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The Health Impact of Smoking and Obesity and What to Do About It

The Health Impact of Smoking and Obesity and What to Do About It

Hans Krueger
Dan Williams
Barbara Kaminsky
David McLean
Copyright Date: 2007
Pages: 352
  • Book Info
    The Health Impact of Smoking and Obesity and What to Do About It
    Book Description:

    The Health Impact of Smoking and Obesity and What to Do about Itprovides solid evidence and practical advice to health care planners, decision-makers, and frontline providers alike.

    eISBN: 978-1-4426-8493-5
    Subjects: Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)

    • 1 Introduction: Planning to Reduce the Risks of Chronic Disease
      (pp. 5-13)

      The Health Impact of Smoking and Obesity and What to Do About Itrepresents a distillation of multiple reports that emerged from a risk factor project initiated in 2004 by the British Columbia Healthy Living Alliance (BCHLA). The objective of the project was to create a plan to aggressively tackle risk factors and reduce chronic disease rates in the province of British Columbia over the long term. British Columbia is the most western of Canada’s ten provinces and three territories; situated adjacent to the Pacific Ocean, and known for its spectacular mountains, rivers, and forests, British Columbia prides itself on...

    • 2 Risk Factors and the Burden of Disease
      (pp. 14-31)

      The main motivation for selecting risk factors and then setting targets must be to reduce the associated burden of disease. To evaluate the potential impact of any risk factor reduction, it is important to know how much that factor contributes to the onset of disease. How to quantify this disease burden is the subject of the first section of this chapter. Then the impact of our two focal risk factors will be itemized. Finally, the factors that can contribute to obesity, that is, physical inactivity and unhealthy eating, are examined in terms of their independent health consequences. This chapter should...

    • 3 The Economic Cost of Risk Factors B.C. Risk Factor Plan (1)
      (pp. 32-40)

      Although the health burden of risk factors and related diseases presented in the previous chapter is the most important motivator in terms of human values and policy priorities, cost avoidance is also a worthy incentive. After all, preventing unnecessary spending in the health care system allows funds to be redirected to different health needs or other public goods. The benefits can become cyclical and cumulative as resources are freed up. This positive picture does not even take into account the improved productivity and reduction in out-of-pocket expenses for individual sufferers and their families and the consequent economic boost to society...

    • 4 Risk Factor Targets around the World B.C. Risk Factor Plan (2)
      (pp. 41-56)

      Many jurisdictions are actively engaged in indicator target-setting to encourage improvements in the prevalence of risk factors and consequent chronic disease within their populations. It is evident that there is significant international momentum around this form of health care planning. This chapter provides a sampling of risk indicator targets from Canada and other countries, first for our main factors – tobacco use and obesity – and then for the contributing factors of physical inactivity and unhealthy eating.

      The public health initiatives that have produced such positive results in recent decades around tobacco use continue to inspire more ambitious target-setting in jurisdictions around...

    • 5 The Benefits of Reducing Risk Factors B.C. Risk Factor Plan (3)
      (pp. 57-74)

      One of the powerful benefits of addressing risk factors is cost avoidance, in terms of both direct health care spending and indirect productivity losses. These costs are estimated using different assumptions and algorithms. Of course, the absolute totals, whatever the methodology, are unique to each jurisdiction. In the case study following this chapter, key economic principles are applied to British Columbia to come up with a picture of cost avoidance for that province. The numbers are as compelling there as they are for many other settings.

      Before concerning oneself withfinancialbenefits, however, it is important to examine thehealth...


    • [PART TWO Introduction]
      (pp. 75-80)

      SETTING A TARGET IS RELATIVELY EASY. But to truly make the intended direction and benchmark meaningful, there needs to be a full commitment to an action plan that could feasibly move towards and even reach the target in the allotted time frame. In short, planners need to be mindful that setting targets is one thing, achieving them is another.

      Gathering evidence on which to base sound health care decisions is so well-established as a principle that it is simply assumed to be a priority in planning processes. This is very much the case with risk factor programs: policymakers understandably want...

