case study of film

profileLeahD
11.1Chronicdiseases_clean.pptx
Home>Social Science homework help>Philosophy homework help>case study of film

11.1: NCDs/Chronic diseases

NCD =

1

Exam study guide topics (1)

Know the top 5 chronic diseases and that many of them have shared risk factors

Know the 6 risk factors that contribute the most to chronic disease

Know the most “cost-effective” interventions (aka “best buys”) per WHO guidance (see the pdf that we will talk about during lecture) for three of the specific risk factors for NCDs: 1) harmful use of alcohol, 2) physical inactivity, and 3) tobacco use

Understand the difference between primary, secondary, and tertiary prevention. If given an example of an intervention (e.g., colonoscopies, healthy eating education, stroke rehabilitation services), determine if it is an example of primary, secondary or tertiary prevention.

2

Learning objectives (2)

Why do some people say that cervical cancer and liver cancer blur the line between infectious disease and chronic disease? Be able to explain.

From a list of health interventions, be able to identify which are focused on structural determinants of health and which are focused on individual behaviors

Exam study guide topics (2)

What do we mean by chronic diseases?

Often called NCDs (non-communicable diseases)

The big ones:

1. heart disease & stroke

2. chronic respiratory disease

3. diabetes

4. cancer

5. mental health

Also : blindness, arthritis, musculoskeletal, neurologic disorders and more

4

What do these chronic diseases have in common?

Some have shared risk factors

Often are long-lasting and take a long time to fully develop

Often these diseases co-exist

5

Shared risk factors for NCDs

Tobacco use and exposure to secondhand smoke

High blood pressure

Obesity (high body mass index)

Physical inactivity

Excessive alcohol use

Poor diets (low in fruits and vegetables; high in sodium and saturated fats)

Source: CDC

6

How would these chronic diseases impact the DALY?

In general, NCDs would have high YLL because of so many people dying young from NCDs

In general, NCDs have high YLL because so many people are affected and die from NCDs

In general, NCDs would have a significant number of years of disability due to the long-lasting nature of the diseases (YLD part of the calculation)

A and C

B and C

7

What can excessive alcohol use cause?

Impacts of short-term alcohol use: injuries, violence, miscarriage, risky sex, alcohol poisoning

What about long-term use?

High blood pressure, heart disease, stroke, liver disease, and digestive problems.6,16

Cancer of the breast, mouth, throat, esophagus, liver, and colon.6,17

Learning and memory problems, including dementia and poor school performance.6,18

Mental health problems, including depression and anxiety.6,19

Social problems, including lost productivity, family problems, and unemployment.6,20,21

Alcohol dependence, or alcoholism.5

CDC Fact sheet: Alcohol use and your health

8

3 types of prevention

Primary Prevention—intervening before health effects occur

Secondary Prevention—catching diseases in the earliest stages, before the onset of signs and symptoms

Tertiary Prevention—managing disease post diagnosis to slow or stop disease progression

9

Which type of prevention would an initiative to promote healthier eating be?

Primary prevention because it aims to change the risk factors before disease develops

Primary prevention because the intervention is considered the most important step in addressing chronic illness

Secondary prevention because the intervention utilizes screenings to catch people in the early phases of disease

Secondary prevention because the intervention is considered the second most important step in addressing chronic illness

10

Your ideas: Effective Public Health initiatives targeting 3 risk factors

Harmful use of alcohol

Physical inactivity

Unhealthy diet

11

The WHO’s “Best Buys” for chronic diseases

Document is one of the assigned readigns in this week’s Canvas: or available here http ://www.who.int/ncds/management/WHO_Appendix_BestBuys_LS.pdf

CEA = Cost Effectiveness Analysis

LMIC = Low and Middle Income Countries

12

WHO position on cost-effectiveness as a tool for decision making about public health policy

“Cost-effectiveness analysis is a useful tool but it has limitations and should not be used as the sole basis for decision-making. When selecting interventions for the prevention and control of NCDs, consideration should be given to effectiveness, cost-effectiveness, affordability, implementation capacity, feasibility, according to national circumstances, and impact on health equity of interventions, and to the need to implement a combination of population-wide policy interventions and individual interventions.”

13

Understanding WHO “Best Buys” for NCDs

14

Effective Public Health initiatives targeting 3 risk factors http://www.who.int/ncds/management/WHO_Appendix_BestBuys_LS.pdf

Which PH measures would be effective?

