Rise In Chronic Diseases Research Articles

Framing international trade and chronic disease.

There is an emerging evidence base that global trade is linked with the rise of chronic disease in many low and middle-income countries (LMICs). This linkage is associated, in part, with the global diffusion of unhealthy lifestyles and health damaging products posing a particular challenge to countries still facing high burdens of communicable disease. We developed a generic framework which depicts the determinants and pathways connecting global trade with chronic disease. We then applied this framework to three key risk factors for chronic disease: unhealthy diets, alcohol, and tobacco. This led to specific 'product pathways', which can be further refined and used by health policy-makers to engage with their country's trade policy-makers around health impacts of ongoing trade treaty negotiations, and by researchers to continue refining an evidence base on how global trade is affecting patterns of chronic disease. The prevention and treatment of chronic diseases is now rising on global policy agendas, highlighted by the UN Summit on Noncommunicable Diseases (September 2011). Briefs and declarations leading up to this Summit reference the role of globalization and trade in the spread of risk factors for these diseases, but emphasis is placed on interventions to change health behaviours and on voluntary corporate responsibility. The findings summarized in this article imply the need for a more concerted approach to regulate trade-related risk factors and thus more engagement between health and trade policy sectors within and between nations. An explicit recognition of the role of trade policies in the spread of noncommunicable disease risk factors should be a minimum outcome of the September 2011 Summit, with a commitment to ensure that future trade treaties do not increase such risks.

Researching the end-of-life in old age: cultural, ethical and methodological issues

ABSTRACTIncreased life expectancy has strengthened the association between old age and death, with significant implications for gerontology and for the generation of knowledge through research. The global rise in chronic disease has had a significant impact on the duration and shape of dying trajectories in old age and their variations. This development poses ethical and methodological challenges for researchers, not least because it is often difficult to establish whether an older person is ‘dying from’ as opposed to ‘living with’ one or more diseases. This paper reports a comprehensive literature review of empirical research on the end-of-life in old age, and has two inter-related themes. It explores the social and cultural contexts of death and critically analyses the methods and ethical approaches adopted by researchers. Cross-cultural studies and studies in which cultural factors were of prime interest were selected with a view to examining the concept of a ‘good death’ in old age. The paper discusses the evidence of cultural similarities and differences and the impact of social and cultural change on ideas concerning a good death. It identifies contemporary influences and pressures on end-of-life care for older people and discusses the significance of communication and the roles of families and service providers. The paper concludes by identifying substantive and methodological lessons for researchers in gerontology and suggests ways in which the impact of research might be enhanced.

Celebrating connecting with Communities: coproduction in global Primary Health Care

The rise of chronic diseases in many countries means that current models of care are inadequate for addressing population health needs. Primary health care (PHC) has a major role to play in health reforms as it can be the first level of contact of individuals with the national health system and constitutes the first element of a continuing health care process. Consequently, the development of PHC initiatives, which work co-operatively with communities to improve health, is of importance.Case studies included in a compendium of nurse and/or midwife-led PHC models compiled as part of a World Health Organisation (WHO) project identified strategies for enhancing how nurses can work with communities to improve health. A thematic analysis showed that one of the themes related to coproduction in health, and how nurses and midwives can be positioned to work with communities to jointly lead PHC. Coproduction describes an active relationship between health professionals and communities in which substantial resource contributions are made by all parties. While this was not the initial focus of this study, it was a key development and worthy of identification and exploration for the purpose of this paper.In most projects, the democratic engagement and empowerment of both staff and community was a key requirement for success. The achievement of health in projects based in coproduction of health was not considered to be the domain solely of health care professionals, planners and policy-makers. Commitment and motivation were essential, and were developed through culturally appropriate and sensitive engagement with communities.Health care organisations and professionals must experience a paradigm shift in both their approach to providing health care and in their understanding of health care communities as co-producers. The concept of community partnership, moving towards community control, will help to establish these models of PHC.

