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A Prism on the Future2nd Saudi Commission for Health

Specialties Conference

Riyadh 2015

Zubair Amin Dept of Paediatrics,

National University of Singapore

What we know will be different in the Future

• Changing demographics • Changing practice pattern • Information acquisition to knowledge navigation• Population-based thinking • Prevention/wellness and health• Fusion of learning and work

Health is an Entity

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

World Health Organization (WHO), 1948

The definition remain unchanged since 1948.

http://www.indexmundi.com/

New Morbidities

• Mental health

• Developmental disorders

• Childhood obesity

• Trauma and accidents

• …….

WHO. Years Loss to Disability. Eastern Mediterranean Region

2012Rank Cause YLD (000s) % YLD YLD per 100,000

population0 All Causes 63,582 100.0 103831 Unipolar depressive disorders 8,819 13.9 14402 Iron-deficiency anaemia 5,090 8.0 8313 Back and neck pain 4,192 6.6 6844 Anxiety disorders 3,247 5.1 530

5Chronic obstructive pulmonary disease

2,507 3.9 409

6 Diabetes mellitus 2,369 3.7 3877 Migraine 1,474 2.3 2418 Asthma 1,439 2.3 2359 Refractive errors 1,408 2.2 230

10 Skin diseases 1,365 2.2 223

Mental Health among Pediatric Population in Saudi Arabia

• Secondary school children in Taif (Abdel-Fattah& Asal 2007)– 33%: moderate to severe depression– 11%: severe to very severe depression range

• High School students (boys) from Abha (Al-Gelban 2006)– 59%: significant level of either depression, stress, or anxiety

• High School students (girls) from Abha (Al-Gelban 2009)– Phobic anxiety: 16%– Psychoticism: 15%– Anxiety: 14%– Somatization: 14%– Depression: 14%

Yong Loo Lin School of Medicine

Mental Health

• Half of all the lifetime cases of mental illness begin by the age of 14 years; – Mental disorder is a chronic disease of the young

• Mental disorders are equally distressing for the individual and families

• Mental health is seldom a part of pediatric curriculum

(www.brigthfuture.org)

Yong Loo Lin School of Medicine

CONFIDENTIAL

Childhood Obesity: Need for Different Approach

Comorbidities in Childhood Obesity

• Psychological impact– Bullying, low self-esteem, Depression Headache

• OSA or obstructive sleep disordered breathing• Chronic cough, nocturnal cough, asthma• GERD• Constipation • Bone and joint pain (e.g., SCFE) • Insulin resistance, type 2 DM and metabolic

syndrome• Fatty liver• Acne

Radical Reorientation of Pediatric Curriculum

• Balanced representation of health and disease

• Health promotion and disease prevention

• Fusing clinical science and education

Balance between Health and Disease

• Medical curriculum (UG and PG) is heavily disease focused

• Health and disease is not a dichotomous entity

• Health and disease exist in a continuum

• Health should be an essential element in the curriculum

Health Promotion and Disease Prevention

•Many chronic diseases originate in childhood

•Could be equally severe– Childhood depression is equally dangerous and distressing to

family

•Too late to start when the disease is firmly in place

Health Promotion and Disease Prevention

• Nutrition• Life-style• Accidents and trauma• Mental health• Adolescent health care

• Blueprinting the curriculum• Blueprinting the assessment

Green et al. The Ecology of Medical Care Revisited: NEJM. 2001. 344(26): 2021-5.