This document discusses health risks and their impact on diseases globally and in India. It identifies the top five leading global health risks as high blood pressure, tobacco use, high blood glucose, physical inactivity, and overweight/obesity. It also examines risks related to diet, addictions like smoking and alcohol, and environment factors like air pollution. India is experiencing a shift from communicable to non-communicable diseases due to lifestyle changes, urbanization, and an aging population. Heart disease incidence is increasing in India due to multiple interconnected socioeconomic factors.

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How do we determine a
person is healthy?

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Determinants of Health
• Genetic make up
• Age
• Gender
• Lifestyle choices
• Community influences
• Income status
• Geographical location
• Culture
• Environmental factors
• Work conditions
• Education
• Access to health services
Source: Dahlgren G. and
Whitehead M. 1991

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Multi-sectoral Dimension of the
Determinants of Health
• Malnutrition –
– more susceptible to disease and less likely to recover
• Cooking with wood and coal –
– lung diseases
• Poor sanitation –
– more intestinal infections
• Poor life circumstances –
– commercial sex work and STIs, HIV/AIDS
• Advertising tobacco and alcohol –
– addiction and related diseases
• Rapid growth in vehicular traffic
increased pollution levels

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Health risks

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Introduction - health risks
• Understanding health risks is key to
preventing disease and injuries.
• A particular disease or injury is often
caused by more than one risk factor Ex: BP,
smoking
• By understanding the impact of risk factors
on diseases, evidence-based choices can be
made about the most effective interventions
to improve global health.

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Introduction - health risks
• To prevent disease and injury, it is
necessary to identify and deal with their
causes – the health risks that underlie them.
• Each risk has its own causes, and many
roots in a complex chain of events over
time, consisting of
– socioeconomic factors,
– environmental factors
– individual behavior.

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Nature of health risks
• Modifying these background causes is more
likely to have amplifying effects, by
influencing multiple proximate causes;
– Education : awareness increase
– Physical activity : reduces all theses risks
• Hence such modifications will lead to
improvements in health conditions.

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Risk transition
As country is developing, the types of diseases that affect a
population shift from primary infectious, such as diarrhoea
and pnemonia, to primary non- communicable, such as
cardiovascular disease and cancers.
This shift is caused by:
1. Improvements in medical care, which mean that
children no longer die from easily curable conditions
such as diarrhoea
2. The ageing of the population, because non -
communicable diseases affect older adults at the
highest rates
3. Public health interventions such as vaccinations and
the provision of clean water and sanitation, which
reduce the incidence of infectious diseases.

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Traditional risks
• The risks that affecting population also shifted
over time, from those for infectious disease to
those that increase noncommunicable disease
• Low-income populations are most affected by
risks associated with poverty, such as
undernutrition, unsafe sex, unsafe water, poor
sanitation and hygiene, and indoor smoke from
solid fuels; these are the so-called “traditional
risks”.

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Modern risks
• As life expectancies increase and the major causes
of death and disability shift to the chronic and
noncommunicable, populations are increasingly
facing modern risks due to physical inactivity;
overweight and obesity, and other diet-related
factors; and tobacco and alcohol-related risks.
• As a result, many low- and middle-income countries
now face a growing burden from the modern risks to
health, while still fighting an unfinished battle with
the traditional risks to health.

14. 1. Diet related risk factors
In the present world scenario population
live in a country where overweight and
obesity kills more people than
underweight
The six risks showed in the diagram
account for 19% of global deaths
These risk factors have the greatest
effect on cardiovascular
diseases – 57% of cardiovascular deaths can be
traced back to one of these risk factors

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• High Blood Pressure: Raised blood pressure changes
the structure of the arteries. As a result, risks of stroke,
heart disease, kidney failure and other diseases
increase, not only in people with hypertension but also
in those with average, or even below-average, blood
pressure. Diet – especially too much salt – alcohol,
lack of exercise and obesity all raise blood pressure,
and these effects accumulate with age
• High Cholesterol: Diets high in saturated fat, physical
inactivity and genetics can increase cholesterol levels.
This increases the risks of heart disease, stroke and
other vascular diseases. Globally, one third of
ischaemic heart disease is attributable to high blood
cholesterol.

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• High Blood Glucose: Changes in diet and reductions in
physical inactivity levels increase resistance to insulin,
which, in turn, raises blood glucose. Raised blood
glucose causes all diabetes deaths, 22% of heart disease
and 16% of stroke deaths.
• Over weight and obesity: The risk of coronary heart
disease, stroke and type 2 diabetes grows steadily with
increasing body mass, as do the risks of cancers of the
breast, colon, prostate and other organs. Chronic
overweight contributes to osteoarthritis – a major cause
of disability. Globally, 44% of diabetes burden, 23% of
heart disease burden and 7–41% of certain cancer
burdens are attributable to overweight and obesity.

