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Liu C, Zhang Z, Wang B, Meng T, Li C, Zhang X. Global health impacts of high BMI: A 30-Year analysis of trends and disparities across regions and Demographics. Diabetes Res Clin Pract 2024; 217:111883. [PMID: 39368489 DOI: 10.1016/j.diabres.2024.111883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Revised: 09/27/2024] [Accepted: 10/01/2024] [Indexed: 10/07/2024]
Abstract
OBJECTIVE This study explores the global disease burden associated with high Body Mass Index (BMI) from 1990 to 2021, using data from the Global Burden of Disease Study 2021 (GBD 2021). METHODS We applied Joinpoint regression to assess trends in deaths and Disability-Adjusted Life Years (DALYs) and employed ARIMA models to project future BMI-related burdens. RESULTS From 1990 to 2021, global deaths linked to high BMI surged by 153.97%, rising from 1.46 million to 3.71 million. DALYs increased by 167.57%, with the highest rises in North Africa, the Middle East, and South Asia. Women, particularly those aged 75 and above, experienced the most significant burden, with a faster rate of increase in disease burden compared to men post-2000. Future projections indicate a continued rise in BMI-related health impacts, particularly in low- and middle-income countries. CONCLUSIONS The global disease burden attributable to high BMI is increasing rapidly, particularly in low- and middle-income regions. Targeted public health interventions, especially for women and the elderly, are crucial to addressing this growing health challenge.
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Affiliation(s)
- Changxing Liu
- First Clinical Medical School,Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Zhirui Zhang
- First Clinical Medical School,Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Boyu Wang
- First Clinical Medical School,Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Tianwei Meng
- First Clinical Medical School,Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Chengjia Li
- First Clinical Medical School,Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Xulong Zhang
- Acupuncture department, Shaanxi Rehabilitation Hospital, Xi'an 710065, China.
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2
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Lu JD, Tan KY. Colorectal cancer: Getting the perspective and context right. World J Clin Oncol 2024; 15:599-602. [PMID: 38835844 PMCID: PMC11145960 DOI: 10.5306/wjco.v15.i5.599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 04/07/2024] [Accepted: 04/15/2024] [Indexed: 05/21/2024] Open
Abstract
Colorectal cancer (CRC) is a significant global health burden, being the third leading cancer globally. Its incidence has been observed to be higher in developed regions such as North America and Europe with geographical variations in mortality rates. Efforts to address this disease burden include promoting early detection through screening and implementing treatment strategies to improve patient outcomes. With the growing and aging population, the incidence of CRC will undoubtedly increase. These epidemiological trends will mean that healthcare professionals will increasingly encounter CRC in more complex patients. Hence, it becomes imperative to have a deeper appreciation of the pathophysiology of CRC and understand the intricate interplay between a patient's physiology and their goals of care before offering treatment. This review article will aim to encapsulate the important nuances and perspectives of managing this disease in the context of an elderly patient.
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Affiliation(s)
- Jun De Lu
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore
| | - Kok Yang Tan
- Department of Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore
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Wang Y, Chen H. The impact of the implementation of hierarchical medical system on population health: evidence from China. Front Public Health 2024; 12:1402832. [PMID: 38846612 PMCID: PMC11153785 DOI: 10.3389/fpubh.2024.1402832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/14/2024] [Indexed: 06/09/2024] Open
Abstract
Introduction The implementation of a hierarchical medical system holds significant practical importance in advancing the Healthy China strategy and elevating the overall health status of the population of China. Methods This article empirically examines the influence of the implementation of a hierarchical medical system on the health of the population using the latest 2020 China Family Panel Studies database. Furthermore, it investigates the variability of this impact across distinct health insurance participation statuses and literacy groups. Results The findings of the study demonstrate that the implementation of the hierarchical medical system substantially enhances the health of the population, not only in terms of self-assessed health but also through a notable positive effect on alleviating chronic diseases. These results maintain their validity even after conducting robustness tests utilizing a replacement estimation model. Heterogeneity analysis reveals that the impact of the hierarchical medical system on the population's health status exhibits significant variation concerning health insurance participation and literacy. Specifically, regarding health insurance participation, the hierarchical medical system effectively improves both self-assessed health and chronic disease status among the insured population. However, for those not enrolled in health insurance, the hierarchical medical system only demonstrates improvement in chronic disease status, with insignificant results observed in enhancing self-assessed health status. Moreover, propensity score matching (PSM) was also used to address endogeneity problems resulting from sample selectivity bias. The findings demonstrate that endogeneity issues can be suitably addressed by the PSM model. Additionally, they point out that an overestimation of the impact of the hierarchical medical system on the population's self-assessed health state would result from failing to take sample selectivity bias into account. On the other hand, it will lead to the underestimation of the effect of the hierarchical medical system on the status of chronic diseases. Discussion Moving forward, steadfast efforts should be directed toward further enhancing the implementation of the hierarchical medical system. This includes the comprehensive promotion and using the pivotal role of the hierarchical medical system in improving the health of the population.
