Healthy Eating and Physical
Activity for Health
Risk factors
• Ageing populations and longer life expectancy have led to an increase
in long-term (chronic), expensive-to-treat diseases and disabilities
• It is important that we, as a society and users of healthcare systems,
understand the causes and risk factors behind these diseases so that
we can actively take part in cost-effective prevention and treatment
programs
• Health and well-being are affected by many factors – those linked to
poor health, disability, disease, or death are known as risk factors
• A risk factor is a characteristic, condition, or behavior that increases
the possibility of getting a disease or injury
Risk factors
• Risk factors are often presented individually, however in practice,
they do not occur alone. They often co-exist and interact with one
another.
For example:
physical inactivity -> weight gain -> high blood pressure and high
cholesterol levels -> These significantly increase the chance of
developing chronic heart diseases and other health-related problems.
risk factors can be categorized into the following
groups:
• Behavioral
• Physiological
• Demographic
• Environmental
• Genetic
Behavioral risk factors
‘actions’ that the individual has chosen to take. They can therefore be
eliminated or reduced through lifestyle or behavioral choices. Examples
include:
• smoking tobacco
• drinking too much alcohol
• poor diet and nutrition
• physical inactivity
• spending too much time in the sun
• not having certain vaccinations
Physiological risk factors
Those relating to an individual’s body or biology. They may be
influenced by a combination of genetics, lifestyle, and other broad
factors. Examples include:
• being overweight or obese
• high blood pressure
• high blood cholesterol
• high blood sugar (glucose)
Demographic risk factors
Those that relate to the overall population:
• Age
• Population subgroups such as occupation, religion, or income.
Environmental risk factors
cover a wide range of topics such as social, economic, cultural, and
political factors as well as physical, chemical, and biological factors:
• access to clean water and sanitation
• risks in the workplace
• air pollution
• social relationships
Genetic risk factors
Are based on an individual's genes. Some diseases, such as cystic
fibrosis and muscular dystrophy, come entirely from an individual's
‘genetic makeup’. Many other diseases, such as asthma or diabetes,
reflect the interaction between the genes of the individual and
environmental factors.
Global Risk for Mortality
Rank Risk Factor % of total deaths For high- and middle-income
countries, the most important risk
1 High blood pressure 12.8 factors are those related to long-
2 Tobacco use 8.7 term diseases whereas, in low-
3 High blood glucose 5.8 income countries, factors such as
4 Physical inactivity 5.5 childhood malnutrition and unsafe
5 Overweight and obesity 4.8 sex are much more widespread
6 High cholesterol 4.5
7 Unsafe sex 4.0 The top six leading risk factors are
8 Alcohol use 3.8 all linked to the potential
9 Childhood underweight 3.8 development of long-term
10 Indoor smoke from solid fuels 3.3 diseases, such as heart disease,
diabetes, and cancer
WHO numbers the 10 leading global risks for mortality (death)
The risks that affect a
population also shift over
time, from those for
infectious diseases to
those that increase
noncommunicable
disease
The global burden of diseases and injuries
• Worldwide, Africa accounts for 9 out of every 10 child deaths due to malaria, 9 out of
every 10 child deaths due to AIDS, and half of the world’s child deaths due to diarrheal
disease and pneumonia.
• In low-income countries, the leading cause of death is pneumonia, followed by heart
disease, diarrhea, HIV/AIDS, and stroke. In developed or high-income countries, the list is
topped by heart disease, followed by stroke, lung cancer, pneumonia, and asthma or
bronchitis.
• Men between the ages of 15 and 60 years have much higher risks of dying than women in
the same age category in every region of the world. This is mainly because of injuries,
including violence and conflict, and higher levels of heart disease. The difference is most
pronounced in Latin America, the Caribbean, the Middle East, and Eastern Europe.
• Depression is the leading cause of years lost due to disability, the burden being 50% higher
for females than males. In all income strata, alcohol dependence and problem use are
among the 10 leading causes of disability.
Reducing Exposure to Risk Factors
• The Systematic Coronary Risk Evaluation Project (SCORE project)
• The SCORE project data are based on national data sets from Europe, totaling around
250,000 people with around 3 million patient years of follow-up.
• The SCORE risk assessment is a simple tool to predict deaths relating to heart or
circulation problems (fatal cardiovascular disease, CVD) over a 10-year period.
It is based on the following risk factors:
• Gender
• Age
• Smoking habits
• Systolic blood pressure
• Total cholesterol levels.
The threshold for being at high risk is defined as ≥ 5% (greater than or equal to 5 percent);
this means that 5 or more out of 100 people will die within 10 years.
Example: SCORE
A 55-year-old man, who is a smoker, visits his doctor for a routine
health check. The checks show the following:
• His blood pressure is 160/90 (mm Hg) - a normal range of blood
pressure is <120 and <80 (mm Hg).
