Lecture 1 - Introduction lecture
Types of prevention:
- Primary: to prevent (the development) of diseases
- Secondary: screening of diseases/early detection
- Tertiary: prevent/reduce the seriousness/or complications of diseases
Universal prevention: designed to reach the entire population, without regard to
individual risk factors and are intended to reach a very large audience.
Selective prevention: target subgroups of the general population that are determined
to be at risk for a disease. Subgroups may be distinguished by traits such as age,
gender, family history, or economic status.
Indicated prevention: aims to identify individuals who already exhibit early signs of a
disease and other related problem behaviors associated with a health problem and
target them with special programs.
Folic acid example is primary prevention.
Depression example is primary prevention because we want to prevent depression (in
a sick group), but preventing this is the primary aim. But it can also be secondary
prevention, because of the word sub threshold depression. You screen the people with
diabetes on the level of depression, these are people who are having signs of
depression but not yet diagnosed. Two answers could be right:
prevention or secondary prevention.
VU health measurement is primary prevention.
Palliative care (after tertiary prevention): end of life care, to
relieve the pain of the patient and increase comfort, mostly for
terminally ill people.
Intervention levels
VU intervention is on organization level.
Tools/instruments:
- Education
- Facility
- Law
- Prices
Many health problems are determined by both environmental as lifestyle
determinants. Lifestyle factors could be physical exercise, smoking, alchohol, sexual
behavior and nutrition. These factors are related to health problems.
Health behavior is a choice: to do something or don’t do something. The choice may
be driven by personal determinants (as severity of the disease, risk perception,
attitude, social influence, social efficiency, habits). Next to lifestyle factors there are
also risk factors (low level of physical exercise, more than 10 cigarettes a day, more
than 7 glasses a day).
Health promotion: maintain peoples current health status and ideally a shift towards
better health.
- ‘Smoking reduction’ with the aim to maintain an optimal respiratory and CV system
Disease prevention: to prevent people getting a disease and prevent a shift towards
the seriousness of a disease.
- ‘Smoking reduction’ with the aim to reduce the change of getting lung cancer
,VU intervention has its focus health promotion and therefore an effect on disease
prevention.
Lecture 2 - Upstream determinants of lifestyle behaviors and chronic disease
risk 2 nov
This lecture is about the environment of healthy lifestyles and more specifically about
"Geographies of Food Consumption". It will focus on how busy and dynamic life-
styles of urban dwellers, in combination with the food-abundant environment we live
in nowadays, affect dietary behavior from the perspective of a systems ap-
proach.
What are upstream determinants?
Non-communicable diseases are caused by unhealthy metabolic states (high blood
pressure, overweight, etc.) driven by unhealthy lifestyle. The lifestyle behaviors are
determinants like unhealthy metabolic states, but they are more upstream. There are
also individual determinants, like knowledge and psychological factors.
Even higher upstream: the environment (build envi-
ronment, friends, economy, policy) for
example there are many more fast-food options in
shopping malls compared to healthy options.
Genome: the complete set of an individual’s genetic
information
Exposome: represents an individual’s complete set
of environmental exposures throughout their
lifetime.
—> Our genome and exposome interact throughout
our lives
in
causing various diseases.
Structuring environmental determinants
via
the ANGELO framework
socio-cultural,
physical, economic and political
environments.
—> Every environment can be
subdivided into micro-meso-macro.
Other determinants are also important:
commercial environments. This also
influences the other four environments.
The evidence in a nutshell
- Socio-cultural environment
,- Lower SEP —> higher change of obesity
- Social capital
- Social network —> higher social cohesive network, lower odds on obesity
- Economic: the evidence is mostly form this field
- Healthier diets are generally more costly
- Pricing strategies are effective: increase/discounts; especially if salient
- Most evidence from controlled settings
- Effect on weight status and disease outcomes yet to be determined
- Political environment
- Mandatory food labeling —> evidence that this works
- Car-free streets/Sundays to increase physical activity
- Advertisement ban until children’s bedtime works
- Healthier canteens in schools
- Sugary drink taxes —> evidence is quite strong
- Industry lobby is very strong in NL, probably the reason it’s not implemented yet
- Physical/build environment
- Fast-food exposure, urbanization, land use mix and urban sprawl —> associated
with obesity
- Higher degree of urbanization —> higher degree of obesity
- Urbanized area vs rural area. Urban area —> more diabetes (RR 1.40)
- Higher green space —> lower risk of diabetes (RR. 0.90)
- Higher walkability —> lower risk of diabetes (RR. 079)
—> … evidence base is relatively thin
, Challenges in upstream research
Evidence base is mostly in physiology and behaviors —> easier?
While the influence of an intervention on the population has a bigger impact on
environmental level —> shift needed in research?
Some challenges:
- Study designs
- RCT are difficult; RCTs of environmental factors is often not possible
- Mostly are cross-sectional —> no causality
- Self-selection: people do choose where they live
- Based on preference: active person rather lives in environments where they can be
active and thus looks to live in an environment where they can be active (so is
activity caused by the environment then?)
- Confounding factors
- Non-linear relations: may be a certain threshold
- Area of exposure: what is a person’s activity space (what
area does he/she face?)
- Definition of exposure: for example how do you measure
the amount of food outlets
- Mismatch: subjective/objective data (self-reported
questionnaires vs. accelerometer)
- Single exposure studies: many studies look at one
exposure and one outcome, while people are exposed to
a lot of factors
- Interactions: relationship between importance of environment + motivation for
healthy behaviors —> if you’re highly motivated, the environment does not really
matter, as well as if you’re not motivated at all, the environment does not matter —
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