1. Dr. H.S.S. Perera Department of Community Medicine, Faculty of Medicine, Peradeniya

2. Hypo=lack Kinetic= movement They are conditions that occur due to NO exercise or Lack of exercise, usually due to a sedentary lifestyle >70% of population suffering from one hypo kinetic disease

3. Ischemic heart Diseases Stroke Diabetes Mellitus High blood pressure High cholesterol Obesity Osteoporosis Some cancers Back Pain?

4. In 1900s the leading causes of death were infectious diseases like Tuberculosis and Typhoid. Today the leading causes of death are HYPOKINETIC diseases. In some cases, hypo kinetic disease can be drastically reduced or even eliminated through exercise and lifestyle modification.

5. They occur in large amounts Some can kill you fast Some make you ill for a long period of time Some can leave you with serious disabilities Expensive treatment Time Consuming A lot of problems for you, the family, the society and the country

6. Health indicators tell you about how healthy a population is. Out of these certain indicators can be used to measure the impact of a disease. Mortality- How many are killed Morbidity- How much ill health is caused Disability- What are the consequences of the disease

7. How many are killed? Useful in diseases with high case fatality rates. Do not reveal the burden of ill health Specific Death Rate for the disease= Number of deaths due to that disease in that year/mid year population*1000 Gives the proportion of the total population that died as a result of that particular disease

8. Case Fatality Rate= Number of deaths due to a certain disease/Total number of cases*1000 Does not take into account the duration of disease before death

9. Any departure, subjective or objective from a state of physiological well being Supplements mortality data Useful in disease with low cases fatality Eg:DM Three main indicators 1. Frequency of occurrence 2. The severity of illness 3. The duration

10. Number of new cases of the specific disease during that period/population at risk during that period*1000 Refers only to new cases during a given period in a specific population A measurement of the rate at which new cases are occurring It is not influenced by the duration

11. This refers to all current cases(old and new) existing at a given point in time/over a period of time in a given population Therefore the longer the duration of a disease the higher the prevalence If the disease in fatal although incidence is high prevalence becomes low

12. Quality of life A composite measure of physical, mental and social wellbeing as perceived by individuals This is also important in measuring the public health impact since health is something more than just staying alive Disability rates measure persisting consequences of a disease

13. Disability Adjusted Life Years An estimate of the years of life lost to premature deaths and number of years lived with disability It is a measure of the Burden of disease Takes in to account The incidence, Age of onset, Duration of illness The degree of disability

14. One DALY is one lost year of healthy life 0= good health Takes severity of disability into account Class 1-Limited ability to perform at least one activity in one of the following areas recreation, education, procreation Class 6-needs assistance with Activities of Daily Life such as eating, personal hygene, toilet use

15. A measure of disease burden, including both the quality and the quantity of life lived The QALY is based on the number of years of life that would be added by the intervention. Each year in perfect health is assigned the value of 1.0 down to a value of 0.0 for death. If the extra years would not be lived in full health, for example if the patient would lose a limb, or be blind or have to use a wheel chair, then the extra life-years are given a value between 0 and 1 to account for this.

16. “Diabetes Mellitus is a public health problem” Discuss the above statement.

17. On the person- Death Chronic ill health or disability More prone to other diseases Affects his mental status Affects his job and economy Affects his relationship

18. On the family Loss of the bread winner and family economy Loss or decreased commitment from that member More money and time to be allocated to the ill person On the country Loss of some productive years Cost on drugs, hospital stay, equipment, Hospital staff rehabilitation Cost for caregivers

20. A chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. Raised blood sugar, is a common effect of uncontrolled diabetes and leads to serious damage to many of the body's systems, especially the nerves and blood vessels.

21. 346 million people worldwide have diabetes. In 2004, an estimated 3.4 million people died from consequences of high blood sugar. More than 80% of diabetes deaths occur in low- and middle-income countries. WHO projects that diabetes deaths will double between 2005 and 2030.

22. Over time, can damage the heart, blood vessels, eyes, kidneys, and nerves. Increases the risk of heart disease and stroke. 50% of people with diabetes die of cardiovascular disease (primarily heart disease and stroke). Combined with reduced blood flow, neuropathy in the feet increases the chance of foot ulcers and eventual limb amputation. Diabetic retinopathy - an important cause of blindness After 15 years of diabetes, approximately 2% of people become blind, and about 10% develop severe visual impairment. Diabetes is among the leading causes of kidney failure. 10- 20% of people with diabetes die of kidney failure. Damage to the nerves as a result of diabetes, affects up to 50% of people with diabetes. The overall risk of dying among people with diabetes is at least double the risk of their peers without diabetes.

