scholarly journals 'Tobacco and alcohol use are playing critical role in the interaction of social determinants of non-communicable diseases in Nepal': a systems perspective

2019 ◽  
Author(s):  
Sudesh Raj Sharma ◽  
Anna Matheson ◽  
Danielle Lambrick ◽  
James Faulkner ◽  
David W Lounsbury ◽  
...  
Keyword(s):  
Data Analysis ◽  
Alcohol Use ◽  
Health System ◽  
Social Determinants ◽  
Systems Approach ◽  
Critical Role ◽  
Communicable Diseases ◽  
Causal Mechanism ◽  
Non Communicable Diseases ◽  
Causal Loop

Abstract Background: Tobacco and alcohol use are major behavioural risks in developing countries like Nepal contributing to rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health system. Systems approach has potential to facilitate understanding of such complex causal mechanism. The objective of this paper was to describe the role of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal. Method: The study was a qualitative study design guided by the Systemic Intervention methodology. The study involved key informant interviews (n=63) and focus group discussions (n-12) at different levels (policy, district and/or community) and was informed by the adapted Social Determinants of Health Framework . The data analysis involved case study based thematic analysis using framework approach and development of causal loop diagram. The study also involved three sense making sessions with key stakeholders. Results: Five key interacting themes emerged during the data analysis. Habit and misconception relating to alcohol and tobacco use contributed to the use and addiction of tobacco and alcohol. Low focus on prevention by health system further contributed to the problem. Decline in community capital and gendered social constructs influenced tobacco and alcohol use. Socio-economic status of families/communities was discussed as a potential root cause of use and addiction of tobacco and alcohol. These interacting themes were utilized to develop iterative causal loop diagrams showing the influence of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal. Conclusion: Tobacco and alcohol use and addiction causally linked broader social determinants (social, economic and political) to NCD in the context of Nepal. These CLDs showed how socio-economic circumstances was influencing addiction and availability of tobacco and alcohol products in Nepal. A multi-sectoral response led by health system is urgently needed.

scholarly journals The role of tobacco and alcohol use in the interaction of social determinants of non-communicable diseases in Nepal: a systems perspective

2020 ◽  
Author(s):  
Sudesh Raj Sharma ◽  
Anna Matheson ◽  
Danielle Lambrick ◽  
James Faulkner ◽  
David W Lounsbury ◽  
...  
Keyword(s):  
Data Analysis ◽  
Alcohol Use ◽  
Health System ◽  
Health Systems ◽  
Social Determinants ◽  
Economic Status ◽  
Non Communicable Diseases ◽  
Causal Loop ◽  
Socio Economic Status

Abstract Background: Tobacco and alcohol use are major behavioural risks in developing countries like Nepal, which are contributing to a rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health systems. The systems approach has potential to facilitate understanding of such complex causal mechanisms. The objective of this paper is to describe the role of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal. Method: The study was a qualitative study design guided by the Systemic Intervention methodology. The study involved key informant interviews (n=63) and focus group discussions (n=12) at different levels (policy, district and/or community) and was informed by the adapted Social Determinants of Health Framework . The data analysis involved case study-based thematic analysis using framework approach and development of causal loop diagrams. The study also involved three sense-making sessions with key stakeholders. Results: Three key interacting themes emerged during the data analysis. Widespread availability of tobacco and alcohol products contributed to the use and addiction of tobacco and alcohol. Low focus on prevention by health systems and policy influence of tobacco and alcohol companies were the major contributors to the problem. Gender and socio-economic status of families/communities were identified as key social determinants of tobacco and alcohol use. These interacting themes were utilised to develop causal loop diagrams and system archetypes. Conclusion: Tobacco and alcohol use facilitated interaction of the social determinants of NCDs in the context of Nepal. Socio-economic status of families was both driver and outcome of tobacco and alcohol use. Health system actions to prevent NCDs were delayed mainly due to lack of system insights and policy influence. A multi-sectoral response led by the health system is urgently needed.

scholarly journals The role of tobacco and alcohol use in the interaction of social determinants of non-communicable diseases in Nepal: a systems perspective

