Cases semester 2: communicable and non-
communicable diseases
Case 1, From hygiene to new public health
In Europe the NCD’s are more prevalent due to an ageing population.
In other countries the communicable are more prevalent due to bad hygiene measures.
Communicable diseases
Transmission between individuals/species in the classic way (directly or indirectly).
Caused by microorganisms (pathogens) such as bacteria, viruses, parasites, and fungi.
Vector = organism that transports the pathogen.
All communicable diseases are infectious. But not all infectious diseases are communicable.
How do these diseases spread:
o Physical contact with an infected person
o Contact with a contaminated surface or object
o Bites from insects or animals that can transmit the disease
o Travel through the air (tuberculosis & measles)
Examples:
- Ebola
- Tuberculosis
- Rabies
Infectious diseases
It’s not communicable in the classical way.
Caused by microorganisms (pathogens): bacteria, viruses, fungi, or parasites.
Not all infectious diseases are communicable.
Some infections can become chronic, like HIV (which becomes AIDS).
How do these diseases spread:
- Person to person
- Insect/animal to person
- Indirect contact, thru objects, and surfaces
- Via contaminated food or water
- Thru air
Examples:
- Malaria
- Tetanus infectious but not communicable
,Non-communicable (chronic) diseases
It is often not transferable between people, and they are generally long-lasting diseases.
It’s not being caused by an infectious agent, but it’s often the result of a combination of
genetic, physiological, environmental, and behavioral factors . (WHO)
NCD’s make out 86% of deaths and 77% of disease burden in the European region. (WHO)
Difference between NCD and chronic disease?
A chronic disease lasts at least 1 year.
Low back pain can start out as non-communicable but can become chronic over time.
They can be divided into four categories:
1. Cardiovascular disease heart attacks, strokes
2. Cancers
3. Chronic respiratory diseases asthma
4. Diabetes diabetes type-2 liked to obesity
Other examples:
- Mental disorders
!!! Chronic diseases can also be communicable, like Aids.
New public health
Tulchinsky:
“A contemporary application of a broad range of evidence-based scientific, technological,
and management systems implementing measures to improve the health of individuals and
populations.”
“An integrative approach to protecting and promoting the health status of both the
individual and the society.”
Awofeso:
“Health promotion describes the health education interventions and related organizational,
political and economic interventions that are designed to facilitate behavioral and
environmental changes to improve health.”
Contemporary, evidence-based framework.
It’s because of re-emerging health treats and risk + globalization.
For protecting and promoting the health status of the society.
- 3 core components: health education, prevention, protection
- evidence-based
- re-emerging health threats and risks
,Traditional public health
Primarily a discipline for studies and measures for control of communicable diseases
primarily by sanitation and vaccination.
New Public Heath:
Aims to avoid disease, injuries, disabilities, and death while promotes and maximizes a
healthy environment and optimal conditions for current and future generations.
The new public health is an approach which brings together environmental change and
personal preventative. It recognizes the importance of the social aspects of health problems
which are caused by lifestyles.
Relevance to this course:
- knowing when which diseases emerged/ controlled
- understanding Public Health approaches to disease control/prevention
- understanding current obstacles/challenges to diseases
The article “what’s new about the new public health” is written in the 1990’s. (Awofeso)
What has changed since then?
o There are more chronic diseases.
o Ageing population is a big problem nowadays.
o Because of globalization people move around more and faster which will spread
more diseases.
o Society works together in health on epidemiological facts, data, and patients.
(Example. covid pass and data is accessible for everyone)
o The covid-19 pandemic. How far can the government interfere (freedom rights), and
health care capacity.
+ see table on next page
,Case 2, epidemiological changes in Europe
,The East-West health gap in Europe
The transition from infectious to chronic diseases started in Western Europe before
occurring in Eastern Europe.
However, after WW II (1939-1945), the transition got off to a better start in Eastern Europe
(FSE countries).
During the early 1960’s a quicker increase in life expectancy in the East led to an equalization
of the health differences.
Mid 1960’s:
In the FSE countries the adult mortality began to increase (while the childhood (infectious
disease) mortality continued to decline).
Increase in mortality due to lung cancer, liver cirrhosis and sudden death from injury.
And an increase in cardiovascular mortality (especially among men).
From the 1970’s onwards:
In Western Europe there was a rapid decline in cardiovascular mortality.
Late 1980’s:
A health gap was created between Eastern and Western Europe.
Breakup of the Soviet Communist System:
In most of the FSE countries the increase of adult mortality rates rose more rapidly.
There was a peak in the years 1992-1994 more than 1 million additional premature
deaths.
After 1990:
A reversal occurred in Central and Eastern Europe. The life expectancy began to increase
rapidly, and there was a dramatic decline in morbidity and mortality from cardiovascular
diseases.
Causes of the reversal:
- Dietary changes introduction of a market economy and changes in prices of food
items
- Increased consumption of polyunsaturated fatty acids
Right now, the health improvement in Central Europe is just beginning.
Differences between east and western Europe
, In Eastern Europe and Central Asia, initial falls in life expectancy occurred due to
unprecedented rise in deaths from external causes (including in countries without civil
conflict) and cardio-vascular mortality.
These changes were accompanied by a more general deterioration of socio-economic
conditions, under-financing, and under-development of health systems, as well as
deregulation and poor control of health hazards such as tobacco, alcohol, illicit drugs.
Now Eastern Europe has only seen modest improvements in life expectancy, accounted for
by reductions in infant and premature mortality, particularly in men, and, only recently, by
some modest progress in older age women.
In Eastern Europe and Central Asia, over the 25 years, life expectancy only increased by a
maximum of 2.1 years.
This was a small recovery from the big drop in 1995, where there were huge increases of
mortality in both genders and most age groups (mostly male though). This could be a reason
for low infant mortality rates and preceded until 2005.
In Central Europe, changes in life expectancy are more positive throughout the period,
although little gain was seen initially. In part this is due to the inclusion of the Baltic States,
