1 GHME Conference 2013 Would addressing high- priority risk factors from the Global Burden of Disease (GBD) Study 2010 potentially reduce health inequalities?: A case study Nick Wilson, Tony Blakely University of Otago, Wellington, New Zealand [email protected]uow.otago.ac.nz/BODE3-info.html
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Would addressing high-priority risk factors from the Global Burden of Disease (GBD) Study 2010 potentially reduce health inequalities?: A case study
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GHME Conference 2013
Would addressing high-priority risk factors from the Global Burden of
Disease (GBD) Study 2010 potentially reduce health
inequalities?: A case study
Nick Wilson, Tony BlakelyUniversity of Otago, Wellington, New Zealand
Aim: To determine if addressing the top 10 risk factors for a region in the GBD Study 2010 would help reduce ethnic inequalities in health – using New Zealand (NZ) as a case study.
Methods: Comparison with previous NZ work, literature searches (RF distribution in NZ; availability of preventive population-level interventions).
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New Zealand’s location
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Risk factor (as per GBD 2010 Study)
GBD 2010 – Australasia Region (Lim et
al 2012)
Previous (2004) risk factor ranking for NZ
(Ministry of Health, 2004)
High body-mass index 1 6
Tobacco smoking, including SHS 2 2
High blood pressure 3 5
Alcohol use 4 13 (with other drugs)
Physical inactivity & low physical activity 5 7
High fasting plasma glucose 6 8 (pre-diabetes)
Diet low in fruits 710 (with low vegetable
intake)
Diet low in nuts and seeds 8 Not considered
High total cholesterol 9 4
Drug use 10 13 (with alcohol)
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Table 2: Evidence for unequal distribution of the top ten risk factors (Māori vs non-Māori)
Prioritized risk factor [RF]
RF higher for Māori vs non-
Māori? Evidence-base
High body-mass index + Many studies & national health surveys
Tobacco smoking, including SHS
+ Many studies & national health surveys (also for SHS exposure)
High blood pressure + Many studies & national nutrition surveys
Alcohol use + Many studies & national surveys
Physical inactivity & low physical activity
+ (partial & women only)
Some studies – but inactivity only (no differences by physical activity levels)
High fasting plasma glucose
+ Many studies & national surveys
Diet low in fruits + Some studies & national surveys
Diet low in nuts and seeds
+ (women only)
Just 1 national survey
High total cholesterol No Survey data
Drug use + Many studies & national surveys
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Figure 1: Rate ratios for selected risk factors for Māori men & women (relative to non-Māor)
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
Sedentary Cannabis in thepast year
High body-mass(obese)
Hazardousdrinking of
alcohol
Tobacco smoking(current)
Ad
juste
d r
ate
rati
os
Men Women
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Figure 2: Prevalence of hypertension and smoking for Māori vs non-Māori
0
5
10
15
20
25
30
35
40
45
50
Hypertension Tobacco smoking (current)
Pre
vale
nce
(%
)
Maori NZ European/Other
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Table 3: Extent of population-level preventive actions in NZ Prioritized risk factor Level of response in NZ (prevention)
High body-mass index Minimal
Tobacco smoking, including SHS
Relatively advanced internationally (Smokefree 2025 goal, series of tax increases, new marketing restrictions)
• Ongoing annual tobacco tax increases (10%).• Expanding outdoor smokefree areas – parks etc.• Mass media campaigns; some Māori focus.• Prohibited retail displays (in 2012)• Plans for a plain packaging law.• National quitline
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Example: Tobacco control activities in NZ
Tariana Turia, Assoc Minister of
Health & Māori Party Leader
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Promoting “auahi kore” (smokefree in Māori language)
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Table 4: Examples of population-level preventive interventions reported as “cost-saving”
Prioritized RF Examples (refs in Wilson et al 2012 Bull WHO & available on request)
High body-mass index A 10% tax on unhealthy food; reduction of TV advertising (high fat/high sugar foods & drinks); traffic light nutrition labeling.