1205MED Health challenges in the 21st Century PDF

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1205MED Health challenges in the 21st Century Overview of lecture  Defining health: many different people and profession view health in different ways 

Public health and an ecological approach to health: Biomedical perspective on health -Western medical definition: the standard medical definition of health refers to health as “ the absence of disease.” -Freedom from disease or ailment -Mechanistic- health is body working efficiently -Breakdown in body system means it is not healthy -Reductionist- fix part that is not working -Promotes capitalist value system- people as forces of production -If body not diseased then health- health as “absence of disease” A Holistic approach of health -“ Health is a state of complete physical, mental, and social wellbeing and not merely the absence of disease and infirmity. -Added spiritual well-being (specifically for indigenous communities) -Positive vision of health -Holistic and inclusive -Counter medical model of health -Utopian/ idealistic -Broadens health activity beyond prevention of disease. Concepts of health- Key points -Health means different things to different people. -Health is determined by interacting factors e.g. environment -To improve population health requires interdisciplinary approach- the cooperation of many sectors Public health: “the science and art of prevent disease, prolonging life and promoting, protecting and improving health through the organised efforts of society.”

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Determinants of health -A factor or characteristic that brings about a change in health, either for the better or the worse -In recent year there have been increasing in social determinants of health: those conditions into which people are born, grow, live, work and age.

Lecture 2: 1205MED Health challenges in the 21st Century  

WHO definition of health: state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity Determinants of health: A factor or characteristic that brings about a change in health, either for the better or the worse

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Describe global health/disease patterns and trends Explain key global health indicators: -Size of population

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Explain several global health issues: -Malaria: life-threatening disease cause by parasitise that are transmitted to people through bites of infected mosquitoes. -Malaria cause most death in African children -Climate change, still water, housing alter the location in which the parasites can harvest. -Tuberculosis: 2012, 8.6 million contracted TB, 1.3 million died from TB -95% of TB deaths occur in love and middle-income countries -Second to HIV/AIDS as the greatest killer world wide due to a single infectious agent

-Transmitted person-to-person via air borne droplets -Housing, overcrowding -COPD (chronic obstructive pulmonary disease) -Progressive and disabling condition that limits airflow in the lungs -Primary cause: indoor air pollution, occupational dust and chemicals, outdoors air pollution and smoking etc. -Diarrheal disease -Leading cause of malnutrition in children under 5 years old -Safe drinking-water, sanitation and hygiene

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Describe national health/disease patterns and trends -Nationally out health and disease pattern seems to be getting better. We gave become healthier. Much of the disease occurs in the later years.

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Name national health priorities Australian government have focused attention on 9 diseases and condition because they contribute significantly to the burden of illness and injury across Australia. - Cancer - Cardiovascular health - Injury prevention and control - Mental health - Diabetes mellitus - Asthma - Arthritis and musculoskeletal conditions - Obesity - Dementia Most focus and chronic conditions -Lifestyle related and ageing populations Explain several national health issues Explain obesity patterns and trends -Strong trend increase upwards -Inactivity, proportion sizes of food have both increased -More than doubled since1980- 1 in 10 adults -Strong association with health problems

Extra -First billion in population in 1804 -2.1 is replacement. Child birth gives the population static -Noncommunicable disease: chosen lifestyle diseases -communicable disease: environmental disease. Non choosen

Lecture 3: 1205MED Health challenges in the 21st Century (11 August) Environmental determinants  What is a determinant of health: A factor or characteristic that change health for better or the worse.  Total deaths by injuries in males is lowest in: High income countries  Highest: low middles income countries  Diseases- Least likely to be national health priority in the UK: Tuberculosis  Least industrialised country would contain: Tuberculosis  Term DALY: Disability- adjusted life year  Not a crude indicator of population health: Distribution of population   

Ecological footprint: The load imposed by a given population on nature Biocapacity (Capacity) vs. ecological footprint (Demand) Gap between supply and demand: overshoot

Human life and the planet Summary points Planetary capacity and human demands:  Biocapacity vs ecological footprint  Population growth plus growth plus increasing consumption  Demands exceed capacity  Global overshoot Physical Environmental determinants of health: Global to Local  Definition of Environment: the environment is all the physical and biological factors external to a person and all the related behaviours. (E.g. pollution of air, water.) Why interested in Environment?  24% of burden of disease (Globally) directly related to the environment Linking disease with environment  Diarrhoea- disease with the largest environmental contribution (no. 1) (94%) Environmental Determinants of Health  Health is to a considerable extent determined by environmental quality. As a consequence environment and health are closely related. Summary points: Physical environmental determinants of health: global to local  Definition of environmental determinant  Different types of environmental determinants  The burden of disease associated with environment Climate change  CO2 main greenhouse gases

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We added more greenhouse gases. Less escapes We need green house gases Temperature and precipitation

