Dr Ravinder Singh

Stressand Lifestyle DiseasesDr. Ravinder SinghJackson Pollock (1948) $ 140 m

Physical EnvironmentEconomySocial EnvironmentHRQOLQOLHEALTHFUNCTION

In a little over a decade from now, chronic diseases like diabetes, hypertension, cancer and AIDS would account for over 65 per cent of deaths in India compared to 53 per cent in 2005. By 2020, chronic diseases (Lifestyle) are expected to claim 7.63 million lives in India, compared to 3.78 million in 1990, a study said.

India that is already home to the largest number of diabetes patients is projected to have 30 million diabetics by 2020, of which 6.6 million or 22 per cent would suffer from complications such as diabetic nephropathy. Similarly, stress both at work and at home is going to take a further toll with the number of people suffering from hypertension estimated to rise 213.5 million in 2025, compared to 118.2 million in 2000 representing an 80 per cent rise in a span of a quarter century.

LIFESTYLESTobacco Use is Increasing Diets are Rapidly Changing Physical Activity Reduced Alcohol Use Increasing Obesity due to fatty and junk foods Diabetes Hypertension are increasing in Most Parts Of the World,While Under-nutrition Remains a Severe Issue

‘Supersizing’ of French Friescalories610 calories7505002501970s1960s1980s1990s2002

Sodas Then and NowCoke/Pepsi Pitcher 500ml1950 Classic Coke 200 ml

Hamburger in the old daysMaharaja BurgerHamburgers Then and Now

Global lifestyle diseases realityLifestyle disease contribute 60 % of deaths and 43 % of the global burden of disease. Already 79% of these lifestyle diseases are occurring in developing countries.

By 2020 these deaths will account for 73% deaths and 60% of the disease burden.

Half of these deaths are attributable to cardiovascular diseases.

There are more CVD deaths in India or China than in all developed countries added together.“It makes little sense to expect individuals to behave differently from their peers; it is more appropriate to seek a general change in behavioural norms and in the circumstances which facilitate their adoption.” – Geoffrey Rose, 1992

Fundamental axiom in Preventive Medicine“A large number of people exposed to a small risk may generate many more cases than a small number exposed to high risk”

Rose pointed out that wherever this axiom applies, a preventive strategy focusing on high-risk individuals will deal only with the margin of the problem and will not have any impact on the large proportion of disease occurring in the large proportion of people who are at moderate risk.

For example, people with slightly raised blood pressure suffer more cardiovascular events than the hypertensive minority. While a high-risk approach may appear more appropriate to the individuals and their physicians, it can only have a limited effect at a population level. It does not alter the underlying causes of illness, relies on having adequate power to predict future disease, and requires continued and expensive screening for new high-risk individuals.

Lifestyle disease A disease associated with the way a person or group of people lives. e.g.Atherosclerosis, Heart Disease & StrokeObesity and Type 2 DiabetesRoad Traffic Accidents; and Diseases associated with Smoking, Alcohol & Drug Abuse. Alzheimer’s disease, asthma, cancer, chronic liver disease or cirrhosis, chronic obstructive pulmonary disease, metabolic syndrome, nephritis or chronic renal failure, osteoporosis, acne, depression

Eight of the top nine causes are directly related to behavioral (lifestyle) risk factors (infection is the exception). At least 45 percent of all deaths can be traced to unhealthful behavior. The percentage of day-to-day health problems related to unhealthful behavior is even higher.

