Public Health Dr Linda de Caestecker Director of Public Health NHS Greater Glasgow and Clyde What is public health What we as a society do, collectively, to assure the conditions in which people can be healthy. What people believe about Glasgows health Glaswegians are unhealthy
Its because they smoke a lot If only they adopted healthy habits, they would be healthy It is in their genes There is nothing that can be done to change this Only ONE of these statements is true! The Determinants of Health Social determinants of Health: Major Factors
Poverty, Income Inequality, and Deprivation What a devil art thou, Poverty! How many desireshow many aspirations after goodness and truthhow many noble thoughts, loving wishes toward our fellows, beautiful imaginings thou hast crushed under thy heel, without remorse or pause! Walt Whitman Unemployment, Underemployment, and Job Insecurity If a man doesnt have a job or an income, he has neither life nor liberty nor the possibility for the pursuit of happiness. He merely exists. Martin Luther King, Jr. Food Insecurity There will never cease to be ferment in the world unless people are
sure of their food. Pearl Buck Determinants of Health Poor Housing Quality and Housing Instability The connection between health and the dwelling of the population is one of the most important that exists. Florence Nightingale Adverse Features of the Built Environment Where you stand depends on where you sit. Nelson Mandela Poor Access to Health Care Of all the forms of inequality, injustice in health care is the most shocking and inhumane. Martin Luther King, Jr.
Determinants of Health Discrimination and Social Exclusion No one is born hating another person because of the color of his skin, or his background, or his religion. People must learn to hate, and if they can learn to hate, they can be taught to love, for love comes more naturally to the human heart than its opposite. Nelson Mandela Adverse Early Life Experiences
The Child is father of the Man. William Wordsworth Poor Education The school is the last expenditure upon which America should be willing to economize. Franklin D. Roosevelt 23% of all premature deaths can be attributable to preventable factors. 18 51 18 -18 55 53 18 -18
99 97 20 -20 03 01 -2 00 5 Life expectancy trends Life expectancy: Scotland & other Western European Countries, 1851-2005 Source: Human Mortality Database 90.0
80.0 70.0 Portugal 60.0 Scotland 50.0 40.0
30.0 20.0 Female life expectancy by deprivation years in 5 y b d e reas
in the c s n i r a h e t r y i b
and by 3 tancy at c w e o p g x s of over e a l
p e a G f i g l f o g e l n
s a i t Fem a widen ived par r o t p e g d
n i t s d a the lea reasle a d e v i r
p most de 10 years Increases in LE since 2001/03 Scotland 3.6 years males 2.3 years females
WHO definition of health (1948) A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity WHO Constitution A better definition of health Just as environmental scientists describe the health of the earth as the capacity of a complex system to maintain a stable environment within a relatively narrow range, we propose the formulation of health as the ability to adapt and to self
manage. Huber et al 2011 The causes of wellness Optimistic outlook Sense of control and internal locus of control Sense of purpose and meaning in life
Confidence in ability to deal with problems Supportive network of people Nurturing family Social Relationships and Mortality 2010 review of 148 studies with 308,849 participants, 50% increased likelihood of survival for participants with stronger social relationships social isolation is an independent variable for life expectancy Compression of morbidity (Adapted from Fries 2003)
Physical Activity The best buy for health Physical activity Any body movement produced by the skeletal muscles that results in a substantial increase over resting energy expenditure (Bouchard & Shephard, 1994) What is Physical Activity?
Anything that gets you moving! UK wide CMO Physical Activity Recommendations - 2011 For older adults 1st time Headlines Accumulating 150 mins per week + Strength and balance 2 x pw Decreasing sedentary behaviour
Older adults Moderate intensity accumulating 150 minutes per week OLDER ADULTS (65 + ) Should aim to be active daily. Weekly activity > 150 minutes of moderate intensity activity in bouts of 10 minutes or more. (For those already regularly active at moderate intensity), comparable benefits through 75 minutes vigorous intensity activity across the week, or combinations of moderate and vigorous activity.