Look through the BestBuys pdf and pick read the most cost-effective intervention for each of these:

Harmful use of alcohol (p. 7)

Physical inactivity (p. 9)

Tobacco use (p. 6)

WHO, 2017, ‘BEST BUYS’ AND OTHER RECOMMENDED INTERVENTIONS FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES

15

WHO NCD Targets

Governments have endorsed nine global voluntary targets with the overarching aim to reduce premature death from the four major NCDs by 25% by 2025.

Cardiovascular disease

Cancer

Diabetes

Chronic Respiratory diseases

16

17

Secondary prevention of chronic illness

Early diagnosis and treatment of:

High blood pressure

Overweight/obese

High blood sugar levels

Credit: Goldie, S., Global Health Clip-Chronic Disease 1.

18

What about diabetes?

Type I diabetes:

Pancreas doesn’t produce enough insulin

Most often develops in childhood, thought to be an auto-immune disease.

Type II diabetes:

Cells lose sensitivity to insulin

This is an NCD, connected to individual behaviors.

Insulin is important because it keeps blood glucose levels stable in the body. If glucose builds up in the blood, rather than entering cells or being store, it can wreak havoc. Complications of diabetes include Complications of diabetes include kidney disease, nerve damage, heart problems, eye problems, and stomach problems.

19

Type II diabetes risk factors:

You are more likely to develop type 2 diabetes if you

are overweight or obese

are age 45 or older

have a family history of diabetes

are African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander

have high blood pressure

have a low level of HDL (“good”) cholesterol, or a high level of triglycerides

have a history of gestational diabetes or gave birth to a baby weighing 9 pounds or more

are not physically active

have a history of heart disease or stroke

have depression 

have polycystic ovary syndrome , also called PCOS

have acanthosis nigricans—dark, thick, and velvety skin around your neck or armpits

Source: National Institute of Diabetes and Digestive and Kidney Diseases

20

Global Cancer Facts

Cancer is the second leading cause of death globally.

Tobacco use is responsible for approximately 22% of global cancer deaths.

Cancer causing infections, such as hepatitis and human papilloma virus (HPV), are responsible for up to 25% of cancer cases in low- and middle-income countries.

Late-stage presentation and inaccessible diagnosis and treatment are common in low-income countries.

Source: http://www.who.int/mediacentre/factsheets/fs297/en/

21

Global top 10 cancers

Cancer is a leading cause of death worldwide, accounting for an estimated 9.6 million deaths in 2018. The most common cancers are:

Lung (2.09 million cases)

Breast (2.09 million cases)

Colorectal (1.80 million cases)

Prostate (1.28 million cases)

Skin cancer (non-melanoma) (1.04 million cases)

Stomach (1.03 million cases)

Source: WHO

Source: WHO

22

Risk factors for cancer

According to the WHO, around one third of deaths from cancer are due to:

high body mass index

low fruit and vegetable intake

lack of physical activity

tobacco use

alcohol use

23

Are there any vaccines that prevent cancer?

Cervical cancer:

HPV vaccine

Have you had the HPV vaccine series?

Liver cancer:

Hepatitis B vaccine

24

Cancer prevention: secondary interventions

Screening for Breast, Cervical, Colorectal (Colon), and Lung Cancers

25

CDC works to prevent chronic disease and associated risk factors in 4 ways:

Epidemiology and surveillance refers to systems that are used to track chronic diseases and their risk factors.

Environmental approaches refers to changes in policies and physical surroundings to make the healthy choice the easy choice.

Health care system interventions refers to improvements in care that allow doctors to diagnose chronic diseases earlier and to manage them better.

Community programs linked to clinical services refers to those that help patients prevent and manage their chronic diseases, with guidance from their doctor.

26

Behavioral Interventions versus Structural Interventions

Should we think about a more “BioSocial” approach to NCDs?

27

“What we describe as a structural approach to NCDs focuses on enduring social arrangements that determine the pattern and distribution of NCDs and their risk factors in a society. Even if we assume that individuals have the ability to make rational choice with respect to healthy behavior/lifestyle, such a choice occurs within certain boundaries set by society, government, and organizations [25]. We suggest that a structural approach conceives of the NCD epidemic as the byproduct of changes to domestic and international systems that have dramatically changed modes of living and created environments that encourage the adoption of harmful patterns of behavior.”

https ://www.ncbi.nlm.nih.gov/pmc/articles/PMC6035457/pdf/12992_2018_Article_380.pdf

28

Structural versus individual interventions?

Encouraging someone to eat a healthier diet, versus:

Incentives for supermarkets to locate in lower income neighborhoods

Taxes on sugary beverages

Subsidies for fruits and vegetables rather than for corn and soybeans

Expanding SNAP and WIC benefits

Enacting laws that require a living wage (raising the minimum wage)