There is a rising prevalence of chronic disease globally. Although there has been a decrease in preventable deaths from chronic cardiovascular and respiratory diseases, the prevalence of chronic diseases such as diabetes is increasing associated with the ageing of the population and worsening of some of the risk factors for chronic diseases.
This places an increasing demand on health services as well as contributing a major social and economic burden to society. The risk factors for chronic disease include overweight and obesity, physical inactivity, poor diet, smoking and excessive alcohol consumption.
Smoking is the only risk factor with a favourable trend, decreasing over the past two decades. Risky alcohol consumption,poor diet and obesity are all increasing. The median body mass index of adults increased from of 25.7 in 1995 to 26.3 in 2007-08 with an increase in the proportion who were obese from 19% to 25%. There was little overall change in physical activity. The quality of the diet deteriorated with the age -standardised proportion who consumed less than the recommended serves of vegetables increasing from 88% to 93% in men, and from 84% to 90% in women from 2004 -5 to 2007 -8.
Health risks operate across the lifecycle to cumulatively increase the prevalence of chronic disease. Thus the increasing rates of insufficient physical activity, risk alcohol consumption and poor diet in those aged 14 -17 years from 2004 -5 to 2007-8 are likely to be translated in increased prevalence of chronic disease decades into the future.
Both chronic diseases and their risk factors are in turn influenced by the social and economic determinants of health. These shape the physical and social environment in which people are born, develop, live, work and age. The social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status and the social gradient between those who have higher and lower incomes, education and social status. For example there is evidence of a social gradient in the prevalence of cardiovascular diseases and diabetes according to both education and income. There are also social gradients, in the prevalence of smoking, risky alcohol consumption and obesity, with education and income.
These inequities need to be addressed by a mix of strategies including population and public health interventions to address the social determinants of ill health. Primary health care also provides an opportunity to address some of these problems. This is because of its high population reach (with more than 88% of the population visiting a general practitioner at least once a year for example and acceptance by patients of the role of primary health care providers in preventive care.
Patients with the physiological and behavioural risk factors for chronic conditions frequently present in general practice, providing an opportunity for primary prevention. In 2007
– 08, 59% of general practice encounters were with patients who were overweight or obese, 26% with those who drank alcohol at risky levels and 17% with those who smoked daily. But General Practice is often acute illness orientated. To assist your general practitioner and to become one of the ‘better’ statistics do an eDoc preventative health screen and take control.