1 A Prism on the Future 2 nd Saudi Commission for Health Specialties Conference Riyadh 2015 Zubair Amin Dept of Paediatrics, National University of Singapore

What we know will be different in the Future Changing demographics Changing practice pattern Information acquisition to knowledge navigation Population-based thinking Prevention/wellness and health Fusion of learning and work

Health is an Entity “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” World Health Organization (WHO), 1948 The definition remain unchanged since 1948.

New Morbidities Mental health Developmental disorders Childhood obesity Trauma and accidents …….

WHO. Years Loss to Disability. Eastern Mediterranean Region 2012 RankCauseYLD (000s)% YLDYLD per 100,000 population 0All Causes 63, Unipolar depressive disorders 8, Iron-deficiency anaemia 5, Back and neck pain 4, Anxiety disorders 3, Chronic obstructive pulmonary disease 2, Diabetes mellitus 2, Migraine 1, Asthma 1, Refractive errors 1, Skin diseases 1,

Mental Health among Pediatric Population in Saudi Arabia Secondary school children in Taif (Abdel-Fattah& Asal 2007) –33%: moderate to severe depression –11%: severe to very severe depression range High School students (boys) from Abha (Al-Gelban 2006) –59%: significant level of either depression, stress, or anxiety High School students (girls) from Abha (Al-Gelban 2009) –Phobic anxiety: 16% –Psychoticism: 15% –Anxiety: 14% –Somatization: 14% –Depression: 14%

Yong Loo Lin School of Medicine Mental Health Half of all the lifetime cases of mental illness begin by the age of 14 years; –Mental disorder is a chronic disease of the young Mental disorders are equally distressing for the individual and families Mental health is seldom a part of pediatric curriculum (

Yong Loo Lin School of Medicine CONFIDENTIAL Childhood Obesity: Need for Different Approach

Comorbidities in Childhood Obesity Psychological impact –Bullying, low self-esteem, Depression Headache OSA or obstructive sleep disordered breathing Chronic cough, nocturnal cough, asthma GERD Constipation Bone and joint pain (e.g., SCFE) Insulin resistance, type 2 DM and metabolic syndrome Fatty liver Acne

Radical Reorientation of Pediatric Curriculum Balanced representation of health and disease Health promotion and disease prevention Fusing clinical science and education

Balance between Health and Disease Medical curriculum (UG and PG) is heavily disease focused Health and disease is not a dichotomous entity Health and disease exist in a continuum Health should be an essential element in the curriculum

Health Promotion and Disease Prevention Many chronic diseases originate in childhood Could be equally severe –Childhood depression is equally dangerous and distressing to family Too late to start when the disease is firmly in place

Health Promotion and Disease Prevention Nutrition Life-style Accidents and trauma Mental health Adolescent health care Blueprinting the curriculum Blueprinting the assessment

Green et al. The Ecology of Medical Care Revisited: NEJM (26):