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EPI 320 Epidemiology Question: Epidemiology and Prevention Policy for Noncommunicable Diseases   Cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases are the top four noncommunicable diseases (NCDs). Together, they contribute to the largest morbidity and mortality rates worldwide (World Health Organization, 2011). Once considered “diseases of affluence,NCDs are now epidemic in developing countries (World Health Organization, 2011). The determinants of an NCD are complex as multiple risk factors contribute to the development of an NCD. Traditionally, these risk factors are categorized as nonmodifiable and modifiable. Nonmodifiable risk factors are age, sex, and genetic makeup. In contrast, modifiable risk factors are poor diet, physical inactivity, tobacco use, and harmful alcohol use—the health habits. These health habits are powerfully influenced by social networks and social environment—the social determinants. Public health programs and health care delivery should be integrated into policy to fully address the burden of NCDs. However, policy alone is not enough unless it is implemented effectively. There must be a long-term and continuing collaboration among multiple stakeholders (e.g., agencies, foundations, nongovernmental organizations, and the private sector). Subsequent steps may require implementation of best buys”investments in innovative preventive health strategies, improvements in surveillance, agreement on targets, and the creation of realistic timelines. For this Discussion, review the weeks Learning Resources. Select one of the NCDs you read about in the Learning Resources on which to base your discussion. Then, in the Walden Library or the Internet, search for information on this NCD in a country other than yours. Think about initiatives that might reduce the burden of this disease.   A brief description of the NCD that you selected and include the descriptive epidemiology of the disease in a country different from your own. Explain how the modifiable risk factors for the NCD differ between the country you selected and the country you live in. Based on the risk factors, explain an initiative that you might advocate to reduce the burden of the disease in the country you selected. Support your post using scholarly sources. Answer: Introduction Diabetes, cardiovascular diseases, chronic respiratory diseases and cancer are the most significant chronic or non communicable diseases throughout the world. However, they are more persistent in developing countries in comparison to developed countries. They greatly contribute to the high mortality and morbidity rates when their impacts on individuals are coupled. Development of these diseases is contributed by manifold risk factors, rendering the determinants of these conditions intricate. In this paper, the focus will be on vascular diseases. The descriptive epidemiology of cardiovascular diseases and the risk factors will be described in detail and an initiative to reduce the burden of disease proposed in this paper. Cardiovascular Diseases In India Epidemiology India is a lower-middle-income economy or developing country in South Asia. In India, CVDs’ prevalence has been proven to increase at a higher rate compared to other developing countries. CVDs are the leading death cause, with a quarter of all deaths being associated with these diseases (Prabhakaran, Jeemon, & Roy, 2016). The most predorminant cardiovascular diseases’ types are stroke and ischematic heart disease, which account for more than 80% of all cardiovascular related causes. According to Prabhakaran, Jeemon, & Roy (2016), CVDs were attributed to a 59% increase in premature mortality in 2010 as indicated by the years of life lost as compared to 1990’s premature deaths. The number rose to 37 million premature deaths in 2010 from 23.2 million in 1990. In India’s case, CVDs are the death leading causes in all parts of the country despite the broad CVDs risk factors’ heterogeneity in its prevalence across diverse regions (Prabhakaran, Jeemon, & Roy, 2016). Additionally, recent trends indicate that in younger age group, these diseases have higher incidence (Chauhan & Aeri, 2013). Risk Factors There are some general modifiable risk factors for cardiovascular diseases in India and United states, where I come from. However, some risk factors may be associated with a paricular country, especially considering the different lifestyles of individuals in these two regions. The overall modifiable risk factors of CVDs include high blood pressure, physical inactivity, exposure to tobacco, unhealthy diets, obesity, harmful alcohol use, high cholestrol and diabetes (World Heart Federation, n.d). In India, modifiable risk factors associated with poor nutrition are more rampant in comparison with U.S. This is because, India, being a lower-middle-income economy, most citizens rely on poor diets for their daily survival (World Heart Federation, n.d). Additionally, as Prabhakaran, Jeemon, & Roy (2016) states, In India, individuals from low socioeconomic backgrounds tend to take low vegetables and fruits, rendering their diets unhealthy. Poor dietary habits, according to Lucero, et al. (2014), affect manifold risk factors of cardiovascular diseases such as blood pressure, obesity, glucose levels and choleterol levels. In this regard, poor nutition plays a more significant role in India than U.S as a CVDs risk factor. However, the study by Lucero, et al. (2014) revealed that across the overall population in U.S , there exist poor habits of consuption of vegetables and fruits, debatably explaining why even in the U.S CVDs are a significant health problem. High nutrient-rich fruits and vegetable diet reduces the likelihood of developing many diseases. Tobacco smoking, as already mentioned is also a CVDs risk factor. Both in the U.S and India, tobacco exposure is a significant risk factor, contributing greatly to increased prevalence of these diseases. In the U.S, approximately 443000 premature deaths occurred due to cigarette smoking every year between 2000 and 2004 (Lucero, et al., 2014). 