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Preventing Non-Communicable Diseases in Youth

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Sandra Villumsen

on 1 September 2014

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Transcript of Preventing Non-Communicable Diseases in Youth

Preventing Non-Communicable Diseases in Youth
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

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)
Non-Communicable Diseases (NCDs) cover large disease groups as:
Cardiovascular diseases
Chronic respiratory diseases
NCDs cause a great burden on the quality of life.
1.5 billion DALYs are lost every year - 45% is due to NCDs
NCDs are characterized by being:
The main determinants of NCDs

Social and Economic drivers of NCDs:
Demographic changes
Urbanization and social mobility
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
Pollution of air, soil and water
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%)
NCD risk factors in youth:
4% overweight
84% physical inactive
16% smoking
75% passive smoking
18% mental distress
Social and Economic drivers of NCDs:
Unplanned urban growth
Social inequity
High unemployment rates
Refugees and Migrants
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
National Youth Strategy (Higher Council for Youth) addressing:
Unhealthy lifestyles
Limited participation in decision-making
Restricted mobility for young women
Mental health needs
Jordan's Youth Policies:
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
All Jordan Youth Commission:
Community Development Centers
Youth Committees

The Community Empowerment Center (Queen Rania)
Children rights and youth participation

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
The leading risk factors are:
Physical inactivity, 60%
Smoking, 35%
Hypertension, 22%
Overweight, 20%
Obesity, 5%
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.
Social and Economic drivers:
Unplanned urban growth
Social and economic inequity
High cost on health services
Cultural drivers:
Food culture: pre-cooked food, take-away

Environmental drivers:
Indoor air pollution
Physical pollution (mental distress)
Environmental disasters (volcanoes, earthquakes and typhoons)
Youth Policy: Youth in Nation-Building Act (1995)
National Youth Commission
National Youth Parliament (youth advocacy)
Local Youth Development Councils
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
Rights holders:
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
Civil Society
Individuals and groups with 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
State and non-state actors with obligations
Rights-based approach
Seeking to understand inequalities generated by development, to change discriminatory practices
and unjust distribution of power impacting human development
Common Understanding
(UN, 2003)
Stages of right-based approaches:
: The realization of rights
: Rights should guide programs
: Realization of rights through processes:
contributing in meeting obligations of duty-bearer
contributing to right-holders claiming their rights
Aim: to ensure a key focus on participation, community empowerment and vulnerable populations in planning, implementation and evaluation of programs
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

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.

Youth Advocacy
School programs
Health Education
Community mobilization
Social Marketing
Effective Interventions for NCD Prevention in Youth
Youth Advocacy
Aim at overcoming structural barriers instead of behavioral, by:
Challenging vested interests
Promoting policy solutions
Questioning community norms
Key: Multi-setting, multi-component long-term, and adapted to local context
Effective Advocacy Campaign
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
Education & skill development
Community Readiness Assessment
Community infrastructure
Campaign materials
Community activities
Saludable Omaha
Social Marketing
"Marketing social change"
Using commercial strategies in promotion of health rarely empower people, instead strategies are made on behalf of people - challenging a right-based approach.
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?
The 4 or 5 P's
Partnership - EPODE obesity program
Policies for NCD prevention
Aim: to make healthy choices available, accessible and affordable
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.
Help to quit smoking, warning on consequences, smoke ban in public places, ban on advertisement etc.
Education of consumer, restricted access to retail, taxes to raise prices, drink-driving policies, ban on advertisement and sponsorship.
Changing Lifestyles
School-based interventions
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
Aim at using existing social structures reducing barriers to implementation, integrating activities into school curricula and targeting multiple risk factors.
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.
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