Gesundheitsförderung bei Kardiovaskulären Erkrankungen (German Edition)

Decisions on measures that counteract rising costs in health care need to be evidence-based to ensure the responsible use of limited resources. This is accomplished by health-economic analyses of the cost-effectiveness of a measure, since both costs and effects are considered. Physical inactivity is one of the most crucial, modifiable risk factors of morbidity and mortality, therefore physical activity promoting interventions for schoolchildren should be first priority. In fact,althoughmeasures to promote physical activity in children are widespread, economic evaluations of these interventions are still very rare.

This review articlepresents successful school-based interventions with proven cost-effectiveness.

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A practical and sensitive outcome measure for the determination of the effectiveness of a physical activity promoting intervention is the waist-to-height ratio WHtR , a measure of abdominal obesity. Even without considerable weight loss, the exercise-induced reduction of abdominal fat mass generates health benefits. For many years, economies in developed countries have been confronted with increasing costs in their health care systems.

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The total expenditure on health, as a percentage of gross domestic product, has almost doubled in the Federal Republic of Germany from 6. The latest numbers were 9. One of the main cost drivers are non-communicable diseases NCDs like cardiovascular disease, chronic respiratory disease, cancer, diabetes and mental illness. Health economy started looking at the expenditure side of health care measures years ago. The aim of this review article is to take a closer look at early preventive measures in terms of youth physical activity promotion to encounter the double burden of the continuing increase of NCDs and the parallel rise in health expenditures.

E-Health: Pädiatrische Adipositas-prävention unter Nutzung neuer Medien

Thereby the focus of this article is set on economic aspects of physical activity and promotion efforts for good reasons: Many preventive and health promoting interventions are financed, and take place outside of the health sector. Due to limited financial resources, it is important for stakeholders and decision makers to identify interventions that are not only effective but are also cost-effective.

Health economy will give support to decisions of resource use which aim to increase efficiency and welfare. The main reasons for the increase in health care expenditure can be summarised in three categories:. Technological Advances and New Pharmaceuticals New medical technology is a main driver of growth of health care expenditure.

Health economists complain about a considerable proportion of fake innovations 13 , referring to drugs that are very similar to drugs which already exist. Demographic Changes and Longevity In high-income countries like Germany, the age structure of the population has changed significantly during the last 50 years. The proportion of under years-olds in the entire population decreased from This trend is parallel to an increase in longevity.

The life expectancy of a newborn in was 65 years, in it is estimated to be 78 years, with a further upward trend Older persons need more health care in general, and more specialized services due to their more complex pathologies Epidemiological Changes and Changes in Lifestyle Some of the epidemiological changes are due to demographic transition. An aging population brings an increase in chronic diseases, multi- and co-morbidities, functional impairments, and psychiatric disorders of the elderly An increasingly unhealthy lifestyle has led to rising numbers of non-communicable diseases NCDs , mainly diabetes, cardiovascular diseases, cancers, chronic respiratory diseases, and mental illnesses.

NCDs pose an immense economic burden on health care systems and economies, and will rise to an estimated There is a strong contribution from physical inactivity; which is the fourth leading risk factor for mortality worldwide Other modifiable behavioral risk factors include an unhealthy diet and the harmful use of alcohol and tobacco. Reasons for the rise in NCDs are predominantly secular changes in lifestyle and environment. The composition of the human diet has changed considerably, with globalization and urbanization making energy-dense processed foods cheaply and readily available.

In Canada, for instance, the caloric share of processed food products rose from According to this plan, a vast body of knowledge and experience regarding the preventability of NCDs exists, and there are also immense opportunities to control them Shift these funds into successful programs.

[Cardiovascular Prevention: Acceptance of Enhanced Occupational Health Care].

To do so, policy makers need to receive information on both, the costs and the effectiveness of programs. Cost-effectiveness means a comparison of costs and benefits to analyze the economic efficiency of measures.

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The challenge is now to decide whether this number of costs per unit of health outcome reflects cost-effectiveness. Therefore, a threshold for cost-effectiveness is essential. The societal willingness to pay for specific improvements in health represents such a threshold.

Moreover, to make outcomes from different programs comparable across the boundaries of several disciplines or indications, a common measure for health outcomes is required. Both concepts facilitate the comparison of health outcomes across disciplines. The QALY is used in most economic evaluations, especially where cost-effectiveness is requested in decision-making processes According to this definition, an intervention is supposed to be cost-effective if the costs for one averted DALY is below three times GDP per capita Despite the growing number of lifestyle interventions with the promotion of physical activity in schools, the number of economic evaluations remains manageable.

