Preventing Non-Communicable Diseases in Youth

The main determinants of NCDs

Social and Economic drivers of NCDs:

• Demographic changes
• Urbanization and social mobility
• Inequality
• Consumption-driven economies

Cultural drivers of NCDs:

• Social, cultural and behavioral norms
• Health beliefs and behaviors
• Global food trends
• Gender inequality

Environmental drivers of NCDs:

• Physical environment
• Infrastructure
• Pollution of air, soil and water

Preventing Non-Communicable Diseases in Youth

Non-Communicable Diseases (NCDs) cover large disease groups as:

• Cardiovascular diseases
• Diabetes
• Chronic respiratory diseases
• Cancer

NCDs represent 43% of the global burden of disease

80% of NCD deaths occur in LMICs representing 50% of total premature mortality (below 60 years of age)

NCDs are characterized by being:

• Multifactorial
• Chronic
• Early-onset

NCDs cause a great burden on the quality of life.

1.5 billion DALYs are lost every year - 45% is due to NCDs

82% out of 5.7 million live in urban areas

40% of the population is between 12-30y

NCDs cause almost 50% of the disease burden in the region

The leading risk factors are:

• High BMI (36% obese)
• 50% are physical inactive
• 50% of men are smoking
• Mental distress (10%)

50% of 98 million live in urban areas

NCDs cause more than 60% of the disease burden

90% of the population is exposed to min. one NCD risk factor

Jordan's Youth Policies:

NCD risk factors in youth:

• 4% overweight
• 84% physical inactive
• 16% smoking
• 75% passive smoking
• 18% mental distress

The leading risk factors are:

• Physical inactivity, 60%
• Smoking, 35%
• Hypertension, 22%
• Overweight, 20%
• Obesity, 5%

National Youth Strategy (Higher Council for Youth) addressing:

• Unhealthy lifestyles
• Limited participation in decision-making
• Unemployment
• Restricted mobility for young women
• Mental health needs

Social and Economic drivers:

• Unplanned urban growth
• Social and economic inequity
• High cost on health services

Initiatives:

• Youth for the Future: "Youth Hubs" for recreation, education and skill training.
• Youth Voice Campaign (90.000 participants)
• 74 youth centers
• 6 sports cities
• 14 sport complexes

NCD risk factors in youth:

• Smoking, 40%
• Physical inactivity, male: 18%, female: 87%
• Overweight, 4-5%
• Mental distress, 30-40%
• Consumption of soft drinks, fats and oil.

All Jordan Youth Commission:

• Community Development Centers
• Youth Committees

Cultural drivers:

• Food culture: pre-cooked food, take-away
• Celebrations/parties

Environmental drivers:

• Indoor air pollution
• Physical pollution (mental distress)
• Environmental disasters (volcanoes, earthquakes and typhoons)

The Community Empowerment Center (Queen Rania)

• Children rights and youth participation

Youth Policy: Youth in Nation-Building Act (1995)

• National Youth Commission
• National Youth Parliament (youth advocacy)
• Local Youth Development Councils

Social and Economic drivers of NCDs:

• Unplanned urban growth
• Social inequity
• High unemployment rates
• Refugees and Migrants

NCD initiatives for communities:

• Integrated community-based NCD prevention and control program (demo-sites: Pateros and Guimaras)
• National Healthy Lifestyle Campaign
• Decade of Healthy Lifestyle (2005-2015)
• Pilipinas Go4Health Movement

Cultural drivers of NCDs:

• Traditions and hospitality
• Food culture
• Gender inequality

Environmental drivers of NCDs:

• Safety and mobility in streets
• Polluted cities
• Lack of green space and sites of activity
• Scarcity of fertile soil and water

1. Global NCD burden

2. Risk Factors and Social Determinants

3. NCDs in Jordan and the Philippines

4. A rights-based approach to NCDs

5. Intervention strategies

• Changing Environments
• Changing Lifestyles
• Measuring Change

Rights-based approach

Rights holders:

Seeking to understand inequalities generated by development, to change discriminatory practices

and unjust distribution of power impacting human development

Individuals and groups with rights

Youth

Family

Common Understanding (UN, 2003)

Stages of right-based approaches:

1. Goals: The realization of rights

2. Processes: Rights should guide programs

3. Outcome: Realization of rights through processes:

• contributing in meeting obligations of duty-bearer
• contributing to right-holders claiming their rights

Protection from 'unhealthy' advertisement

Freedom to move safely

Non-discrimination in access to affordable and

healthy food

Freedom to mobilize and participate

Right to a standard of living adequate for the

health and well-being of oneself and ones family

Non-discrimination in access to health care

Freedom of expression and access to information

Right of the child to food, clean water and air

Right to necessary social services and security

Right to systems of health protection

Right to participate in decision-making

at all levels

Build capacity and entitlements through

community empowerment

Ensure accountability through civil participation

Formulate needed policy with community

Aim: to ensure a key focus on participation, community empowerment and vulnerable populations in planning, implementation and evaluation of programs

Community

Civil Society

Goal: The realization of the rights required for active and informed participation in decision-making that has a bearing on the health of youth, families and communities

The Right to Health

"The right of everyone to the enjoyment of the highest attainable standards of physical and mental health"

Meaning, not only health care, but also the underlying determinants of health, including participation in all health-related decision-making.

