1 Physical Activity & Tobacco Prevention as the Keys for Health Promotion Mohammad R. Torabi, PhD,...

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Physical Activity &Physical Activity &Tobacco Prevention Tobacco Prevention as the Keys for Health as the Keys for Health PromotionPromotion

Mohammad R. Torabi, PhD, MPH, Mohammad R. Torabi, PhD, MPH, CHESCHES

Interim Dean & Chancellor’s ProfessorInterim Dean & Chancellor’s Professor

School of Health, Physical Education, and School of Health, Physical Education, and Recreation Recreation Indiana University – BloomingtonIndiana University – Bloomington

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Leading Causes of DeathLeading Causes of Death

Paradigm ShiftParadigm Shift

Economics of PreventionEconomics of Prevention

Actual CausesActual Causes

OpportunitiesOpportunities

ConclusionsConclusions

OutlineOutline

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Leading Causes of Leading Causes of DeathDeath

44

3 Leading Causes of Death, 3 Leading Causes of Death, 19001900

(Transmissible Diseases) (Transmissible Diseases)

Source: Centers for Disease Control Prevention, National Center for Health Source: Centers for Disease Control Prevention, National Center for Health Statistics, National Vital Statistics System and unpublishedStatistics, National Vital Statistics System and unpublished

8.3

11.3

11.8

0 5 10 15

Diarrhea/Enteritis

Tuberculosis

Pneumonia

% of all deaths

55

3 Leading Causes of Death, 3 Leading Causes of Death, 20002000

(Non-Transmissible Diseases) (Non-Transmissible Diseases)

7

23

29.6

0 10 20 30 40

Stroke

Cancer

Heart Disease

% of all deathsSource: Minino et al. Deaths: final data for 2000. Natl Vital Stat Rep. 2002; 50:1-120.

66

Top 3 Actual Causes of Death, Top 3 Actual Causes of Death, 20002000

(Lifestyle Related) (Lifestyle Related)

3.5

16.6

18.1

0 5 10 15 20

AlcoholConsumption

Poor Diet /Inactivity

Tobacco

% of all deaths

Source: JAMA, March 10, 2004; 291(10): 1238-1246

435,000435,000

400,000400,000

85,00085,000

(Numbers of Death Shown in Red)(Numbers of Death Shown in Red)

Mortality rates due to major Mortality rates due to major causes of death, Thailand, 1967-causes of death, Thailand, 1967-

20062006

88

Diseases and risk factors Diseases and risk factors among Thai males, 2004among Thai males, 2004

Source: Working Group on Burden of Disease and Risk Factors in Thailand, International Health Policy Programme, 2006.

99

Diseases and risk factors Diseases and risk factors among Thai females, 2006among Thai females, 2006

Source: Working Group on Burden of Disease and Risk Factors in Thailand, International Health Policy Programme, 2006.

1010

Joseph A. Califano: Joseph A. Califano: (former secretary of the US Department of Health and Human (former secretary of the US Department of Health and Human

Service)Service) We are killing ourselves by... We are killing ourselves by...

You, the individual, can do more for your own You, the individual, can do more for your own health and well being than any doctor, any health and well being than any doctor, any hospital, any drug, or any exotic medical hospital, any drug, or any exotic medical device.device.

our own careless habits, our own careless habits,

carelessly polluting the environment, & carelessly polluting the environment, &

permitting harmful social conditions to persist permitting harmful social conditions to persist – conditions like poverty, hunger, and – conditions like poverty, hunger, and ignorance which destroy health. ignorance which destroy health.

Control of infectious disease Control of infectious disease paralleling paralleling the emergence of chronic diseasethe emergence of chronic disease

Percentage of causes of Percentage of causes of disability-adjusted life years disability-adjusted life years (DALY) lost of Thai people by (DALY) lost of Thai people by

age group, 2004age group, 2004

1313Source: Working Group on Burden of Disease and Risk Factors, Thailand. International Health Policy Programme, 2006.

