Prevention Medicine

Introduction part

5-8,13-16,21-24,29-32,37-40,45-48,

Wenhua Ling
 Introduction
Medicine has been developing in human
process of the survival.
Promoting health, prevention and treatment
of diseases.
Medicine is also a permanent abyss of human
development and scientific and technological
progress and the inexhaustible driving force of
social development.
 Medicine
Clinical medicine
Basic medicine
Preventive medicine
 Hygiene
Prevention Medicine
Public Health
 Hygiene
Hygiene: Hygiene first studies the relationship
between the external environment factors and
people health, clarified effect of environmental
factors on population health.
From the history of development of hygiene,
which is given priority with the study of natural
environment, and artificially can be divided into
living environment (air, water, food and geology
and soil) and professional environment.
 Preventive Medicine
Aim at population, to study the disease
distribution, influence factors by
applying biomedical , enviromental
medicine and social medicine, making up
the preventive measures for population
health.
 Academic
Preventive medicine Science

Social
Public Health practice
 What is public Health
a case

Public health in the news

SARS, ADIS

AIDS epidemic

AIDS control
 AIDS epidemic
July 3,1981 New York Times ran a story rare cancer seen in 41

homosexuals, Kaposis sarcoma;

Aug 29, 1981, 60% killed by pneumonia.

May 1982, gay-related immune deficiency syndrome (GRID);

Acquired Immune Deficiency Syndrome (AIDS)

By mid-1983, the public began to panic.

That scared a lot of people.

 AIDS was a fatal disease,
With its large gay population, the police
officers demanded special masks and gloves
for handling people suspected of having AIDS.
School refused to allow children with AIDS
into the classroom.
In 1984, AIDS as a virus disease.
July 3, 1981
New York Time
Epidemiology
Rare cancer in 41
homosexuals

Biomidical
Aug 28, 1981 science
60% killed by
pneumonia

Social
May 1982 GRID
behaviour
Summer, 1982 AIDS

Mid, 1983 Agents

Could be spread by Goverment
routine household
conduct
Epidemic of HIV in China

1985 1995

1989 1998
Etiology of HIV

HIV shape
 HIV Serology Dynamics After Infection
acute infectious incubation ADIS
conc
Ab Anti-gp41/120
HIV RNA Ag
(anti-gp36)

Anti-P24

Infection 1 2 3 4 wk 1 y 2 y 3 y. .1 0 y..
 HIV Ab
CD 4+ T 350/mm3
Prevention
Risk population
Sexual workers
Addics
 Public Health definition
Charles-Edward A. Winslow, in 1920, defined public health as:
"the science and art of preventing disease, prolonging life,
and promoting physical health and efficiency through
organized community efforts for the sanitation of the
environment, the control of community infections, the
education of the individual in principles of personal hygiene,
the organization of medical and nursing service for the early
diagnosis and preventive treatment of disease, and the
development of the social machinery which will ensure to
every individual in the community a standard of living
adequate for the maintenance of health.
 The Institute of Medicine (IOM) (1988), in its
seminal report on the Future of Public Health,
proposed one of the most influential
contemporary definitions: Public health is
what we, as a society, do collectively to
assure the conditions for people to be
healthy.
 health illness

