Presentation
On
“Changing patterns of health & disease”
Meaning Of Disease
Disease simply means “without ease” or
“uneasiness”.
Disease is defined as any deviation from
normal functioning or state of complete
physical or mental well being.
Changing pattern of diseases
according to age
Among children 0-4 yrs top 3
causes of deaths are:
Perinatal conditions (33%),
Respiratory infections (22%),
Diarrhoeal diseases (14%),
Chief causes of deaths are perinatal
conditions: complications during the time of
child birth like obstructed
labour,haemorrhage etc..
Among children 5-14 yrs top 3
causes of deaths are:
Diarrhoeal diseases (17%),
Unintentional injuries: other (16%),
Other infectious and parasitic diseases
(15%),
Mortality rate is low as compared to deaths
among 0-4 [Link] causes are diarrhoeal
diseases.
In age group of 15-24 yrs top 3
causes of deaths are:
Intentional self-harm (16%),
Unintentional injuries: other (12%),
Symptoms signs and ill-defined conditions
(7%),
In age group chief causes of deaths are
accidents , homicides and suicides.
In the age group 25- 69 leading
causes of deaths are:
Cardiovascular diseases (25%),
COPD, asthma, other respiratory (10.2%),
Tuberculosis (10.1%),
In this age group mortality rate rises
sharply. They suffers more from non-
communicable diseases as a result of
today’s lifestyle, industrialization etc.
CONCLUSIONS
FACTOR PREVIOUS ERA RECENT ERA
Life expectancy mid 40 yrs above 60 yrs
Leading cause of death Pneumonia Heart diseases
Influenza Cancer
Maternal mortality In 1945-582 deaths 7 deaths/
In 1986-40 deaths 1,00,000
live births
Infant mortality Higher Decreased sharply
CONCLUSIONS
FACTOR PREVIOUS ERA RECENT ERA
Rate of infectious 61.2% 2%
diseases
Rate of accidental 21.4% 43.9%
deaths.
Mental problems Low Increased sharply
Type of diseases ruled Communicable Non
communicable
the era diseases diseases
Recent trend of diseases
Major causes for changing
pattern
The major declines in child mortality that occurred
because of improved socioeconomic conditions
and public health strategies, including
improvements in water treatment, food safety,
solid waste disposal, and public education.
Deaths from polio, tetanus, and Influenza disease have
also been virtually eliminated by mass vaccinations.
Rise in cardiovascular diseases , respiratory diseases
,mental problems are due to various reasons such as
changes in lifestyle, increase in stress level,
urbanization etc…
e
CHANGING PATTERN OF DISEASES
The disease patterns have changed
significantly through human history.
The factors that play role in the changing
pattern of diseases are:-
[Link] lifestyles and living standards.
[Link] and urbanization.
[Link] factors.
CHANGING PATTERN OF DISEASES
infections
diseases
Morbidities
cardiovascular
diseases and
cancer
Psychological
and
mental
disorders
1960 1980 2000
Changing pattern of diseases
USA as example: The leading causes of death
in United States from 1900-1983.
The factors that led to the decline of
infectious/ communicable disease are:-
Clean water, sanitation and nutrition.
Improved medical technology.
Importance of antibiotics.
The table shows an increase in the lifestyle
disease.
Causes of death in USA
DEVELOPED COUNTRIES
The table shows that during the past years,
the developed countries has experienced a
dramatic change in the pattern of diseases.
The greatest part of this development has
been the decline of the infectious diseases
e.g. tuberculosis, typhoid fever, diphtheria.
Rapid industrialization and changes in
lifestyle have led to an increase in coronary
heart disease, cancer and accidents.
DEVELOPING COUNTRIES
In developing countries most deaths results
from infectious and parasitic diseases.
With the development of industries, various
occupational diseases e.g. asbestosis,
pneumoconiosis are on the increase.
INDIAN SCENARIO
In India, most deaths results from infectious
and parasitic diseases accompanied by
malnutrition.
Diarrhoeal diseases are widespread.
Polio has shown a declining trend.
Coronary heart disease, hypertension,
cancer, diabetes and accidents have shown
an increasing trend.