Housing and sanitation  Access to sanitation and health strong health  Same level access: Ecuador (opportunity)  Non same level access: in-ecuador  Equality and Inequality (outcomes) Summary points:  Global issues: -The Basic climate change -Cause, effect and health impacts -How housing/living conditions impact health -The link between sanitation and health -The interconnected nature of these determinants Local issues: Obesity and obesogenic environments  Obesity is the accumulation of excessive fat in the body  Imbalance between energy intake and energy expenditure  Global: Obesity has more than double since 1980.  CVD: long term condition of stroke, heart or circulatory condition) -11% of overall health expenditure -35million Australians aged 16-85 CVD -16% of overall disease burden -26% of total YLL in Australia  Obesity and overweight prevalence: 0 number countries decreasing obesity in last 33 years Summary- health outcomes of obesity  Obesity as risk factor for chronic disease  Obesity related CVD, diabetes on increase  Significant human, Social and economic cost Determinants of obesity (1)  Energy imbalance between calories consumed and calories expended  Globally, there has been: -An increased intake of energy-dense foods -Decrease in physical activity Determinants of obesity (2)  Not just about lifestyle changes  Environmental and social changes Obesity and Obesogenic environments  Prevention and treatment of obesity has focused on: -Pharmacological

-Educational -Behavioural interventions -Limited overall success 

Idea of the environment as shaping choices -Driving force behind rise in obesity -Obesity not caused by single factor

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Obesogenic environment: an environment that promotes gaining weight and one that is not conductive to weight loss within the home or workplace. Obesogenicity of an environment: -The sum of influences that the surrounding, opportunities, or condition of life have on promoting obesity in individuals or populations.

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Elements that influence  Built environment  Socio-cultural rules e.g. teens  Socio-economic status of environment  Microenvironments e.g. school.  Macroenviroments e.g. education Summary points  Obesity as a global issue: -Global- not just highly industrialised countries -Determinants of obesity -Food and exercise “choices” -Define obesogenic environment -Change environment- change scope/nature of the problem

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What is it called when global ecological footprint greater than available bio capacity? Overshoot Leading cause of malnutrition in children under 5 year old globally? Diarrheal disease Expected human health impact of climate change will include Increase mortality associated with heatwaves Environment makes the greatest contribution toward which of the following diseases? Diarrhoea

Conclusion  Many environmental determinants of health  Global to local issue -Linked with industrialisation -Way of living -Spotlight on climate change and health  Global to local issue- globesity -Obesogenic environments- context of choice

Lecture 4: 1205MED Health challenges in the 21st Century     

Ecological footprint: The load imposed by a given population on nature Obesogenic environment: an environment that promotes gaining weight and one that is not conducive to weight loss within the home or workplace Obesogenicity of an environment: the sum of influences that the surrounding opportunities, or condition of life have on promoting obesity in individuals or populations. Percentage of global burden of disease is attributable to environment factors: 24% Percentage of diarrheal disease amount children 0-14 years globally is attributable to environment? 94%

Social determinants of health  Describe the concept of social determinant of help  Define dominant define SDoH Determinants of health:  A person health and wellbeing result from a complex interplay between biological, lifestyle, socioeconomic, societal and environmental factors, many of which can be modified to some extent by health and other interventions.  Increasing interest in the social determinants of health: those conditions into which people are born, grow, live , work, and age  Health outcomes are a reflection of ones social position in the society as indicated by factors such as: -Education -Income -Gender (not just sex, about position within society) -Employment and occupation -Living condition- housing

Social determinants of health- definition  The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.

The SDoH (social determinants of health)   

Gender (not sex)- roles etc. Ethnicity Religion

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Minority group membership (e.g. linked with sexuality) Education-no. of years in education Employment and occupation Income Social support including family Community resources Living conditions-housing Access to health services Having food or being able to get food (food security)

Summary point  Definition of what is a determianant of health  Definition of the SDoH -List of SDoH  The idea that social structures determine health  Gender as a SDoH -How gender shapes health The Solid Facts  Poor conditions lead to poor health. An unhealthy material environment and unhealthy behaviours heave direct harmful effects, but the worries and insecurities of daily life and the lack of supportive environments also have an influence.  Social gradient in health, explains how psychological and social influences affect physical health and longevity. Commission on social determinants of health (CSDH) 1. Improve daily living conditions 2. Tackle the inequitable distribution of power, money and resources 3. Measure and understand the problem and assess the impact of action Summary points:  The solid facts -Seminal work raising profile of SDoH  Social gradient and health  Commission of SDoH  Australian government position The link between education and health -Time for exercise by education- high level of education thinks they have more time for exercise -Physical activity by education- lower level of education likely to be obese -Overweight by education 

Thinking about the determinants -Education, income and occupation: higher education higher income better occupation

-Health/ mortality and education, income and occupation: Lower educationlower health lower income and bad occupation -Richer have lower mortality Summary points  SDoH are inter-linked -Education, occupation, income etc  Change one and thereby change situation  Global in scope Social Determinants  Together, SDoH predict the greatest proportion of health status variance  They structure health behaviours  Interact with each other to produce health or disease Some are more vulnerable 1  First nation peoples  People living in rural and remote areas  Disadvantaged Australians  People with disability  Prisoners  Migrants- after arising to Australia  Defence force members  The veteran community Summary points:  SDoH predict greatest variation in health -Different populations impacted differently  Moving upstream to address SDoH -Downstream advantages -Less health care needed Ways to think about determinants  Proximal determinant of health: refer to any determinant of health that is readily and directly associated with the change in health status. E.g. care or wound straight away. Also nail stood on.  Distal determinants of health: refer to a determinant that is distant in time or place from the change in health status. E.g. education of parent or person. ** Environment

Determinants of health (3)  The way that we think about determinants impact on the types of interventions that are considered to improve individual or population health.  Thinking narrow, and think widely.

