1、Global Health: The Burden of Chronic Diseases,Jeffrey P. Koplan, MD, MPH Vice President for Global Health Director Global Health Institute,The Demographic Transition,A change in the population dynamics of a country as it moves from high fertility and mortality rates to low fertility and mortality ra
2、tes.,The Epidemiologic Transition,A transition from infectious disease to chronic, degenerative, or man-made diseases as the primary causes of mortality.,Changes in Life Expectancy,Ref: The 2006 Revision and World Urbanization Prospects: The 2005 Revision, http:/esa.un.org/unpp, Wednesday, March 12,
3、 2008,Ref: National Intelligence Council, The Global Infectious Disease Threat and Its Implications for the United States, 2000. Adapted.,The Epidemiologic Transition,Population Pyramids by Growth Pattern,Population Pyramid: Scotland, 1901,Ref: General Register Office for Scotland. Available at: www
4、.gro-scotland.gov.uk/files/04fig2.4.gif. Accessed 12 February 2008.,Population Pyramid: Scotland, 2001,Ref: General Register Office for Scotland. Available at: www.gro-scotland.gov.uk/files/04fig2.4.gif. Accessed 12 February 2008.,Projected rankings for 15 leading Causes of Death, 2002 vs 2030,Ref:
5、Mathers CD, Loncar D. PLoS Med. 2006 Nov;3(11):e442.,Projected rankings for Causes of Death, high vs low income, 2030,Ref: Mathers CD, Loncar D. PLoS Med. 2006 Nov;3(11):e442.,Ref: WHO. Preventing chronic diseases: a vital investment (2005).,Projected foregone income due to early mortality from hear
6、t disease, stroke and diabetes, 20052015,Driving the Demographic and Epidemiologic Transitions,Western model: driven gradually by economic, scientific, and technological development New model: driven more rapidly by economic development plus rapid uptake of health-related science and technology,The
7、New Risk Factors,Industrialization has led to Chronic DiseaseRisk factors: Smoking Pollution Automobiles Diet Sedentary lifestyleAging populationUrban migration,“On one point, however, there is nearly complete consensus of opinion, and that is that primary malignant neoplasms of the lungs are among
8、the rarest forms of the disease. This latter opinion of the extreme rarity of primary tumours has persisted for centuries.” I Adler, Primary Malignant Growths of the Lungs and Bronchi: A pathological and clinical study. Longmans, Green and Co., London, 1912.,Most smokers live in developing countries
9、,Source: Jha et al, 2002, AJPH,Current smokers in 1995 (in millions) Region NumberLow/Middle income 933High Income 209World 1,142Quit rates low in low income countries5-10% in China, India30-40% in UK,Large and growing number of deaths from smoking,Source: Peto and Lopez, 2001,Past and future tobacc
10、o deaths (in billions) Time Billions of deaths1901-2000 0.1 (mostly in developed countries)2001-2100 1.0 (mostly in developing countries)0.5 B among people alive today 1 in 2 of long-term smokers killed by their addiction1/2 of deaths in middle age (35-69),Ref: WHO. Report on the Global Tobacco Epid
11、emic (2008).,Source: http:/ Brazil,Prevalence of excess weight (Body Mass Index 25) Population of 15 years of age in 15 Brazilian Capitals and FD 2002-2003,Mexico,From 88 to 99, in 2 - 4 year olds the rate of obesity or at risk for obesity increased from 21.6% to 28.7%6-11 year olds, 21% obese or at
12、 risk for obesity24% of Mexican adults are obese8% of adults 20 y.o. have type 2 Diabetes30% have HBP,Figure 7 Changes in mean food purchases in 1996 (relative to 1994) by food group. Source: Rivera et al., 2004,MEXICO,Chinese Household Food Consumption Trends,Ref: Wang H, Du S, Zhai F, Popkin BM. T
13、rends in the distribution of body mass index among Chinese adults, aged 2045 years (19892000). International Journal of Obesity 31(2007):272278.,Dietary energy from fat more than 30%,Source: The China Economic Population Nutrition and Health Survey Sample size: 5789 (1989), 5838 (1991),5468 (1993),
14、5334 (1997), 4831 (2000), 4474 (2004),CHINA,Figure 5 Mean Time dedicated to video viewing and physical activity, Mexico City Children 9-16 years old 1999,Ref: Mexico Nutrition Survey 1999,MEXICO,Number of color TV sets owned per 100 households,year Urban rural1985 17.211990 59.041995 89.79 16.921999
15、 111.572000 116.56 48.742001 120.52 54.412002 126.382003 130.50,Source: State Statistical Bureau, China Statistical Yearbook, 1985-2005,CHINA,Ref: Yangfeng Wu; Overweight & obesity in China, website: 19 Aug 2006,CHINA,Shifts in the BMI distribution for Chinese men, 19892000,Ref: Wang H, Du S, Zhai
16、F, Popkin BM. Trends in the distribution of body mass index among Chinese adults, aged 2045 years (19892000). International Journal of Obesity 31(2007):272278.,India,Metabolic Syndrome 5 to 50% prevalence- insulin resistance- glucose intolerance- abdominal obesity- hyper insulinemic- hyper triglycer
17、idemic,Projected Growth in Road Traffic Fatalities, 20022020,Ref: Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006 Nov;3(11):e442.,Global Prevalence of Mental Health Disorders,Ref: Prince M, Patel V, Saxena S, et al. No health without ment
18、al health. Lancet. 2007;370:859-877.,The Behavioral Transition,An increase in individual and collective behaviors, promoted and spread by global communication, that leads to the increased prevalence of unwanted health outcomes. The behavioral transition has led to an increase in “communicated diseas
19、es.”,Communicable Disease Model,HOST,AGENT,VECTOR,Communicated Disease Model?,HOST,AGENT,VECTOR,Communicable/Communicated Diseases,Communicable: Communicated:,AGENTSMicro organisms- viruses- bacteria- parasitesFood Drink Tobacco Inactivity,Communicable/Communicated Diseases,Communicable: Communicate
20、d:,Vectors InsectsMedia Sports TV/Cinema Social pressure,Communicable/Communicated Diseases,Communicable: Communicated:,Environmental ConditionsGlobal warmingIncreased affluence Urbanization,Communicable/Communicated Diseases,Communicable: Communicated:,Socio-cultural ContextWaste disposal Hygiene C
21、oughing etiquetteNo smoking places Value of activity Safe driving/roads,Communicable/Communicated Diseases,Communicated Diseases,obesity motor vehicle collisions and injuries decreased fitness and activity CHD diabetes hypertension stroke many cancers chronic lung disease,DEATHS DUE TO CHRONIC DISEASES (NCDs),Interventions,Community health promotionSchool base programsLegislation/regulationTaxationMass mediaPartnershipsGovernment leadership,KTL website (www.ktl.fi),