By 2020 , over 70 percent of the global
burden of disease in developing and newly
industrialized countries will be caused by
non - communicable diseases , mental health
disorders and injuries up from 51 % in 1990
1990 2020
15%
21% 22%
9%
49%
14%
27%
43%
developing and
newly
industrialized
Communicable Noncommunicable
Source: Murray&Lopez, 1996
countries
CHANGES IN NUTRITION PATTERN
Changes in lifestyle lead to wrong eating
habits.
Not having diverse and balanced nutrition.
DEFINITION
The enviornment is all the
physical,chemical and biological
factors external to the human host and
all related behaviours.
COMPONENTS OF
ENVIORNMENT
Pollution of air, water and soil with
chemical and biological agents
UV and ionizing radiation
Noise, electro-magnetic field
Occupational risk
Build enviornment including housing,
land use pattern roads
Agriculture methods
Man-made climate change, ecosystem
change.
Enviornmental factors contribute to
23% of all deaths worldwide and 36%
of all death among children O-14
year old.
SWINE FLU
Thisis a respiratory infectious disease.
Countries with 171 confirmed cases.
Deaths due 14,387 to swine
TOP 10 KILLERS OF 2010
Heart disease
Cancer
Infectious diseases
Tuberculosis
Chronic obstructive pulmonary disease
Lower respiratory tract infections
HIV/AIDS
Malaria
Diarrhoea
Measles
CHANGING PATTERN
OF
HEALTH
Where are we now ?
Important Health Statics:
During the half century since India adopted the family planning
programme as its official programme, India has seen the following
improvements in its demographic situation (Ministry of Health
and Family Welfare, 2008):
• A halving of the infant mortality rate from 136 per 1,000 live
births in 1991 to 62 per 1,000 live births in 2008.
• A quadrupling of the couple protection rate from 10 percent in
1991 to 34 percent in 2006
• A reduction of the crude death rate from 25 deaths per 1,000
population in 1991 to 7 in 2008
• The addition of 18 years to life expectancy from 47 years to 65
years
• A reduction in the total fertility rate from 4.71 in 1991 to 3.2 in
18000
16534
16000
14338
14000
12000 11234
6th plan (1981-85)
10000 9700 7th plan(1985-90)
8th plan(1992-97)
8000 7598
9th plan(1997-2002)
6000 10th plan(1997-2002)
11th plan(1997-2002)
4000
2160
2000
0
Budget of Indiangovt on healthcare(Rs. In Crore)
HEALTH PATTERN ARE CHANGING….
Why ?
The answer to the question is……….
SHIFTING OF MIND
vShift one: feeforservice to covered lives
vShift two: drive out costs, drive up quality
vShift three: toward wellness
vShift four: Beyond prevention
vThe final shift: Beyond healthcare
Shift one: feeforservice to covered
lives
The first shift springs from changing
incentives. Federal reform, various state
reforms, business alliances, and the
integration of the industry are all driving in
the same direction: the economic base of
much of the industry is moving from feefor
service to covered lives.
Shift two:
drive out costs, drive up quality
The first shift changed incentives will lead
directly to the second shift: With most institutions
sharing risk on covered lives, competition on both
price and quality will move them to a vigorous use
of outcomes measurement, matched to TQM and
other "new management" techniques, to drive the
costs out and drive the quality up.
Shift three: toward wellness
The third shift will come as an important
realization spreads among boards and
management teams: they can no longer
survive just curing the sick. In order to earn
survival margin, they will have to widen the
gap between what they get paid per covered
life, and what they spend to care for that life.
If they are going to cover people's lives, they
will have to learn how to keep those people
healthy.
Shift four: Beyond prevention
Healthcare will rapidly find it has to go well beyond
providing more prevention, to changing people's minds.
As long as people see health as the mere absence of
disease, as the province of doctors and hospitals, as
something you buy from someone else rather than build
for yourself, healthcare organizations will be playing
fool's poker with money they don't have.
They will be forced by circumstances into massive
efforts to shift the public awareness of health, disease,
The final shift: Beyond healthcare
What happens next the final shift is even more
interesting.
It is still the 2nd largest industry in world . In almost all
local economies it is one of the largest employers.
Hospitals alone directly employ 4.72 percent of all India.
In many local economies the single largest employer is a
hospital.
The industry touches people's lives with a scope and
intimacy that no other industry does. And people still
trust it more than any other industry you don't find
volunteers parking cars or staffing the gift shop at a
silicon chip factory or a brokerage.
THANK YOU ...
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