Preventive Clinical
medicine medicine
 The main task of preventive medicine
To study the effect of environmental factors on
health
Environment: Refers to the human survival
space and contains a variety of factors.
natural and social environment factors
Natural one refers: atmospheric environment,
water environment, soil environment,
biological environment, geological
environment.
 Natural one refers: atmospheric environment,
water environment, soil environment,
biological environment, geological
environment.
According to the environmental setting
attributes:
Chemicals , physical, and biological.
 Social factors:
settlement environment, traffic environment,
cultural environment.
 genetic factor
spontaneous mutation of DNA is 0.5%/ 1
million years.
Over the past ten thousand years of human
genes change very little
Nowadays human genes and 40 million years
ago paleolithic ancestors are very similar.
 Human survival environment in constant
change, these changes in environmental
factors cause the occurrence and
development of human diseases.
 Endangering human health disease consists of
infectious disease and non-infectious disease.
Now that environmental factors are infectious
diseases and major risk factors for non-
communicable diseases.
 In human history, in the middle ages of
cholera, plague, leprosy, tuberculosis and
other infectious diseases spread across
Europe, causing tens of thousands of people
die from infectious diseases.
 In recent years, new infectious diseases and
the resurgence of infectious diseases is still
the important problem of harm to people's
health, such as HIV, SARS, tuberculosis. Are all
these infectious disease is caused by the
external environment of pathogenic
microorganisms.
 With the development of science, since the
20th century human basically control the
infectious diseases caused by pathogenic
microorganisms on the dangers of human.
 But with the change of the lifestyle,
endangering human health disease mainly
chronic non-communicable diseases (Non -
communicable diseases, NCDs), mainly
including cancer, cardiovascular disease,
diabetes, etc.
 The WHO report recently, the global more
than 36 million people die each year from
NCDs, accounted for 63% of total global
deaths, mainly cardiovascular disease, cancer,
chronic respiratory diseases and diabetes.
30-70 years of age died of NCDs more than 14
million, of which 86% is the residents of the
low and middle income countries.
 NCDs is a major health problem currently
endangering human.
WHO says NCDs risk factors mainly smoking,
alcohol, poor diet and lack of sports, etc.
Social psychological factors in this kind of
disease occurrence and development plays an
important role.
Natural environmental factors including from
professional, public, living bedroom
environment and food pollution.
 With the deepening of genome and genome
research after, human understanding of
disease has entered a new stage. Human
diseases, especially in NCDs is the result of the
interaction between environmental factors
and genetic.
Individual nutrition gene interaction -
nutrition, nutrition and epigenetic

Nutrigenomics

AS

Nutrigenetics
 individualization of Chronic
disease prevention
The individual

LIPC-514 C/T
Interaction of of diet

with genes
HDL

Prevention strategies

Nature Reviews Genetics (2006)

39
Public health vs medical care
 There are many distinctions between public health and the
clinical health professions.

Public health is comprised of many professional disciplines

such as medicine, dentistry, nursing, optometry, nutrition,
social work, environmental sciences, health education, health
services administration, and the behavioral sciences, its
activities focus on entire populations rather than on individual
patients.
 Medicine is concerned with individual patients, Public Health

regards the community as its patient

Doctors usually treat individual patients one-on-one for a

specific disease or injury.

Public health professionals monitor and diagnose the health

concerns of entire communities and promote healthy practices

and behaviors to assure our populations stay healthy.

 Items Public health Medical care

Subjective Community population Individual

patients

Question Status, events symptom

Methods Statistics, epidemiology, Analysis on

behaviors pathogenesis

Data origin Community Disease history

Residents Physical exam
Healthy file Lab exam
Regular records
Investigation

Objective Health problems of community Disease diagnosis

results resources Cause of diseases
Risk factors Individual health
Community health promoting plan promoting plan
 Public health diagnoses and treats the
communitys ill by way of assessment, policy
development and assurance.

Public health relies on the tools of science and

politics.
 Medicine individual patients,
healing illness
doctor-patient

Public health community as patients

preventing illness
public health-government-
population
 Public health contributes a great deal more to
the health of a population than medicine does
Life expectancy increased from 45 to 75 years
over the past century. Only 5 of those 30
additional years can be contributed to medical
care system.
 Science of public health
Six areas:
Epidemiology
Statistics
Biomedical sciences
Environmental science
Social and behavior science
Health policy and management or health administration
 Epidemiology
Epidemiology as basic science of public health;
focus on human population
common exposure
causative factors
Provide first indication of new disease
such as HIV in 1980
smoke and cancer
lipids and cardiovascular diseases
 Assessment
Determine a probable cause or reason
Institute methods to prevent and control
diseases
 John Snow on Cholera

Snow on Cholera
1825-1854: the great cholera pandemics originated
in India, spread via rapid transportation to Europe
and North America,
In 1829, Moscow, ~33,000 deaths
In 1832, Paris, cholera epidemic killed >18,000 P.

