CHRONIC DISEASES IN INDIA – CROSS CUTTING ISSUES :

POVERTY,ENVIRONMENT & GENDER

BY DR. K.L.SHARMA

INDIAN GERONTOLOGICAL ASSOCIATION, JAIPUR

MODIFABLE RISK FACTORS FOR NON-COMMUNICABLE DISEASES

• GENERAL ENVIRONMENTAL EXPOSURES• Physical Environment : Ambient air quality , Water quality Occupational and work site Food safety and availability

MODIFABLE RISK FACTORS FOR NON-COMMUNICABLE DISEASES

• Social Environment : Income Cognitive Education Cultural Education Access to Health Services Availability of Public Health and Community

Services

MODIFABLE RISK FACTORS FOR NON-COMMUNICABLE DISEASES

• Personal Environmental Exposures Smoking ( and tobacco use) Nutrition and Obesity Dietary Intake, Micronutrient adequacy and

Caloric balance Physical Activity, Alcohol/ Drug Abuse Genetic endowment, monogenetic, gene-

environment interaction

Chronic diseases are non communicable illnesses that are prolonged in duration, do not resolve spontaneously, and are

rarely cured completely.

Examples of chronic diseases include heart disease, cancer, stroke, diabetes, and

arthritis.

What Are Chronic Diseases?

Key Chronic Diseases : The Facts

• Heart disease and stroke are the first and third leading causes of death, accounting for more than 30% of all U.S. deaths each year.

• Cancer, the second leading cause of death, claims more than half a million lives each year.

• Diabetes is the leading cause of kidney failure, non traumatic lower extremity amputations, and new cases of blindness each year among U.S. adults aged 20–74 years.

• Arthritis, the most common cause of disability, limits activity for 19 million U.S. adults.

• Obesity has become a major health concern for people of all ages. 1 in every 3 adults and nearly 1 in every 5 young people aged 6–19 are obese.

CHRONIC DISEASES SOME FACTS : Chronic diseases cause 7 in 10 deaths each year in the

United States. 

About 133 million Americans—nearly 1 in 2 adults—live with at least one chronic illness. 

More than 75% of health care costs are due to chronic conditions. 

Approximately one-fourth of persons living with a chronic illness experience significant limitations in daily activities. 

The percentage of U.S. children and adolescents with a chronic health condition has increased from 1.8% in the 1960s to more than 7% in 2004.

CHRONIC DISEASES SOME FACTS :

Chronic diseases—such as heart disease, cancer, and diabetes—are the leading causes of death and disability.

These diseases also cause major limitations in daily living.

Chronic Diseases Leading to deaths

CHRONIC DISEASESDistribution in Indian elderly:(n=1000)

IndiaIndia   

RuralRural  

UrbanUrban  

Chronic DiseaseChronic Disease MM FF MM FF

CoughCough    250250 195195 179179 142142

PilesPiles    3333 1616 3232 1818

Joint ProblemsJoint Problems 363363 404404 285285 393393

High/low BPHigh/low BP 108108 105105 200200 251251

Heart DiseaseHeart Disease 3434 2727 6868 5353

Urinary ProblemUrinary Problem 3838 2323 4949 2424

DiabetesDiabetes    3636 2828 8585 6666

CancerCancer    22 33 22 44

Any of the aboveAny of the above 527527 514514 528528 560560

National Sample Survey 52nd Round Survey, 1995-96

Distribution of Physical Disability in Aged (n=1000)

IndiaIndia    RuralRural

   UrbanUrban

  

                 

DisabilityDisability    MM FF MM FF

VisualVisual    249249 291291 225225 260260

HearingHearing    139139 156156 111111 132132

SpeechSpeech    3232 3838 2929 33

LocomotorLocomotor 107107 115115 8080 9494

Amnesia/SenilityAmnesia/Senility 9696 113113 6161 8080

Any DisabilityAny Disability 380380 425425 333333 367367

National Sample Survey 52nd Round Survey, 1995-96

Estimated Cost of major CD & S

HEALTH PROMOTION & DISEASE PREVENTION

DEFINITION:

Health promotion activities are those activities in which an individual is able to practically engage, in order to advance or improve his or her health.

Health Promotion Three levels of health promotion activities: Primary Prevention: Activities are designed to completely prevent a disease. Example : Immunization against Pneumonia or Influenza

Secondary Prevention : Early detection and management of diseases. Example : Colonoscopy to detect small cancerous polyps

Tertiary Prevention : To manage clinical diseases in order to prevent them from

progressing or to avoid complications of the disease. Example : Use of beta blockers to help remodel the heart in congestive heart failure.

AREAS OF HEALTH PROMOTION

The need to focus on the following areas in order to promote health and prevent disabilities in the elderly client :

1. Physical activities 2. Nutrition 3. Tobacco use 4. Safety 5. Immunization

Activities of Daily living and Health Promotion

Independence in activities of daily living is an important goal for health promoting activities.

Preventing Strategies in lessening disabilities : 1.)Smoke Cession 2.) Immunization 3.)Physical activity 4.)Weight control 5.)Blood pressure control 6.)Arthritis 7.)Diabetes self management program

SELF MANAGEMENT OF CHRONIC DISEASES (CDSMP)

• CDSMP Of Kate Loring (M.D.) was supported by Agency for Health Care Research and Quality (AHRQ).

• It is a 17 hours. course for patients with chronic diseases that is taught by lay peoples.

CHRONIC DISEASE SELF MANAGEMENT PROGRAMME

The course aims at :1.To teach patients to improve symptom

management.2.To maintain functional ability.3.To adhere to medical regiment.

HOW TO JUDGE THE EFFECTIVENESS OF THE PROGRAMME ?

BY THE IMPROVED SELF EFFICACY OF CLIENTS WHO PARTICIPATE IN THE PROGRAMME.

WHAT IS THE DIFFERENCE BETWEEN SELF MANAGEMENT PROGRAMME AND HEALTH PROFESSIONALS GOAL ?

THE GOAL AND CONCERNS ARE DIFFERENT FIVE ELEMENTS OF SELF MANAGEMENT PROGRAMME :1. PROBLEM SOLVING2. DECISION MAKING3. RESOURCE UTILIZATION4. FORMING A HEALTH CARE PROFESSIONAL / CLIENT

PARTNERSHIP5. TAKING ACTION

CHRONIC DISEASE SELF MANAGEMENT PROGRAMME