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

2. 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

3. 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.

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

6. WHO. Years Loss to Disability. Eastern Mediterranean Region
2012
Rank
Cause
YLD (000s)
% YLD
YLD per 100,000 population
All Causes
63,582
100.0
10383 1
Unipolar depressive disorders
8,819
13.9
1440 2
Iron-deficiency anaemia
5,090
8.0
831 3
Back and neck pain
4,192
6.6
684 4
Anxiety disorders
3,247
5.1
530 5
Chronic obstructive pulmonary disease
2,507
3.9
409 6
Diabetes mellitus
2,369
3.7
387 7
Migraine
1,474
2.3
241 8
Asthma
1,439
235 9
Refractive errors
1,408
2.2
230 10
Skin diseases
1,365
223
Talk about adoloscences
WHO. Years Loss to Disability. Eastern Mediterranean Region

7. 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%

8. Mental Health (www.brigthfuture.org)
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 (

9. Childhood Obesity: Need for Different Approach
CONFIDENTIAL

10. 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
(Childhood depression is as serious as adult depression)

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

12. 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

13. 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

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

15. Green et al. The Ecology of Medical Care Revisited: NEJM. 2001