CMO, Start Active Stay 25 Active, 2011 Older Adults Sedentary, Strength and Balance Older adults should: Minimise amount of time spent being sedentary (sitting) for extended periods. Also undertake physical activity to improve muscle strength on at least two days a week. Older adults at risk of falls should
incorporate physical activity to improve balance and co-ordination on at least two days a week. CMO, Start Active Stay Active, 2011 What can exercise do for you? Reduce the risk of the three leading causes of death: heart disease, stroke, and cancer Enhance mental abilities Improve sleeping habits and increase energy levels Lift depression and help manage stress Control weight, improving self-image, appearance and
health Exercise & Cardiovascular Disease Sedentary lifestyle is a risk factor for CVD, according to the American Heart Association Exercise reduces Blood Pressure High blood pressure (above 140/90) is the main cause of Heart Attack and Stroke Exercise prevents Atherosclerosis (clogged arteries) Exercise reduces cholesterol plaques that clog arteries and can lead to stroke and heart
attack WHO 2002 Exercise and Cancer Exercise helps to prevent obesity, a major risk factor for several types of cancer Exercise enhances immune function Exercise activates antioxidant enzymes that protect cells from free radical damage WHO 2002 Exercise and Depression
Exercise can help prevent depression. In fact, recent studies have shown that exercise was found to be just as effective (despite a slower initial response) as antidepressant medication for treatment of depression. WHO 2002 Exercise and Your Mind Short-term benefits: Boost alertness (possibly by triggering the release of epinephrine and nor epinephrine) Improve memory Improve intellectual function
Spark creativity Long-term benefits: Exercise has been shown to slow and even reverse age-related decline in mental function and loss of short-term memory A report of Surgeon general, Physical Activity and health, 1996 Making activity choices >3 hrs per week targeted exercise Heart Attack - 3 x less likely
Osteoporosis - 2 x less likely Hip fracture - 2 x less likely Also reduces risk of high blood pressure, obesity, stroke and diabetes and improves quality of life with medical conditions >3 hrs per week on your feet Reduced risk of falls and fractures ACSM 2007; CDC 1996,2002; Sesso 2000; Nicholl 1994; WHO 1997; NIA 1998; BHF 2010. Sedentary Behaviour = Active bone and strength loss
No standing activity leads to active loss of bone and muscle 1 wk bed rest leg strength by ~ 20% 1 wk bed rest spine BMD by ~1% Sedentary behaviour = worse balance
Nursing home residents spend 80-90% of their time seated or lying down (Krolner 1983; Tinetti 1988; Skelton 2001; Beyer 2002) Its never too late to exercise The lower the baseline level of physical activity, the greater the health benefit associated with an increase in physical activity (Haskell 1994)
A 12 week high Intensity Strength Training programme in >90 yr olds doubled their strength (Fiatarone, 1990) In 3 months a 65-90 year old can rejuvenate 20 years of lost strength (Skelton, 1995) Falls in the UK 11 million people aged > 65 yrs 28,000 women aged > 90 yrs
Fractures costs 1.8 billion pa 1 Hip Fracture every 10 mins 1 Wrist Fracture every 9 mins 1 Spine Fracture every 3 mins 500 admitted to Hospital every day 33 never go home Annual European Home and
Leisure Accident Surveillance Survey (EHLASS) Report UK 2000 DoH Prevention Package 2009 Factors affecting participation in physical activity Biological factors Age Gender Demographic factors Ethnicity Marital status Socio-economic status Education
Psychological factors Self-efficacy, confidence, beliefs, attitudes & values Fear & concern for personal safety Social factors Environmental factors (BHF 2012) Common Reasons Not To Exercise I dont have the time
I dont like to sweat Ill look silly It hurts I dont know what to do Its not important Physical activity interventions routinely - . embedded into hospital settings.
At least 1/3 of adults are not sufficiently active NHSGGC Health and Wellbeing Survey 2014 Making Physical Activity a Part of Your Life. There are 1440 minutes in every day... Schedule 30 of them for physical activity.
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