Health Determinants and The Lalonde Report

The Lalonde Report (1974)

• Published by Marc Lalonde, Canada's Minister of National Health and Welfare
• Transformed the way the world thinks about health, emphasizing factors beyond medical care
• Remains a foundational document in the field of health promotion
• Key Insight: Health is influenced by both internal and external factors. Lifestyle choices and environmental factors play significant roles in determining health.

Determinants of Health (World Health Organization)

• Physical Determinants of Health: Health is affected by factors such as where people live, quality of their environment, genetics, income, education level, and relationships with friends and family.
• Determinants are often categorized into social, economic, environmental, and behavioral factors.

Life Expectancy and Wealth (Preston Curves)

• The Preston Curve shows the relationship between wealth (GDP per capita) and life expectancy
• As wealth increases, life expectancy tends to increase, but the effect diminishes at higher levels of wealth.
• Economic conditions play a significant role in improving health and longevity

Built Environment and Community Health

• Built Environment: Physical surroundings such as buildings, parks, and transportation systems.
• It significantly influences physical activity and, thereby, public health.
• York University is an example of how institutions can create a supportive built environment to promote health and well-being.
• Role of Communities: Communities are crucial in promoting and sustaining physical activity by providing safe spaces like parks and gyms for people to engage in healthy behaviors.

Importance of Pulmonary Volume Measures

• They help evaluate lung health and capacity, which is crucial for assessing exercise performance and diagnosing chronic respiratory diseases such as bronchitis, asthma, COPD, and emphysema.
• Key Pulmonary Volume Measures: Total Lung Capacity (TLC), Vital Capacity (VC), Tidal Volume (TV), Inspiratory Reserve Volume (IRV), Expiratory Reserve Volume (ERV), and Residual Volume (RV).
• Factors Affecting Pulmonary Volumes: Body Size, Sex, Fitness Level, Function of Ventilatory Muscles, Airway Obstructions/Restrictions.

Main Types of Respiratory Diseases

• Pulmonary Circulation Diseases: Issues with blood flow between the heart and lungs, such as pulmonary embolism.
• Restrictive Lung Diseases: Conditions that limit lung expansion, affecting lung structure and making it difficult to take a deep breath. Examples include Pulmonary fibrosis, sarcoidosis, and severe obesity. Effects include increased work of breathing, increased oxygen demand, reduced tidal volumes, and shallow breathing. Fibrosis also impairs gas transfer at the alveolar-capillary surface.
• Obstructive Airway Diseases: Conditions where airway obstruction makes it hard to exhale all the air in the lungs. Examples include Asthma, chronic bronchitis, and emphysema.

Pulmonary Embolism (PE)

• Occurs when a blood clot (often originating from a deep vein thrombosis, DVT) travels to the pulmonary arteries, blocking blood flow in the lungs.
• Risk Factors: Cancer, injury, or surgery that leads to prolonged immobility. Deep Vein Thrombosis (DVT): Clots usually develop in the lower extremities and can travel to the lungs.
• Symptoms: Sudden shortness of breath, Chest pain that worsens with breathing or coughing, Cough (sometimes with blood), Rapid pulse and lightheadedness.
• Treatment: Anticoagulants (blood thinners) to prevent clot growth, Oxygen therapy to alleviate respiratory symptoms, Surgical removal or filtering of clots in severe cases.

Restrictive Lung Diseases

• Pulmonary Fibrosis: A chronic disease characterized by scarring and thickening of lung tissue, making it stiffer and harder to expand. Causes include infections, environmental agents like asbestos, and chronic inflammation. Symptoms include increased work of breathing, reduced tidal volume, increased lung oxygen demand, and impaired gas exchange. There is no cure, but treatments focus on managing symptoms. Options include medications to reduce inflammation and in some cases, lung transplantation.

Asthma

• Definition: A chronic condition in which the airways become inflamed and narrowed, making breathing difficult.
• Cause and Risk Factors: Triggered by environmental factors (e.g., cold weather, chemicals, pollen), Family history and other respiratory infections can also increase risk, Allergies, obesity, and exposure to irritants like tobacco smoke are common risk factors.
• Physiological Changes: Inflammation of the airways, increased mucus production, and bronchospasm (constriction of the smooth muscle surrounding the airways).
• Symptoms: Wheezing, breathlessness, tight chest, and coughing. Emergency Symptoms: Bluish lips, severe anxiety, rapid pulse, and extreme difficulty breathing.
• Treatment: Preventers: Inhaled corticosteroids to reduce inflammation, Controllers: Long-acting anti-inflammatory medications, Relievers: Quick-acting bronchodilators for immediate symptom relief.
• Physical Activity: Individuals with asthma may avoid physical activity due to symptoms, but regular aerobic exercise improves lung function and reduces symptom severity.

