Post on 09-Feb-2016
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COMBATING OBESITY
Current Situation in St. Kitts & Nevis: Trends, Drivers, Barriers, Solutions, Recommendations
Patrick MartinChief Medical Officer
@ PACO III, ArubaJune 2013
THE CARIBBEAN
ABOUT ST. KITTS & NEVIS
• 52, 300 pop; LE: 75 years• Total Health Expenditure ~ US$ 600 per capita
• Epidemiology Profile– 2/3 deaths = CHD; Stroke; Cancer; Diabetes
• NCDs costs ~ 2% of GDP– Diversion from growth and development activities
OVERWEIGHT PREVALENCE
2005 2008 2011Birth - 5 years 9 11
13-15Total 19 32.5Males 17.3 32.6Females 20.9 32.5
25-64
Percent
From 1/5 to 1/3 in 6 years
OBESITY PREVALENCE2005 2008 2011
Birth - 5 years
13-15Total 14.4Males 16.6Females 12.1
25-64Total 45Males 37.9Females 52.5
Percent
10 year boy
71Kg
BMI » 30
WHY COME TO PACO III
Health is
• “Intrinsic to human dignity”
• A pre-condition of– Sustainable Economic Growth and Development– Social Stability and National Security
Epidemic Childhood Obesity: A threat to All
• Children learn by imitation (they behave like the people around them)
• Obesity Continuum
Health Sector$$$,$$$,$$$
Obesity = Energy Equation manipulation/distortion
FOCUS # 1: THE ENERGY EQUATION
EQUATION OUTCOME
Energy Intake = Energy Output Weight Same
Energy Intake < Energy Output Weight Loss
Energy Intake > Energy Output Weight Gain
Obesity = Energy Equation manipulation/distortion
EQUATION OUTCOME
Energy Intake = Energy Output Weight Same
Energy Intake < Energy Output Weight Loss
Energy Intake > Energy Output Weight Gain
Obesity = Energy Equation manipulation/distortion
EQUATION OUTCOME
Energy Intake = Energy Output Weight Same
Energy Intake < Energy Output Weight Loss
Energy Intake > Energy Output Weight Gain
Obesity = Energy Equation manipulation/distortion
EQUATION OUTCOME
Energy Intake = Energy Output Weight Same
Energy Intake < Energy Output Weight Loss
Energy Intake > Energy Output Weight Gain
Obesity = Energy Equation manipulation/distortion
EQUATION OUTCOME
Energy Intake = Energy Output Weight Same
Energy Intake < Energy Output Weight Loss
Energy Intake > Energy Output Weight Gain
Influenced by Price & Mindset
EQUATION OUTCOME
Energy Intake = Energy Output Weight Same
Energy Intake < Energy Output Weight Loss
Energy Intake > Energy Output Weight Gain
How to Reduce Price of Unhealthy Foods
Subsidies Low Wages
Mass production No/Low Border Tariffs
EQUATION OUTCOME
Energy Intake = Energy Output Weight Same
Energy Intake < Energy Output Weight Loss
Energy Intake > Energy Output Weight Gain
How to Shape Mindset of A People
Marketing/Advertising Perception Body Image
Perception of Social Status
OBESITY VECTORS ARE IMPORTED
• Vectors 1. Energy-Dense Food2. Energy-Sparing Gadgets & Games
• Importation driven by supply and demand.
• In SKN, demand stimulates supply.
• Therefore, Focus # 2 is DEMAND REDUCTION
BARRIERS
SOLUTIONSRECOMMENDATION
PROGRESS
DEMAND REDUCTION
BARRIER: FOOD IS A STATUS SYMBOL
• Shopping in air-conditioned comfort means I have arrived!
• Root Vegetables are “Poor people food” I now eat Pizza ...
BARRIER: FATNESS IS AN ASSET• A healthy child is “nice and fat”
• Slimness attributed to HIV/AIDS and other illnesses
• Fatness (females) is sexy
BARRIERS
SOLUTIONSRECOMMENDATIONS
PROGRESS
DEMAND REDUCTION
COMPETITIVE PRICING• Make Healthy Food More Affordable– Increase Food Security– Subsidize local production – Limited by tight fiscal space
• Make Unhealthy Food More Expensive– Higher VAT: Proposed by MoH– Not enacted: Unhealthy foods are popular
RE-SHAPE MINDSET
• Prohibit advertising– Need policy & legislation (regional template)
• Social Marketing Strategy – PSAs promoting Healthy Diet & Physical Activity
(regional action)
• Junk-Food Free schools– Alliance Building with Education Sector
RE-SHAPE MINDSET & HABITS
• “Eat Local Day” and “Caribbean Wellness Day”– High Level Political Support
• Food Service Menus– Reduce salt, refined sugar and fat content– Alliance Building with Private Sector and School Meals
Program
• Off-Road exercise trails – Alliance Building with Physical Planning
SOLIDARITY IS KEY• Global– “Champion of Change” (e.g. WHO’s FCTC)
• Regional– CARPHA/PAHO : Support for
• National research• Translation of Research to Policy• Regional SMS + Production of PSAs• Performance Monitoring & Evaluation
• PACO – Best Practices; Lessons Learned; Progress Assessment
CONCURRENCE
• Obesity is fundamentally a Social Determinants of Health issue– Genetics plays a minor role
• Multi-factorial/sectorial Interventions• Trade, Education, Agriculture, Tax, Health
OBESITY DRIVING FACTORS
1. CHOICES PEOPLE MAKE (price & mindset)
2. CHOICES MADE FOR PEOPLE (manipulation)
“Although obesity has profound health outcomes and impacts, combating Childhood Obesity requires healthy public policy action on several fronts including the sectors responsible for international trade rules, national taxation, education, and food security.”