CDP 101 Chronic Disease Prevention and Alcohol

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CDP 101 - Chronic Disease Prevention and Alcohol
Other Drug Use An Overview

• ODAP FRC Symposium February 24, 2004
• Pat Sanagan Consulting

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Whos Here?

• Region of Ontario?
• Affiliation Health? Enforcement? Treatment?
  Education? Other?
• Mandate FOCUS? Drug Awareness Committee? Other?
• Stage of Life Adult? Parent? Youth? Senior?
  Other?
• Know a lot about chronic disease prevention? Know
  a little bit? Know nothing? Other?

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Who am I?

• Pat Sanagan, RN., BScN.,MEd.
• Clinical - AOD treatment programs 1970 - 1982
• Health promotion and public health 1983 1996
• Training and Management, 1994-1999 (Hong Kong and
  Canada)
• 1999 present Consultant to Government,
  Non-profit Agencies, Education and Private
  Business
• 2003 - Recipient of the Queens Golden Jubilee
  Medal for Health Promotion in Canada
• President of Pat Sanagan Consulting
  Health-e-Tips Inc.

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Workshop Objectives

• To provide information on the links between
  alcohol and other drugs and chronic disease.
• To provide information on the research which
  shows links between alcohol and chronic disease.
• To provide information on past and current work
  in chronic disease health promotion around
  alcohol other drugs.
• To examine ideas as to how a community group
  might proceed in addressing the issues of alcohol
  as a risk factor in chronic disease.

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Workshop Agenda

• 130 140 - Introductions
• 140 220 - Powerpoint on W5
• 220 250 - Small groups look at
  How
• 250 320 - Regional Report
• 320 330 - QA

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Chronic Disease What?

• Definition of Chronic Disease
• Diseases which have one or more of the
  following characteristics they are permanent,
  leave residual disability, are caused by
  nonreversible pathological alteration, require
  special training of the patient for
  rehabilitation, or may be expected to require a
  long period of supervision, observation, or
  care.
• (World Health Organization)

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Chronic Disease Prevention What?

• Definition of CDP Chronic disease prevention
  (CDP) Action or measures not only to prevent
  the occurrence of disease, such as risk factor
  reduction, but also to arrest its progress and
  reduce its consequences once established.
  (Adapted from WHO, 1998
• Broader than lifestyle,CDP is disease
  prevention in health promoting way
• Health promotion the process of enabling people
  to increase control over, and to improve, their
  health (Ottawa Charter, WHO, 1986,

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Chronic Disease Prevention Why?

• Chronic diseases are leading causes of death
  disability worldwide
• In Canada, about two thirds of total deaths are
  due to cardiovascular disease (heart disease and
  stroke), cancer, chronic obstructive lung disease
  (bronchitis and emphysema), and diabetes
• More than half of Canadians (16 million) live
  with chronic illness

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AND.

• Chronic diseases are major demand on health care
  system total cost of illness, disability death
  in Canada due to chronic disease is over 80
  billion annually
• Major chronic diseases in Canada share common
  causes (e.g. inactivity, poor diet, smoking).
  This represents major opportunity for chronic
  disease prevention, health care cost savings,
  improved quality of life avoidance of
  unnecessary premature death.
• Based on Preventing Chronic Disease and
  Promoting Public Health An Agenda for Health
  System Reform

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Risk Factors for Chronic Disease

• Social, economic or biological status,
  behaviours or environments which are associated
  with or cause increased susceptibility to a
  specific disease, ill health or injury (WHO,
  1998 )
• Physical inactivity, unhealthy eating, tobacco
  exposure, obesity/unhealthy weight, unmanaged
  stress
• Risk factors chronic illness more likely to be
  present in low-income, disadvantaged populations
• Risk-factor prevalence can be modified on
  population level, but no magic bullets
• Effective interventions comprehensive,
  multilevel, culturally relevant, well-coordinated
  mutually reinforcing, evidence-based, with
  sufficient intensity sustainable

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CDP - Integration is Key

• Address common risk factors at the same time
• Recognize address relationship between
  lifestyle choices social determinants of health
• Consolidate prevention efforts within life
  contexts (e.g. work, school, community settings)
• Engage partners within across systems to take
  collaborative action
• Adapted from OHPE Bulletin 312.1 An Overview of
  Chronic Disease Prevention )

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Chronic Disease Prevention Who?

