Lecture 29 Flashcards
(26 cards)
Epidemiologic transition
Characteristic shift in common causes of death and disability from perinatal and communicable (infectious) diseases to non-communicable (chronic) diseases
Risk transition (overtime)
Increasing socioeconomic status (SES) of country = increasing risks for NCDs, decreasing risks for perinatal and communicable diseases
Risk transition (SES of country)
Changes in risk factor profiles as countries shift from low to higher income countries, where common risks for perinatal and communicable disease (unclean water) are replaced by risks for NCDs (tobacco)
Double burden of disease
Perinatal and communicable diseases + NCDs
Common in middle-income countries
This causes a challenge, policy and resource wise, they need to find was to address risk factors and develop interventions for both NCDs and perinatal and communicable diseases
Population groups most affected by NCDs
- Populations living in poverty
- Those living in LMICs
Myth: NCDs or chronic diseases affect mostly high-income countries
> 80% of NCDs in LMICs
Myth: NCDs or chronic diseases affect mostly rich people
Concentrated among poor
Myth: NCDs or chronic diseases LMICs should control infectious diseases first
“double burden” requires double response
Myth: NCDs or chronic diseases primarily affect old people
Almost half in <70 years (30 to 69 year olds)
Smoking prevalence in NZ: 2006 and 2013 census
Pooer neigbourhoods are more likely to smoke
Disparity between different groups hasn’t reduced overtime
Yes there is a decrease in the prevalence of smoking but the difference between the socioeconomic groups hasn’t changed
Leading risk factors contributing to GBD
What role does the commercial sector play in NCD epidemic?
commercial sector (upstream determinant) –> creates uneven distribution of risks –> unequal NCD epidemic
GBD
Global Burden of Disease
NCD
Non-communicable diseases
How have commercially driven epidemics come to be?
- Social normed changed
- A greater emphasis on downstream (compared to upstream) strategies has put equity in public health at risk
Strategies used by industry
- Shaping the evidence
- Employing narratives and framing techniques
- Consistency building
- Policy substitution, development and implementation
- Big money behind harmful products
Emphasis on downstream strategies
Emphasis on behavioral change
It’s hard to tell people to stop doing something like smoking or binge drinking etc
Offering choice
Policy (government) intertia in implementing recommended policies
- Weak governance system/political timidity
- Conflict of interest
- Belief in education approaches and market solutions
- Unwilling to battle industry
- Industry opposition, lobbying
Lack of sufficient public demand for policies
Usually supportive of policy actions
Not translated into pressure for change
Industrial epidemic
Disease arising from over-consumption of unhealthy commercial products
WHO: Tobacco control strategies - The 6 MPOWER measures
M - monitor tobacco use and prevention policies
P - protect people from tobacco use
O - offer help to quit tobacco use
W - warn about the dangers of tobacco
E - enforce bans on tobacco advertising, promotion and sponsorship
R - raise taxes on tobacco
To address the commercial determinants of NCDs and health inequities
Shift focus from individual behaviours to broader environment and upstream drivers of unhealth product consumption
Tackle the broader determinants of health
Develop effective health policy recognising the tension between commercial and health objectives
Shaping the evidence
Shaping research and funding priorities
Employing narratives and framing techniques
Focusing on youth, schools
Focus on individual problem behaviours
Being “part of the solution”
Focus on corporate social responsibility
Constituency building
Promoting or sponsoring efforts beyond core business
Partnerships with charities or health/education-related foundations
