Population and high risk preventive strategies
Original distributionPopulation approach
Combined Strategies
High risk approach
Distribution Destiny
Risk Factor
Risk factors
Population based approach: How to do it? I
Culturally and linguistically appropriate and effective community health promotion and disease prevention programs should be encouraged and made widely availableIf they already exist, they should be strengthened and integrated with the formal health care sector
CVD prevention should be integrated with primary heath care
CV health education should be integrated with other health promotion initiatives (e.g., that for cancer and diabetes).
• Population based approach II
• Target population-wide lifestyle interventions• Involves population-wide screening for risk factors
• Lifestyle advice should center on tobacco cessation, weight control, healthy diet, physical activity and stress management.
• CV health promotion should be part of the national media strategy
• CV health should be addressed in schools as part of the curriculum
• CV health education should be offered in places of worship and worksites where appropriate.
•
Hypertension control at community level
Reduction of average population BP (desirably <130 mmHg systolic BP and <80 mmHg diastolic BP for adults) by salt reduction (<5 gm per day), healthy food, regular physical activity and control of obesity/alcohol consumptionTreatment of hypertensive patients (if BP ≥140 systolic or ≥90 diastolic).
Tobacco control at community level
Tobacco
• Enact comprehensive bans on tobacco advertising and promotion
• Require the placement of health warnings on tobacco packaging that cover at least 50% of display areas
• Ban deceptive terms like “light” and “mild”;
• Protect citizens from passive smoking in workplaces, public transport and indoor public places
• Combat smuggling
• Increase tobacco taxes.
Diet, blood cholesterol and physical inactivity control at community level
Promoting healthy foods: Foods of plant origin (low fat, low saturated fat, low cholesterol, low sodium, low refined sugar, high complex carbohydrates, high minerals, vitamins and fiber and low energy intake) and small portions of fish, poultry, lean meat and low-fat diary products.Promotion of physical exercise: Regular daily exercise, e.g., fast walking, jogging…etc. Recommended level: 30 min/day moderate-to-vigorous exercise for adults, 60 min/day for children.
• Some famous population based programs
• North Karelia Project in Finland.• Non-Communicable Disease Intervention Program in Mauritius.
• Five Stanford City Project in USA.
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High risk approach I
Identification of High Risk population from a community( those with CVD, or ≥ two risk factors of CHD, or diabetics)
Cost-effective diagnostic and management guidelines should be developed
The guidelines should be made available to and adopted by health professionals in primary and secondary care facilities.
Effective and affordable drugs, equipment and procedures.
Referral chains to provide effective links between primary, secondary and tertiary health care centers when needed.
High risk approach II
Physicians need the support of related health professionals such as dietitians.A risk management curriculum should be introduced for physicians and health professionals during the course of training.
Specialist opinion should be sought (through referral) whenever essential.
Public Health Approach Vs. High Risk Strategy
High-RiskBenefit for individual large
Easy to understand, hence
there are motivation and
rewards for individuals
Needs person’s co-operation
Limitations
Impact on total burden small
Often misused
Costly (screening)
Palliative (does not solve overall problem)
Distracts from population
approaches
Population- based
Radical ( ↓ incidence)
Potential large benefits
Cost effective
Can target unaware Population
Limitations
Need for mass change hard to
communicate
Interventions other than policies hard to implement
Benefit for individual small, weak motivation of physicians
Intervention can challenge interests/ societal norms
Strengthening Research Capacity
Research training required for health care professional to obtain basic research skills:Basic knowledge of Epidemiology, Biostatistics and Public health should be part of undergraduate and post-graduate education, continuous medical education and training programs for doctors.
Action Framework for a Comprehensive Public Health Strategyto Prevent Heart Disease and Stroke I
Fatal CVD Complications/ Decompensation
Unfavorable Social and Environmental Conditions
Adverse Behavioral Patterns
Major Risk Factors
First Event/ Sudden Death
Disability/ Risk of Recurrence
The Present Reality
Good Quality of Life Until Death
Social and Environmental Conditions Favorable to HealthBehavioral Patterns that Promote Health
Low Population Risk
Few Events/ Only Rare Deaths
Full Functional Capacity/Low Risk of Recurrence
A Vision of the Future
Policy and Environmental Change
Behavior ChangeRisk Factor Detection and Control
EmergencyCare/Acute CaseManagement
Rehabilitation/ Long-term Case Management
Intervention
Approaches
End-of-Life Care
PREVENTION
10 Prevention20 Prevention
30 Prevention
Action Framework for a Comprehensive Public Health Strategyto Prevent Heart Disease and Stroke II
Fatal CVD Complications/ Decompensation
Unfavorable Social and Environmental ConditionsAdverse Behavioral Patterns
Major Risk Factors
First Event/ Sudden Death
Disability/ Risk of Recurrence
The Present Reality
Good Quality of Life Until Death
Social and Environmental Conditions Favorable to Health
Behavioral Patterns that Promote Health
Low Population Risk
Few Events/ Only Rare Deaths
Full Functional Capacity/Low Risk of Recurrence
A Vision of the Future
Policy and Environmental Change
Behavior ChangeRisk Factor Detection and Control
EmergencyCare/Acute CaseManagement
Rehabilitation/ Long-term Case Management
Intervention
ApproachesEnd-of-Life Care