24. A group of disorders of the heart and blood vessels Heart attacks and strokes are usually acute events and are mainly caused by a blockage that prevents blood from flowing to the heart or brain CVDs are the number one cause of death globally Estimated 17.3 million people died from CVDs in 2008, representing 30% of all global deaths. ( 7.3 million due to coronary heart disease and 6.2 million due to stroke)

25. Approximately 300,000 new cases of MI per year Only half of this survive the initial attack Further 10% die in the hospital Up to10% more die in next two years Only 50% of the initial survivors are alive at 10 years In 2006, CVD cost the healthcare system in the UK around £14.4 billion. The cost of hospital care for people who have CVD accounts for about 72% of these costs, whereas 20% of the cost is due to drugs. In 2006, production losses due to mortality and morbidity associated with CVD cost the UK over £8.2 billion, with around 55% of this cost due to death and 45% due to illness in those of working age.

26. Due to reduced blood supply to the brain A leading cause of death and disability. Annually, about 16 million first-ever strokes occur in the world, causing a total of 5.7 million deaths Ranks as the second cause of death in the world population after ischemic heart disease Death rate following a stroke is 25%

27. Global epidemic not a problem limited to western or high-income countries. About 85% of all stroke deaths are registered in low- and middle-income countries, which also account for 87% of total losses due to stroke in terms of disability- adjusted life years (DALYs) While stroke will firmly remain the second cause of death in the world by 2030, its ranking as a major cause of DALY loss will increase during the same period

28. About half of stroke survivors are left with some degree of physical or cognitive impairment The need of support for common daily activities directly impacts quality of life of patients and their relatives Direct costs, to country include the cost of physicians and other health professionals, acute and long-term care, medications and other medical durables( 67% of total costs,) Indirect costs consider lost productivity resulting from morbidity and mortality

30. Abnormal or excessive fat accumulation that may impair health. a BMI greater than or equal to 30 In olden days and in some cultures it was perceived as a symbol of wealth and fertility The fifth leading risk for global deaths. At least 2.8 million adults die each year as a result of being overweight or obese.

31. In addition, 44% of the diabetes burden, 23% of the ischemic heart disease burden and between 7% and 41% of certain cancer burdens are attributable to overweight and obesity. Once considered a problem of high income countries Now rising in both developing and developed countries On average obesity reduces life expectancy by 6-7 years

32. A disease characterized by decreased bone mass and micro architectural deterioration of bone tissue leading to increased bone fragility and increased risk of bone fracture

33. It leads to serious fractures, including those in the wrist, hip and spine Worldwide, an osteoporotic fracture is estimated to occur every 3 seconds, a vertebral fracture every 22 seconds. Estimated to affect 200 million women worldwide - approximately one-tenth of women aged 60, one-fifth of women aged 70, two-fifths of women aged 80 and two-thirds of women aged 90. The fractures from osteoporosis can be painful and may even limit your independence and freedom. The disease is most common among the elderly and women, though it can also occur in men and young people. Once you get osteoporosis, it lasts the rest of your life

35. One adult in three in America has high blood pressure In the UK hypertension affects over 16 million people and is responsible directly for half of all strokes and heart attacks. Failure to control blood pressure in the UK is estimated to lead to 62000 deaths each year. Iran - 43.8 percent Sudan - 19.8 percent Oman - 27.6 percent Egypt. - 19.4 percent Jordan 36 percent

36. Healthy arteries are flexible, strong and elastic If you have high blood pressure, the increased pressure of blood flowing through your arteries gradually can cause a variety of problems, including Artery damage and narrowing Aneurysm Uncontrolled high blood pressure can damage your heart in a number of ways, such as: Coronary artery disease, enlarged left heart, heart failure

37. But high blood pressure can cause several problems, including: Transient ischemic attack (TIA), Stroke,Dementia. Dementia is a brain disease resulting in problems with thinking, speaking, reasoning, memory, vision and movement. High blood pressure can injure both the blood vessels in and leading to your kidneys, causing several types of kidney disease (nephropathy).

38. Prevalence of High blood Pressure, Diabetes Mellitus and obesity in 4 provincial areas aged 30=65years N=6047 High blood pressure in males =18.8% in females =19.3% Diabetes in males =14.2% In females =13.5% Obesity in males =20.3% In females =36.5%

39. Case Fatality Rates for selected diseases

41. A Cross –sectional study conducted between 2005 and 2006 for Diabetes Prevalence Standardized prevalence for Sri Lankans aged ≥20 years – 10.3% Prevalence in the urban population was 16.4% Prevalence in the rural population was 8.7% Prevalence of pre-diabetes in urban and rural population was 11.5% Overall prevalence of some form of dysglycaemia (sugar problems) was 21.8%

42. You Can Wake Up Now! Thank You!