2020 ◽  
Author(s):  
Sudesh Raj Sharma ◽  
Anna Matheson ◽  
Danielle Lambrick ◽  
James Faulkner ◽  
David W Lounsbury ◽  
...  
Keyword(s):  
Data Analysis ◽  
Alcohol Use ◽  
Health System ◽  
Health Systems ◽  
Social Determinants ◽  
Economic Status ◽  
Non Communicable Diseases ◽  
Causal Loop ◽  
Socio Economic Status

Abstract Background: Tobacco and alcohol use are major behavioural risks in developing countries like Nepal, which are contributing to a rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health systems. The systems approach has potential to facilitate understanding of such complex causal mechanisms. The objective of this paper is to describe the role of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal. Method: The study adopted a qualitative study design guided by the Systemic Intervention methodology. The study involved key informant interviews (n=63) and focus group discussions (n=12) at different levels (national, district and/or community) and was informed by the adapted Social Determinants of Health Framework. The data analysis involved case study-based thematic analysis using framework approach and development of causal loop diagrams. The study also involved three sense-making sessions with key stakeholders. Results: Three key themes and causal loop diagrams emerged from the data analysis. Widespread availability of tobacco and alcohol products contributed to the use and addiction of tobacco and alcohol. Low focus on primary prevention by health systems and political influence of tobacco and alcohol industries were the major contributors to the problem. Gender and socio-economic status of families/communities were identified as key social determinants of tobacco and alcohol use. Conclusion: Tobacco and alcohol use facilitated interaction of the social determinants of NCDs in the context of Nepal. Socio-economic status of families was both driver and outcome of tobacco and alcohol use. Health system actions to prevent NCDs were delayed mainly due to lack of system insights and commercial influence. A multi-sectoral response led by the health system is urgently needed.

scholarly journals The role of tobacco and alcohol use in the interaction of social determinants of non-communicable diseases in Nepal: a systems perspective

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sudesh Raj Sharma ◽  
Anna Matheson ◽  
Danielle Lambrick ◽  
James Faulkner ◽  
David W. Lounsbury ◽  
...  
Keyword(s):  
Data Analysis ◽  
Alcohol Use ◽  
Health System ◽  
Health Systems ◽  
Social Determinants ◽  
Economic Status ◽  
Non Communicable Diseases ◽  
Causal Loop ◽  
Socio Economic Status

Abstract Background Tobacco and alcohol use are major behavioural risks in developing countries like Nepal, which are contributing to a rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health systems. The systems approach has potential to facilitate understanding of such complex causal mechanisms. The objective of this paper is to describe the role of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal. Method The study adopted a qualitative study design guided by the Systemic Intervention methodology. The study involved key informant interviews (n = 63) and focus group discussions (n = 12) at different levels (national, district and/or community) and was informed by the adapted Social Determinants of Health Framework. The data analysis involved case study-based thematic analysis using framework approach and development of causal loop diagrams. The study also involved three sense-making sessions with key stakeholders. Results Three key themes and causal loop diagrams emerged from the data analysis. Widespread availability of tobacco and alcohol products contributed to the use and addiction of tobacco and alcohol. Low focus on primary prevention by health systems and political influence of tobacco and alcohol industries were the major contributors to the problem. Gender and socio-economic status of families/communities were identified as key social determinants of tobacco and alcohol use. Conclusion Tobacco and alcohol use facilitated interaction of the social determinants of NCDs in the context of Nepal. Socio-economic status of families was both driver and outcome of tobacco and alcohol use. Health system actions to prevent NCDs were delayed mainly due to lack of system insights and commercial influence. A multi-sectoral response led by the health system is urgently needed.

scholarly journals The role of tobacco and alcohol use in the interaction of social determinants of non-communicable diseases in Nepal: a systems perspective

2020 ◽  
Author(s):  
Sudesh Raj Sharma ◽  
Anna Matheson ◽  
Danielle Lambrick ◽  
James Faulkner ◽  
David W Lounsbury ◽  
...  
Keyword(s):  
Data Analysis ◽  
Alcohol Use ◽  
Health System ◽  
Health Systems ◽  
Social Determinants ◽  
Economic Status ◽  
Non Communicable Diseases ◽  
Causal Loop ◽  
Socio Economic Status