51
 Dr. John
Snow

(1813 - 1858)

In 2003 survey for

the greatest doctor all
the time by Hospital
Doctor magazine,
1st John Snow
2nd Hippocrates
52
Cholera Epidemics in England

1831 1832 : 22,000 deaths

1848 1849 : 52,000 deaths
1853 1854 : John Snows work

It was against this background of confusion that

John Snow carried out his work.

53
 London, 1854
Map of Central London 1853

54
Broad Street Pump Handle
55
 John Snow
Noticed that death rates from cholera high
in a particular area of London
Charted the frequency and distribution of
cholera
Death rates per 100,000 population according to
water company supplying the sub district
Death rates per 10,000 houses according to
water company supplying the house
Combined the three components in the
definition of epidemiology
Distribution, determinants and frequency
56
Deaths from cholera epidemic in districts of
London supplied by two water Co.

Water Supply Number of Deaths Cholera

Co. Houses from deaths
Cholera /10,000
houses
Southwark and 40,046 1,263 315
Vauxhall
Lambeth 26,107 98 37

Rest of London 256,423 1,422 59

57
 Snows work
Confirmed the hypothesis that the cholera
epidemic source was the contaminated
water from the Thames River
Was one of the classic epidemiologic
investigations.
A natural experiment, with a study and
control group occurring in an actual disease
outbreak
Strengthened the germ theory

58
 Doll and Hill: smoke and lung cancer

1945-1950 case control

Then, cohort study, 40,000 doctors
follow-up 10 year, 1964 published the
article

59
 Statistics
Population study depend heavily on statistics
data on births, deaths, cause of death,
outbreaks of communicable diseases, cause of
cancer, occupational injuries, and other
health-related issues.
 Biomedical sciences
Public health and medicine depend on the
biomedical sciences:
infectious disease: how spread, how affect
human, how control;
chronic diseases: cancer, heart disease
 Environmental health sciences
Spread of diseases through water, air, and
food;
Safe drinking water and waste disposal,
Chemical pollution
Ozone layer
Social and behavioral sciences
Dietary pattern
Exercise pattern
Smoking
Abuse drugs
Alcohol,
Sexual behaviors
Violence
Income
 Health Management
Health insurance
Health economic
Health management
Health resources
Health policy
 Public Implementation:
How do you
Health do it?
Intervention
Approach Evaluation:
What
works?
Risk Factor
Identification:
What is the
cause?
Surveillance:
What
is the
problem?

Response
Problem
 Why is public health controversial

Economic impact
public health have a negative economic impact:
tobacco industry
environmental regulation
(smog, pesticide on fruits and vegetables)
 Individual liberty
Moral and religious opposition
sex education, providing condom, safe
abortion
AIDS-homosexual, drug use
Powers and responsibilities of government

Federal versus state authority

Regulation
Law works
Nongovernmental role in public health
Education
Lobby
Research (foundations)
American heart association
Cancer society ect
History of Public Health
THE DAWN OF HISTORY TO THE FALL OF ROME

the earliest primitive villages: hunter-gatherer tribes

diseases were caused by malevolent supernatural
forces.
all primitive societies have created a class of
"shamans"persons specially trained to intervene
on the spiritual and physical level.
 The great cities had municipal water supplies
and sewerage systems. Aqueducts supplied
the city with water in amounts comparable to
many modern municipal systems and sewers
and drains carried away the wastewater.
 In 5th-4th, B.C, in Greece, an empirical
explanation of disease was proposed by the
physician Hippocrates
In his book On Airs, Waters, Places, the
relations of disease to physical, social, and
behavioral settings are presented for the first
time.
This book may be considered the first rational
guide to the establishment of a science-based
public health.
 The Early Medieval Period
(500~1500 AD)

