1. HEALTH PROMOTION AND DISEASE PREVENTION Christine M. Zammit, RPA-C

2. HEALTH Health is not only the absence of illness Described as a state of complete physical, mental and social well being

4. Determinants of Health Biology Genetic makeup, family history and health problems acquired during life Behaviors Individual responses to internal or external stimuli Personal choices and physical and social environment can affect behaviors Social environment Interactions with family, friends, coworkers and others in the community

5. Physical environment That which can be seen, touched, smelled or tasted Invisible agents such as radiation, carbon monoxide, etc. Policies and interventions Stop smoking campaign Back to sleep campaign Child restraints Immunizations

6. Access to Health Care Expanding access to healthcare will increase quality years of life for all Americans

7. Healthy People 2010 Goal # 1 To help individuals of all ages increase life expectancy and improve their quality of life Life expectancy The number of years persons born in a given year are expected to live based on age specific death rates Today life expectancy is about 77 years Quality of life General sense of happiness and satisfaction with life and our environment

8. Leading Causes of Mortality for All Ages in the United States Diseases of the heart Malignant neoplasms Cerebrovascular disease Chronic lower respiratory diseases Accidents Diabetes Influenza and pneumonia Alzheimer’s disease

9. Nephritis, nephrotic syndrome and nephrosis Septicemia Suicide Chronic liver disease and cirrhosis Essential hypertension and renovascular hypertension Parkinson’s disease Pneumonitis

10. Leading Causes of Mortality from Ages 1-4 Accidents Congenital malformations, chromosomal abnormalities Malignant neoplasms Homicide Diseases of the heart

11. Leading Causes of Mortality from Ages 5-14 Accidents Malignant neoplasms Congenital malformations, chromosomal abnormalities Homicide Suicide

12. Leading Causes of Mortality from Ages 15-24 Accidents Malignant neoplasms Congenital malformations, chromosomal abnormality Homicide Suicide

13. Leading Causes of Mortality from Ages 25-44 Accidents Malignant neoplasms Disease of the heart Suicide Homicide

14. Leading Causes of Mortality from Ages 45-64 Malignant neoplasms Disease of the heart Accidents Diabetes mellitus Cerebrovascular disease

15. Leading Causes of Mortality Ages 65 and older Disease of the heart Malignant neoplasms Cerebrovascular disease Chronic lower respiratory disease Alzheimer’s disease

16. Leading Health Indicators Healthy People 2010 ExerciseMental health ObesityEnvironmental quality Smoking/Substance abuse Sexual behaviorImmunization Access to health care

17. Leading Health Indicators Reflect the major public health concerns in the United States Specific indicators used to track progress Motivate action Goal is to help everyone understand the importance of health promotion and disease prevention

18. Physical Activity Regular physical activity can Decrease the risk of CHD, colon cancer, CVA, DM, HTN Promotes healthy bones, muscles and joints Prevents obesity Decrease the prevalence of falls in adults and arthritis pain Decrease LDL, increase HDL Increase lean muscle mass and decrease body fat Enhance psychological well being and decrease incidence of depression

19. The following populations have low levels of physical activity Women African Americans and Hispanics Low socioeconomic class on lower education Persons with disabilities Those who live in northeastern and southern US

20. Barrier to physical activity Time constraints Motivation Environment Those who find exercise boring

21. Recommendations Adults 30 minutes of moderate intensity physical activity at least 5 times/week Children and adolescents 60 minutes of moderate intensity physical activity most days of the week

23. Overweight and Obesity Major contributor to causes of preventable deaths in the US 2/3 of the population in the US are overweight 30.5% of the US population is obese Prevalence has increased in all age groups, genders, races Increased prevalence in African Americans and Hispanics 67% of patients with Type 2 DM have a BMI >27

24. Overweight and Obesity Overweight and obese persons are at increased risk for morbidity and mortality from CHD CVA DM Gallbladder disease Osteoarthritis Breast/endometrial/prostate and colon cancer