Abstract Background: Tobacco and alcohol use are major behavioural risks in developing countries like Nepal, which are contributing to a rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health systems. The systems approach has potential to facilitate understanding of such complex causal mechanisms. The objective of this paper is to describe the role of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal. Method: The study adopted a qualitative study design guided by the Systemic Intervention methodology. The study involved key informant interviews (n=63) and focus group discussions (n=12) at different levels (national, district and/or community) and was informed by the adapted Social Determinants of Health Framework . The data analysis involved case study-based thematic analysis using framework approach and development of causal loop diagrams. The study also involved three sense-making sessions with key stakeholders. Results: Three key themes and causal loop diagrams emerged from the data analysis. Widespread availability of tobacco and alcohol products contributed to the use and addiction of tobacco and alcohol. Low focus on primary prevention by health systems and political influence of tobacco and alcohol industries were the major contributors to the problem. Gender and socio-economic status of families/communities were identified as key social determinants of tobacco and alcohol use. Conclusion: Tobacco and alcohol use facilitated interaction of the social determinants of NCDs in the context of Nepal. Socio-economic status of families was both driver and outcome of tobacco and alcohol use. Health system actions to prevent NCDs were delayed mainly due to lack of system insights and commercial influence. A multi-sectoral response led by the health system is urgently needed.

scholarly journals Dietary practices, physical activity and social determinants of non-communicable diseases in Nepal: a systemic analysis

2021 ◽  
Author(s):  
Sudesh R Sharma ◽  
Anna Matheson ◽  
Danielle Lambrick ◽  
James Faulkner ◽  
David W Lounsbury ◽  
...  
Keyword(s):  
Physical Activity ◽  
Health System ◽  
Social Determinants ◽  
Communicable Diseases ◽  
Junk Food ◽  
Dietary Practices ◽  
Dynamic Interactions ◽  
Non Communicable Diseases ◽  
Increased Risk ◽  
The Social

Background: The objective of this paper was to describe the role of dietary practices and physical activity in the interaction of the social determinants of non-communicable diseases (NCDs) in Nepal. Method: The study was a qualitative study design guided by systemic intervention methodology. Qualitative data were collected through key informant interviews (n=63) and focus group discussions (n= 12), and case study-based thematic analysis was carried out. Causal loop diagram was utilised to illustrate the dynamic interactions of the social determinants based on the themes. The study also involved sense-making sessions with policy level and local stakeholders. Findings: Four key interacting themes emerged from the study. Dietary and physical activity practices have shifted significantly at community level contributing to increased risk of NCDs. The practice of healthy and locally produced meals was gradually being displaced by junk food and linked to junk food availability and declining agricultural activities. Health system was ineffective in preventing unhealthy practices. Gender and social economic factors were driving the poor dietary practices and physical inactivity. Conclusion: While the current dietary and physical activity-related practices within communities were poor, the broader determinants such as socio-economic circumstances and gender further fuelled such practices. The health system has potential to play an effective role in the prevention of the behavioural and social determinants of NCDs.

scholarly journals Aiming for Health Equity: The role of Public Health Policy and Primary Healthcare Comment on "Universal Health Coverage for Non-Communicable Diseases and Health Equity: Lessons From Australian Primary Healthcare"

2021 ◽  
Author(s):  
Bo Burström
Keyword(s):  
Public Health ◽  
Social Determinants Of Health ◽  
Healthcare System ◽  
Health Equity ◽  
Social Determinants ◽  
Primary Healthcare ◽  
Communicable Diseases ◽  
Determinants Of Health ◽  
Non Communicable Diseases

This commentary refers to the article by Fisher et al on lessons from Australian primary healthcare (PHC), which highlights the role of PHC to reduce non-communicable diseases (NCDs) and promote health equity. This commentary discusses important elements and features when aiming for health equity, including going beyond the healthcare system and focusing on the social determinants of health in public health policies, in PHC and in the healthcare system as a whole, to reduce NCDs. A wider biopsychosocial view on health is needed, recognizing the importance of social determinants of health, and inequalities in health. Public funding and universal access to care are important prerequisites, but regulation is needed to ensure equitable access in practice. An example of a PHC reform in Sweden indicates that introducing market solutions in a publicly funded PHC system may not benefit those with greater needs and may reduce the impact of PHC on population health.

scholarly journals Prevalence of risk factors for non-communicable diseases in Aligarh: a community based study

