1 Health Promotion WHO u Health Promotion The

1) Health Promotion의 WHO 정의 u Health Promotion ' The process of enabling people to increase control over, and to improve their health ' World Health Organization(1984) Health Promotion: a WHO Discussion Document on the Concepts and Principles. n 질병예방을 포함하는 광범위한 정의

HIA; Health Impact Assessment

Integrated environmental HIA

Tasks for Preparing to do an HIA 1. 2. 3. 4. 5. 6. 7. 8. aims for the HIA which elements or aspects of the plan/project physical and social boundaries for the HIA stakeholders key information management arrangements for the HIA workshop process for results, monitoring, and evaluation

Matrix for stakeholder analysis

Four-step HIA

HIA Final Report

History of USA Healthy People 1979 - Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention 1980 - Promoting Health/Preventing Disease: Objectives for the Nation 1990 - Healthy People 2000: National Health Promotion and Disease Prevention Objectives 2000 - Healthy People 2010 – Helathy People 2020

Healthy People 2010 u. Two overarching goals u 28 focus areas u 467 specific objectives u 10 Leading Health Indicators

Two Overarching Goals 1. Increase quality and years of healthy life 2. Eliminate health disparities

28 focus areas 1. Access to Quality Health Services 2. Arthritis, Osteoporosis, and Chronic Back Conditions 3. Cancer 4. Chronic Kidney Disease 5. Diabetes 6. Disability and Secondary Conditions (Continued)

467 specific objectives; Examples u 27 -10. Reduce the proportion of nonsmokers exposed to environmental tobacco smoke. (Baseline 65%, 2010 target 45%) n This is a measure for a Leading Health Indicator u 1 -5. Increase the proportion of persons with a usual primary care provider. (Baseline 77%, 2010 target 85%)

Elimination of Disparities u 24 -1 d. Reduce asthma deaths. (adults aged 35 to 64 years) National baseline American Indian or Alaska Native Asian or Pacific Islander Black or African American White Hispanic or Latino 2010 target 1998 data – rates per million 17. 8 DSU 12. 8 52. 3 13. 3 16. 4 9. 0

Increase in Objectives

Leading Health Indicators Ten Major Public Health Issues 1. 2. 3. 4. 5. Physical activity Overweight and obesity Tobacco use Substance abuse Responsible sexual behavior 6. 7. 8. 9. 10. Mental health Injury and violence Environmental quality Immunization Access to health care

Physical Activity Leading Health Indicator Participation in regular physical activity, United States, 1990– 99 *The definition of moderate physical activity was changed in 1997. Sources: Centers for Disease Control and Prevention. Youth Risk Behavior Survey. 1991– 97. Centers for Disease Control and Prevention, National Center for Health Statistics. National Health Interview Survey. 1990– 99.

취약계층의 수검률 향상 중재 방안 u Access enhancing n 비용(저렴, 바우처), 교통(이동차량 등), 편리한 스케쥴 u Individual directed n n in the health care setting / in a community setting 일대일 면담, 전화 상담, (맞춤형) 안내문, reminder u Community education n 지역사회 정보제공 프로그램, 안내문 배부 u Media campaigns n TV , 신문 광고 등 u Social networks n Peer leader, 일반인 건강 조언자(lay health advisor)

Tailored Intervention: Barbershop health advisors

Tailored Intervention : Black Cosmetologists

Tailored intervention-church based program

일반건강검진 제도 First step Abnormalities of HTN or DM Secondary step 1. Anthropometric index and Physical examination - history taking, ht, wt. BMI, WC - BP, visual/hearing test 2. Chest PA 3. U/A: protein 4. Blood test : 11 items - Hemoglobin, Fast Blood Glucose, TC, HDL-C, TG, LDL-C, AST, ALT, γ-GTP, Creatinine, GFR 5. Oral health 6. Report with HRA 1. Counseling 2. Follow-up and Management

암검진 제도 Items Organ Stomach (option 1) UGI (40+) (option 2) GFS → Bx → report Breast Mammography → report (40+) Cervix Pap smear) → report (30+) Liver (40+) Liver US + AFP → report Colon(50+) Occult stool Hb →Barium enema CFS → Bx → Report

생애전환기 검진 u. For “transitional period” subjects n People aged 40 and 66 years u. Launched in April 2007 u. New Items n n n Health Risk Appraisal Geriatric Health Assessment (66) Mental Health Examination (Depression, Dementia) Lifestyle Assessment (Korean version of Lifescripts) Follow-up care by Primary Care Doctors

생애전환기 검진 Basic Test Items : same as General Health Screening Program First step Whole subjects Secondary step Additional Items 1. HBs. Ag, HBs. Ab(40 years old) 2. DEXA(66 year-old female) 3. Physical Function Test for elderly (66 years old) 4. Mental Health Examination (Depression, Dementia) 1. 2. Counseling : LSM Follow-up & Management Additional Items 1. Lifestyle assessment and management 2. In-depth exam for high risk group : Depression(40, 66) 3. In-depth exam for high risk group : Cognitive Fn Test(66)

건강위험평가 (Health Risk Assessment) u. Lab test n Surrogate Marker : FBS, Cholesterol u. Physical Measurement n n BP, PR Ht, Wt, Obesity u. Questionnaire n n Irreversible Factors n Sex, Family History Reversible (Behavioral) Factors n Health Behaviors : Smoking, Alcohol, Ex

The HALE Study 4 Life Styles • Mediterranean diet • Being physically active • Moderate alcohol use • Nonsmoking (Knoops, JAMA. 2004) Asia Pacific Geriatric Conference 2008

2) Compliances; Health Risk Translation u. Health Risks n Smoking, Alcohol, Exercise è Risk to develop disease (or death) n MI, CVA Asia Pacific Geriatric Conference 2008

Korean National Screening Program u. Lab. Test n n n Cholesterol, FBS, UA LFT, Hepatitis B Ag/Ab Bone Mineral Density u. Physical Measurement n n BMI n Weight, Height, WC BP u. Health Behavior n Smoking, Alcohol, Exercise, Diet pattern Asia Pacific Geriatric Conference 2008

Outcome variables calculated by HRA u. Relative Risks to develop ‘Four main diseases’ n n n CVA MI DM, HT u. Comparing to the healthiest people Asia Pacific Geriatric Conference 2008

NPHE report form with HRA Disease Risk Why ? Risk Signal Lamp How ? How to manage the Risk Asia Pacific Geriatric Conference 2008

HRA and mortality (Kwon HT, in press) Asia Pacific Geriatric Conference 2008