26. Obesity is the result multiple factors including genetics, environment, social, culture and behavior Efforts to maintain a healthy weight should begin in early childhood and persist through adulthood Increasing physical activity is also important to attain this goal

27. Goals Increase number of adults at a healthy weight Decrease the number of obese children Increase physical activity Working together with school system to encourage healthy lifestyle Making environment more accessible to those who engage in outdoor physical activity

28. Healthy foods Fruits and vegetables Low fat milk and dairy products Fish Lean meat Poultry Beans Whole grains

29. Tobacco Use Cigarette smoking is the most preventable cause of death in the US 430,000 tobacco related deaths in the US per year Main goals of this objective are to reduce the number of adolescent and adult tobacco smokers

31. Smoking is a risk factor for major cardiac events as well as stroke and lung cancer Smoking during pregnancy can result in preterm labor, STOP, SIDS Environmental tobacco smoke increases the risk of asthma and bronchitis Also responsible for lung cancer

32. Groups at risk Adolescent smoking is on the rise White high school students have the highest incidence American Indians, Alaskan natives, blue collar workers and military personnel have highest rate Men are slightly more likely to smoke than women Persons with low income are more likely to smoke than those with higher income

33. Goals Decrease adult and adolescent tobacco smokers Increase number of physicians and doctors who counsel their patients about smoking cessation Increase number of schools that provide information on tobacco use Increase average age of first use of tobacco Eliminate tobacco advertising Increase federal and state tax on tobacco products

34. Promote smoke free indoor areas Reduce illegal buy rate among minors

35. Substance Abuse Alcohol and illicit drug use are associated with all of the following accidents, injury, homicide, suicide, assault, HIV transmission child and spousal abuse Leads to low worker productivity, and homelessness Disrupt family, personal and social life Alcohol abuse alone can lead to cirrhosis, pancreatitis

37. Reduce illegal sale of alcohol to minors Education in schools about the dangers of alcohol and drug abuse Support groups

38. Responsible Sexual Behavior Unsafe sexual practices can lead to unplanned pregnancies, transmission of STD’s Abstinence is the only method of complete protection Condoms can help in the prevention of STD’s and unplanned pregnancies if used correctly

40. Half of all pregnancies in US are unintended Rates have been declining Highest prevalence in teenagers, women over 40 and low income African American women STD’s 15 million new cases of STD’s per year 4 million of these are in adolescents Women have higher complication rates than men African Americans and Hispanics have a higher rate

41. 800,000-900,000 people infected with HIV/AIDS in the US ½ of newly diagnosed patients are under the age of 25 years old Leading cause of death for African American men aged 25-44

42. Goals Decrease number of unintended pregnancies Decrease transmission of HIV and other STD’s Encourage abstinence Encourage safe sexual behaviors Safe sex education in schools and at home Condom distribution in high schools and on college campuses

43. Mental Health – Focus on Depression 20% of people in the US are afflicted with a mental illness Mental health is the state of successful mental functioning, resulting in productive activities, fulfilling relationships, ability to adapt to change and cope with adversity Depression is the most common mental disorder with over 19 million patients affected Depression causes high degree of disability and is the cause of 2/3 of suicides

45. Depression is under diagnosed and under treated Affects all ages, races, and genders however Older adults have a higher rate of depression Women are affected 2 times as often as men Poor, uneducated women are more commonly affected More common among those with coexisting medical conditions

46. Depression Patients with depressive disorder are often unable to fulfill the daily responsibilities of being a spouse, partner or parent People often do not seek help, because of the stigmata associated with mental illnesses One of main goals for the mental illness indicator is that people with recognized depression be treated appropriately

47. Environmental Quality 25% of preventable illnesses worldwide can be attributed to poor environmental quality Two indicators being looked at are ozone and environmental tobacco smoke Physical and social environment play major roles in the health of individuals and communities Environmental quality is a global concern

48. Poor air quality contributes to respiratory disease, cardiovascular disease and cancer Although air pollutants have decreased steadily in last few decades, it is still a major concern Environmental tobacco smoke is a major problem, with home and the workplace being major sources