1414

LifestyleLifestyle++

Health Health Education/ Education/ PromotionPromotion

++EnvironmentEnvironment


TreatmentTreatment++

QuarantineQuarantine++

HygieneHygiene

1515

Economics of Economics of PreventionPrevention

1616

Annual Economic & Health Burden of Chronic Disease

Disease/Risk Factors

Morbidity (Illness)

Mortality (Death)

Direct Cost/Indirect Cost

Diabetes 20.8 million

200,000 $174 billion

Heart Disease & Stroke

80 million 870,000 $448 billion

Cancer 1.3 million new cases /year

553,000 $219 billion

Tobacco 45.3 million adults

438,000 $193 billion

Obesity/ Physical Activity/ Nutrition

64% of adults are overweight or obese

400,000. $117 billion

Source: http://www.cdc.gov/NCCdphp/press/index.htm

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During the Past 30 Years the Percentage During the Past 30 Years the Percentage of the GDP Consumed by Health Care of the GDP Consumed by Health Care

DoubledDoubled

1919

The Cost of Health Care Threatens the Ability The Cost of Health Care Threatens the Ability of the U.S. to Compete Economically with of the U.S. to Compete Economically with

Other NationsOther Nations

2020

Is This a Rational Investment Is This a Rational Investment Strategy?Strategy?

Proportion of health Proportion of health expenditure going to expenditure going to the population-wide the population-wide core functions of public core functions of public health vs. medical health vs. medical treatmenttreatment

Proportion of early deaths Proportion of early deaths that could be prevented that could be prevented by population – wide by population – wide public health approaches public health approaches vs. medical treatmentvs. medical treatment

2121

Actual CausesActual Causes

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Major Causes of Morbidity & MortalityMajor Causes of Morbidity & Mortality

#1 Tobacco Use#1 Tobacco Use

- - Cigarette: the Gateway Drug -Cigarette: the Gateway Drug -

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Dose-Response Relationship Between Dose-Response Relationship Between Cigarette Smoking and Other Drug UseCigarette Smoking and Other Drug Use

By Indiana Students in Grades 5-12By Indiana Students in Grades 5-12

Source: Torabi et al.

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Dose-Response Relationship Between Dose-Response Relationship Between Cigarette Smoking and Other Drug UseCigarette Smoking and Other Drug Use

By Indiana Students in Grades 5-12By Indiana Students in Grades 5-12

Source: Torabi et al.

2525

Cigarette Smoking Among US Men, Women, High Cigarette Smoking Among US Men, Women, High School Students, and Mothers during Pregnancy, School Students, and Mothers during Pregnancy,

1965 – 20031965 – 2003

Source: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group

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If you are a smoker, your If you are a smoker, your life…life…

74.4 79.8

61.2 65.3

0

10

20

30

40

50

60

70

80

US Mean Smokers

Males Females

Source: MMWR 1997;46:444-51

-13.2 yrs-14.5 yrs

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If smoking relaxes you, then don’t If smoking relaxes you, then don’t quit. Being dead is very relaxing.quit. Being dead is very relaxing.

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#2 #2 Overweight/ObesityOverweight/Obesity

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Obesity Trends Among U.S. AdultsObesity Trends Among U.S. AdultsBRFSS, 1985BRFSS, 1985

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

No Data <10% 10%–14%

Source: Behavioral Risk Factor Surveillance System, CDC

3030



No Data <10% 10%–14%


3131



No Data <10% 10%–14 15%–19%


3232



No Data <10% 10%–14% 15%–19% ≥20


3333




No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

3434




No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

3535

Source: National Health and Nutrition Examination Survey, 2004

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Source: National Health and Nutrition Examination Survey, 2004

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Why Has Caloric Intake Why Has Caloric Intake Increased?Increased?

More food availableMore food available CheaperCheaper Greater varietyGreater variety Easier to acquireEasier to acquire Heavily marketed by more effective mediaHeavily marketed by more effective media More calorie dense foodsMore calorie dense foods High-fructose corn syrupHigh-fructose corn syrup Super-sizedSuper-sized More people who model increased caloric More people who model increased caloric

intakeintake

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Why Has Caloric Output Why Has Caloric Output Decreased?Decreased?