The growth of cities

Some cities developed from old Roman settlements,
others arose at river fords and on important commercial
routes, near fortified Episcopal sees or the castles of
feudal lords
 The Early Medieval Period
(500~1500 AD)
Sanitary problems of urban life
Inadequate supply of clean water and foods
Street cleaning and garbage disposals
Spread of infectious diseases
 The Early Medieval Period
(500~1500 AD)
Disease in the Middle ages
Two great epidemics
The plague of Justinian (543)
The Black Death ,(1348)
Other larger or smaller outbreaks of disease
Leprosy (, Bubonic plague, Smallpox ,
Diphtheria , measles influenza, ergotism,
tuberculosis, scabies, erysipeals, anthrax,
trachoma, the sweating sickness, dancing mania

 The Early Medieval Period
(500~1500 AD)
Disease in the Middle ages

The Black Death (Bubonic plague) ,(1348)

Spread from central Asia to Europe with the Mongol invasions, and
transmitted via trade routes throughout Europe by sea and overland.

Was introduced into China with the Mongol invasions, between AD

1200-1400

Killed 1/3 of the population in Europe

Origins and Spread of the Black Death in Asia
 The Black Death

The Black Death rapidly spread European painting of the Black

along the major European sea
Death
and land trade routes
 The Early Medieval Period
(500~1500 AD)
Quarantine --- the most effective measure
Prevent the entry of a plague
Communities refused admission to persons from areas where the
plague raged
To isolate and observe all suspected persons and objects for a
specified period under stringent conditions until it was
definitely established that they were free of the plague
 The Early Medieval Period
(500~1500 AD)
Quarantine
Isolation: patients had to be reported to the authorities,
they were then examined and isolated in their houses for
the duration of the illness. Every house containing a
plague victim was placed under a ban.
 The Early Medieval Period
(500~1500 AD)
Quarantine
The institution of quarantine
Was taken first at Venice in 1348
Set up a system for segregating suspected ships, goods, and people.
In 1377, ordered a 30 d period of isolation for those coming from
plague-stricken areas, later this period was extended to 40d.
In 1383, Marseillesrigid inspection of incoming vessels, all
travelers and cargoes from infected or suspicious ships were detained
for 40d and exposed to air and sunshine
 The Early Medieval Period
(500~1500 AD)
Quarantine
In 14th century: in Italy, southern France, Set up a
system of sanitary controlcombat contagious
disease
Observation stations, isolation hospitals, disinfection
procedures
The old Quarantine buildings
 THE ENLIGHTENMENT AND SANITARY REFORM

The Enlightenment (the period from 1750

until the midnineteenth century) was
characterized by unprecedented industrial,
social, and political developments, and the
resulting societal impacts were immense,
culminating in the Industrial Revolution.
 It was in Germany that the first major
contribution of the period to public health
occurred.
 BACTERIOLOGY

the discoveries of pathogenic bacteria by Louis

Pasteur in France and Robert Koch in Germany in
the late 1870s and early 1880s, the science of
microbiology was born.
Consequent developments in immunology and
parasitology provided epidemiologists and other
public health workers.
 COLONIALISM AND PUBLIC HEALTH

