PrinciplesofPublicHealth

Session6:RiskFactors

SessionObjectives
Bytheendofthissession,participantswillbeableto: 1. Defineriskfactor 2 Identifydifferentphysiological 2. physiological,behavioral behavioral,social andenvironmentalriskfactors 3. Namedifferentbehavioralriskfactors 4. Describethesocialdeterminantsofhealth 5 Identifydifferentriskfactorsthatcontribute 5. significantlytomorbidityandmortalityin developing p gcountries.

PresentationOutline
I. . Definition e t o of o risk s factor acto II. Typesofriskfactors
A. B. C. D. E. Physiological y g Behavioral Psychological Physicalenvironment SocialDeterminantsofhealth

III. Ecological l i lmodel d l IV. Majorriskfactorsindifferentpartsoftheworld

Definitionofriskfactor
Ahealthriskfactorisanythingthatincreases oneschancesofgettingadisease.Common categories g ofriskfactorsinclude:
Biologicalorphysiologicalfactors Behavioralfactors Psychosocialfactors PhysicalEnvironment Socialdeterminantsofhealth

Key ydistinction:neithernecessary ynorsufficient

RiskFactorAnalysis
Direct contributing factor Indirect contributing factor Indirect contributing factor Indirect contributing factor Indirect g contributing factor Indirect contributing factor Determinant Di t Direct contributing factor Indirect contributing factor Indirect contributing factor

D t Determinant i t Direct contributing factor Healthp problem

ExamplesofPhysiological riskfactors
Malnutrition:anemia, anemia VitaminAdeficiencies Highbloodpressure High i hcholesterol h l llevels l l Bloodsugarregulationindiabetes

Physiologicalriskfactor

ExamplesofBehavioral RiskFactors
Poordiet Unsafesex S ki Smoking Alcohol&druguse Lackofphysicalactivity

ExamplesofPsychologicalRiskFactors
Mentalhealth Stress Depression i

ExamplesofEnvironmental riskfactors
Unsafewatersupply Poorairquality Exposuretolead l dpoisoning i i

Socialdeterminantsofhealth
1. 2. 3 3. 4. 5 5. 6. Poverty,Income Education Employment Housing&theEnvironment Mobility/Transportation Nutrition&AgriculturalPolicy
Source:IndependentInquiryintoInequalitiesinHealth.The AchesonReport,London,1998

Social determinants of health

Source: WHO, The Solid Facts, 2nd edition, 2003

1.Thesocialgradient 2.Stress 3.Earlylife 4.Socialexclusion 5.Work

6.Unemployment 7.Socialsupport 8.Addiction 9.Food 10.Transport

PrestonCurve
Relationshipeconomicdevelopment&lifeexpectancy

PrestonCurve
Relationshipeconomicdevelopment&lifeexpectancy

Whataretwoimportantconclusionsthatyou drawfromobservingthisgraph?

Socialgradient: Level lof fincome&health h lh

Levelofeducation&health

Literacy&healthstatus
Statistical Statisticalanalysisindicatesthat,amongthe variablesforwhichcomparableinformationis available,socialfactors(representedbylevels ofliteracyandschoolenrollment)seem dominantexplainersofvariationsininfant mortality li and dlif lifeexpectancyamong developingcountries.
So Source: rce GrosseR R,Auffrey A ffre C. C Literac Literacy&healthstatus stat sin developingcountries.:AnnualReviewsofPublichealth, 1989

(Female)literacy&health
Explanatory variables: % Change in Child Mortality (under 5) associated with a 1 % change in a given variable i bl Regressions (1) p water source (% ( of Access to improved population) Access to safe sanitation (% of population) Female literacy in age group 15-24 (%) I Immunization i ti (% of f children) hild ) HIV prevalence (% of adults 15-49 years) Dummy u y SS SSA region eg o Dummy High mortality countries in MEC region Dummy - High mortality countries in ASP g region Adjusted R2 0.78 -0.41 ( (-2.30) ) -0.28 (-2.29) -0.83 (5.15) -0.38 0 38 (-2.07) ( 2 07) 0.09 (4.43) (2) -0.31 ( (-2.10) ) -0.25 (-2.44) -0.53 (3.80) -0.24 0 24 (-1.50) ( 1 50) 0.08 (3.24) 0.58 ( (4.84) .8 ) 0.60 (4.07) 0.51 (3.82)

0.86

Worldwideliteracyrates

Worldwideliteracyrates,bygender

Conceptualizingtheimpactofdifferent categoriesof frisk kf factors

Conceptualmodelforcapturingeffects of fd different ff k kinds d of frisk kf factors

Populationattributablerisk(PAR)

Relativecontributionofselectriskfactors
Mortalityrates

Highmortalitydevelopingregions

Source,Ezzati,etal,SelectedMajorriskfactorsandglobalandregionalburdenofdisease. Lancet,2002

Lowermortalitydevelopingregions

Source,Ezzati,etal,SelectedMajorriskfactorsandglobalandregionalburdenofdisease. Lancet,2002

Developedregions

Source,Ezzati,etal,SelectedMajorriskfactorsandglobalandregionalburdenofdisease. Lancet,2002

Globalburdenofdiseaseriskfactors:Mortalityrates

Source:WHO,GlobalHealthRisks:Mortalityandburdenofdisease,attributable toselectedmajorrisks,2009

Globalburdenofdiseaseriskfactors
Mortalityrates

Globalburdenofdiseaseriskfactors
DALYs

Summary
Whatarethemajorpointscoveredinthis presentation?