1. Social determinants of health and life style Miloslav Klugar, Ph.D., PhDr. Social Medicine and Medical Ethics Department of Social Medicine and Health Care Policy Office number: 5.087 Office hours: Friday 9:00 – 11: 00 Faculty of Medicine and Dentistry Palacky University in Olomouc

2. Social risks of contemporary society  Economical  Different standards of living and poverty  Discrimination and social exclusion  Unemployment and the nature of work  Environmental  Environmental threats  Globalization  Genetic experiments  Social stress  Traffic issues

3. Social risks of contemporary society  Demographical  Population ageing  Life protection  Political  Institution malfunctioning  Hidden threats  Terrorism  Transnational capitalism  The Values  Inheritance of cultural and social capital  Social inequality  Excessive consumption  Extinction of emotions  Relativity of values

4. Social Determinants, Social Medicine  Social risks of contemporary societies determine the health risks as well (differences in health status of the population)  “Social Medicine” particularly engaged with social prevention in the biomedical field  …also deals with health care system, social epidemiology and social gerontology or social pediatrics, social psychiatry

5. Lalonde’s Health Field Concept  Marc Lalonde  Health minister in Canada in the 70s  Concept of YPLL (years of potential life lost)  YPLL  Measure of relative impact of several diseases and health problems in a society  Illustrates the losses suffered as a consequence of the death  Premature death  Occurs before a given predetermined age (life expectancy at birth)

6.  calculation of YPLL for a defined cause  adding all the deaths for that cause in each age group  multiplying that sum by the years between the median of the age  chosen age limit, as in the following formula l - the lower age limit established L - the upper age limit established i - the age at death di - the number of deaths at age i Years potential life lost

7. Lalonde’s analysis 1981 Car accident213 000 IHD193 000 Other accidents179 000 Respirational d. + lung c. 140 000 Suicide 69 000 He proved in the five most significant causes of death the main influence of environmental factors and consequences of personal choices. Not only influence of health care organizations.

8. Human Biology 10 – 15% The Environment 20 – 25% Health care Organization 10 – 15% Lifestyles, behaviours and Risk Factors 50 – 60 % Health Status Horizontal concept of Determinants of Health by Lalonde and WHO

9. Vertical concept of Determinants of Health LS Environment Socioeconomic system Value system Cultural and Political tradition Genome

10. Horizontal concept of Determinants of Health

11. LIFESTYLE AND BEHAVIORAL RISK F.  Substance abuse  Tobacco, Alcohol, Drugs http://gamapserver.who.int/gho/interactive_charts/tobacco/policies/atl as.html?filter=filter4,South-East%20Asia  European Football Championship (EURO 2012) was totally tobacco free.  Tobacco use contributes to the deaths of some 650 000 European Union (EU) citizens a year, including thousands who never smoked but had to breathe the smoke from others.  Alcohol consumption –interactive chart http://gamapserver.who.int/gho/interactive_charts/gisah/consumption_ 2005/atlas.html

12. LIFESTYLE AND BEHAVIOURAL R. F.  Use of protective devices  Seat belts  Bicycle helmets  Skiing and Snowboarding helmets  Sexual practices

13. LIFE STYLE  A healthy lifestyle  WHO recommendations eating lots of fruits and vegetables, reducing fat, sugar and salt intake and exercising.  12 steps to healthy eating according to WHO 1) “Eat a nutritious diet based on a variety of foods originating mainly from plants, rather than animals. 2) Eat bread, grains, pasta, rice or potatoes several times per day. 3) Eat a variety of vegetables and fruits, preferably fresh and local, several times per day (at least 400 g per day). 4) Maintain body weight between the recommended limits (a BMI of 18.5–25) by taking moderate levels of physical activity, preferably daily. 5) Control fat intake (not more than 30% of daily energy) and replace most saturated fats with unsaturated vegetable oils or soft margarines.

14. 6) Replace fatty meat and meat products with beans, legumes, lentils, fish, poultry or lean meat. 7) Use milk and dairy products (kefir, sour milk, yoghurt and cheese) that are low in both fat and salt. 8) Select foods that are low in sugar, and eat refined sugar sparingly, limiting the frequency of sugary drinks and sweets. 9) Choose a low-salt diet. Total salt intake should not be more than one teaspoon (6 g) per day, including the salt in bread and processed, cured and preserved foods. (Salt iodization should be universal where iodine deficiency is endemic.) 10) If alcohol is consumed, limit intake to no more than 2 drinks (each containing 10 g of alcohol) per day. 11) Prepare food in a safe and hygienic way. Steam, bake, boil or microwave to help reduce the amount of added fat. 12) Promote exclusive breastfeeding up to 6 months, and the introduction of safe and adequate complementary foods from the age of about 6 months. Promote the continuation of breastfeeding during the first years of life.”

15. LIFE STYLE  According to WHO 2011  Obesity is one of the greatest public health challenges of the 21st century.  Prevalence tripled in industrials countries from 1980s  Alarming is child obesity > rice at an alarming rate  Obesity > NCD  Obesity is directly responsible for 2-8% of health costs and 10-13% of deaths