Public Health Preventive Medicine primary prevention health promotion

1. Public HealthPreventive Medicineprimary preventionhealth promotion Samar Musmar,MD,FAAFP Consultant, family medicine Clinical assistant Professor

2. Introduction • What is Health? • WHO-- defin,pros ,cons(2) • Dubos—Successful Adaptation Stress(helpful-eustress)(harmful- dystress) Continuous stress-ongoing demand for adaptation-allostatic load- ?ch.dses • Satisfactory Functioning:to individual and group

3. Measures of Health Status • Mortality data—low age-adjusted death rate and high life expectancy--?good health • Health related quality of life?Measurement • Health status indexes-adjust life expectancy on basis of morbidity ,quality of life • Life Expectancy: average #of years of life remaining at given age • Quality Adjusted Life Years(QALY) :life expectancy and quality of life

4. QALY • Examples • CVA—disability

5. Healthy life Expectancy:(combines morbidity and mortality in one index (less subjective)—how many years expected to live without disability • Others—combine several measures • General wellbeing Adjustment scale: index –anxiety,depression,general health,positive well-being,self control and vitality • Life Expectancy Free of disability: • CDC-Health related quality of life(HR-QOL)—BRFSS data (Behavioral Risk factor Surveillance System)

6. Natural history of Disease • Predisease state Factors—promote or resist dse e.g genetic,demography,environmental,nutritional ,social,immunological,behavioral • Latent state (asymptomatic)=window of oppurtunity • Symptomatic (manifest) • Example AMI

7. Levels of Prevention • Leavell’s levels: • Primary • Secondary • Tertiary

8. Health Promotion • Adequate Nutrition(palestine) • Safe Environment(war) • Behavior • Socioeconomic condition(income & education) (UK 5 scales), USA(education ,occupation,residence)—Hollingshead—mental health • Safe employment • Environmental system(water,sewage0 • Regulation of environment,commerce and piblic safety • Social support system

9. Nutrition • Undernutrition--war • Starvation • Marasmus—def all nutrient elements/ infants • Kwashiorkor---ptn energy malnutrition(excess energy-weaning) • Synergy malnutrition and infection

10. undernutrition

11. Over nutrition • Nutritional excess and imbalance factors:Indusrilization:Western Diet • Proliferation of mech device→↓phys act • Implementation of agricultural methods→food eccess • ↑ avail animal products • Popular sedentary activity TV watching • Food ads → food behavior • Availability & affordability of easy to prepare—energy-dense/nutrient-dilute

12. Obesity?Epidemic • Factors: • Diet • Life Style • Genetic • BMI wt2/ht2 • 25-29.9-overwt • 30-34.9 obeseI • 35-39.9 obese II • 40 and above obese III

13. Nutritional Counselling • USPTSF(US Preventive Task Force) • Nutrition pyramid (portions)

14. Food Pyramid

15. Environmental • Harmful—dystress • Helpful---eustress • Factors • Biological • Chemical • Physical • Psychological • Social • Physician role • Help pt analyze risk • Explore possibility of envir as cause • Reporting env dses

16. Routes and Effects of env hazards • Routes: skin,GIT,Resp • Acute ,chronic exposure---dose response

17. Env and occupation • Threshold level—below can adapt successfully • Not all have threshold level • TLV—Threshold Limit Value • Nonthreshold Exposure—ionizing radiation • Methods of measuring:monitor level /time regularly,measure serum level of chem/blood • Biologic exposure index(BEI) • Ames Test—mutagenic exposure(potential)

18. Steps in assessment of env risk • Identify env substance? Hazard • Establisg dx criteria for outcome of concern • Characterise contact(#of exposure,duration,time)cause before effect • Determine?Statistical association between exposure and outcome,look for dose response relationship • On basis of 1-4 determine risk for exopsed individual,also probable impact on population

19. Identify env substance? Hazard • Qualitative • E.g lead exposure—form/s represent hazard • Careful survielence

20. Criteria for dx • S&s of dse e.g lead—cns damage children or ch abd sympt and motor nuropathy adults

21. Quant and qualitative • # of exposures • Duration • Intensity • timing

22. Look for statistical association • Dificult to do • Ames test • Animals and human –same dse • Look for dose response relationship

23. Assess risk of exposure to indiv and population • Difficult • Most data on high level and acute exposure • Obtain by plotting observed levels of association against associated known risk or damage • Calculate regression line and examine risk for lower exposure

24. Methods of environmental modification • Identify specific factors(biologic ,physical,chemical,social) • Modify env accordingly • Methods: • Elimenating or ↓offending agent(e.g) X DDT,lead free gasoline • preventing contact between people and env hazard(e.g) .public measures ,water sanitation,sewage disposal,resturant saniatation,control of dse vector or individual measures personal hygiene,food hygiene at home ,clothes proper or legislative mandated e.g seat belt wearing,helmet or sound protection device in airport for crew

25. Sources of Environmental hazards • Air pollution • Water pollution • Waste solid • Electromagnetic radiation • Contaminated food • Disease vectors

26. Behavioral factors in health promotion • Important in choices :nutrition,environment • Level of education • Occupation • Recreation • counselling

27. Counseling • Women before &during pregnancy • Parents—nutrition,safety,immunization • Patients with risk factors