33% of these deaths were connected to CVDs in individuals aged above 35 years. In India, more than 981100 premature deaths are caused by tobacco related diseases every year (The Tobacco Atlas, 2014). As of 2010, 14.3% of men, which is equivalent to 15441 deaths, occur every week due to diseases related to tobacco smoking. Thus, although tobacco smoking is significant both U.S and India, the deaths caused in India seem to be higher. The significance tobacco use causes in regard to CVDs in India is elevated by the early exposure of children to tobacco. In 2013, for instance, 5.8% of boys smoke cigarettes each day, which is equivalent to 1851800 boys (The Tobacco Atlas, 2014). Early exposure to tobacco increases the risk of developing CVDs more (World Heart Federation, n.d). Physical inactivity is an important CVDs risk factor. In the U.S, most people engage in physical activities, but still quite a huge number does not. According to CDC (2014) approximately 21% of all individuals in U.S meet the physical activity guidelines proposed in 2008. This is equivalent to 1 in every 5 individuals (CDC, 2014).  In India, a study by Anjana, et al. (2014), results indicated that 54% of Indians were found to be generally inactive with most active individual being from urban rather than in rural areas. The study indicated that less than 10% of all Indians engage in leisure physical activity. Therefore, just like this study suggests, physical inactivity can be partly attributed to the high prevalence of chronic diseases in India. Compared with the U.S, physical inactivity exposes more individuals in India to CVDs. Initiatives CVDs are complex and long-term threats to health of the affected. Thus, long-term as well as sustainable initiatives should be advocated for to reduce the burden of these conditions. As IOM, (2010) suggests, initiatives targeting the risk factors should be developed and  implemented. These initiatives should coordinate across different sectors integrating prevention, health promotion, as well as disease management. Interventions should be focused on all life course stages so as to prevent acquisition, risk augmentation, detect and reduce risk, and prevent CVDs progression (IOM, 2010). The new initiative by the World Health Organization and US Centers for Disease Control and Prevention referred to as Global Hearts is also an advocatable strategy. Global Hearts targets to help scale up control and prevention of CVDs (WHO, 2016). This initiative encompasses of three CVDs prevention and control packages (WHO & CDC, 2016). They include MPOWER package, SHAKE package and HEARTS technical package. The MPOWER package aims to control usage of tobacco, SHAKE to reduce consuption of salt while HEARTS to strengthen CVDs management in primary level of health care (WHO & CDC, 2016). Coupled, the three packages provides evidence-based involvement which ensures global improvement of heart health. MPOWER is comprised of a six set affordavle, achievable and practical measures that aids in implemntation of precise provisions provided by WHO framework Convetion on control of Tobacco. Thus, the global heart intiative works on reducing the CVD  burden by prevention of occurrence of these diseases by avoiding intake of salt and tobacco, which have been proven to play critical roles in increasing the risk of developing CVDs. Additionally, the initiative helps in management of already developed CVDs through provision of standardized, quality and equitable ongoung primary health care (WHO, 2016). Initiatives that help modify behavaiours that increase the chances of developing CVDs would also be helpful. Since the modifiable risk factors all revolve around people’s way of life and behaviors, community based health promotion programmes that offer education and encourage individuals to embrace healthy lifestyles  would prove usesful. For instance, programmes teaching the importance of regular physical activity as a prevention strategy of CVDs would be of help. For population-based CVDs prevention setting new or changing policies, regulations and incentives related to agriculture, food, and tobacco should also be coupled with public education programmes. For example, regulations and taxation on sales and production of tobacco (IOM, 2010). Additionally, regulations on food labelling and marketing, subsidies alterations for foods as well as introduction of agricultural strategies that make swift urbanization health friendly. These regulations will help create a condusive environment for individuals since they will be protected from exposure and easy access to risk elevating factors to CVDs. Conclusion Therefore, since the huge burden of CVDs is contributed significantly by multiple risk factors, reducing the burden for these diseases should be multi-focused, incorporating educational programs, policy change, behavioral changes and quality and easily accessible health care. With such multi-focused initiatives, CVDs burden can be reduced and its prevalence trends reversed in the future. References Anjana, R. M., Pradeepa, R., Das, A. K., Deepa, M., Bhansali, A., Joshi, S. R., et al. (2014). Physical Activity and Inactivity Patterns in India- Results from the ICMR-INDIAB Study (Phase 1). International Journal of Behavioral Nutrition and Physical Activity , 11:26. Centers for Disease Control and Prevention, CDC (2014). Physical Activity . Retrieved on April 9 2017 from Chauhan, S., & Aeri, B. T. (2013). Prevalence of Cardiovascular Disease in India and its Economic Impacts- A Review . International Journal of Scietific and Research Publications , 3(10): 1-4. Institute of Medicine, IOM.  (2010). Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health . Washington, DC: The National Academies Press. Lucero, A. A., Lambrick, D. M., Faulkner, J. A., Fryer, S., Tarrant, M. A., Poudevigne, M., et al. (2014). Modifiable Cardiovascular Disease Risk Factors among Indegenous Populations . Advances in Preventive Medicine , 1-13. Prabhakaran, D., Jeemon, P., & Roy, A. (2016). Cardiovascular Diseases in India: Current Epidemiology and Future Directions. Circulation , 133(16):1605-1620. TheTobacco Atlas. (2014). Country Fact Sheet: India . Retrieved on April 9 2017 from WHO, & CDC. (2016). Flobal Hearts Initiative: Working Together to Beat Cardiovascular Disease. Retrieved on April 10 2017 from World Health Organization, WHO. (2016). New Initiative Launched to Tackle Cardiovascular Disease, the World’s Number One Killer. Retrieved on April 10 2017 from  World Heart Federation. (n.d). Cardiovascular Disease Risk Factors .Retrieved on April 9 2017 from

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