan..

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Germany – Platform for Diet and Germany – Platform for Diet and Physical ActivityPhysical Activity

Partnership with public and private sector, Partnership with public and private sector, NGO'sNGO's … , … ,

Focus obesity prevention in preschool childrenFocus obesity prevention in preschool childrenFunding projectsFunding projectsUse of the logo by initiatives that follow the Use of the logo by initiatives that follow the

established requisitesestablished requisites

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ISSUES AND ISSUES AND CHALLENGES: CHALLENGES:

The Global Evidence Debate in The Global Evidence Debate in Health PromotionHealth Promotion

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Issues in urbanization: major public Issues in urbanization: major public health concern of an urbanizing worldhealth concern of an urbanizing world

PopulationPopulationPollutionPollutionDegradation (environment)Degradation (environment)MigrationMigrationDestructionDestructionDesertificationDesertification

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Ozone health effectsOzone health effects

Susceptible subgroups includeSusceptible subgroups include::AsthmaticsAsthmaticsChildrenChildrenThe elderlyThe elderlyThose with certain underlying diseasesThose with certain underlying diseases

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Evidence Iceberg in Health Promotion

dvmcq 2001

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Conclusions IConclusions I

Implementation well underway in most regions, Implementation well underway in most regions, credible response but inadequatecredible response but inadequate

Global and national investment well short of Global and national investment well short of requirementsrequirements

National strategies developed in various countries but National strategies developed in various countries but not universalnot universal

Commendable actions seen in the private sector, Commendable actions seen in the private sector, especially food and drinkespecially food and drink

Physical activity programmes remain weak in many Physical activity programmes remain weak in many countries – capacity limitedcountries – capacity limited

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Conclusions IIConclusions II

WHO will continue to develop and disseminate WHO will continue to develop and disseminate suitable tools and evidence-based guidelines in suitable tools and evidence-based guidelines in

various areas e.g. monitoring frameworkvarious areas e.g. monitoring framework..Member States are encouraged to fully utilize the Member States are encouraged to fully utilize the

opportunity created by DPAS to make progress and opportunity created by DPAS to make progress and strengthen their national capacities for action to strengthen their national capacities for action to

prevent and control chronic diseases and their prevent and control chronic diseases and their common risk factorscommon risk factors..

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ACCOMMULATION OF ACCOMMULATION OF HAZARDSHAZARDS

Risk behaviorRisk behaviorUnbalanced dietUnbalanced dietInactivityInactivityObesityObesitySmokingSmoking

8484

Successful Health PromotionSuccessful Health Promotion

Regular ExerciseRegular ExerciseBalanced DietBalanced DietIdeal Body WeightIdeal Body WeightNo SmokingNo Smoking

8585

Thank youThank you

1. 2 anticipatory care & health promotion prof. sulaiman al-shammari department of family &...

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