    • 6 Tobacco Control Evidence (1): Preventing Uptake
      (pp. 81-95)

      If it were not for the advent of organizations dedicated to reviewing scientific literature, pulling together the data on tobacco use would be a daunting task. Fortunately, extensive summaries have recently been completed that expertly review the current evidence on tobacco control strategies, sometimes incorporating dozens or even hundreds of studies. Our approach here is to compare and collate all of this work and offer a state-of-the-art review of reviews. In contrast with obesity control and other emerging areas of public health care, the evidence available for tobacco interventions is extensive and compelling.

      We start this chapter by introducing a...

    • 7 Tobacco Control Evidence (2): Smoking Cessation
      (pp. 96-116)

      Smoking cessation has been called the ‘gold standard’ of prevention strategies in health care because it produces additional years of life at costs well below those estimated for many other accepted medical treatments.¹ One comprehensive review of preventive services positioned tobacco cessation counselling for adults at virtually the highest priority based on effectiveness and cost-effectiveness; it was rated second in the list of interventions, only superseded in importance by childhood vaccinations.² Approaches to increase tobacco cessation rates include strategies to:³

      Increase the number of users who attempt to quit

      Improve the success rate of individual cessation attempts

      Achieve both of...

    • 8 Tobacco Control Evidence (3): Second-Hand Smoke, Specific Populations, and a Summary
      (pp. 117-133)

      This chapter begins with a look at the relatively new and important field of secondhand smoke, also known as environmental tobacco smoke (ETS). We especially examine exposures experienced by children, after which we consider some other specific populations in reference to tobacco use. The chapter ends with a summary of all of the tobacco control interventions that have been reviewed in Part 2 of this book.

      Due to the well-documented risks,1,2reducing exposure to ETS in public places and family settings is an important public health goal. Many players are involved with the efforts to reduce such exposure, including researchers,...

    • 9 Tobacco Control Evidence (4): Cost-Effectiveness
      (pp. 134-151)

      Information on the cost-effectiveness of tobacco control interventions is more limited than information on the effectiveness of those same interventions.¹ Indeed, summaries from the early 1990s typically pointed to a ‘paucity of studies’ concerning tobacco control economics.² That situation is beginning to change. A recent comprehensive assessment of the literature between 1990 and 2001 revealed 41 cost-effectiveness studies related to tobacco control, or fully 10% of the total number of economic papers in the area of health promotion.³ It still should be noted that, although these figures suggest an increased level of research, the volume of studies is still well...

    • 10 Lessons from the Tobacco Wars
      (pp. 152-158)

      From the inventory of interventions described in previous chapters, five essential strategies float to the surface. They demonstrate the most significant public health impact over the past 40 years of tobacco control research and implementation. These strategies are:

      Increased price for tobacco products, usually through taxation. In terms of preventing uptake or increasing cessation, this approach works for all segments of the population. It is particularly potent for important subgroups such as teens and pregnant women.

      Increased control of activities that promote tobacco consumption, as a further step towards ‘denormalizing’ both smoking and the image of the tobacco industry. This...


    • [PART THREE Introduction]
      (pp. 159-164)

      THIS PART OF THE BOOK INTEGRATES THREE RISK FACTORS: overweight/obesity, unhealthy eating, and physical inactivity. The critical link between them is causal. There is evidence that a large proportion of overweight and obese people can trace their excess weight directly to a persistent imbalance between energy intake (i.e., food calories) and energy expenditure (i.e., physical activity). This basic formula gets translated into important hypotheses related to health care and abalanced lifestyle:

      Reducing intake of food energy and/or increasing physical activity can produce weight loss.

      Healthy eating (especially an appropriate level of caloric intake) and/or an active lifestyle can prevent...