2017 ◽  
Vol 4 (7) ◽  
pp. 2576
Author(s):  
Riyaz Ahmad S. ◽  
Mohd Haroon Khan ◽  
M. Athar Ansari
Keyword(s):  
Risk Factors ◽  
Alcohol Use ◽  
Urban Areas ◽  
Fruits And Vegetables ◽  
Uttar Pradesh ◽  
Communicable Diseases ◽  
Age Group ◽  
Community Based ◽  
Cross Sectional ◽  
Non Communicable Diseases

Background: Non-communicable diseases (NCD) are now recognized as major cause of morbidity and mortality. All countries, irrespective of their stage of economic development or demographic and epidemiological transition, face an increasing burden of non-communicable diseases (NCDs). The objective of the study was to estimate the prevalence of risk factors associated with non-communicable diseases.Methods: This is a community based cross sectional study conducted at field practice areas of the urban and rural health training centers, Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh. 640 study subject’s age group 18-65 years. Systematic random sampling and proportionate to population size method (PPS). SPSS version 13 and Chi-square was used to analyse the data.Results: The age group for the present study was chosen to be 18-65 years of age. The study population consisted of 340 females and 300 males. 27.1% belong to younger age group (18-25 years), whereas in urban areas majority (27.3%) belongs to 26-35 years age group. Also, the study group comprised of higher percentage of females (53%) compared to males (47%).129 (20.2%) subjects were found to be current smokers. Only 4 (1.3%) women were smokers. The prevalence of smokeless tobacco use which was found to be 21.6% (28.3% in males and 15.6% in females). The prevalence of current alcohol use in our study to be 10.3% in males and 0.6% in females. The overall prevalence of alcohol use was 5.2%. Alcohol use showed inverse relation with socioeconomic class, About 87% of the respondents did not have sufficient intake of fruits and vegetables. The physical inactivity during work was more in males (30.7%) compared to females (15.5%. Mean body weight, BMI and waist circumference showed significant changes with age in both sexes.Conclusions: It can be concluded from our study that the burden of risk factors for non-communicable diseases (NCDs) among the rural and urban areas of Aligarh is quite high.

scholarly journals Fairness evaluation of health financing between 2007 to 2010 in China

2020 ◽  
Author(s):  
Guan Wang ◽  
Qing Shen
Keyword(s):  
Health Behavior ◽  
Health System ◽  
Chronic Diseases ◽  
Chronic Conditions ◽  
Health Financing ◽  
The Elderly ◽  
Communicable Diseases ◽  
World Health ◽  
Health Conditions ◽  
Non Communicable Diseases

Abstract Background: Population aging and the increasing burden of non-communicable diseases (NCDs) are increasingly a strain on health systems. The World Health Organization (WHO) uses fairness of health financing as one of the criteria for assessing health system performance. The Chinese government has undertaken a series of health reforms to reduce the pace of disease transition towards non-communicable diseases, as well as protecting people from catastrophic health expenditures. The aim of this study was to assess the fairness of health financing among the elderly with different health conditions in China during the year of 2007 to 2010. Methods: The data source was the WHO Study on global AGEing and adult health (SAGE) Wave 1, a national weighted data collected from adults older than 50 years. In this study, 10099 respondents were included for analysis. Chi-square and partial proportional odds model test were applied to assess the distribution of socioeconomic and health behavior factors among different chronic conditions. Fairness of healthcare financing analysis was used to evaluate how the burden of health financing is distributed according to the household ability to pay (ATP). Dominance tests were applied for comparing different ways of health financing among health conditions. Results: More than half of the elderly had at least one chronic condition, and around 20% people suffered from multi-morbidity. Several socioeconomic as well as health behavior factors were found associated with developing NCDs. Out-of-pocket payment dominated other health finance sources in Non-NCD, single morbidity and multi-morbidity groups with a regressive pattern. Even though mandatory insurance had covered more than 70% of the elder population in China, due to the relative lower proportion reimbursement for chronic diseases, people still had to pay a lot for seeking healthcare between 2007 to 2010. Conclusion: When reimbursement for chronic diseases is relatively low, high mandatory insurance coverage does not ensure fairness of health financing. The Chinese health system should be developed further in order to meet the needs of elderly with different chronic conditions.

Sign in / Sign up

Export Citation Format

Share Document