The Theory of Epidemiologic Transition: the Origins of a Citation Classic

In 1971 Abdel R. Omran published his classic paper on the theory of epidemiologic transition. By the mid-1990s, it had become something of a citation classic and was understood as a theoretical statement about the shift from infectious to chronic diseases that supposedly accompanies modernization. However, Omran himself was not directly concerned with the rise of chronic disease; his theory was in fact closely tied to efforts to accelerate fertility decline through health-oriented population control programs. This article uses Omran's extensive published writings as well as primary and secondary sources on population and family planning to place Omran's career in context and reinterpret his theory. We find that "epidemiologic transition" was part of a broader effort to reorient American and international health institutions towards the pervasive population control agenda of the 1960s and 1970s. The theory was integral to the WHO's then controversial efforts to align family planning with health services, as well as to Omran's unsuccessful attempt to create a new sub-discipline of "population epidemiology." However, Omran's theory failed to displace demographic transition theory as the guiding framework for population control. It was mostly overlooked until the early 1990s, when it belatedly became associated with the rise of chronic disease.

What Can Improve Chronic Disease Care?

Chronic disease care is a central part of geriatrics. The rise in chronic disease draws attention to the need to find better ways to deliver effective care. This essay examines the effectiveness of several strategies for providing better chronic disease care, reviewing the literature and relying on extant reviews whenever possible. The evidence of effectiveness is mixed; a few areas show promise. The case for cost-effectiveness is even less strong. New strategies may be indicated, including more-proactive monitoring of clinical courses and assessing patients' readiness to participate actively in their own care.

The Public Health Challenge of Obesity in North Carolina

besity is one of the most important public health issues of our time. Just as infectious diseases threatened the health and well being of communities in the early 20th century, chronic diseases are now the greatest threat of the 21st. The risk factors for obesity, physical inactivity and poor nutrition have begun to approach the public health impact of tobacco use. 1 The resulting rise in chronic diseases that is directly attributed to these three risk factors threatens to undo much of the progress made to improve health in the last century and worsen existing health disparities. At no other time in our history have we had the majority of our population affected or threatened by an epidemic; over 67% of American adults are overweight. 2 As with any public health epidemic, we must take aggressive steps. Progress in containing infectious disease epidemics of the past occurred when epidemiologists shifted focus from identifying

Agricultural Biodiversity, Nutrition, and Health: Making a Difference to Hunger and Nutrition in the Developing World

In spite of the strides made globally in reducing hunger, the problems of micronutrient deficiencies and coexisting obesity and related cardiovascular and degenerative diseases constitute a formidable challenge for the future. Attempts to reverse this trend with single-nutrient intervention strategies have met with limited success, resulting in renewed calls for food-based approaches. The deployment of agricultural biodiversity is an approach that entails greater use of local biodiversity to ensure dietary diversity. To outline a new strategy proposed by the International Plant Genetic Resources Institute (IPGRI) that employs agricultural biodiversity as the primary resource for food security and health. The authors carried out a meta-analysis to review and assemble existing information on the nutritional and healthful properties of traditional foods based on a diverse set of case studies and food composition and nutritional analysis studies. The methods highlight particular examples of foods where analysis of nutrient and non-nutrient composition reveals important traits to address the growing problems of malnutrition associated with the rise of chronic diseases. Finally, the authors analyze social, economic, and cultural changes that undermine the healthful components of traditional diets. Based on this multidisciplinary and comparative approach, the authors suggest a holistic food-based approach that combines research to assess and document nutritional and healthful properties of traditional foods, investigating options in which nutritionally valuable traditional foods can contribute to better livelihoods, and ways that awareness and promotional campaigns can identify healthful components of traditional diets that fit the needs of urban and market-oriented consumers. There is an urgent need for agricultural research centers, national agricultural research systems, universities, and community-based organizations to work together under a shared policy framework with the aim of developing a strong evidence base linking biodiversity, nutrition, and health. Although these initiatives are still ongoing, the gains realized in small-scale and local pilot efforts have encouraged IPGRI to work with local partners toward the implementation of scale-up efforts in various regions.

