1 chronic disease prevention: the power of public health by dr. john frank, scientific director,...
TRANSCRIPT
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Chronic Disease Prevention:The Power of Public Health
By Dr. John Frank, Scientific Director,
CIHR-Institute of Population & Public Health
11th World Congress on Public Health Conference
August 2006
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Presentation at a Glance
Chronic Disease Prevention Challenges Selected examples
What does the evidence tell us?
Need for a population and public health approach
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Yach, D. et al. JAMA 2004;291:2616-2622.
Global Mortality From Chronic Diseases
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Yach, D. et al. JAMA 2004;291:2616-2622.
Deaths Attributable to 16 Leading Causes in Developing Countries, 2001
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20-Year Trends in Smoking: Current smokers by age, Canada, 1981-2001
A Canadian Success Story but….
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Males Females
Age-Standardized Mortality Rates for Cardiovascular Diseases, Canadian Males and Females, 1950-1999.
Source: Health Canada, 2003. Age-standardized to the 1991 Canadian population.
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Source: 2004 CPHI report, Improving the Health of Canadians.
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Source: 2004 CPHI report, Improving the Health of Canadians.
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Renewing our Public Health Principles
1) Seek the root causes of disease and disability - a focus on determinants
2) Consider and deal with whole populations
3) Understand and apply the principles of social change, over the life course
Most Public Health Interventions
Health Outcomes
Most Health Care
Political Social Cultural Economic Spiritual Ecological Technological
Forces Nation-States
Regions
(Urban Entities)
Neighborhoods / Communities
Families / Couples / Households
Lifecourse of Individuals
Population Health Framework
Biological Endowment
Gene-Environment Interactions
Physical & Social Environmental Exposures
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The Bell-Curve Shift in Industrial Populations
Increasing Serum LDL Cholesterol & CHD Risk
% of Population
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..
Population – level factors
(largely environmental)
Individual(largely genetic
for CHD)
Source: Rose G. Sick Individuals and sick populations. 1985; Int J Epid 12:32-38.
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The Importance of Population Distributions of Exposure
Source: The World Health Report : 2002. Reducing Risks, Promoting Healthy Life. Chapter 2, Figure 2.3
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Action on Obesity:Three Different Paradigms
Environmental and
Policy Approaches
Educational,High Risk
and ClinicalPreventive Services
Approaches
Treatment
Upstream Downstream
Individually-orientedPopulation-oriented
Compliments of PHRED program
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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.
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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
Community-based interventions – Hype or Hope? (cont’d)
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.
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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.
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“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