International Health Care Management
Part 2c
Steffen Fleßa
Institute of Health Care Management University of Greifswald
1
Risk Factors
2 Demand for Health Services
2.1 Determinants of Demand: Overview
2.2 Demographic and Epidemiologic Transition 2.3 Epidemiology of Infectious Diseases
2.4 Epidemiology of Non-Infectious Diseases 2.5 Risk Factors
2.5.1 Nutrition
2.5.2 Water and Hygiene
2.5.3 Smoking, Alcohol and Environmental Influences 2.5.4 Pregnancy and Delivery
2.5.5 Health in unstable Populations
2.5.6 Health and Health Care in Megacities
2.6 Filter Between Need and Demand
2
2.5.3 Smoking, Alcohol and Environmental Change
http://www.sanger.ac.uk/news/view/smoking-pack-day-year-causes-150-mutations-lung-cells
3
Alexandrov, Ludmil B., et al. "Mutational signatures associated with tobacco smoking in human cancer." bioRxiv (2016): 051417.
Tobacco associated fatalities in Germany (incl. passive smoking)
– Cancer: 60,000
– Cardio-Vascular Diseases: 52,000 – Respiratory Diseases: 28,000
– Total: > 140,000 (16 % of total fatalities)
– Almost every 6 th resident of Germany dies due to consuming tobacco
– 86 % of smokers die due to tobacco as estimated by the Centre for Disease Control
4
Prevalence of Smoking in Germany
5
15–20 20–25 25–30 30–35 35–40 40–45 45–50 50–55 55–60 60–65 65–70 70–75 >75 0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Age [years]
Prevlance of Smoking
Männer
Source: Destatis 2016
Frauen
Cost of Smoking
(Germany)
• Average consumption: 16.6 cigarettes per smoker per day
• Tobacco Tax (2008): 13.6 billion Euro
• Cost:
– Direct Cost: 7.5 billion Euro
• Outpatient care: 24 %
• Drugs: 24 %
• Rehabilitation: 4 %
• Acute hospital care: 48 %
– Indirect Cost: 13.5 billion Euro
• Mortality: 4.7 billion Euro
• Morbidity: 8.8 billion Euro
Source: Neubauer et al. (2006): Mortality, Morbidity, and Costs attributable to Smoking in Germany. Tobacco Control 15, p. 464-471
6
Cost of Smoking
(International)
• Australia (2004/5)
– Tobacco Tax: 5.1 billion US$
– Direct Cost: 1.7 billion US$
– Indirect Cost: 3.1 billion US$
• Massachusetts (USA)
– Direct Cost: 4.3 billion US$
– Indirect Cost: 1.7 billion US$
• Taiwan (2001)
– Direct Cost: 2.3 billion US$
– Indirect Cost: 2.0 billion US$
Source: Collins, D.J.; Lapsely, H.M. (2008): the costs of tobacco, alcohol and illicit drug abuse to Australian society. Commonwealth of Australia, Canberra Huans, X. et al. (2008): Smoking-attributable mortality and economic costs. Bureau of substance abuse services, Department of Public Health, Mass.
Yang, M.C. et al. (2005): Smoking attributable medical expenditures… Tobacco Control 14, 62-70
7
Preva lence
of Daily Smok
ing (≥18 Years, 2003- 2004)
So ut h Ea st As ia
Af ric a
Ea st er n M ed ite rra ne an
W es te rn Pa cif c
Am er ica
Eu ro pe 0
10 20 30 40 50 60
Poorest Quintile Richest Quintile WHO Region
P re va le n ce [ % ]
8
Smoking: from social acceptance to
marginalisation
Development
• Here: total cigarette consumption Germany
10
19900 1995 2000 2005 2010 2015
50 100 150 200 250 300 350 400 450
time [years]
Cigarettes p.a. [mio.]
Source: Destatis 2016
Model of Smoking
11
Phase I Phase II Phase III Phase IV
P ro po rt io n of S m ok er s in A du lt P op ul at io n [ % ] F at al it ie s D u e to S m ok in g [% ]
Male Smokers Female Smokers
Fatalities in Male Smokers
Fatalities in Female Smokers
(own, Vietnam 2016)
12
13
http://www.tobaccofreeworld.info/wp-content/uploads/2014/03/Currently_Smoking_ANY-Tobacco_Product-Male-Percent-2009_2.jpg
Consumption of Alcohol
http://gamapserver.who.int/mapLibrary/Files/Maps/Global_adult_percapita_consumption_2005.png
14
Risk Profle
http://gamapserver.who.int/mapLibrary/Files/Maps/Global_patterns_drinking_score_2005.png
15
Results
http://gamapserver.who.int/mapLibrary/Files/Maps/Global_subregions_dalys_2004_generalized.png
16
Environ- mental Influences
17 Economic Growth
Demand Production
- CO2 - CFC - CO - N2O - CH4
- H2O
Water Temperature
Glaciers Storms Floods Sea
Level
Migra- tion
Shift in Cli- mate Zones
Health Effects Air Temperature
Dyke Con- struction
Soil Pro- tection
Exploita- tion dam con-
struction