Diseases of Longevity or Diseases of CivilizationThe WHO estimates that mortality from diabetes and heart disease cost India about $210 billion every year and is expected to increase to $335 billion in the next 10 years.StressMental and physical condition that occurs when a person must adjust or adapt to the environmentIncludes marital and financial problemsEustress (optimum): Good stress (e.g., travel)Distress (Bad and Harmful Stress)Stress Reaction: Physical response to stressAutonomic Nervous System is arousedStressor: Condition or event that challenges or threatens the person and is considered to be beyond the available resources by the person facing it

Lifestyle Factors Associated with StressHigh Blood Pressure Diabetes Smoking Alcoholism Improper Nutrition Obesity Lack of Activity Drugs

Cardiac PersonalitiesType A Personality: Personality type with elevated risk of heart attack; characterized by time urgency and chronic anger or hostilityAnger and hostility may be the key factors of this behaviorType B Personality: All types other than Type As; unlikely to have a heart attack

Hardy PersonalityPersonality type associated with superior stress resistanceSense of personal commitment to self and familyFeel they have control over their livesSee life as a series of challenges, not threats

ImmunityImmune System: Mobilizes bodily defenses like white blood cells against invading microbes and other diseasesPsychoneuroimmunology: Study of connections among behavior, stress, disease, and immune system

Epidemiological model for disease evaluation

Comparison of US Federal expenditure to allocation of mortality according to epidemiological model

Michael SpurlokOne month onMcDonald’s food:Gained 12 kgDepression, irritation,mood swings

Distal socioeconomic causes Incomeeducation andoccupation, all of which affect levels of Proximal factors inactivity, diet, tobacco use and alcohol intake; interact with

Physiological and Patho-physiological causes, such as blood pressure, cholesterol levels and glucose metabolism, to cause cardiovascular disease such as stroke or coronary heart disease. The sequelae include death and disability, such as angina or hemiplegia

Self Analysis related to Stress and Lifestyle Factors1. Are you a non-smoker ? 2. Do you check your BP regularly ? 3. Do you drink within limits ? 4. Do you avoid self –medication? 5. Do you take time off each day to relax ? 6. Do you take minor hassles in your stride ? 7. Are you at your ideal body weight ? 8. Do you eat a balanced diet ? 9. Do you exercise regularly ?

What do your scores indicate ?If the number of your “Yes” falls between 7 – 9 Excellent5 - 7 Good3 - 5 Poor0 - 3 V. PoorWhen your scores are below 7 , you need what is called as “The Lifestyle Modification Plan “

Cardiovascular diseases are the leading causes of death in the worldCVD are heart attacks and stroke.At least 80% of premature deaths from CVD and strokes could be prevented through a healthy diet, regular physical activity and avoiding the use of tobacco.(Source: WHO Global Burden of Disease)

Importance of Changing Health BehaviorsShift from infectious disease to chronic and/or degenerative illnesses emphasizes the need for primary, secondary and tertiary preventionHealthy behaviors lead to:Increased longevityReduced disability ratesBetter mental health and cognitive functionLower healthcare costs

Physical Inactivity:A Global Public Health Problem

Why are people inactive?Urbanization has resulted in several environmental factors which may discourage participation in physical activity: population over-crowding increased poverty increased levels of crime high-density traffic low air quality lack of parks, sidewalks and sports / recreation facilities.

Modes of Physical ActivityLifestyleWorkLeisureHouseholdTransportationExercise

The risk factors for diabetes(a) High familial aggregation. (b) Obesity, especially central obesity. (c) Insulin resistance. (d) Lifestyle changes due to urbanization. Moreover, diabetes occurs at a much younger age in India than in the developed countries. Family History of Diabetes, Age, Body Mass Index (BMI), waist to hip ratio and sedentary life-style

Road traffic injuries are projected to rise from the ninth leading cause of death globally in 2004, to the fifth in 2030More than 3500 people die from road traffic crashes every day and millions are injured or disabled for life. There is need to increase awareness of this preventable cause of death by promoting road safety practices such as wearing helmets and seat-belts, and not speeding or driving under the influence of alcohol (WHO).