From 16th to 19th century, the major tropical

diseases (e.g., malaria and yellow fever).
In India, in 1897, identified the mosquito
vector of malaria, leading to the partial
control of the world's most prevalent endemic
disease.
 THE EARLY TWENTIETH CENTURY

maternal and child health programs were

initiated with an emphasis on nutrition,
medical care, and, eventually, health
inspection in schools.
Mental health was identified as a public
health issue, and specific nutritional
deficiencies were recognized as risk factors for
a spectrum of diseases.
 The growing scope and complexity of public
health concerns led to the establishment of
academic programs to expand research and
train relevant technical personnel
 In mid twenty century, the basic activities of
public health had been widely recognized in
the industrialized world.
These components were: communicable
diseases control, environmental sanitation,
maternal and child health services, health
education, occupational and industrial
hygiene, nutrition, and, in most developed
countries, the provision of medical care.
 Foundation: the Rockefeller Foundation
Milbank Fund
Voluntary health agencies
organizations like the Pennsylvania Society for
the Prevention of Tuberculosis
 THE LATE TWENTIETH CENTURY

the aging of the populations

importance of behavioral factors
As infant and child mortality declined in the
industrialized countries, life expectancy and
the proportions of the elderly in populations
increased.
diseases such as heart disease and cancer
became more important.
 Domestic violence, gang warfare, ethnic
conflicts and genocide, and civil wars
Increased globalization and technological
advances have resulted in worldwide
economic, political, and social
interdependence.
 The emergence of new infectious diseases,
including HIV/AIDS
the increased production and use of addictive
drugs.
the eradication of one of the human species'
most dreaded and lethal diseases, smallpox,
was completed.
 Great changes in public health
Mid nineteenth century
10 newborn infants:
2-3 never reached their first birthday;
5-6 died before they were 6 year old;
2-3 beyond the age of 25.
 People healthier today
Clean water, air, food;
Safe disposal of sewage;
Better nutrition;
Education concerning healthy behaviors
Ten Great Public Health Achievements of last century
--

Vaccination
Vaccination has resulted in the eradication of
smallpox; elimination of poliomyelitis in the Americas;
and control of measles, rubella, tetanus, diphtheria,
Haemophilus influenzae type b, and other infectious
diseases in the United States and other parts of the
world.
 Motor-vehicle safety
Improvements in motor-vehicle safety have
resulted from engineering efforts to make
both vehicles and highways safer and from
successful efforts to change personal behavior
(e.g., increased use of safety belts, child safety
seats, and motorcycle helmets and decreased
drinking and driving).
 Safer workplaces
Work-related health problems, such as coal workers'
pneumoconiosis (black lung), and silicosis -- common
at the beginning of the century -- have come under
better control. Severe injuries and deaths related to
mining, manufacturing, construction, and
transportation also have decreased; since 1980, safer
workplaces have resulted in a reduction of
approximately 40% in the rate of fatal occupational
injuries.
 Control of infectious diseases
Control of infectious diseases has resulted from clean
water and improved sanitation. Infections such as
typhoid and cholera transmitted by contaminated
water, a major cause of illness and death early in the
20th century, have been reduced dramatically by
improved sanitation.
In addition, the discovery of antimicrobial therapy has
been critical to successful public health efforts to
control infections such as tuberculosis and sexually
transmitted diseases (STDs).
 Decline in deaths from coronary heart disease and
stroke
Decline in deaths from coronary heart disease and
stroke have resulted from risk-factor modification,
such as smoking cessation and blood pressure
control coupled with improved access to early
detection and better treatment. Since 1972, death
rates for coronary heart disease have decreased 51%.
 Safer and healthier foods
Since 1900, safer and healthier foods have resulted
from decreases in microbial contamination and
increases in nutritional content. Identifying essential
micronutrients and establishing food-fortification
programs have almost eliminated major nutritional
deficiency diseases such as rickets, goiter, and
pellagra in the United States.
 Healthier mothers and babies
Healthier mothers and babies have resulted
from better hygiene and nutrition, availability
of antibiotics, greater access to health care,
and technologic advances in maternal and
neonatal medicine. Since 1900, infant
mortality has decreased 90%, and maternal
mortality has decreased 99%.
 Family planning
Access to family planning and contraceptive services
has altered social and economic roles of women.
Family planning has provided health benefits such as
smaller family size and longer interval between the
birth of children; increased opportunities for
preconceptional counseling and screening; fewer
infant, child, and maternal deaths; and the use of
barrier contraceptives to prevent pregnancy and
transmission of human immunodeficiency virus and
other STDs.
 Fluoridation of drinking water
Fluoridation of drinking water began in 1945 and in
1999 reaches an estimated 144 million persons in the
United States. Fluoridation safely and inexpensively
benefits both children and adults by effectively
preventing tooth decay, regardless of socioeconomic
status or access to care. Fluoridation has played an
important role in the reductions in tooth decay (40%-
70% in children) and of tooth loss in adults (40%-
60%).
 Recognition of tobacco use as a health hazard
Recognition of tobacco use as a health hazard and
subsequent public health anti- smoking campaigns
have resulted in changes in social norms to prevent
initiation of tobacco use, promote cessation of use,
and reduce exposure to environmental tobacco
smoke. Since the 1964 Surgeon General's report on
the health risks of smoking, the prevalence of
smoking among adults has decreased, and millions of
smoking-related
Current Challenges of
Chinese Public Health
History, current situation and
challenge of public health in
China
History of public health in China

