Taking Preventative Action
3.2 The Role of Prevention
The effectiveness of a sustained approach to prevention has been demonstrated by the dramatic decline in mortality from cardiovascular disease Australia experienced over three decades from the 1960s. Mortality from coronary heart disease for men 35 to 74 years fell from nearly 400 per 100,000 in 1968 to under 100 per 100,000 in 1998. Around half of all the lives saved can be attributed to preventative interventions, particularly reductions in smoking and improvements in diet, and the other half to improvements in treatment and care.11 But while people are no longer dying from these diseases at an early age, the high prevalence of unhealthy lifestyles means that a large number of people continue to have serious preventable health problems, and cardiovascular disease continues to be a leading cause of disability.12
The WHO has estimated that effective targeting of risk factors through prevention could increase healthy life spans by up to five years in developed countries.13 In the United States, it has recently been estimated that reducing four preventable risk factors alone to optimal levels would add 4.9 years to life expectancy for men, and 4.1 years for women.14 A recent economic analysis by the OECD and the WHO of interventions to tackle unhealthy diets and sedentary lifestyles, found that most of the preventative interventions evaluated had favourable cost-effectiveness ratios, compared with treating chronic diseases once they emerge.15
Analysis of the drivers of preventable chronic disease demonstrates that a small number of modifiable risk factors are responsible for the greatest share of the burden. These risk factors are common to many of the major chronic conditions as shown in Table 1. The behavioural risk factors not only affect health and wellbeing directly, but also help drive the biomedical risk factors identified in the table. Together these and other risk factors, led by obesity, tobacco and alcohol, account for nearly one third of Australia’s total burden of disease and injury.16 Reducing the impact of these risk factors alone therefore has benefits across a wide range of health problems. Alcohol misuse also has wider harmful effects in the short term, such as anti-social behaviour, which is not captured here but discussed later in the document.
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Table 1: Common risk factors for selected chronic diseases and conditions
|Conditions||Tobacco smoking||Physical activity||Alcohol misuse||Nutrition||Obesity||High blood pressure||High blood cholesterol|
|Ischaemic heart disease||o||o||o||o||o||o||o|
|Type 2 diabetes||o||o||o||o|
|Chronic obstructive pulmonary disease||o|
(B) Relates to osteoarthritis.
The benefits of adopting healthier lifestyles accrue across the lifecourse. Scientific knowledge of the role of modifiable risk factors in relation to the ageing process has grown dramatically in recent years. Recent studies suggest that following a healthy lifestyle may also contribute to the prevention of dementia.17 For example, large prospective studies have established that smoking is a risk factor Alzheimer’s disease as well as vascular dementia. This knowledge is particularly important in light of the fact that it is predicted that neurological conditions – together with type 2 diabetes – will cause the largest growth in disability in older populations in future years. A recent OECD report which examined a number of policy options to promote healthy ageing found that achieving better lifestyles has probably the largest potential for improving the health of the elderly.18
14 Danaei G et al (2010) The Promise of Prevention: The Effects of Four Preventable Risk Factors on National Life Expectancy and Life Expectancy Disparities by Race and County in the United States. PLoS Med 7(3): e1000248 doi:10.1371/journal.pmed.1000248.
17 National Institute for Health and Clinical Excellence (2007) National Clinical Practice Guideline Number 42: Dementia British Psychological Society: London; Patterson, C. et al Diagnosis and treatment of dementia: Risk assessment and primary prevention of Alzheimer disease CMAJ 2008; 178 (5). doi:10.1503/cmaj.070796.
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