Table 1 shows notable examples of economic evaluations of school-based programs from international literature. The depicted studies have been taken from a systematic review of programs encouraging physical activity in children and adolescents An Individual-Participant Data Meta-analysis.

Evidence of increased Stress Responses to increased Break Autonomy. A systematic review and meta-analysis. Wahrendorf M, Blane D Does labour market disadvantage help to explain why childhood circumstances are related to quality of life at older ages? Aging and Mental Health, doi: Bewertung durch Studierende des ersten Semesters. Effects of organisational-level interventions at work on employees' health: BMC Public Health A meta-analysis of health effects of randomized controlled worksite interventions: Does social stratification matter?

Neuroimaging and psychophysiological investigation of the link between anxiety, enhanced affective reactivity and interoception in people with joint hypermobility.

Frontiers in Psychology, doi: Wahrendorf M , Siegrist J Proximal and distal determinants of stressful work: BMC Public Health, Journal of Psychiatric Research. Wahrendorf M , Previous employment histories and quality of life in older ages: Ageing and Society, doi: Journal of Alzheimer's Disease. A Pooled Analysis of Men and Women. Diabetes Care , Results from a German feasibility study. European Journal of Public Health, Social Psychiatry and Psychiatric Epidemiology, Work, health, and welfare: International Journal of Health Services, The contribution of the psychosocial and physical work environment to health inequalities in Europe and the European health divide.

Individual-participant Metaanalysis of 95 Men and Women.

Gesundheit und Ökonomie – Warum wir körperliche Aktivität bei Kindern fördern sollten

New developments in Germany. Work-life bal-ance, health and wellbeing in European welfare states. European Journal of Public Health European Heart Journal 35 The Heinz Nixdorf Recall Study. European Journal of Preventive Cardiology, 21 9: International Journal of Behavioral Medicine 21 5 , —6. A Prospective Study in Junior Physicians. American Journal of Industrial Medicine, 56 Work Stress is associated with diabetes and prediabetes: International Journal of Behavioral Medicine, 20 4: International Journal of Health Services, 43 3: British Medical Journal, Ergebnisse der Heinz Nixdorf Recall Studie.

Gender specific lipid profile determinants of plaque burden on behalf of the Heinz Nixdorf Recall Study Investigators. Current Opinion in Cardiology; PLoS One; 8 8: Hoven H , Siegrist J Work characteristics, socioeconomic position and health: American Journal of Public Health, Batty D Association of job strain and lifestyle factors with the risk of coronary artery disease: Canadian Medical Association Journal, 9: Findings from an individual-participant Meta-analysis of over working Adults.

American Journal of Public Health European Journal of Preventive Cardiology, doi Journal of the American Society of Echocardiograph, Advances in Life Course Research, Journal of the American College of Cardiology, Physical occupational exposures during working life and quality of life after labour market exit: European Journal for Epidemiology, Reinhardt JD, Wahrendorf M , Siegrist J Socioeconomic position, psychosocial work environment and disability in an ageing workforce: Siegrist J Effort-reward imbalance at work and depression: Do effects differ by occupational grade?

European Sociological Review, 29 4 , Relationships of disability with age among adults aged 50 to PLoS One, 8 8 , e Sperlich S, Arnhold-Kerri S, Siegrist J , Geyer S The mismatch between high effort and low reward in household and family work predicts impaired health among mothers. Life course influences on quality of life at age 50 years: Longitudinal and Life Course Studies, 3 3: American Journal of Epidemiology, Public Health Forum, Journal of Internal Medicine, American Journal of Public Health. Hoffmann B, Dragano N , Schweitzer-Krantz S Living situation, occupation and health-related quality of life in adult patients with classic Galactosemia.

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, Journal of Occupational Health, Siegrist J The changing role of physicians. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, 55 9: Results from a population-based study. Results from a population-based study using residential histories. Globalization and Health, 8: A study with older employees from 11 European countries.

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Patient Education and Counseling, The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, Li J, Siegrist J Physical activity and risk of cardiovascular disease--a meta-analysis of prospective cohort studies. The effort-reward imbalance questionnaire in Greek: Journal of Occupational Health, 54 2: American Journal of Industrial Medicine, International Archives of Occupational and Environmental Health, PLoS One; 7 6: Siegrist J A theoretical model in the context of economic globalization.

Siegrist J, Wahrendorf M Eds. Work Stress and Health in a Globalized Economy. The Model of Effort-Reward Imbalance. Springer International Publishing, Cham, p.

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Siegrist J , Wahrendorf M Eds. Wahrendorf M , Chandola T A life course perspective on work stress and health. Springer International Publishing , Cham, p.