The right to health incorporates other rights e.g. through socio-economic factors promoting health, such as ensuring transparency, equality, participation, accountability and non-discrimination.

Duty-bearers:

State and non-state actors with obligations

• Must meet their obligations under international law
• Must ensure transparency in cases of non-realization of rights
• Must ensure transparent policies and policy-making processes
• Should prioritize enforceable commitments to corporations e.g. laws and regulations

Effective Interventions for NCD Prevention in Youth

Policy

Advocacy

Youth Advocacy

School programs

Health Education

Community mobilization

Social Marketing

Media

Key: Multi-setting, multi-component long-term, and adapted to local context

Youth Advocacy

Policies for NCD prevention

Social Marketing

Aim at overcoming structural barriers instead of behavioral, by:

• Challenging vested interests
• Promoting policy solutions
• Questioning community norms

"Marketing social change"

Aim: to make healthy choices available, accessible and affordable

Communication strategies are made in 2 steps:

1. Getting the right message

e.g. 'eat healthy', '30 min of exercise will...'

2. Getting the message right

e.g. How to present it? How to attract attention?

Nutrition and physical activity:

• Well-planned infrastructure: access to facilities as walking paths, bike trails, community centers etc.
• Food labeling: clear and sufficient information on ingredients and energy content.

Effective Advocacy Campaign

Using commercial strategies in promotion of health rarely empower people, instead strategies are made on behalf of people - challenging a right-based approach.

Tobacco:

• Help to quit smoking, warning on consequences, smoke ban in public places, ban on advertisement etc.

• Clear policy goals (ban on advertisement)
• Evidence for action (national/local data)
• Messages linked to fairness, equity and social justice
• Community participation
• Network and coalition building
• Understand the opposition (viewpoints, strategies etc.)
• Use media to set public agenda (tell the story)
• Use political processes to create change

The 4 or 5 P's

• Product
• Price
• Place
• Promotion
• Partnership - EPODE obesity program

Alcohol:

• Education of consumer, restricted access to retail, taxes to raise prices, drink-driving policies, ban on advertisement and sponsorship.

Saludable Omaha

Education & skill development

Community Readiness Assessment

Community infrastructure

Campaign materials

Community activities

Changing Lifestyles

School-based interventions

Aim at using existing social structures reducing barriers to implementation, integrating activities into school curricula and targeting multiple risk factors.

Nutrition interventions:

• Nutrition education: breakfast, cooking classes, school gardens
• Food policies: canteen food, access to food vendors, sale of soft drinks, fruit breaks, price regulation
• Parental involvement in activities

Physical activity interventions:

• Physical education: in- and out-of-school
• Facilities: Access to playgrounds and sport facilities, walking school bus

Alcohol interventions:

• Health education: risk of heavy drinking, skills to resist advertisements and peer influence

Tobacco interventions:

• Health education: risk of smoking, skills to resist advertisement and peer influence.
• Tobacco policies: ban on smoking, advertisement and sponsorships in school

Community-based interventions

Example of community intervention process (based on OPIC and CIH)

1. Youth Mobilization and Interviews (on socio-cultural factors impacting body size, eating and activity patterns)

2. Community Readiness Assessment, Environmental Scan and Policy Reviews

3. Community Mobilization by Youth

4. Participatory Action Plan

5. Intervention Strategies to achieve goals/objectives

• Health Education (on healthy behavior and risk factors)
• Youth Advocacy (structural changes, challenging norms, campaigns)
• Community-driven activities (festivals, community garden, cooking classes, sports games and collective exercises)
• Social Marketing (local partnerships with supermarkets, shops etc.)
• Evaluation and monitoring

Measuring Change

An intervention needs clear and appropriate indicators in order to evaluate and monitor changes in behavior, as well as surveillance is important for guiding health policies and programs.

WHO recommends the STEPS approach to NCD risk factor assessment, with the aim of standardizing variables and allowing country comparison of data.

STEP 1 and 2 can be conducted with few resources. The optional modules enable adjustments to local or regional interests. The age group 15-25y is recommended for youth.