(2.1)--行为决定健康行为医学.pdf

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1、Human Behaviors Determine Health:Strategic Thoughtson the Prevention of Chronic Non-communicableDiseases in ChinaAbstractBackground In the last three decades,peoples livingstandards have significantly increased along with the rapidgrowth of the national economy of China.However,theprevalence of unhe

2、althy behaviors and unfavorable life-styles(e.g.,smoking,excessive use of alcohol,physicalinactivity,and unhealthy diets)also steadily increased,which may contribute to the growing epidemic of chronicnon-communicable diseases(CNCDs)such as diabetes,coronary heart disease,stroke,and cancers.Purpose T

3、o briefly summarize the major studies fromChina concerning epidemic and burden of CNCDs andunhealthy lifestyles,and propose intervention strategiestoward unhealthy lifestyles and behaviors aiming foreffective control of the growing epidemic of CNCDs inChina.Methods We first review the major national

4、 studiesaddressing the epidemic and the burden of CNCDs andunhealthy behaviors in China.Then,we aim to develop thepreventive strategies against the increasing epidemic ofCNCDs by focusing on the intervention campaign towardhealth unfavorable behaviors and lifestyles.Results CNCDs have posed major ch

5、allenges to publichealth and the ongoing reform of health care system inChina.Unhealthy lifestyles and behaviors(e.g.,smoking,excessive alcohol consumpsion,physical inactivity,andimbalanced diets)are responsible for the growing epidemicof CNCDs.Adherence to healthy behaviors and lifestyles iscritica

6、l for maintaining physical and mental health.Conclusion Active implementation of the population-wideintervention program of health education and promotion bytargeting unhealthy behaviors and lifestyles may help toconstrain the growing epidemic of CNCDs in China.Keywords Lifestyles.Chronic non-commun

7、icable diseases(CNCDs).Intervention study.Preventive strategies.ChinaIntroductionIn the last half century,many countries in the world haveinvested huge financial and personnel resources for pre-venting chronic non-communicable diseases(CNCDs)suchas diabetes mellitus,cardiovascular disease(coronary h

8、eartdisease CHD and stroke),and cancers.However,theglobal burden of CNCDs continues to increase 1,2.Inparticular,the achievements among low-and middle-income countries in controlling the epidemic of CNCDsare not as remarkable as expected 14.For example,inChina the national data show that CNCDs,as th

9、e majorcauses of death,appear to steadily increase over the last fewdecades 5,6;the proportion of deaths caused by CNCDsis as twice as that of all infectious diseases.Thus,CNCDshave become the major threat to public health and healthcare service system in the country.In recent years,Z.-Y.Y.and Z.Y.c

10、ontributed equally to this work.Z.-Y.Yang:L.Zhu:C.QiuInstitute of Behavioral Medicine,Jining Medical College,Shandong,Peoples Republic of ChinaZ.YangZhongshan Hospital,Fudan University,Shanghai,Peoples Republic of ChinaC.Qiu(*)Aging Research Center,Karolinska Institutet-Stockholm University,Gvlegata

11、n 16,113 30 Stockholm,Swedene-mail:chengxuan.qiuki.seInt.J.Behav.Med.DOI 10.1007/s12529-011-9187-0numerous studies from China have demonstrated thatthe majority of CNCDs are likely to be caused by high-risk behaviors andunhealthy lifestyles;of which,smoking,excessive alcohol consumption,sedentarylif

12、estyle,imbalanced diets,and overweight or obesityare of particular importance 713.In this article,weseek to briefly summarize the major studies from Chinaconcerning epidemic and burden of CNCDs and unhealthylifestyles,and propose intervention strategies towardunhealthy lifestyles and behaviors aimin

13、g for effectivecontrol of the growing epidemic of CNCDs in China.Epidemic of CNCDs in ChinaDiabetes Mellitus In 2009,the large-scale national surveyamong 14 provinces in China showed that the prevalence ofdiabetes among adults aged 20 years or over was 9.7%(10.6%in men and 8.8%in women),which repres

14、ents amarked increase from 2.0%in 1995 and 5.5%in 2001 14.It also revealed a prevalence of 15.5%for pre-diabetes.This survey suggested that China had the largest number ofpatients with diabetes and pre-diabetes in the world;92.4million people were affected by diabetes,and additional148.2 million peo

15、ple had pre-diabetes.Similar prevalencerates of diabetes and pre-diabetes(WHO criteria)werereported in a large-scale survey of rural population 15.Asdiabetes is strongly associated with increasing age andurbanized lifestyles(e.g.,consumption of more meats andless physical activity),increasing trend

16、of population aging,and rapid urbanization in China will contribute to thefurther growing epidemic of diabetes over the next fewdecades 5,6,16.Cardiovascular Disease(CHD and Stroke)Since the1970s,several national population-based projects in China,such as the World Health Organization(WHO)Sino-MONIC