"Treat before getting illness

the philosophic idea of public health in China.

Early practice of public health

experiences of Dingxian County in Hebei province 1930s.

Development and characteristics of public health in contemporary China

Import/Introduction of public health model from Soviet Union.

Achievement and characteristics of public health of China.

Idea of Preventive Medicine in
Chinese Traditional Medicine

Huang-ti Nei ching

Saint treats persons sickless, but not sickness

To this legendary emperor is attributed the earliest

known Chinese medical writing, Huang-ti Nei ching
(The Canon of Internal Medicine).
This work consists of two treatises, one a dialogue
about living matter between Huang Ti and his
minister Qibo, and the other a description of medical
physiology, anatomy, and acupuncture.
 Prevention on three levels

Primary prevention
Secondary prevention
Tertiary prevention

2016/8/30 113
 Primary prevention
Primary prevention

Avoid occurrence of an illness and injury by

preventing exposure to risk factors

2016/8/30 114
 Primary Prevention

Definition Preventing exposure Environmental protection, Eliminate pollution,

to risk factors
Improvement of work environment, Occupational safety

guarantee, Health education, healthy life style, self-care,

Objects Healthy and
Susceptible Rational Nutrition, Nutrition and Food Hygiene
Population

Measures Integrated
Methods
environmental
organic Vaccination, planned immunity, physical exercise,

Significances The ultimate goal Prenatal and postnatal care

The most positive
Health for the susceptible populations
Effectiveness
Clear cause to identify Prevention abuse of drug and medical measures
disease
Health Promotion

2016/8/30 115
 (Primary Prevention)

2016/8/30 116
 Secondary prevention
Primary prevention
avoid occurrence of an illness and injury by
preventing exposure to risk factors

Secondary prevention
minimize the severity of illness or damage

2016/8/30 117
 Secondary Prevention
Census screening , Periodical examination, Intensive
monitoring, Specialty Clinic ; Environmental health
Definition Preclinical supervision and monitoring, Health Education, self-
prevention examination

Objects preclinical people

Diagnosis Improvement Advanced detection method,
Micro-/ sensitive diagnosis techniques
Measures early detection
Drugs taken early and reasonably,
early diagnosis Psychotherapy
early treatment
Infectious disease reporting system and reports from
early quarantine CDC should be faithfully implemented.
early reporting

The earlier the better

Significance minimize disability by
providing medical care
rehabilitation service
Cut-off transmittion, Prevent the communicable dieases
2016/8/30 118
 (Secondary Prevention)






/



()
()

2016/8/30 119
 Tertiary prevention

Primary prevention
avoid occurrence of an illness and injury by
preventing exposure to risk factors
Secondary prevention
minimize the severity of illness or damage
Tertiary prevention
minimize disability by providing medical care
and rehabilitation service
2016/8/30 120
 Tertiary Prevention
Tertiary Prevention

Definition Clinical Prevention

Timely and effective Specific treatment.