    • 11 Obesity and Tobacco Control: New Territory and Established Pathways
      (pp. 165-175)

      The need for intensified research into both the basic science and the possibilities of controlling of overweight and obesity has become very palpable in the past few years. While there have been remarkable reductions in tobacco consumption in developed countries, health care authorities are alarmed that obesity represents a rising epidemic. In some quarters, obesity has even been seen as a rival to smoking as a top public health concern in terms of chronic disease development and lowered quality of life.¹ The resulting call for serious action is understandable. Although the following results could be duplicated for many developed countries,...

    • 12 Obesity Control Evidence (1): Reducing Energy Intake
      (pp. 176-206)

      As we move into the topic of controlling overweight, unhealthy eating, and physical inactivity, readers will notice that the evidence presented is less substantial than that related to tobacco consumption and exposure to secondhand smoke. This is largely due to the longer track record enjoyed by tobacco control and the intellectual effort directed to tobacco issues. Contrary to the relatively recent advances in obesity science, the relationship between smoking and adverse health effects was clearly identified many decades ago. Three studies published in 1950, one each by Levin et al.¹ and Wynder and Graham² of the United States, and one...

    • 13 Obesity Control Evidence (2): Increasing Energy Expenditure
      (pp. 207-227)

      The rationale for pursuing physical activity in weight control includes the evidence that maintenance of weight loss is enhanced when individuals adhere to exercise programs.¹ There is also a theoretic base for utilizing exercise or other physical activity in weight reduction. Energy is expended in the body in a number of ways, including:²

      The thermic effect of physical activity: this can range from 0% of total expenditure to more than 50% in elite athletes

      The thermic effect of eating food: 10% to 15% of expenditure relates to digestion and absorption

      The resting metabolic rate, or the amount of energy needed...

    • 14 Obesity Control Evidence (3): Combined Approaches, Cost-Effectiveness, and a Compendium
      (pp. 228-247)

      As in many other areas of health promotion and prevention, combined programs incorporating multiple therapeutic strategies are popular approaches in weight loss. In the case of obesity control, combining diet, exercise, and counselling for optimal and sustainable weight loss makes good intuitive sense. However, there are still large gaps in understanding the individual and combined roles of diet, exercise, and counselling in different settings.

      The first section of this chapter examines the available evidence on effectiveness with respect to combined programs. Whereas the previous two chapters made energy intake and energy expenditure the main entry point, the emphasis here is...

    • 15 Important Issues in Obesity Control B.C. Risk Factor Plan (4)
      (pp. 248-264)

      There are several issues that arise regarding interventions in obesity control, beginning with the topic of prevention. Is there any parallel to the exposure prevention initiatives in tobacco use, which mostly involve stopping teen smoking uptake? The natural comparison is the prevention of weight gainin the first place, and especially in the context of children. This topic is outlined below, along with the special cautions needed. Unlike using tobacco, healthy eating and physical activity are important to child development, making controlling weight more complicated.

      Dealing with childhood obesity is made even more complex, especially in adolescents, by the phenomena...

    • 16 Collaborating for Health
      (pp. 265-274)

      As indicated in the introduction, this book emerged out of the British Columbia Healthy Living Alliance’s risk factor project. The aim and hope is that the project’s content and the conclusions will be highly transferable to other jurisdictions. One of the underlying features of the project has been embracing the contemporary importance of building effective coalitions and alliances to address health care issues and of crafting strategic communication plans. This chapter will look at the ‘case study behind the case study,’ that is, what it took to assemble a coalition, devise a plan, and communicate the results – all geared to...

    • Conclusion: Four Fundamentals for Reducing Risk Factors
      (pp. 275-286)

      We had several important purposes in putting together this volume. A key focus was to identify useful interventions for controlling tobacco use and the development of obesity. A closely related theme involved drawing a comparison of these two risk factor arenas (see chapter 11). In the planning process that originally inspired this book, it was important to separate the wheat from the chaff and to pick out the best or most promising public health and clinical practices. To aid other planners, we have provided summaries of all of the interventions – the good, the less proven, and the unproven – at the...

  6. Notes
    (pp. 287-366)
  7. Index
    (pp. 367-374)