An inventory of the South african fitness industry

Objective. The aim of this study was to create an inventory of fitness facilities in South Africa, their location, equipment and services offered, and the demographics, education and training of the staff working in these facilities. Design. A total of 750 facilities were identified, and descriptive data were gathered from 442 facilities (59%) with the use of a questionnaire administered telephonically and via the website of the Sports Science Institute of South Africa. Setting. The study was initiated by the Sports Science Institute, and the results were presented at the 4th Annual Discovery Vitality Fitness Convention on 4 May 2006. Results. Results show that the industry comprises mainly independent facilities (68%). All types of facilities were found to be located mostly within urban areas, and reported providing services to just less than 2% of the South African population. Facilities offer a wide range of equipment and services to their members. Of the fitness-related staff at facilities, the majority were reported to be young (18 - 25 years, 55% of male, and 49% of female staff), and in terms of racial proportions most staff were white (males 40% of total staff and females 33% of total staff).Less than a quarter of fitness-related staff hold university qualifications, and just over 80% of instructors hold qualifications aligned with the National Qualifications Framework. The importance of education and training of staff was emphasised by respondents. Conclusions. This report highlights the widespread value of assessing the fitness industry, particularly within the context of the rise of chronic diseases in South Africa and government initiatives to promote healthy lifestyles. South African Journal of Sports Medicine Vol. 18 (3) 2006: pp. 93-104

Health expectancy and the problem of substitute morbidity.

During the past century, the developed world has not only witnessed a dramatic increase in life expectancy (ageing), but also a concomitant rise in chronic disease and disability. Consequently, the tension between 'living longer' on the one hand and health-related 'quality of life' on the other has become an increasingly important health policy problem. The paper deals with two consequences of this so-called epidemiological transition in population health. The first one concerns the question of how--given the impressive changes--population health can be measured in an adequate and policy relevant present-day fashion. The second one is the so-called phenomenon of 'substitute morbidity and mortality': more and more acute fatal diseases are replaced by non-fatal delayed degenerative diseases like dementia and arthritis. How the phenomenon of substitute morbidity and mortality affects the development of population health is illustrated with the epidemiological transitions, worldwide shifts in the main causes of death, assumptions used in models, adverse consequences of medical technologies and some results from intervention trials. Substitute morbidity and mortality may thwart our disease-specific expectations of interventions and asks for a shift to a 'total population health' perspective when judging potential health gains of interventions. Better understanding of the dynamics that underly the changes in population health is necessary. Implications for data collections are more emphasis on morbidity data and their relation with mortality, more longitudinal studies, stricter requirements for intervention trials and more use of modelling as a tool. A final recommendation is the promotion of integrative measures of population health. For the latter several results are presented suggesting that, although the amount of morbidity and disability is growing with an increasing life expectancy, this is mild unhealthiness in particular. This finding supports the 'dynamic equilibrium' theory. In absolute numbers, however, the burden of disease will continue to increase with further ageing of the population.

Policy and Epidemiology: Financing Health Services for the Chronically Ill and Disabled, 1930-1990

The six-decade rise in chronic disease and disability, along with interested parties and their beliefs about duly organized health care, shaped financing policy for American health services. If by the late 1930s some scientists and health experts convinced other colleagues to recognize the prominence of chronic illness, physicians and hospital leaders took ten more years to view the management of those illnesses as a major priority, largely owing to prevailing payment schemes. Chronic disease, since the introduction of Medicare and Medicaid, has become the key focus of insurer and public health care financing. Added incentives for disease prevention and treatment in less costly settings, and recalculation of doctors' fees, may lead to meeting the growing chronic care demands without sharp cost increases.