Objects Late-stage clinical
treatment
/Convalescence Family bed.
Community-based
Medical surveillance rehabilitation,
Measures prevention for Psychological
eterioration counseling and
Complication and Rehabilitation therapy
guidance.
disability prevention
Recovery promotion Functional recovery, Sickness but not disable

Psychological rehabilitation, Adjustive

Implication Adverse consequences rehabilitation, Fuctional rehabilitation.
reduction Apply to the chronic diseases, the age and the
disabled
2016/8/30
To prolong life-span 121
and improve life quality
 (Tertiary Prevention)

/

()

2016/8/30 122
 The Characteristics of China Health
Medical Care
1949-1977 Welfare medical care for the whole population
Government paid health services

1978-1996 Public medical care

Government & hospital paid health service

1996-now Welfare public health medical care

Government, collective & individual paid
health services
Double Burdens of Diseases
Increasingly serious threats from

Communicable diseases
Re-emerging: TB, STD, plague, cholera
Emerging: AIDS, SARS

Non-communicable diseases (NCD)

stroke, cancer, CHD, diabetes,
chronic obstructive pulmonary diseases (COPD),
mental diseases
 Double burden of disease

The harm of infectious diseases are still serious

Emerging infectious diseases:

AIDS, Ebola Hemorrhagic
Fever (EBHF), Escherichia
coli O157 : H7, SARS

Inherent infectious
diseases:
Revived disease
Plague, Measles STD, TB
Hepatitis, Cholera
Communicable Diseases
The Proportion (%) of Different Communicable Diseases by Etiology in
China, 1950s-2002s

Respiratory Gastrointestinal Vector-borne & Transmitted by

natural endemic sex or blood

2002

2000

1995

1990-
Year

1980-

1970-

1960-

1950-

0 10 20 30 40 50 60 70 80 90 100
(%)
 Communicable diseases

Infectious diseases caused by a

Emerging infectious disease
new species or a new
(EID)
pathogenic micro-organisms.

Infectious diseases which has

Reemerging infectious been basically brought under
disease (REID) control are once again
becoming popular.

Source: From The 9th World Health Alliance International Conference

 REID over the last 20 years
Total 20 reemerging infectious diseases

Rabies black death neuro cysticercosis

Dengue Fever diphtheria Acanthamoebiasis

yellow fever tuberculosis giardiasis

malaria chincough echinococcosis

schistosomiasis cholera streptococcal infection

of group A
pneumococcal visceral trench fever
infections leishmaniasis
salmonella toxoplasmosis anthrax
contamination
Double Burdens of Diseases
Increasingly serious threats from

Communicable diseases
Re-emerging: TB, STD, plague, cholera
Emerging: AIDS, SARS

Non-communicable diseases (NCD)

stroke, cancer, CHD, diabetes,
chronic obstructive pulmonary diseases (COPD),
mental diseases
 Overweight & Obesity(2002)
20 18.9
18
16 14.7
14 0-6 Years
12 7-17 Years
10 18- Years
Rate (%)

8 total
6 4.2
3.4 2.9 2.6
4
2 1.8
2
0
overweight obesity

In 2002, the prevalence rate of overweight was 14.7% and the prevalence
rate of obesity was 2.6%, especially the adults with a overweight rate of 19%.

The biggest concern is overweight and obesity also occurred in children

under 7 years old, this group are probably keep this problem till adulthood
and is also the high risk group to chronic disease.
 Overweight & Obesity(2010-2012)

35
30.1
30

25 6-17 Years
20
18- Years
Rate (%)

15 11.9
9.6
10 6.4

0
overweight obesity
Hypertension

The prevalence of
hypertension among adults
was 22.8%.

