Health Improvement An Overview

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Health ImprovementAn Overview

• Salman Rawaf
• Strategy Development Workshop 7th January 2005

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Enabling People
Health Improvement
Aim How? Where? Who?
Enabling People Individuals/HR/Pop-wide
Health (ALL)
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Enabling People
Health Improvement
Aim How? Where? Who?
Enabling People Individuals/HR/Pop-wide
Health (ALL)
Home/Schools/Work/ Community/Primary C
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Enabling People
Health Improvement
Aim How? Where? Who?
Enabling People Individuals/HR/Pop-wide
Health (ALL)
Home/Schools/Work/ Community/Primary C
Individuals/Employers/ Com Org/Schools/LA/ Health/
Vol Org/Gov
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Atherosclerosis Is a Chronic Inflammatory Disease
With LDL-C at the Core
Enabling People
PHASE I Initiation PHASE II
Progression PHASE III Complication
Libby P. J Intern Med. 2000247349-358.
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Most MIs arise from smaller Stenoses



Enabling People


68
68
60
60
MI Patients ()
40
40
18
18
20
20
14
14
0
0
lt50
5070
gt70


Stenosis
Falk
Falk
et al.
et al.
Circulation
Circulation
.199592657671.
.199592657671.
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Risks
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A new factor or new disease?The Metabolic
Syndrome
Risks
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CHD Risk Multiplies With Additional CV Risk
Factors

• Risk multiplies with additional risk factors

Risks
Dyslipidemia TC 6.5 mmol/L X2.3
Hypertension SBP 150 mm Hg X1.5
X3.5
X6.2
X2.8
X4
Glucose intolerance X1.8
Risk shown above is compared with baseline risk
for a 40-year-old male nonsmoker withTC 4.7
mmol/L, SBP 120 mm Hg, and no glucose
intolerance, who is ECG-LVH negative and whose
probability of developing CVD is 15/1000 (1.5)
in 8 years.
Kannel WB. In Hypertension Physiopathology
and Treatment.1977888-910.
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Levels of Risk Associated with Smoking,
Hypertension and Hypercholesterolaemia
Hypertension (SBP gt195 mmHg)
Risks
x3
x9
x4.5
x16
x1.6
x4
x6
Smoking
Serum cholesterol level (gt8.5 mmol/L, 330 mg/dL)
Adapted from Poulter N et al., 1993
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Health Improvement
Aim How? Where? Who?
Enabling People Inequalities
Individuals/HR/Pop-wide (Areas/Population)
Disadvantaged
Inequalities
Health (ALL) Wider
Determinants (Risks)
(Wellbeing, Health, Illness)

Home/Schools/Work/ Communities
Community/Primary C
(Small Areas Wards)
Individuals/Employers/
Individuals/C Gov/LA/ Com
Org/Schools/LA/ Health (Targeted
Service Health/Gov
Provision)
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Hospital Admissions by deprivation
Inequalities
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Health Improvement
Aim How? Where? Who?
Enabling People Inequalities
Quality Treatment Individuals/HR/Pop-wide
(Areas/Population) Care Meeting H. Needs
Quality Treatment Care
Health (ALL) Wider
Determinants
Illness (Risks)
(Wellbeing, Health, Illness)
Home/Schools/Work/ Communities
Home/Primary Care/ Sec Care/
Community/Primary C
(Small Areas Wards) Specialist
Services/Carers
Individuals/Employers/
Individuals/C Gov/LA/
Individuals/Families/ Com Org/Schools/LA/
Health (Targeted Service
Health Services Health/Gov
Provision)
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Results Mean Percent Change from Baseline in
Lipid Values
Mean change from Baseline
Quality Treatment Care
p lt 0.0001
p lt 0.0001
p lt 0.0001
p lt 0.0001
p lt 0.0001
p 0.0028
Structured Care vs Usual Care
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. Peoples Health