Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada.
Public Health Medicine Unit, Ottawa Public Health, Ottawa, Canada.
Can J Public Health. 2019 Jun;110(3):285-293. doi: 10.17269/s41997-018-0168-9. Epub 2019 Jan 9.
Physical inactivity is an important behavioral risk factor for chronic disease in Canada. Individual-level strategies are used in clinical medicine to target individuals for preventive intervention based on one or more risk factors. In contrast, this study examines the impact of a population-level intervention: a municipal policy outside the healthcare sector that influences the built and social environment.
What is the preventive effect of a municipal transportation policy to increase active transportation on a chronic disease outcome measure-diabetes incidence-when it is viewed as a population-level health intervention to increase physical activity?
The impact of increases in active transportation for regular commuting to work in the city of Ottawa, Ontario was modeled to estimate number of diabetes cases prevented over 10 years. As a health-sector comparison, the reduction in incidence was equated to an individual-level approach to prevention targeting those who are inactive, meant to represent a clinical preventive intervention.
The population-level policy shift could prevent as many as 1620 incident cases of diabetes over 10 years, the largest number prevented by increases in public transit use. This population effect was equal to 17,300 inactive individuals or 12,300 inactive individuals > 45 years old undertaking a clinical preventive intervention to increase physical activity.
The results demonstrate why public health matters today as population-level interventions that exist as policies outside the healthcare sector, supported by public health, may have an unrecognized and therefore underappreciated impact on population health.
身体活动不足是加拿大慢性病的一个重要行为风险因素。在临床医学中，个体层面的策略被用于针对个体进行预防干预，依据是一个或多个风险因素。相比之下，本研究考察了人群层面干预措施的影响：一个医疗保健部门以外的市级政策，影响着建筑和社会环境。
当将增加身体活动视为一项增加人群健康的干预措施，来提高公共交通出行以增加体力活动时，市级交通政策对慢性病（糖尿病）发病率的预防效果如何？
对安大略省渥太华市增加日常上班的体力活动交通出行的影响进行建模，以估计 10 年内预防多少例糖尿病。作为卫生部门的比较，将发病率的降低等同于针对不活跃人群的个体层面预防方法，旨在代表临床预防干预。
这种人群层面的政策转变可能会在 10 年内预防多达 1620 例糖尿病新发病例，其中通过增加公共交通使用预防的病例最多。这种人群效应相当于 17300 名不活跃的个体，或 12300 名年龄超过 45 岁的不活跃个体接受临床预防干预来增加体力活动。
结果表明，为什么公共卫生在今天很重要，因为作为医疗保健部门以外的政策存在的人群层面干预措施，得到公共卫生的支持，可能对人群健康产生未被认识到的、因此被低估的影响。