Compared with the data of

2002, the prevalence rate 22.8%
increased by 21%. 18.8%
14.5%

1991 2002 2010-2012

Diabetes
The prevalence of diabetes among adults was 6.8% and 14.7% in 2002
and 2012.

This means there are more than 80 million diabetic patients in China.

14.7
16
14
P re va le nc e Ra te ( %)

12 9.8
10
6.8
8 2002
6 4.3 2010-2012
3.1
4
1.3
2
0
18-44 45-59 60-
Age Group
 Blood Lipid Abnormality

49.4 50
50 41.6 42
37.1
Prevanlence

40
Rate (%)

24.8
30
male
20
10 female
0
18-44 45-59 60-
Age Group
Blood Lipid Abnormality rate is 39.9% (male 48.8%,female 31.3%).

In age groups like 18-44 and 45-59, men tend to have higher Blood Lipid
Abnormality rate than women, while, in the age group of 60-, women suffer
higher rate of Blood Lipid Abnormality .
 Blood Lipid Abnormality (>18y)

40.5
45 38.1 37.7
Prevanlence Rate (%)

40
35
30 20.2 21.3
21
25 2002
20
2010-2012
15
10
5
0
urban large city small-medium
city

There is a mildly increase of blood lipid abnormality rate from 2002 to

2010-2012.
The blood lipid abnormality rate between large city and small-medium city
is almost the same
 The secular change of population size
1950~2050

10 (billion)
world population
10(billion)

Population


Population

Trend of Population and Aging in China
(0.1 Billion)
18
2015
16
Aging 14%
14

12

1949
10
Total 0.058 billion 2050
2000
Aging
8 8% Aging 25%
Total 0.126 billion
Aging 10%
6

0
1953 1964 1982 1990 1995 2000 2015 2050
 The secular change of population size
1950~2050

10 (billion)
world population
10(billion)

Population


Population

Total Popu

>65y

Proportion of senile(%)

Population
(0.1billion)

2000~2050
China population
 Behavioral Risk Factors
Increasing tobacco consumption
Quickly changing dietary pattern
Decreasing physical activity
Alcoholism
Ascending numbers of obesitydiabetes, hypertension
patients around the world
 Global smoking situation
smoking
WHO prevalence(%) The number of smokers
Districts
Male Female
Africa 34 9 70mil 7000

America 33 24 163mil 1.6

Middle
35 7 61mil 6000
East
Europe 48 22 206mil 2.0
Southeast
56 7 317mil 3.17
Asia

WPR 63 6 428mil 4.28

Smoking
Trend of Tobacco Sales & Mortality in
Chinese Pop, 1996

Volume of SalesBillion Mortality(1/100,000)

2500 50
Lung Cancer
Volume of Sales
2000 40

1500 30

1000 20

500 10

0 0
1981 1986 1991 1996

Year
Drinking
Statistics of annual sales in China

5,000
In 2000: Estimate to 4726.24
be 47.26 million tons
Annual sales volume of drink

4,000
1990~1995: annual
growth rate of 13.1%
(10,000 ton)

3,000

1982~1989: annual
2,000 growth rate of 13.3%

1,000 1952~1978: annual

growth rate of 5.3%
0
1940 1950 1960 1970 1980 1990 2000 2010
Year
 safety of food and drug

Food poisoning (89 cases,Changchun, Jilin )

Food poisoning (140 students in

Changchun university)

Several food poisoning pupils in 4 primary

school of Jiangxi province

an outbreak of food poisoning in

Nanchang, Jiangxi province (125 cases)
 Health problem resulting from the
urbanization development

depression employment p
ressure
floating popul
ation

drinking

smoking/drug
abuse
 The significance of clinical medical students
learning preventive medicine

Set up the conceptprevention first

integration for medicine
Improve thinking for medical research
Enhancing the capabilities in immerging
bursting public health events