• His cholesterol level is 8 (mM/L) - a normal cholesterol level is less
than 5.2 (mM/L).
• Physical inactivity is estimated as being the principal cause for
approximately 21–25% of breast and colon cancer burden, 27% of
diabetes, and approximately 30% of ischemic heart disease burden
• It has been shown that participation in regular physical activity
reduces the risk of coronary heart disease and stroke, diabetes,
hypertension, colon cancer, breast cancer and depression.
Additionally, physical activity is a key determinant of energy
expenditure, and thus is fundamental to energy balance and weight
control
Mandate on physical activity for health
• In May 2004, the Fifty-seventh World Health Assembly endorsed
Resolution WHA57.17: Global Strategy on Diet, Physical Activity and
Health and recommended that Member States develop national
physical activity action plans and policies to increase physical activity
levels in their populations
• In May 2008, the Sixty-first World Health Assembly endorsed
Resolution WHA61.14: Prevention and Control of Noncommunicable
Diseases: Implementation of the Global Strategy and the Action Plan
for the Global Strategy for the Prevention and Control of
Noncommunicable Diseases
Action Plan urges Member States to implement national guidelines on
physical activity for health and encourages them to develop and put
into practice policies and interventions that:
• develop and implement national guidelines on physical activity for
health;
• introduce transport policies that promote active and safe methods of
traveling to and from schools and workplaces, such as walking or
cycling;
• ensure that physical environments support safe active commuting,
and create space for recreational activity.
Children and youth aged 5–17
• Children and youth aged 5–17 should accumulate at least 60 minutes
of moderate - to vigorous-intensity physical activity daily.
• Amounts of physical activity greater than 60 minutes provide
additional health benefits.
• Most of the daily physical activity should be aerobic. Vigorous-
intensity activities should be incorporated, including those that
strengthen muscle and bone, at least 3 times per week.
Age group 18–64 years
• Adults aged 18–64 should do at least 150 minutes of moderate-intensity
aerobic physical activity throughout the week or do at least 75 minutes of
vigorous-intensity aerobic physical activity throughout the week or an
equivalent combination of moderate- and vigorous-intensity activity.
• Aerobic activity should be performed in bouts of at least 10 minutes duration.
• For additional health benefits, adults should increase their moderate-intensity
aerobic physical activity to 300 minutes per week, or engage in 150 minutes
of vigorous-intensity aerobic physical activity per week, or an equivalent
combination of moderate- and vigorous-intensity activity.
• Muscle-strengthening activities should be done involving major muscle
groups on 2 or more days a week.
Adults aged 65 years and above
• Adults aged 65 years and above should do at least 150 minutes of moderate-intensity aerobic
physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical
activity throughout the week or an equivalent combination of moderate- and vigorous-intensity
activity.
• Aerobic activity should be performed in bouts of at least 10 minutes duration.
• For additional health benefits, adults aged 65 years and above should increase their moderate-
intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-
intensity aerobic physical activity per week, or an equivalent combination of moderate-and vigorous-
intensity activity.
• Adults of this age group, with poor mobility, should perform physical activity to enhance balance and
prevent falls on 3 or more days per week.
• Muscle-strengthening activities should be done involving major muscle groups, on 2 or more days a
week.
• When adults of this age group cannot do the recommended amounts of physical activity due to
health conditions, they should be as physically active as their abilities and conditions allow.
Alcoholism and Drug Addiction
Global strategy to reduce the harmful use of alcohol.
WHO, 2010
• The harmful use of alcohol2 has a serious effect on public health and
is considered to be one of the main risk factors for poor health
globally.
• During the Sixty-third session of the World Health Assembly, held in
Geneva in May 2010, the 193 Member States of WHO reached a
historical consensus on a global strategy to reduce the harmful use of
alcohol by adopting resolution WHA63.13.
• The harmful use of alcohol is a significant contributor to the global
burden of disease and is listed as the third leading risk factor for
premature deaths and disabilities in the world.
• It is estimated that 2.5 million people worldwide died of alcohol-
related causes in 2004, including 320 000 young people between 15
and 29 years of age.
• Harmful use of alcohol was responsible for 3.8% of all deaths in the
world in 2004 and 4.5% of the global burden of disease as measured
in disability-adjusted life years lost
• Harmful drinking is a major avoidable risk factor for neuropsychiatric
disorders and other non-communicable diseases such as
cardiovascular diseases, cirrhosis of the liver, and various cancers.
• A significant proportion of the disease burden attributable to harmful
drinking arises from unintentional and intentional injuries, including
those due to road traffic crashes and violence, and suicides.
• Fatal injuries attributable to alcohol consumption tend to occur in
relatively young people.
Challenges and opportunities
• Increasing global action and international cooperation
• Ensuring intersectoral action
• According appropriate attention
• Balancing different interests
• Focusing on equity
• Considering the “context” in recommending actions
• Strengthening information