17、A surveillance,the Chinese Multi-provincialCohort Study,and the InterASIA study,have beenlaunched,which significantly contribute to the under-standing of epidemiology of cardiovascular disease inChina 16,17.The WHO report of Global Burden ofDisease showed that cardiovascular disease was theleading c

18、ause of death and disability worldwide and inChina as well 1.The age-adjusted incidence of first-everstroke in China ranged 116219 per 100,000 person-years18,and the prevalence of stroke among Chinese elderlypeople is as high as in industrialized countries 19.InChina,more than 230 million people wer

19、e affected bycertain forms of cardiovascular disease,which led to 2million myocardial infarctions,7 million strokes,and 3million deaths every year 20.Increased blood pressure isthe leading cause for premature deaths due to cardiovasculardisease 21.Hypertension is known to be strongly associ-ated wit

20、h harmful alcohol drinking,overweight or obesity,and increasing intake of dietary salt and animal fats.Inaddition,smoking is a well-established risk factor forcardiovascular disease.Therefore,the highly prevalentlifestyle risk factors such as smoking,alcohol abuse,physicalinactivity,and unhealthy di

21、ets are likely to lead to growingepidemic of cardiovascular disease in China.Cancers In China,the overall mortality of cancer(per100,000 populations)increased from 74.2 in the 1970s and108.3 in the 1990s to 135.9 in the 2000s 22,23;canceraccounts for one fourth of all deaths in urban area and onefif

22、th in rural area.Lung cancer,as the leading cause ofcancer deaths,has increased by 465%during the sameperiod 24;it was projected that by year 2025 around 1million Chinese would be diagnosed with lung cancer everyyear.Gastric cancer,liver cancer,and esophageal cancer arethe other most common cancers

23、in China.All these typecancers are strongly associated with smoking.In addition,the dramatic increase in cancer mortality also is likely to befurther driven by population aging and increasing preva-lence of other lifestyle-related factors such as increasingintake of meats,excessive alcohol drinking,

24、environmentalcontaminations,and psychosocial factors(e.g.,depressionand work stress).In summary,CNCDs account for around 80%of alldeaths in China,a proportion similar to that of manydeveloped countries.Thus,with rapid economic growth inthe last three decades,the profile of epidemic and burden ofCNCD

25、s in China has evolved to more closely resemble thatof the developed nation.Preventing and controlling theincreasing epidemic of CNCDs has become a priority of theChinese government.Epidemic of Unhealthy Lifestyles and Behaviorsin ChinaSmoking China is the world largest tobacco producer andconsumer.

26、There are more than 320 million smokers inChina,accounting for approximately one third of allsmokers in the world 6,10,25.The overall smoking ratein adults was 28.2%(53.2%for male and 2.2%for female).Passive exposure to smoking affects an additional 500million people 6.Even more worrisome was the fa

27、ct thatthere were around 15 million regular smokers under18 years of age.The 2005 Cost Estimates of Smoking inChina released by China Economic Center at PekingUniversity estimated that the direct costs caused byInt.J.Behav.Med.smoking were 167 billion Renminbi(RMB;6.5 RMB1$),while indirect costs(e.g

28、.,loss of working time,fires,andenvironmental pollution)could reach 1.2 trillion RMB.Smokers spent about 250 billion RMB per year.Nearly 1million Chinese people died from smoking-related lungcancer,cardiovascular disease,or chronic obstructivepulmonary disease 6,10.Thus,the burden caused bysmoking i

29、n China is far more than the total profit earningsand tax payments made by tobacco industry.The price willbe much higher if long-term indirect cost of smoking istaken into account.Alcohol Consumption The WHO-sponsored national sur-vey of the general population(age 15 years)in Chinasuggested that the

30、 3-month rate of alcohol drinking was43.8%(63.8%in men and 18.3%in women)26.Of thetotal sample,6.7%were heavy drinkers,a group that wouldbe at increased risk for alcohol-related health problems.Theaverage annual alcohol consumption for each adult was4.47 l.Since 2002,China has been the world largest

31、 beerproducer.The production and consumption of alcoholicbeverages have been increasing steadily.The national datasuggested that the prevalence of alcohol consumptionincreased from 35.1%in 1999 and 39.6%in 2002 to84.1%in 2007 for males;the corresponding figures forfemales were 2.6%,4.5%,and 29.3%27;

32、it was estimatedthat more than 500 million Chinese people regularlyconsumed alcohol.In addition to psychiatric disordersowing to excessive use of alcohol,alcohol consumptionhas been associated with oral cancer,esophageal cancer,gastric cancer,and hepatocellular carcinoma amongChinese population 27,2