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• Low fruit intake: Fruit and vegetable consumption is
one element of a healthy diet. Insufficient intake of fruit
and vegetables is estimated to cause around 14% of
gastrointestinal cancer deaths, about 11% of heart
disease deaths and about 9% of stroke deaths worldwide.
Most of the benefit of consuming fruits and vegetables
comes from reduction in cardiovascular disease, but
fruits and vegetables also prevent cancer.
• Physical inactivity: Physical activity reduces the risk of
cardiovascular disease, some cancers and type 2
diabetes. It can also improve musculoskeletal health,
control body weight and reduce symptoms of depression.

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19. 2. Addictive risk factors
Smoking substantially increases the risk
of death from lung and other cancers,
heart disease, stroke, respiratory disease
and others.
Alcohol contributes to more than 60 types
of disease and injury type of deaths.

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1
10
100
Child Teen Young Adult Adult
1.5%
67%
5.5%
<12 12-17 18-25 >25
Addiction is a Developmental Disease:
It Starts Early
26%

21. Percentage of deaths over age 30 caused by tobacco, 2010

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3. Environmental risks
• Unsafe water, sanitation, and hygiene conditions
• Urban outdoor Air pollution
• Indoor smoke from solid fuels

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Of worlds top 20 polluted cities,
13 are in India

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Global patterns of health risks
The five leading global risks for mortality in the
world are
1. high blood pressure,
2. tobacco use, alcohol
3. high blood glucose,
4. physical inactivity,
5. and overweight and obesity.
They are responsible for raising the risk of
chronic diseases, such as heart disease and
cancers. They affect countries across all income
groups: high, middle and low

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Source: W.H.O. Statistics

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Deaths attributed to 19 leading factors,
by country income level

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Estimates
• Between 2008 and 2030, the global population is
projected to grow by 20%, from 6.7 billion to 8.1
billion people.
• Major shift is currently underway in the overall
disease burden in the world.
• In 2008, five out of the top ten causes for mortality
worldwide, other than injuries, were non-
communicable diseases; this will go up to seven
out of ten by the year 2030.
• By then, about 76% of the deaths in the world will
be due to non-communicable diseases (NCDs)1.

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Situation in India
• India has seen a rapid transition in its disease burden
(number of cases/lakh) over the past couple of
decades.
• The load of communicable and non-communicable
diseases (NCDs) is projected to get reversed in 2020
from its distribution in 1990.

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Indian Scenario continues….
• This is largely because, with India’s economic
growth and urbanization over the past decades, a
large section of the population has moved
towards unhealthy lifestyles with decreasing
physical activity, increasing stress levels, and
increasing intake of saturated fats and tobacco.
• The average life span has increased due to
improvements in medical care; the rapidly ageing
population, more prone to NCDs, will also fuel
the growth of NCDs over the next few decades.

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Factors for increase in incidence of
heart diseases in India
• The growth of heart diseases is dependent on a
number of interlinked factors such as aging,
changing lifestyles and food habits, and other
rapidly evolving socioeconomic determinants
across developing nations.
• All these factors together create a domino
effect, resulting in increased incidence of
cardiovascular diseases.
• Socioeconomic determinants like improved
access to healthcare, higher income levels and
globalization, and urbanization drive increases
in CVD risk factors.

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Factors for increase in incidence of
heart diseases in India /2
• Improved healthcare in India has increased the
average life expectancy from 48.8 years in 1970 to
64.1 years in 2009, resulting in a growing aging
population which faces an increased risk of heart
diseases.
• Higher income levels and globalization have induced
a nutritional shift resulting in the rise of unhealthy
food and decreased intake of fruits and vegetables.
• India’s rapid urbanization, led to a number of issues
like reduced physical activity, unhygienic and
overcrowded living conditions, growing levels of
stress, and higher exposure to pollution.

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Factors for increase in incidence of
heart diseases in India /3
• Risk factors like age and genetic makeup can’t be
controlled. For example, the nutritional shift has
moved a number of people to unhealthy eating
habits.
• Between 1983 and 2004, while the per capita
consumption of protein went down, the amount of
fats intake increased by more than 25%, both in
urban and rural areas.
• This, coupled with reduced physical activity, gives
rise to intermediate risk factors such as hypertension
and obesity.