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Social determinants of health: the social determinants of health are the conditions in which people are born, grow, live work and age. These circumstances are shaped by the distribution of money, power, and resources at global, national and local levels. The Solid facts offers an overview of: Social determinants of health

Summary:  Social determinants of health -Overview -Definition -Identify and worked with some.. -Identified import Need: understand social determinants of health, need definition determinants and social of health and need list of SoDH, need crude definitions be able to apply. Identify importance of SODH, upstream.

Lecture 5: 1205MED Health challenges in the 21st Century Work and Health  Introduction: work as a social determinant of health  Centrality of work  Work and health  Global challenges to work and health  Future of work and health Work is an important setting- impact on:  Physical  Economic  Mental  Social wellbeing of workers and their families Social inequality and work  Social factor which regulate who does what job: -Social and economic status -Power -Family -Gender, and -Ethnicity  The jobs people get place people in unequal positions with different treatment and social rewards including access to health or exposure to hazards

Centrality of Work  A means of survival

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Provide a sense of identity An integrated part of social life Regulate social relationships Offer or limit life chances An important social determinant of health

Unemployment  Community: Increase in social isolation  Social injustice syndrome  The chances are: the better you job, the better your health. Work and Health  Work can harm people physically  Work environment and hazard exposure  Biological hazards: needle stick injuries, Large animals Q-fever, Important for Australian agricultural industry  Biological hazard: Widespread by often unrecognised  Biological hazards: Regulatory regime is difficult, intervene with some workers by vaccination. Multi-determinants of workplace health: Physical environment:  Hygiene and safety conditions  Physical hazards  Vibration  Noise  Built environment  Space  Lighting Workplace organisation:  Management style  Leadership  Communication  Decision-making  Division of labour  Shift work  Autonomy  Job satisfaction Workplace culture  Workplace bullying  Group cohesion or conflicts  Caring and supportive culture  Informal social network Work practices and ergonomic factors  Work tasks  Work station design

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Manual handling Repetitive movement Work tools Proper use of protective equipment

Global burden of occupational injuries and diseases  Total number of fatal accidents has increased, especially in Asia and south America  Low and middle-income countries of south-east Asia and western pacific regions

Global challenges to work and health  Key issues to be confronted are: -The globalization of the world economy -Rapid technological changes and work -Aging workforce -Increase of non-communicable diseases including mental health and injuries Globalization and impact on the workplaces  Increased market competition  Changing employment practices  Widening inequality Strain: impacts of stress- short term and long term  Physical impacts  Psychological  Behavioural Future of Work and Health  Technological changes and work  The robots are coming for the professionals Things machines cannot do: (3 aspects)  Creative- intelligence: able to connect with other minds: performing arts, music  Social intelligence: love, compassion and sympathetic reactions  Dexterity: the reception and manipulation of objects 

Use technology as a facilitator of transferable soft-skills. Equip yourself with skills to make decision, not letting machine making the decision for human kind.

Conclusion  Centrality of work in Australia-- individual level  Work and health-- Environmental, organisational and societal level

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Human work activities and the environment and their future on health and human survival – Global level- a sustainable future

Summary  Work is an important determinant of health that can e both positive and negative.  There are multiple determinants of workplace health impacts on the economic, physical, mental and social wellbeing of workers and their families.  The work of work is faced with many global challenges in the context of globalization and technological changes.  It is important to understand the link between work and health, and the implication of future challenges in order to prepare yourselves personally and as health professionals to address the negative determinants of work and health.

Lecture 6: 1205MED Health challenges in the 21st Century Nutrition, Physical Activity and lifestyle Objectives:  Understand the broad relationship between nutrition and health  Link between nutrition/ food choices and disease patterns/ outcomes  Understand how the food environment influences nutrition/ food choices

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Key reason for food consumption: Physiological, physiological and social factor

Nutrients  Macronutrients: Carbohydrate, lipids (fats), proteins.  Micronutrients: Vitamins and minerals  Carbohydrates: 1gm = 16kg  Fat: 1gm = 37kg  Protein: 1gm= 17kg  Alcohol: 1gm = 29kg  

Vitamins ,minerals and water: Provides no dietary energy Need for nutrient dense food vs. a desire for energy dense foods

Nutrition and chronic disease  Optimal diet: adequate supply of required nutrients for tissue maintenance, repair and...