33、8.Sedentary Lifestyles The WHO report suggested that morethan 2 million people worldwide died every year due tosedentary lifestyle,while long-term sedentariness is one ofthe major causes of death of CNCDs 29.Up to 6085%ofadults adopt sedentary lifestyle or physically inactive habit.More than half of

34、 workers are mainly in the pose of sittingand standing during working time,with only a short periodof walking.In recent years,physical activity has furtherdecreased among urban populations in China because ofless bicycling and more driving;only 15%of peopleparticipate in regular physical training,wh

35、ile middle-agedand young people have the lowest rate of physical exercise6.People spend much leisure time on sedentary activities:watching TV and internet access have become the mainforms of daily entertainment for many people,includingteenagers and children.Diets and Overweight or Obesity The livin

36、g standardshave been significantly improved over the past threedecades in China.Unfortunately,this is accompanied byincreasing intake of foods rich in saturated fats,salt,and sugar.Increasing dietary salt,as a risk factor forhypertension,is particularly common in northern andnorthwestern regions of

37、China 30.Unhealthy diets anddietary patterns are associated with high blood pressure,hyperlipidemia,and obesity or overweight,which repre-sent major risk factors for cardiovascular disease.Inaddition,dietary patterns of foods rich in animal fats havebeen associated with an increased mortality of car

38、diovas-cular disease,diabetes,and some type cancers(e.g.,colorectal cancer)31.The prevalence of overweight or obesity has beenincreasing rapidly in China,especially in urban area.The2002 National Nutrition and Health Survey of the generalpopulation revealed that 14.7%were overweight andadditional 2.

39、6%were obese(WHO criteria);it wasestimated that there were 184 million overweight peopleand a further 31 million obese people in China 32.TheNational Hypertension Survey of adults(age 4579 years)found that the prevalence of overweight or obesity wasnearly 29%33,34;it would be much higher when theAsi

40、an-specific criteria were applied.The national data alsoindicated that,since the early 1990s,the prevalence ofoverweight or obesity has almost doubled,and the numberof overweight or obese people has increased by 100 millionpeople.Overweight and obesity are of a particular concernfor urban children.T

41、he increasing epidemic of overweightand obesity is largely owing to sedentary lifestyle,shift oftraditional diets toward consumption of more meats,andrapid urbanization.Depression or Psychosocial Factors The life of economi-cally transitional society in China is characterized by highlyintense workin

42、g and increasing level of stress.Thus,peopleare more likely to be affected by bothering social events,work stress,poor social adaptation,and sleeping disorders.The large-scale survey of adults aged 18 years or over inChina revealed a relatively high 1-month prevalence ofpsychiatric disorders:nearly

43、one in five Chinese(17.5%)were affected by a mental disorder 28,making China oneof the most mentally ill countries in the world.Anxiety andmood disorders(e.g.,depressive disorder)were mostprevalent.However,among individuals with mental disor-der only 8%had ever sought medical help and 5%had everseen

44、 a mental health professional.The INTERHEARTStudy,which involved 52 countries including China,suggested that psychosocial factors such as work stress,depression,and stressful life events were associated with anincreased risk of acute myocardial infarction independent ofsocioeconomic status and smoki

45、ng,contributing to 33%of all cases in the general population 35.Int.J.Behav.Med.In summary,since the 1980s China has experienceddramatic transition in demographics,socioeconomicdevelopment,and traditional culture.However,unhealthylifestyles and high-risk behaviors have not been constrainedwith incre

46、asing wealth.Instead,unhealthy behaviors andlifestyles have become increasingly common.In particular,along with population aging,rapid improvement of livingstandards,shift of traditional diets toward unhealthydietary pattern,sedentary lifestyles as well as increasingepidemic of obesity related to th

47、ese transitions havesignificantly contributed to the growing epidemic ofCNCDs.Thus,in China there is an urgent need ofimplementing intervention programs towards lifestylesand behaviors that have been proven to be cost-effectivein reducing the burden of CNCDs 2,36.Prevention of CNCDs in ChinaPrimary

48、Prevention Action for the control of CNCDs hasbeen taken globally and in China as well.The VictoriaDeclaration(1992)proposed the“four cornerstone”approach(i.e.,healthy dietary habits,a tobacco-freelifestyle,regular physical exercise,and a supportivepsychosocial environment)to maintaining cardiovascu

49、larhealth.Since the 2000s,WHO joined by the worldhighly impact journals have published a series ofarticles aiming to fight against the epidemic of CNCDs,in which the world-leading scientists unanimously calledfor global action to control CNCDs 29,3740.In2005,China ratified the WHO Framework Conventi

50、on onTobacco Control.In 2008,China Ministry of Healthreleased the pocket-book“Health Items 66:HealthMaintenance Reading of Chinese Citizens”,in whichappropriate actions were proposed for the public to dealwith the challenge of CNCDs.The China national Centerof Disease Control and Prevention has laun