La superestructura de los diccionarios bilingües: información sobre las UFS

‘Chronic disease’ is a term that refers to a range of illnesses that are of long duration and usually slow progression (World Health Organization, 2011b). More recently the term ‘non-communicable disease’ (NCD) is being widely used, particularly by the World Health Organization (WHO), to describe a range of diseases such as cardiovascular disease, diabetes, cancers and respiratory diseases. In Australia, the term ‘chronic disease’ is still widely used and understood, so this term is used interchangeably with NCD throughout this thesis.

Chronic diseases including cardiovascular disease, cancers, respiratory diseases and type 2 diabetes are the leading causes of death and disability worldwide (Lozano et al., 2012; World Health Organization, 2011b). Chronic diseases are largely preventable and are related to a range of health risk factors such as overweight and obesity, physical inactivity, unhealthy diet, tobacco smoking and harmful use of

alcohol (Lim et al., 2012; World Health Organization, 2009). The WHO argues that urgent action is required to address the increasing burden that NCD’s pose to health and wellbeing not only in resource rich countries such as Australia, but also in low and middle income countries where they pose a serious and growing problem (World Health Organization, 2008b, 2013). To illustrate the extent of the problem, WHO estimates that of 57 million global deaths in 2008, 63% (36 million) were caused by non-communicable diseases (2011b), principally cardiovascular diseases, diabetes, cancer and chronic respiratory diseases. As populations age and NCD’s increase worldwide, annual deaths from NCD’s are also expected to increase (World Health Organization, 2011b).

By global standards, Australia is considered a high income country with a relatively small population of approximately 23, 050, 000 people, where 89.2% of the population live in urban areas (World Health Organization, 2014b). In Australia, chronic diseases are estimated to account for 91% of total deaths (147,000) where the probability of dying between the age of 30 and 70 years from the four main chronic diseases is 9%.

While age standardised death rates from NCD’s for Australian males and females has decreased in recent times (See Figure 2.1), largely due to improved detection and treatment of cardiovascular disease and cancer in particular, morbidity has increased with people living longer following diagnosis and treatment (World Health Organization, 2011b).

Figure 2.1. Australian Age Standardised Death Rates from Non-communicable Diseases

(World Health Organization, 2014b)

The most recent WHO Global Action Plan for the Prevention and Control of Non-communicable Diseases (2013) emphasises six objectives, including:

1. To raise the priority accorded to prevention and control in global, regional and national agendas;

2. To strengthen national capacity for the prevention and control of NCD’s;

3. To reduce modifiable risk factors and underlying social determinants through creation of health promoting environments;

4. To strengthen and orient health systems to address the prevention and control of NCD’s;

5. To promote and support national capacity for high quality research and development for the prevention and control of NCD’s, and;

6. To monitor the trends and determinants of NCD’s and evaluate progress in their prevention and control.

Further, the WHO Action Plan (World Health Organization, 2013) describes nine voluntary global targets to address the growing burden of non-communicable diseases, including:

 A 25% relative reduction in risk of premature mortality from

cardiovascular diseases, cancer diabetes, or chronic respiratory disease;

 At least 10% relative reduction in the harmful use of alcohol;

 A 10% relative reduction in prevalence of insufficient physical activity;

 A 30% relative reduction in mean population intake of salt/sodium;

 A 30% relative reduction in prevalence of current tobacco use in

persons aged 15+ years;

 A 25% relative reduction in the prevalence of raised blood pressure;

 Halt the rise in diabetes and obesity;

 At least 50% of eligible people receive drug therapy and counselling to

prevent heart attacks and strokes;

 An 80% availability of affordable basic technologies and essential

medicines to treat major non-communicable diseases.

When examining these objectives and targets it is clear that prevention is emphasised as much as control. With reduction of modifiable risk factors being an

essential component of prevention strategies and actions targeting non-communicable diseases.

At a national level in Australia, a National Preventive Health Strategy was launched in 2009 by the Federal Government with an emphasis on the burden of disease caused by obesity, tobacco and harmful alcohol consumption (Australian Government Department of Health and Ageing, 2009). The Australian Institute of Health and Welfare in their recent report Australia’s Health 2014 (2014) emphasise that chronic disease is a major problem that not only has personal and social costs, but also results in a large economic burden due to the combined effects of health care costs and lost productivity from illness and death.

The National Women’s Health Policy 2010 (Australian Government Department of Health and Ageing, 2010) emphasises five priority health issues to improve the health and wellbeing of Australian women in the coming decades. These include: the prevention of chronic diseases through the control of risk factors; mental health and wellbeing; sexual and reproductive health, and; healthy ageing. In relation to the prevention of chronic disease, the policy targets cardiovascular disease, cancer and diabetes and risk factors such as nutrition, physical inactivity, alcohol and tobacco consumption and obesity. The policy also emphasises the need for better understanding of the context of women’s lives “including the barriers that prevent women taking up healthier lifestyle behaviours” (Australian Government Department of Health and Ageing, 2010, p. 8).

In the following section, the impact of the leading chronic diseases that affect Australian women, including cardiovascular disease, cancers, chronic respiratory disease and type 2 diabetes, are discussed in more detail.