• WHO World Health Organization
• CDPAC Chronic Disease Prevention Alliance of
  Canada
• Health Canada - Healthy Living Strategy
• OCDPA Ontario Chronic Disease Prevention
  Alliance
• MOHLTC Ministry of Health Long Term Care
  Chronic Disease Prevention Programming
• Stroke Strategy
• Diabetes Strategy

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Chronic Disease Prevention Where? Canada
Ontario

• Canadian Cancer Society
• Canadian Council for Tobacco Control
• Canadian Public Health Association
• Coalition for Active Living
• Canadian Diabetes Association
• Dietitians of Canada
• Health Canada
• Heart Stroke Foundation

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Ontario Chronic Disease Prevention Alliance

• Canadian Cancer Society, Ontario Division
• Canadian Diabetes Association
• Cancer Care Ontario
• Heart stroke Foundation
• Lung Association
• Ontario Prevention Clearinghouse
• Ontario Public Health Association
• Osteoporosis Association
• Centre for Addiction Mental Health

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(No Transcript)
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And what does the research indicate?

• Clear links for excessive alcohol use with
  cardiovascular disease (heart disease stroke)
• Clear links for alcohol with cancer including
  breast cancer in women dose-response
  relationship
• Clear links for alcohol with GI tract disease
  (pancreatitis)(liver disease) dose-response
  relationship
• Clear links for excessive alcohol use with
  osteoporosis

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Alcohol, Stroke Heart Disease

• It is a balancing act
• Moderate alcohol use (LRDG) may prevent stroke
• More than this doubles your risk of ischemic
  stroke (blood is stopped from getting to the
  brain)(over 80 of all strokes) and 3-4 times
  greater risk for hemorrhagic strokes (blood
  vessel bursts in brain)

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But how.?

• alcohol increases levels of 'good' HDL
  cholesterol and makes the blood less likely to
  clot. Both factors help keep blood vessels
  healthy, reducing the chance that a blood clot
  might dislodge from a damaged blood vessel and
  block blood flow to the brain.
• On the other hand, too much alcohol can
  contribute to high blood pressure and interfere
  with the blood's ability to clot normally - both
  serious medical problems that increase the risk
  of suffering a hemorrhagic stroke. (Heart
  Stroke Foundation)

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Andexcess alcohol can

• Raise the levels of fats in the blood.
• Contribute to weight gain (alcohol is high in
  calories).
• Increase atrial fibrillation (Holiday Heart).
• Increase your blood pressure.
• Lead to congestive heart failure or other heart
  diseases. (Heart Stroke Foundation)

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And as we know already

• Alcohol may change how your medication works.
• Alcohol can affect other medical conditions you
  may have.
• Excessive alcohol is associated with a number of
  diseases and problems, including alcoholism.

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And alcohol also increases blood pressure

• So heavy drinking can lead to chronic diseases
  impacted by increased blood pressure including
• Primary hypertension
• Kidney disease
• Congestive heart failure

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Lets talk about Diabetes..

• Alcohol is  
• a drug that can cause blood sugar levels to
  increase or decrease 
• Ties between alcohol and Type 2 Diabetes are very
  complex with some research indicating it is a
  protective factor, while others see it as a risk
  factor (Alcohol and Diabetes Aging in Canada )

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And Osteoporosis?

• alcohol interferes with calcium and bone
  metabolism, and can seriously deplete essential
  bone-building nutrients, such as calcium and
  vitamin D, which can reduce bone mass (The
  Journal, May June 2000, hyperlink, slide 60)
• excess alcohol is seen as a key risk factor by
  the Osteoporosis Society of Canada, and their
  Clinical Practice Guidelines advise physicians
  to recommend reducing alcohol intake to men
  women over 50 (Osteoporosis Society of Canada)

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And breast cancer?

• Women who consume 14 or more drinks a week run a
  70 to 80 per cent higher risk of developing
  breast cancer than non-drinkers, according to a
  study published in the journal Epidemiology. With
  seven to 10 drinks per week, their risk increases
  10 per cent.
• "With breast cancer, there is a dose-response
  relationship heavier consumption is related to
  higher risk than moderate consumption, which is
  related to higher risk than abstinence.(Jurgen
  Rhem, Journal, CAMH, May June 2000)

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And why is that?

• Possibly because alcohol raises levels of
  naturally-occurring female sex hormone.
• Perhaps alcohol decreases elimination of certain
  cancer-producing substances.
• Perhaps alcohol makes breast tissue more
  permeable to dangerous chemicals. (Hypotheses
  from researchers in Harvard Study, 1998, see
  JAMA, 1998 hyperlink, slide 60)
• ..and alcohol is described by pharmacologists as
  a carcinogen ( Drugs Drug Abuse, 3rd Ed. 1998,
  ARF

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And other cancers e.g. mouth esophagus?
liver?

