The Commonwealth Secretariat has produced the first of a series of advocacy DVDs on youth and Non-communicable Diseases (NCDs) ahead of September’s United Nations High Level Meeting on NCDs. The films aim to raise awareness about NCDs and young people across the Commonwealth and to advocate for an accelerated response by policy makers in preventing and controlling the rise of NCDs in this population group.

NCDs, which include diabetes, cardio-vascular disease, chronic respiratory diseases and cancers are largely preventable, since their main risk factors of tobacco use, unhealthy diets, harmful use of alcohol and physical inactivity can all be modified. Despite this, NCDs have reached epidemic proportions across the world.

“Childhood and adolescence are crucial stages in determining later life health outcomes. Today, children and young people are growing up in countries undergoing rapid economic, epidemiological, nutritional and demographic transitions. As a consequence, the prevalence of non-communicable diseases (NCDs) and their determinants are rising,” explained Dr Sylvia Anie, Director responsible for Health at the Commonwealth Secretariat.

“The links between NCDs and the most vulnerable in society, including the poor and the young, are striking and efforts to prevent NCDs within populations can be particularly effective if targeted towards youth,” she said.

The United Nations High-Level Meeting follows a global campaign championed by the Commonwealth and partner organisations to raise awareness about the “silent epidemic” of NCDs.

A ‘Commonwealth Statement on Action to Combat Non-Communicable Diseases’, which among other things also called for a UN summit, was adopted by Heads of Government in 2009. The statement led to the development of the Commonwealth Secretariat Road Map on Non-Communicable Diseases, which was accepted by ministers of health at the annual Commonwealth Health Ministers Meeting (CHMM) in Geneva, Switzerland, in 2010. This year’s CHMM, held in May, addressed the theme ‘NCDs – A Priority for the Commonwealth’.

The film, with technical input from the UK Young Professional Chronic Disease Network, features case studies from London, Nairobi and New Delhi, as well as messages from the Commonwealth Secretary-General, HE Kamalesh Sharma, and Sir George Alleyne, Director Emeritus of the Pan American Health Organisation, who has been a prominent figure in the global response to the NCD epidemic.

http://www.cnn.com/2011/WORLD/americas/01/04/mexico.obesity/index.html?hpt=Sbin

You can see the color here: http://www.therapycolor.com/BakerMillerPink/Baker-Miller-Pink.php

Could this kind of color theory be useful for designing obesity prevention and treatment strategies? I wonder, for example, what effect painting fast-food joint walls Baker-Miller Pink might have on people’s health?

The first discusses the partnership between UNICEF (the United Nations Children’s Fund), a well-known global advocate for children, and candy-maker Cadbury Adams Canada Inc., which has given UNICEF $500,000 over three years to build schools in Africa. In exchange, Cadbury is allowed to put the widely-recognized UNICEF logo on its candy bar packaging. Roger Collier’s commentary in Canadian Medical Association Journal (CMAJ) questions who – or what – benefits more from such a partnership: the recipients of UNICEF’s charity efforts – or Cadbury’s sales figures.

The second story was an article, “Malnutrition and the Role of the Soft Drink Industry in Improving Child Health in Sub-Saharan Africa”, that proposes fortifying soft drinks to address micro nutrient deficiencies in sub-Saharan Africa, and that resulted in a fiery chain of e-responses.

Of course micro nutrient deficiencies are important issues that certainly should be addressed. And the private sector undoubtedly has the potential to play a key role in helping to find a solution. But is fortifying sugar-sweetened beverages really the best way forward? For example, diabetes prevalence in Africa is projected to increase by 98% over the next 20 years – the largest increase for any region of the world during that time period. Promoting consumption of fortified sugary drinks – while potentially reducing micro nutrient deficiencies – would likely exacerbate this trend. The strategy seems very vertical, considering only one, albeit important, public health issue while largely ignoring another (not to mention dental caries as well). The authors do mention that healthier products should be the ones that are fortified, but I suspect that even those would be unnecessarily high in sugar (and diet versions of colas are not generally available in Africa). And even if they decided to fortify zero-calorie bottled water, is that really better than finding innovative ways to provide dark leafy greens or carrots (actual food) to the population, which contain the micro nutrients naturally and have many other nutritional benefits?

