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 yrs.Chief 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:-
1.Changing lifestyles and living standards.
2.Industrialization and urbanization.
3.Demographic 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 ...
?