• When you drink, the sensitive tissues of your
  upper-respiratory tract are directly exposed to
  alcohol in beverages, causing damage to cells and
  possibly initiating cancer. Cancer of the liver
  is probably preceded by alcoholic liver cirrhosis
  which develops after years of drinking. (Cross
  Currents, Autumn, 2003 see slide 62)

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The Big Guys are concentrating on heart
disease, cancers and diabetes

• Alcohol is key.
• But what about marijuana..?(Marijuana and lung
  disease (acute and chronic bronchitis and
  emphysema ) because of way it is smoked, amount
  of tars, and the fact that marijuana smokers are
  often tobacco smokers. (British Lung Foundation)

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Cannabis Law Reform 2004?

• Federal Drug Strategy
• Impaired driving
• Links with tobacco

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CDP and AOD Why Us?

• Alcohol (risks and protective factors/ reduction
  of problems) is our mandate.
• No one else is doing it (still stigma attached to
  alcohol and other drug use).
• Profile (we should be included).
• Health promotion.

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• Health promotion means we are engaged in
• Development of healthy public policy
• Creating supportive environments
• Supporting community action
• Re-orienting health services
• Increasing awareness, education and skills

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What does that look like - ?

• A range of strategies including -
• Primary strategies like
• increasing community awareness of risk factors
• Secondary strategies like
• working with individuals with modifiable risk
  factors to address them
• Tertiary strategies like
• policy development at schools and workplaces

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Why FOCUS??

• Good evidence that sufficiently intensive
  community-based disease prevention health
  promotion interventions can shift the population
  distribution of shared chronic disease risk
  factors resulting in important health gains

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Why Drug Awareness Committees??

• Already have a coalition with varied partners
  (health, enforcement, treatment and target
  groups)
• Already address multiple agendas
• Have profile within the community
• Are present in many more communities across
  Ontario

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The strategies can go many ways

• Towards target groups /topics e.g.
• Seniors and stroke prevention with awareness
  campaigns about impact of alcohol
• Adult men and hypertension with skill-building
  around LRDG, and ways to reduce risk
• Young women and breast cancer with
  re-orientation of health services to address
  gender risks
• OR towards settings e.g.
• Community Health Centres and education/skill-bui
  lding for professionals on the links between CDP
  and AOD

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How can we do this with no new money??

• Already doing it? (LRDG)
• Linking with partners e.g. Heart Health
  Coalition in Toronto and resource development
• Train The Trainer/Health Care Provider
• Supporting existing initiatives e.g. Osteoporosis
  awareness (Bone China Teas), and share
  information about the impact of alcohol on
  osteoporosis

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Get new money!

• Research Grants
• Wellesley Central Grants Initiative Research to
  address youth (under 25) A focus on determinants
  of health, access to care and services and public
  policy implications (impact of alcohol and
  tobacco use together on young adults)(
• Canadian Tobacco Control Research Initiative
  Research into prevention or cessation among young
  adults (links with alcohol use)
• http//www.ohpe.ca/ebulletin/ViewAnnouncements.cfm
  ?ISSUE_ID349startrow1
• Breast Cancer Foundation Grants
• Other?

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OK I buy it for adults but what about youth?

• Check out Comprehensive School Health/Health
  Promoting Schools programming (Health
  Canada)(http//www.hc-sc.gc.ca/dca-dea/7-18yrs-ans
  /comphealth_e.html)
• Check out Curriculum and School-based Resource
  Centre (http//www.ophea.net/Ophea/Ophea.net/curri
  culumresourcecentre.cfm?CFID241542CFTOKEN900020
  47)
• Address developmentally appropriate messages
• Peer education Use youth to reach other youth
  with prevention messages. Parent Action on Drugs
  Programming [phone].
• Look at gender-specific programming (e.g. girls
  and body image, nutrition and alcohol and other
  drug use)

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Go Girls! Healthy Bodies, Healthy Minds - OPHEA

• An evidence-based program designed to address the
  physical activity, balanced eating, and positive
  self-image needs of young women ages 12-14 based
  on a group mentoring model by University
  students.
• For more information...Phone [phone]Toll
  Free 1-(888)-446-7432Email info_at_ophea.
• http//www.ophea.net/Ophea/Ophea.net/loader.cfm?ur
  l/commonspot/security/getfile.cfmPageID6543

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Or encourage the key influencers of youth to
think about the link with chronic disease

• With education to parents through PTA,
  employment services, with practical gimmicks
  (Fatal Vision Goggles), at community events
  (hockey tournaments, Fish Derby), in the laundry
  room.
• With skill-building for parents on effective
  role-modeling (e.g. the Low Risk Drinking
  Guidelines)
• With education and training for teachers, coaches

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So how do we do it?