Fewer occupations require physical laborFewer occupations require physical labor

Fewer physical household choresFewer physical household chores

Less need and opportunities for manual Less need and opportunities for manual transportation (walking, biking)transportation (walking, biking)

More attractive sedentary leisure-time activities More attractive sedentary leisure-time activities

Less physical education and other physical Less physical education and other physical activity activity

More people who model decreased caloric outputMore people who model decreased caloric output

3939

Why does it take six weeks to lose five Why does it take six weeks to lose five pounds, but only one day to gain it all pounds, but only one day to gain it all

back?back?

4040


#3 Lack of Physical #3 Lack of Physical ActivityActivity

4141

Benefits of Physical ActivityBenefits of Physical Activity

Physical activity can lower the risk of:Physical activity can lower the risk of:

Coronary heart diseaseCoronary heart disease

StrokeStroke

Type II diabetes mellitusType II diabetes mellitus

High blood pressureHigh blood pressure

Colon cancer by 30–50% Colon cancer by 30–50%

Active people have lower premature death Active people have lower premature death rates than people who are the least active rates than people who are the least active

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Adults with 30+ minutes of moderate Adults with 30+ minutes of moderate physical activity 5 or more days per physical activity 5 or more days per

weekweek

Source: Behavioral Risk Factor Surveillance System, 2007

4343

Adults with 20+ minutes of vigorous Adults with 20+ minutes of vigorous physical activity 3 or more days per physical activity 3 or more days per

weekweek

Source: Behavioral Risk Factor Surveillance System, 2007

Age 18-24 25-34 35-44 45-64 65+

Recommended 59.0 53.2 49.6 46.6 39.3

Insufficient 31.9 36.9 39.8 39.6 36.9

Inactive 9.1 9.9 10.7 13.8 23.7

No Leisure-Time Physical Activity

18.4 20.8 22.3 24.8 32.7

2007 National Average: 2007 National Average: Recommended Physical Activity by Age Recommended Physical Activity by Age

Source: Centers for Disease Control and Prevention, 2007

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OpportunitiesOpportunities

4646

ProgressProgress

Slowly prevention getting Slowly prevention getting attention of policy makersattention of policy makers

Funding for tobacco settlementsFunding for tobacco settlements

New funding for nutrition and New funding for nutrition and physical activitiesphysical activities

4747

Smoking Prevention in Smoking Prevention in ThailandThailand

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What fits your busy schedule better,What fits your busy schedule better,

exercising one hour a day or exercising one hour a day or being dead 24 hours a day?being dead 24 hours a day?

4949

ConclusionsConclusions

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What Does Prevention Do for What Does Prevention Do for Us?Us?

10 to 20 years of extended life10 to 20 years of extended life Improved quality of lifeImproved quality of life Reduced chronic diseaseReduced chronic disease Less medications/hospital Less medications/hospital

visit/surgeryvisit/surgery Postponed disabilityPostponed disability Save moneySave money

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RecommendationsRecommendations

BuildingBuilding infrastructure, infrastructure, academic units, academic units, service units, service units, community agencies, community agencies, pilot projects, pilot projects, ProvidingProviding wellness services wellness services Developing and offeringDeveloping and offering a wellness a wellness

course as a core course for all studentscourse as a core course for all students AdvancingAdvancing research research LeadingLeading by examples by examples

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UltimatelyUltimately

Do not start smokingDo not start smoking If you smoke, quitIf you smoke, quit Adopt an active lifestyleAdopt an active lifestyle Limit time spent in front of TV & computerLimit time spent in front of TV & computer Stay intellectually activeStay intellectually active Sleep between 6 to 8 hours a daySleep between 6 to 8 hours a day Have balanced variety of foodsHave balanced variety of foods Reduce stressReduce stress Count your blessingsCount your blessings

5353

““It is health that is real wealth It is health that is real wealth and not pieces of gold and and not pieces of gold and silver.” silver.”

- Mahatma Gandhi- Mahatma Gandhi

5454

Thank You!Thank You!

1 Physical Activity & Tobacco Prevention as the Keys for Health Promotion Mohammad R. Torabi, PhD,...

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