Why do Coca-Cola’s sugar-sweetened beverages need to be the vehicle for micronutrients? Why can’t they instead use their far-reaching supply chains and profits to bring nutrient-rich fruits and vegetables to communities that need them? If they really care about health, why can’t Coca-Cola begin to lobby for agriculture policies that promote investment in healthy crops instead of unhealthy ones – so that they may manufacture a greater number of healthier products and provide them at lower costs? Clearly these are much more complex questions to address, but I think they might lead to more sustainable change.

You can read the full story here.

In January 2009, I moved to Oxford, England to help start a similar community intervention project in Andover, England with Professor David Matthews and others at Oxford Centre for Diabetes, Endocrinology, and Metabolism (OCDEM) at Oxford University. During my time at Oxford, I also collaborated with David Stuckler on a comprehensive text about global chronic diseases, the first such text to cover a full range of perspectives – from epidemiology (what is a chronic disease?) to politics (how can we build a social movement to influence policy?). The result, Sick Societies: Responding to the Global Challenge of Chronic Disease, will be published by Oxford University Press in May 2011.

In late 2010 I moved back to the US. Currently, I am working towards my PhD in Nutrition and Health Sciences at Emory University in Atlanta. Settling back into the student life, I have found myself with a bit more “free time”, and thought it an apropos time to re-instate this blog. We’ll see how long I’m able to keep this up consistently again, but I will try to post regularly, even if just to share links to interesting and news-worthy bits of information.

Actually, a long, healthy life costs more

The sub-headline proclaims that “treating obesity and smoking is cheaper than keeping folks fit.” According to the article, a recent Dutch study found that thin, healthy adults cost the health system more because they live longer. I find myself baffled – did the authors not think to include lifetime earning capacity into the equation? Surely productivity of healthier individuals – which translates into profits – counters the “excessive” healthcare costs they rack up during their long lifetimes, as Bloom/Canning and others (and logic) have pointed out. And what about quality of life for healthy vs unhealthy individuals? Would it not have made more sense to compare ANNUAL healthcare costs, rather than lifetime healthcare costs? Or to compare these figures to lifetime earnings/productivity? What was the point of this study? Were the authors trying to prove that, contrary to popular belief, turning the entire population into obese smokers will make the world a better place and save governments and health systems millions?

Good grief.

The research and intervention programme will directly impact more than two million people across the four sites and is expected to affect more than 16 million people in surrounding areas through regional policy changes. It is the first time such comprehensive community-based interventions will be undertaken and then evaluated across a number of different countries.

Beginning in Spring 2008, the CIH programme will use proven, sustainable strategies, such as coalition-building and education to target schools, workplaces, health centers and community centres. The study will also employ economic and policy changes, including increased access to nutritional information and healthy food choices as well as physical activity to improve health and reduce chronic disease. It will focus on three areas: nutrition, physical activity and reduction in tobacco use.

Professor Stig Pramming, Executive Director of the Oxford Health Alliance, says, “Despite the fact that chronic diseases are by far the world’s biggest killers, they are largely overlooked by governments and donor institutions alike, which is why the CIH programme is long overdue. The real tragedy is that heart disease, diabetes, lung disease and many cancers are almost entirely preventable through lifestyle changes alone, yet they are currently pushing healthcare systems to the brink, not to mention the impact they’re having on national economies.

“In fact, the World Health Organisation predicts that in the next 10 years, China, India and the UK will lose $558 billion, $237 billion and $33 billion, respectively, in foregone national income due to heart disease, stroke and diabetes.”

In each of the four intervention communities, to be specified at a later date, a number of policy changes will be implemented including:

• Smoke-free hospitals with healthy food options;
• Incentives and training for providers to screen for and prevent chronic disease;
• Affordable healthy food and drink in cafeteria and vending machines;
• Advertisement-free schools;
• 30 minutes of physical activity a day, three times per week for students;
• Affordable and accessible fruit carts or farmers markets in the local community;
• Healthy food choices at local establishments and at events;
• Safe routes for walking and bicycling;
• Health risk assessments and smoking-cessation programmes at work;
• Incentives for employees to participate in on-site and off-site physical activity.

The CIH programme will evaluate the health impacts of these interventions on 5,000 people in each community (which will be compared to a similar community), thereby providing a best practice road-map, which can be replicated in other sites around the world.

For more information about the CIH programme, visit the Oxford Health Alliance website at www.oxha.org/initiatives/cih.