1. INDIAN GERONTOLOGICAL ASSOCIATION, JAIPUR
CHRONIC DISEASES IN INDIA – CROSS CUTTING ISSUES : POVERTY,ENVIRONMENT & GENDER
BY DR. K.L.SHARMA
INDIAN GERONTOLOGICAL ASSOCIATION, JAIPUR

2. 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

3. 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

4. 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

5. What Are Chronic Diseases?
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.

6. 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.

7. 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.

8. 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.

9. Chronic Diseases Leading to deaths

10. Distribution in Indian elderly:(n=1000)
CHRONIC DISEASES
Distribution in Indian elderly:(n=1000)
India
Rural
Urban
Chronic Disease M F
Cough
250
195
179
142
Piles 33 16 32 18
Joint Problems
363
404
285
393
High/low BP
108
105
200
251
Heart Disease 34 27 68 53
Urinary Problem 38 23 49 24
Diabetes 36 28 85 66
Cancer 2 3 4
Any of the above
527
514
528
560
National Sample Survey 52nd Round Survey,

11. Distribution of Physical Disability in Aged (n=1000)
India
Rural
Urban
Disability M F
Visual
249
291
225
260
Hearing
139
156
111
132
Speech 32 38 29 3
Locomotor
107
115 80 94
Amnesia/Senility 96
113 61
Any Disability
380
425
333
367
National Sample Survey 52nd Round Survey,

12. Estimated Cost of major CD & S

13. 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.

14. 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.

15. 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

16. 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

17. 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.

18. CHRONIC DISEASE SELF MANAGEMENT PROGRAMME
The course aims at :
To teach patients to improve symptom management.
To maintain functional ability.
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.

19. CHRONIC DISEASE SELF MANAGEMENT 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 :
PROBLEM SOLVING
DECISION MAKING
RESOURCE UTILIZATION
FORMING A HEALTH CARE PROFESSIONAL / CLIENT PARTNERSHIP
TAKING ACTION

20. thanks