Pillar 5 Risk avoidance or mitigation

Risk mitigation, in terms of health, refers to the avoidance or reduction of behaviours that directly increase the risk of disease or death. Broadly, risk mitigation involves activities such as:

  • Making sure you are vaccinated
  • Not smoking or quitting smoking
  • Practicing safe sex
  • Drinking in moderation
  • Protecting yourself from the sun
  • Driving carefully and wearing a seat belt
  • Wearing your helmet when you ride a bicycle

Pillar 5 includes the steps that individuals can take to reduce their own personal risk of avoidable morbidity and mortality.

  • Avoiding risk is important because…

Avoiding high-risk behaviours, particularly tobacco smoking and alcohol intake, have been shown to significantly reduce preventable mortality and reduce all-cause mortality. In several studies, all-cause mortality has been shown to be delayed by between 8 – 12 years in large cohorts of older people when they reduce risky behaviours (Elwood et al, 2013). It is likely that these benefits would be greater when risk avoidance is started from a younger age.

Behaviours that reduce health risks are often some of the most achievable self-care practices. While quitting smoking is difficult, the benefit is significant, immediate and there are a range of options to aid people. Applying sunscreen products when outdoors is simple, cost-effective and has a tangible, immediate benefit in that it prevents painful sunburn. The same applies to safe sex, driving safely, drinking in moderation and many other risk-reducing behaviours. Vaccination, while extremely important, obviously has less immediate and apparent personal benefits. But when it is effective at a population level, the diseases that we vaccinate against no longer circulate, reducing risk to all.

  • Risky behaviour is the cause of…

High-risk behaviours are a significant cause of morbidity and mortality. In contrast to other aspects of self-care, such as maintaining a healthy diet, high-risk behaviours have the added detriment in that they often pose a risk to other individuals who have not engaged in that behaviour, such as second-hand smoke inhalation or exposure to dangerous driving.

Combined, high-risk behaviours cause a large percentage of deaths world-wide. Smoking causes 15% of deaths in men worldwide and 7% in women. Of the five million smoking-related deaths each year, approximately 10% occur in non-smokers due to second-hand smoke inhalation. Alcohol, in turn, causes 5.9% of all deaths worldwide. The prevalence of HIV/AIDS in sub-Saharan Africa ranges between 11 – 26%, largely due to unsafe sexual practices (World Bank, Risking your Health: Causes, Consequences and Interventions to Prevent Risky Behaviors, 2013).

Higher risk behaviours have a significant cost to societies and nations, as well as to the individuals who engage in these behaviours. Health budgets are consumed by these behaviours, and reduced employment, productivity and long-term social consequences, particularly among children, are all well documented as a result of risky behaviour.

  • WHO recommendations for avoiding risk…

Health risk mitigation has been a focus of the World Health Organisation since its inception.

Generally, WHO approaches each high-risk behaviour separately.

WHO considers tobacco to be “one of the biggest public health threats the world has ever faced”. The 2005 document, WHO Framework Convention on Tobacco Control, outlines the Organisation’s recommendations for the control of tobacco, and recommends monitoring tobacco use, warning about the dangers of tobacco, aiding quit attempts, increasing taxation and enforcing existing laws on tobacco marketing. At an individual level, the WHO has a zero tolerance approach to tobacco use; encouraging quitting, with the help of support programmes and pharmaceutical products as helpful, for everybody.

WHO states that the harmful use of alcohol “causes a large disease, social and economic burden in societies”. Harm from alcohol-use is determined by two factors; the volume consumed and the pattern of consumption. By seeking help from health professionals, being aware of your own drinking habits (performing a self-audit) and being honest about any problems that drinking alcohol is causing, the likelihood of harm can be substantially reduced. The “safe” use of alcohol is controversial, but it is generally recommended that less than 150- 200 g of pure alcohol are consumed per week (although this varies between countries).

The WHO document “Global strategy for the prevention and control of sexually transmitted infections” outlines their recommendations for practicing safe sex. There are more than 340 million new cases of treatable sexually transmitted infection each year worldwide; the vast majority of which would be prevented by use of latex condoms and other simple safe sexual practices, such as timely treatment of existing STIs and increased sexual education.

The WHO’s Strategic Advisor Group of Experts (SAGE) on Immunisation states that “Immunization is a proven tool for controlling and eliminating life-threatening infectious diseases and is estimated to avert between 2 and 3 million deaths each year. It is one of the most cost-effective health investments, with proven strategies that make it accessible to even the most hard-to-reach and vulnerable populations.” Stay up-to-date with vaccinations, and know at when new vaccinations or booster doses are required.

The WHO also has recommendations on limiting exposure to sunlight. Overexposure to sunlight is widely accepted as the underlying cause for harmful effects on the skin, eye and immune system, and is the primary cause of skin cancer. Four out of five cases of skin cancer could be prevented by avoiding UV damage. The WHO recommends avoiding midday sun, monitoring of local UV indexes, use shade, wear protective clothing, apply sunscreen and avoid tanning salons and sunlamps.

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