Mildred Blaxter, Health and Lifestyle (1990) Routletge, London. UK, pp. 208

‘Mental Capital and Well-Being’(Foresight Report)The project’s aim was ‘to produce a challenging and long-term vision for optimising mental capital and wellbeing in the UK in the 21st Century—both for the benefit of society, and for the individual’Mental capital was defined as a metaphorical ‘bank account of the mind’, which gets enhanced or depleted throughout the life course

‘Mental Capital and Well-Being’Mental ill-health costs England alone £77 billion (approx. Rs. 5,00,000 cr.) a year; Stress and lack of well-being in the workplace cost around £25.9 billion (Rs. 1,50,000 cr.) per annum in terms of sickness absence, and labour turnoverCosts of dementia over the next 30 years will rise from the current cost base of £17 billion to £50 billion

Main Findings of the Foresight ReportCatch learning difficulties among children (e.g. dyslexia and dyscalculia) early enoughIf we do not also identify the common mental disorders such as stress, anxiety and depression early enough, and provide appropriate treatment and support, we will end up with even more than the current one in six adults currently suffering from common mental disordersWith work being more insecure, people working longer hours and substantially harder, the problems of stress at work have reached nearly epidemic proportions and are now the leading or second leading cause of sickness absence in most developed countriesRef: Cooper, C.L., Field, J., Goswami, U., Jenkins, R., &Sahakian, B. (2009). Mental capital and wellbeing. Oxford, UK: Wiley/Blackwell

Main Findings of the Foresight ReportWe need better trained managers who manage people by praise and reward and not by constant fault finding, a less ‘long hours culture’, more flexible working arrangements, etc.Finally, with the doubling of over 65 years and the tripling of over 80 years over the next 30 years, we need to begin to deal with the ultimate consequences of dementia now with preventative strategies, better early diagnosis and more successful treatment regimes

Healthy LifestylesFor Individual: Effective Way to Prevent Diseases And Promote Health For the Society: A Cost Effective and Sustainable Way to Improve Public Health

Strategies to Reduce Risk:World Health Report 2002 MessagesVery Substantial Health Gains Can be made for Relatively Modest Expenditures on Interventions

Changing Population Distributions of Risk Factors (Like Blood Pressure, Blood Cholesterol) Through General Lifestyle Changes

CVD: Population Wide Strategies to Lower Cholesterol (Quality Of Fat) And Blood Pressure (Salt Reduction) KeyStrategies to Reduce Risk:World Health Report 2002 MessagesTobacco: Higher Taxes, Comprehensive Advertisement Ban

Mix of Population Wide, High Risk And Secondary Prevention Measures, in a Cost Effective Balance

Strengthening Of National Institutions to Implement and Evaluate Risk Reduction Programmes

Protective Health FactorsAmong the psychosocial factors that have been linked to protection in adults are: an optimistic outlook on life with a sense of purpose and direction, effective strategies for coping with challenge, perceived control over life outcomes, and expressions of positive emotion. Epidemiological studies have shown reduced morbidity and delayed mortality among people who are socially integrated. The quality of social relationships in the home (parent–child relations and spousal ties) and the workplace (employer–employee relations and coworker connections) are now recognized as key influences on physical and mental health.

A growing literature underscores the protective health benefits associated with persistently positive and emotionally rewarding social relationships. Positive health behaviours (e.g., proper diet and adequate exercise, and avoiding cigarettes, drugs, excessive alcohol and risky sexual practices) are also influenced by psychosocial factors.

The biological mechanisms through which psychosocial and behavioural factors influence health are a flourishing area of scientific inquiry: investigations in affective neuroscience are relating emotional experience to neural structures, function, dynamics and their health consequences. There is a need for greater emphasis in policy and practice on interventions built around the growing knowledge that psychosocial factors protect health.

Evidence from 25 developing countries, 25 European countries, Canada, Israel and the United States shows that adolescents who report having a positive connection to a trusted adult (parent or teacher) are committed to school, have a sense of spirituality and exhibit a significantly lower prevalence of risky behaviours

Faulty methods of coping with stressSmokingAlcoholFrequent absenteeism from work Anti-Social Activities Irritability / Unjustified Anger Overeating

Stress ManagementDeep Breathing Exercises / Walking Yoga / MeditationMusic Therapy / Take up a hobbyReligious Activities / Social ServiceLaughter Therapy

Dr Ravinder Singh

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Dr Ravinder Singh