50. Goals Continue to ensure clean drinking water Safe waste management Provide safe food Decrease environmental tobacco smoke Improve air quality

51. Immunizations Help prevent disability and death from infectious disease Help to avoid the spread of disease within a community Coverage levels for immunizations in children are high, but need to be higher Coverage levels for adults is less than children

53. Goals include to increase the proportion of children who receive all vaccinations that have been recommended for universal administration for at least 5 years Increase the proportion of non- institutionalized adults who are vaccinated yearly against influenza and ever against pneumococcal disease

54. Access to Health Care Predictors of access to health care Health insurance Higher income Primary care provider

55. Health insurance Provides access to healthcare More likely to have primary care provider More likely to have immunizations and screening tests 44 million people in the US do not have health insurance Primary care provider 40 million Americans do not have a regular doctor, clinic or healthcare center they go to for healthcare

56. Barriers Financial Cultural Spiritual Lack of healthcare providers/specialists Language barriers Poor education

58. Goals Increase the proportion of patients with health insurance Increase the proportion of persons who have a specific source of ongoing primary care Increase the proportion of pregnant women who begin prenatal care in the first trimester

59. Health Disparities 2 nd goal of Healthy People 2010 is to eliminate health disparities Gender Some disparities are a result of biological difference Men have life expectancy 6 years less than women Men have higher death rates for 10 leading causes of death

60. Race Biologic differences between African Americans, Pacific Islanders, Hispanics, Native American Indians do not explain the differences when these groups are compared with non-Hispanic Caucasians African Americans Infant mortality rate double Caucasians Increased death rate from all cancers and HIV/AIDS when compared to Caucasians

61. Hispanics More likely to die from DM Increased prevalence of TB Higher prevalence of HTN and obesity American Indians and Alaska natives Increased infant death rate Prevalence of DM 2x that in the Caucasian population Asians and Pacific Islanders One of healthiest groups in the US Vietnamese women suffer from cervical cancer 5 times more than white women

62. Health Disparities Income and education Populations with worst health status, are those most poverty stricken and those with the least education Higher income groups have better access to health care Disability 21% of US More complaints of anxiety, pain, restlessness and sleeplessness Increased prevalence of obesity

63. Geographic location 25% of Americans live in rural areas Injury related deaths 40% higher in these areas Less likely to use screening measures, wear seatbelts or use helmets Sexual orientation Gay, male adolescents are 2-3 times more likely to attempt suicide than their peers

64. Prevention Primary Prevention Measures provided to individuals to prevent onset of a targeted condition I.e.. Immunization, bicycle helmets, safety belts Most cost effective Secondary Prevention Identify and treat asymptomatic persons who have already developed risk factor or pre- clinical disease but in whom the condition is not apparent Screening tests

65. Tertiary Prevention Involves care of established disease Attempt to restore highest function Prevent disease related complications

66. Recommended Screening Guidelines Breast Cancer Clinical breast exam every 3 years for women in 20’s -30’s and every year after 40 Mammogram yearly after age 40 Follow doctor’s recommendation for those considered to be at high risk Cervical Cancer PAP test within 3 years of beginning vaginal intercourse but definitely by age 21 Yearly PAP with old method, every 2 years with new liquid based PAP

67. At 30 years old, with 3 normal PAP smears, may get screened every 2-3 years At 70 years old, with 3 normal PAP smears, may choose to discontinue screening Colorectal cancer (one of these) Yearly fecal occult blood test (FOBT) Sigmoidoscopy every 5 years Yearly FOBT plus sigmoidoscopy every 5 years Double contrast barium enema every 5 years Colonoscopy every 10 years

68. Recommended Screening Guidelines Prostate Cancer Digital rectal exam and serum PSA yearly for men older than 50 May begin screening earlier for high risk patients Diabetes screening Every 3 years for those with risk factors After age 50, every 3 years Melanoma screening At least every 5 years No more than once/year for those with risk factors

69. Chlamydia and STD screening Once a year for sexually active men and women until age 26 Cholesterol screening At least every 5 years More frequently if high, or with risk factors