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The term chronic disease applies to a group of diseases that tend to be long lasting and have persistent effects. This is opposed to acute diseases, which have a quick onset and are often brief, intense and/or severe.
Many factors influence how healthy we are. Some of these function on an individual level, for example, health behaviours or genetic make-up, while others function at a broader societal level, such as the availability of health services, vaccination programs or a clean and healthy environment. All these influencing factors are known collectively as determinants of health.
Figure 1 presents a conceptual framework of the pathways involved in the health and functioning of individuals and the population.
Source: AIHW 2012. Risk factors contributing to chronic disease. Cat. no. PHE 157.
Health determinants can influence our health in either a positive or negative way. Determinants affecting health in a negative way are commonly referred to as risk factors. They can increase the likelihood of developing a chronic disease, or interfere in the management of existing conditions.
The relationship between selected chronic diseases and their known behavioural and biomedical risk factors is shown in Table 1. Behavioural risk factors are risk factors that individuals have the most ability to modify, such as diet, tobacco smoking and drinking alcohol. Biomedical risk factors are bodily states that carry relatively direct and specific risks for health—such as overweight and obesity and high blood pressure—and are often influenced by health behaviours.
Many chronic diseases share behavioural and biomedical risk factors that are largely preventable. Modifying these risk factors can reduce an individual's risk of developing a chronic disease and result in large health gains by reducing illness and rates of death.
Table 1 reveals that tobacco smoking, obesity and excessive alcohol consumption increase the likelihood of developing numerous chronic diseases. Insufficient physical activity, dietary risks, high blood pressure and abnormal blood lipids are also key risk factors for chronic disease development.
Table 1 highlights individual risk factors where there is strong evidence of a direct association to a chronic disease.
There are numerous risk factors where the evidence is suggestive of an effect on chronic disease but the evidence is not as strong. These have not been included in Table 1.
Some risk factors have an indirect association to a chronic disease, either through influence on other risk factors or other chronic diseases and these also have not been included in Table 1.
Table 1 shows direct associations between risk factors and chronic disease. It does not show associations that may exist between some behavioural risk factors and biomedical risk factors. For example, while poor diet and insufficient physical activity are frequently associated with obesity, high blood pressure and abnormal blood lipids (dyslipidaemia), they may not be recorded in Table 1 unless there is strong evidence of a direct association. Likewise, chronic diseases can in themselves be risk factors for other chronic diseases; for example, cardiovascular disease is a risk factor for type 2 diabetes and chronic kidney disease but they are not recorded in Table 1 as this analysis focuses on biomedical and behavioural risk factors only.
In treating or preventing chronic diseases, it is often important to target associated behavioural risk factors to limit the diseases' development or progression.
• = Strong evidence in support of a direct association between the chronic disease and risk factor.
— = There is either not a direct association or the evidence for a direct association is not strong.
CVD = cardiovascular disease. CKD = chronic kidney disease. COPD = chronic obstructive pulmonary disease.
Cardiovascular disease (CVD)
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US Department of Health and Human Services 2014. The health consequences of smoking: 50 years of progress. A report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, National Centre for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health.
WHO 2004. The atlas of heart disease and stroke, Mackay J and Mensah G, Editors. Geneva: World Health Organization.
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WHO 2003. Diet, nutrition and the prevention of chronic diseases: report of a joint WHO/FAO expert consultation. Geneva: World Health Organization.
Type 2 diabetes
Steyn NP, Mann J, Bennett PH, Temple N, Zimmet P, Tuomilehto J et al. 2004. Diet, nutrition and the prevention of type 2 diabetes. Public Health Nutr 7:147-65.
Chronic kidney disease (CKD)
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Hallan S & Orth SR 2011. Smoking is a risk factor in the progression to kidney failure. Kidney Int 80:516-23.
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Arthritis Australia 2014. Time to move: Rheumatoid arthritis. A national strategy to reduce a costly burden. Broadway, NSW: Arthritis Australia.
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IARC 2012. Personal habits and indoor combustions. Volume 100E. IRAC monographs on the evaluation of carcinogenic risks to humans. Lyon: International Agency for Research on Cancer.
NHMRC 2013. Australian dietary guidelines. Canberra: National Health and Medical Research Council.
US Department of Health and Human Services 2014. The health consequences of smoking: 50 years of progress. A report of the Surgeon General, US Department of Health and Human Services, National Centre for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health: Atlanta, GA.
WCRF & AICR 2011. Continuous update project report. Food, nutrition, physical activity, and the prevention of colorectal cancer. Washington DC: World Cancer Research Fund & American Institute for Cancer Research.
Breast cancer (female)
WCRF & AICR 2010. Continuous update project. Food, nutrition, physical activity, and the prevention of breast cancer. Washington DC: World Cancer Research Fund & American Institute for Cancer Research.
IARC 2007. IARC monographs on the evaluation of carcinogenic risks to humans, Volume 90, Human papillomavirus. Lyon: International Agency for Research on Cancer.
IARC 2012. Personal habits and indoor combustions. Volume 100E. IRAC monographs on the evaluation of carcinogenic risks to humans. Lyon: Internation Agency for Research on Cancer.
WHO 2008. World Cancer Report 2008. Lyon: International Agency for Research on Cancer.
Faith M, Butryn M, Wadden T, Fabricatore A, Nguyen A & Heymsfield S 2011. Evidence for prospective associations among depression and obesity in population-based studies. Obes Rev 12:e438-53.
Luppino F, de Wit L, Bouvy P, Stijnen T, Cuijpers P, Penninx B et al. 2010. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry 67:220-9.
Sanders R, Han A, Baker J & Cobley S 2015. Childhood obesity and its physical and psychological co-morbidities: a systematic review of Australian children and adolescents. Eur J Pediatr 174(6):715-46.
WHO 2015. Guideline: Sugars intake for adults and children. Geneva: World Health Organization.