• Task - Break into small groups according to
  affiliation.
• Please talk about
• One collaboration already ongoing
• One challenge the collaboration faced
• One strategy you used to overcome the challenge
• One person in group complete the flip chart

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Strategies identified at the workshop

• Working on grant proposals together.
• Finding the right person sometimes a matter of
  personality.
• Have sub-committees that will address separate
  issues
• Developing volunteer base from other
  organizations which have a vested interest e.g.
  A.A.
• Sponsoring organization needs to see the breadth
  of the issues e.g. CHC comprehensive mandate
• Use consultants and resources from The Health
  Communications Unit (www.thcu.ca) to facilitate
  the process of alignment and partnership
  retention
• Support for collaboration from the top down

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Strategies contd

• Share resources
• Share equipment
• Share channels and settings e.g. workplaces
• Check out new web sites which address
  collaborative action e.g. NCADI
  (http//www.health.org/features/workplace/)
• Support volunteers with incentives, training,
  recognition, nurturing, respect and trust.

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You are not alone

• We are at the cutting edge of these initiatives
• 2002/2003 was the beginning of CDPAC, OCDPA and
  the Pan-Canadian Healthy Living Strategy
  (http//healthyliving-viesaine.ca/english/)
• Recent provincial developments support alcohols
  inclusion OPHA Promoting Healthy Communities
• The other guys are looking for partners too

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Its a Very Exciting Time for Health Promotion In
Canada

• Grab this opportunity to highlight chronic
  disease prevention as a key area when your
  community or Coalition is looking at health
  promotion around alcohol and other drug use!

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List of web site resources

• WHO Chronic Disease http//www.who.int/health_to
  pics/chronic_disease/en
• WHO Health Promotion http//www.who.int/hpr/
• Chronic Disease Prevention Alliance of Canada
  http//www.cdpac.ca
• Heart Stroke Foundation - http//ww2.heartandstr
  oke.ca and http//ww1.heartandstroke.ca/Page.asp?P
  ageID1017CategoryID2Srcstroke
• Holiday Heart - http//www.emedicine.com/med/topic
  1024.htm
• Osteoporosis - http//www.osteoporosis.ca/english/
  home/default.asp?s1
• Alcohol Cancer http//www.web.ca/apolnet/apoln
  et-l/msg00853.html
• Marijuana and Respiratory Health -
• http//www.lunguk.org/docs/research_papers/A20Sm
  oking20Gun20-21.101.pdf
• Alcohol and Diabetes Aging in Canada
  http//www.agingincanada.ca/Seniors20Alcohol/1e7-
  1.htm

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Additional Web-based Resources

• Ontario Health Promotion Resource System
• http//www.ohprs.ca/
• Canadian Community Health Survey
• http//www.statcan.ca/english/concepts/health/
• The Journal May-June 2000 CAMH
  (http//www.camh.net/journal/journalv3no3/alcohols
  _siege_women.htm
• The Journal of the American Medical Association
  (JAMA) 1998, Vol. 279 (7) -(http//jama.ama-assn.o
  rg/cgi/content/abstract/279/7/535)
• British Lung Foundation (http//www.britishlungfou
  ndation.org/index.asp)
• Health Canada Comprehensive School Health
  (http//www.hc-sc.gc.ca/dca-dea/7-18yrs-ans/comphe
  alth_e.html)
• Ontario Curriculum and School-based Resource
  Centre (http//www.ophea.net/Ophea/Ophea.net/curri
  culumresourcecentre.cfm?CFID157201CFTOKEN394672
  0)
• School Health Profiler, Spring, 2003
  (http//www.region.peel.on.ca/health/commhlth/body
  img/pdfs/2003-spring-issue-4-final.pdf)

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Print Resources

• Preventing Chronic Disease and Promoting Public
  Health An Agenda for Health System Reform by
  Dr. Terry Sullivan, Cancer Care Ontario John
  Garcia, Canadian Council for Tobacco Control
• OHPE Bulletin 312.1 An Overview of Chronic
  Disease Prevention by Nancy Dubois, THCU
  Consultant Member of the Steering Committee of
  the Chronic Disease Prevention Alliance of Canada
• Edwards, Griffith Alcohol, The Worlds Favourite
  Drug, Thomas Dunne Books, St. Martins Press, New
  York, 2002
• Travelling Together A Hands-On Guide for Moving
  Your Community Group to Action, CAMH, 2000

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Print Resources contd

• Raising Awareness of Drinking and Disease.
  Cross Currents The Journal of Addiction and
  Mental Health, Vol 7 No 1, CAMH Autumn 2003
• Drugs and Drug Abuse 3rd Edition, 1998,
  Addiction Research Foundation, Toronto

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Thank you!

• Pat Sanagan Consulting
• 137 Woburn Ave.,
• Toronto, Ontario
• M5M 1K8
• [phone]
• [phone] (Fax)
• info_at_health-e-tips