HLTH200 Lecture Notes - Lecture 10: Water Cycle, Diarrhea, Whitehall Study
28 May 2018
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HLTH200 Week 10 Lectures:
Health Risk Factors
Goals –
• Know the main behavioural risk factors globally
• Barriers to engagement in health risk behaviours
• The social gradient in health and unexplained variance
Why behavioural risk factors?
• Of the 57 million deaths that occurred globally in 2008, 36 million (two
thirds) were due to non-communicable diseases
o Mostly CVD, cancer, diabetes, chronic lung diseases
• Caused to large extent, by four behavioural risk factors
o Tobacco
o Unhealthy diet
o Insufficient physical activity
o Harmful use of alcohol
Deaths attributed to 19 leading factors, by country income level, 2004
1. High blood pressure – mostly middle income (highest)
2. Tobacco use – mostly middle income
3. High blood glucose – middle/low income prevalence
4. Physical inactivity – mostly middle/low income
5. Overweight and obesity – predominantly middle income
6. High cholesterol – middle/low income
7. Unsafe sex – predominantly low income
8. Alcohol use – predominantly middle income
9. Childhood underweight – all low income, little bit middle
10. Indoor smoke from solid fuels – mostly low income, little bit middle
11. Unsafe water, sanitation, hygiene – mostly low income, little middle
12. Low fruit and veggie intake – predominantly middle income, bit low & high
13. Suboptimal breastfeeding – most low, some middle
14. Urban outdoor air pollution – mostly middle income
15. Occupational risks – mostly middle income
16. Vitamin A deficiency – all low income
17. Zinc deficiency – low income
18. Unsafe health-care injections, mostly middle, some low
19. Iron deficiency – mostly low
% of DALYs attributed to 19 leading factors
• Childhood underweight → 5.5 to low income, 0.5 to middle = 6
• Unsafe sex → 3.5 to low income, 1 to middle
• Alcohol use → 3 to middle income, 1 to low
• Unsafe water, sanitation, hygiene → 0.75 to middle, 4.5 to low
• Etc. (more on slides)
Potential life expectancy gain in absence of selected risks to global health
• 8 CVD risks → increase of 3-5 years
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• 7 child risks → 1-2 years increase
• all 28 risks → 7-9 years increase
• Top 10 risks → 5 years increase
• Africa (top 10 risks) → 10 years increase
• Eastern Meditarranean → 7-9 years increase
• SE Asia → 6-8 years increase
• Europe → 10 years increase approx..
• Western Pac → 4-5 years increase
• Americas → 5-6 years increase
• High income → 4/5 years increase
What are the guidelines for the 4 main behavioural risk factors?
• Tobacco
• Unhealthy diet
• Insufficient physical activity
• Harmful use of alcohol
Guidelines – alcohol: what do guidelines recommend?
• For healthy men and women, drinking no more than 2 standard drinks on any
day reduces your risk of harm from alcohol-related disease/injury over a
lifetime
o E.g. damage to: liver, brain, heart
o Increased risk of high BP, CVD and many cancers
• Drinking no more than 4 standard drinks on a single occasion reduces risk of
alcohol-related injury arising from that occasion
o Injury through road trauma, violence, falls and accidental death
• UK findings = 35% of all A&E attendances
• A standard drink contains 10 grams of pure alcohol
o Drink serving size → often more than one standard drink
o There are no common glass sizes used in Australia
Summary of changes: 1995-2008
• Overweight → increase in all ages ranging from 12-65+
• Physically inactive → 12-17 = increase, 18-44 = increasing with age/sex, 45-
64 = no change, 65+ increase with age/sex
• Insufficient vegetables → all age groups increasing, with 65+ group increasing
by age/sex
• Smoking → all age groups decreasing
• Excessive alcohol → 12-17 = decrease, the rest of age groups increasing with
65+ age/sex results increase
There are particular groups and life transitions where PA levels become worse.
• For women studying/working and remaining single, PA levels were better
• Barriers to PA among women with young children → Peter R. Brown , Wendy
J. Brown , Yvette D. Miller & Vibeke Hansen (2001): Perceived Constraints
and Social Support for Active Leisure Among Mothers With Young Children,
Leisure Sciences: An Interdisciplinary Journal, 23:3, 131-144
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o Al 61 child care centres located within a 30km radius of the central
business district of Newcastle in NSW assigned a code representing
socio-economic Index for Area
o Random selection of 21 CCCs
▪ 6 from high SES
▪ 6 from low SES
▪ 9 from middle SES
o A self-complete questionnaire was distributed to all mothers of
children attending these 21 centres
o 1800 survey packages were left at the CCCs for collection by childrens
caregivers
o 654 mothers responded to the survey
o 554 giving consent to participate
o 93% said they would like to be more active either in the next month
(72%) or sometime later (21%)
o Perceived barriers measured by 11 items developed from current
literature on leisure constraints and PA participation e.g. no time due to
children, lack of energy
o Proportion of women identifying each constraint (sometimes or often)
▪ No time due to commitment to children → 98.6%
▪ No time due to commitment to housework/shopping → 86.7%
• 1. The vast majority of mothers would like to be more active but felt inhibited
by a combination of
o Structural influences (e.g. lack of time, money, energy)
o Ideological influences (e.g. sense of commitment to others)
• 2. Access to social support from partners may place some women in a better
position than others to negotiate constraints that inhibit leisure participation
• 3. There is within each socioeconomic group, a wide variation in the time
spent in active leisure, meaning that some women are able to overcome
prevailing constraints and make time for active leisure pursuits, however,
avenues for health promotion
For men…
• Transitioning from school to uni is associated with reduced physical activity
Individual approach
• Focus on individual decision making and behaviours
• Individual goal setting
• Motivational aspect ‘make the time’
• Interventions: aim to help the individual
• ‘get up and move’ to avoid sitting for too long
Public health approach
• Focus on systemic factors
• What barriers do these groups face (e.g. women – childcare and time
constraints)
• Interventions: empowering groups of women by eliminating or easing the
barriers
• And/or encourage populations to do ‘a bit more’
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find more resources at oneclass.com