High Intensity Interval Training (HIIT)

• A method of training that alternates between short periods of intense exercise and periods of recovery.
• Shorter Duration Approaches (Tabata Protocol): Four minutes with 20 seconds of high-intensity exercise followed by 10 seconds of rest.
• Longer Duration Approaches: The 4X4 Approach involves 4 bouts of 4 minutes at high intensity (85-95% HRmax). Each bout is followed by 3 minutes of rest. Total high-intensity time is 16 minutes; total workout time is about 25 minutes.
• Benefits of HIIT: Enjoyment and the intensity achieved, Health and fitness outcomes, such as increased cardiorespiratory fitness (CRF) and improved anaerobic thresholds. It is well-tolerated by many individuals and is time efficient.
• Negatives of HIIT: Increased adverse event risk, High perceived intensity and difficulty may discourage some participants, HIIT is more labor-intensive due to the need for intensity monitoring and precise timing.

Components of a Training Program

• Warm-Up: Prepares the body for exercise by increasing temperature and blood flow to the muscles.
• Aerobic Exercise: Activities that increase heart rate and improve cardiovascular fitness.
• Resistance/Strength Training: Exercises aimed at improving muscular strength and endurance.
• Flexibility: Stretching exercises to enhance the range of motion.
• Cool-Down: Gradually returns the body to resting state and prevents injury.

ACSM Guidelines for Resistance Training

• Frequency: Each major muscle group should be worked 2-3 times per week.
• Intensity: 60-70% 1RM for novice and intermediate exercisers, >80% 1RM for advanced strength trainers, 40-50% 1RM for elderly or previously sedentary individuals.
• Type: Exercises should target major muscle groups and can include a variety of equipment, including body weight, isometric, and isotonic exercises.
• Volume (Sets/Reps): 8-20 reps, depending on training goals and fitness level, 2-4 sets; ≤2 sets for novice or elderly individuals. Rest Periods: 1-3 minutes between sets; at least 48 hours between training the same muscle group.

Determining Resistance Intensity: One Repetition Maximum (1RM)

• 1RM Calculation: 1RM represents the maximum weight a person can lift for one repetition of a given exercise. To determine 1RM: Use the formula: 1RM = Weight Lifted / (%1RM value from table / 100).

Fitness Testing

• Muscular Fitness: Tests include grip strength, push-pull exercises, sit and reach, push-ups, curl-ups, vertical jump, bench press, and others.
• Anaerobic Fitness: Evaluated using the Wingate Test.
• Aerobic Fitness: Assessed via a VO₂max test. Interview: Includes a personal interview to assess various aspects of the athlete beyond physical capabilities.

Bona Fide Occupational Requirement (BFOR)

       - Definition: A qualification or requirement that is essential for carrying out a specific job, particularly in physically demanding occupations.
       - BFORs may include specific fitness standards that must be met to ensure that the employee can safely and effectively perform the duties of their job.
       - Key Considerations for BFORs: Applicable to any physically demanding occupations where failure to perform the job effectively could result in the loss of life or property. Employers must demonstrate that the fitness standards are necessary for the job's purpose and that it would be impossible to accommodate the worker without undue hardship.

The Meiorin Decision (1999, Supreme Court of Canada)

• Case Overview: Tawney Meiorin was dismissed from her firefighter job for failing a minimum fitness standard (a running test). Ms. Meiorin argued that the aerobic standard discriminated against women under the Canadian Charter of Rights and Freedoms.
• The Supreme Court of Canada established a three-part test to determine if a BFOR is justified :
  • the standard is rationally connected to the job requirements;
  • the standard is adopted in good faith to achieve its purpose;
  • it cannot be imposed without undue hardship.
• Key Outcome: The Meiorin decision established the principle that employers must accommodate employees to the point of undue hardship. It shifted the burden of proof onto employers to justify their BFORs and demonstrated that a fitness standard is discriminatory if it does not meet the three-part test.

Explore the transformative insights of The Lalonde Report and its impact on global health perspectives. This quiz delves into the various determinants of health identified by the World Health Organization and examines the relationship between wealth and life expectancy through the Preston Curve.