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Affiliation(s)
- Ying Wang
- School of Public Administration and Law, Hunan Agricultural University, Changsha, Hunan, China
- School of Humanities and Management, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Hong Chen
- School of Public Administration and Law, Hunan Agricultural University, Changsha, Hunan, China
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Dunn M, Rushton AB, Mistry J, Soundy A, Heneghan NR. The biopsychosocial factors associated with development of chronic musculoskeletal pain. An umbrella review and meta-analysis of observational systematic reviews. PLoS One 2024; 19:e0294830. [PMID: 38557647 PMCID: PMC10984407 DOI: 10.1371/journal.pone.0294830] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
AIM The aim of this umbrella review was to establish which biopsychosocial factors are associated with development of chronic musculoskeletal pain. METHODS Ovid Medline, Embase, Web of Science Core Collection, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, PsycINFO, CINAHL, PEDro, PROSPERO, Google Scholar and grey literature were searched from database inception to 4th April 2023. Systematic reviews of observational prospective longitudinal studies, including populations with <3 months (not chronic) musculoskeletal pain, investigating biopsychosocial factors that contribute to development of chronic (>3 months) musculoskeletal pain. Two reviewers searched the literature, assessed risk of bias (Assessing the Methodological Quality of Systematic Reviews-2), and evaluated quality (Grading of Recommendations, Assessment, Development and Evaluation) to provide an overall statement on the certainty of evidence for each biopsychosocial factor. Data analysis was performed through random effects meta-analysis (including meta-analysis of meta-analyses where possible) and descriptive synthesis. RESULTS 13 systematic reviews were included comprising 185 original research studies (n = 489,644 participants). Thirty-four biopsychosocial factors are associated with development of chronic musculoskeletal pain. Meta-analyses of odds and/or likelihood ratios were possible for 25 biopsychosocial factors. There is moderate certainty evidence that smoking (OR 1.24 [95%CI, 1.14-1.34), fear avoidance (LR+ 2.11 [95%CI, 1.59-2.8]; LR- 0.5 [95%CI, 0.35-0.71]) poorer support networks (OR 1.21 [95%CI, 1.14-1.29]), lower socioeconomic status (OR 2.0 [95%CI, 1.64-2.42]), and high levels of pain (OR 5.61 [95%CI, 3.74-8.43]) are associated with development of chronic musculoskeletal pain (all P<0.001). Remaining factors are of low or very low certainty evidence. CONCLUSIONS AND RELEVANCE There is moderate certainty evidence that smoking, fear avoidance, poorer support networks, lower socioeconomic status, and high levels of pain are associated with development of chronic musculoskeletal pain. High risk of bias was evident in most included reviews; this highlights the need for higher quality systematic reviews.
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Affiliation(s)
- Michael Dunn
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport and Exercise Science, University of Birmingham, Birmingham, West Midlands, United Kingdom
- Musculoskeletal Physiotherapy, St. George’s University Hospitals NHS Foundation Trust, London, United Kingdom
- Institute of Medical and Biomedical Education, Centre for Allied Health, St. George’s University of London, London, United Kingdom
| | - Alison B. Rushton
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport and Exercise Science, University of Birmingham, Birmingham, West Midlands, United Kingdom
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Jai Mistry
- Musculoskeletal Physiotherapy, St. George’s University Hospitals NHS Foundation Trust, London, United Kingdom
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Andrew Soundy
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport and Exercise Science, University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - Nicola R. Heneghan
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport and Exercise Science, University of Birmingham, Birmingham, West Midlands, United Kingdom
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Yip W, Fu H, Jian W, Liu J, Pan J, Xu D, Yang H, Zhai T. Universal health coverage in China part 2: addressing challenges and recommendations. Lancet Public Health 2023; 8:e1035-e1042. [PMID: 38000883 DOI: 10.1016/s2468-2667(23)00255-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 11/26/2023]
Abstract
This report analyses the underlying causes of China's achievements and gaps in universal health coverage over the past 2 decades and proposes policy recommendations for advancing universal health coverage by 2030. Although strong political commitment and targeted financial investment have produced positive outcomes in reproductive, maternal, newborn, and child health and infectious diseases, a fragmented and hospital-centric delivery system, rising health-care costs, shallow benefit coverage of health insurance schemes, and little integration of health in all policies have restricted China's ability to effectively prevent and control chronic disease and provide adequate financial risk protection, especially for lower-income households. Here, we used a health system conceptual framework and we propose a set of feasible policy recommendations that draw from international experiences and first-hand knowledge of China's unique institutional landscape. Our six recommendations are: instituting a primary care-focused integrated delivery system that restructures provider incentives and accountability mechanisms to prioritise prevention; leveraging digital tools to support health behaviour change; modernising information campaigns; improving financial protection through insurance reforms; promoting a health in all policy; and developing a domestic monitoring framework with refined tracer indicators that reflects China's disease burden.
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Affiliation(s)
- Winnie Yip
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Hongqiao Fu
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China.
| | - Weiyan Jian
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jay Pan
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; School of Public Administration, Sichuan University, Chengdu, China
| | - Duo Xu
- Institute of Population and Labor Economics, Chinese Academy of Social Sciences, Beijing, China
| | - Hanmo Yang
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Tiemin Zhai
- China National Health Development Research Center, Beijing, China
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Boonmanunt S, Pattanaprateep O, Ongphiphadhanakul B, McKay G, Attia J, Vlaev I, Thakkinstian A. Evaluation of the Effectiveness of Behavioral Economic Incentive Programs for Goal Achievement on Healthy Diet, Weight Control and Physical Activity: A Systematic Review and Network Meta-analysis. Ann Behav Med 2023; 57:277-287. [PMID: 36367428 PMCID: PMC10094952 DOI: 10.1093/abm/kaac066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Healthy diet, weight control and physical activity to reduce obesity can be motivated by financial incentives (FI). Behavioral-economic approaches may improve the incentivization effectiveness. This study compares and ranks the effectiveness of standard and behavioral incentivization for healthy diet, weight control, and physical activity promotion. PURPOSE To investigate whether behavioral-economic insights improve incentivization effectiveness. METHODS A systematic search of Medline and Scopus was performed from database inception to December 2020. Study characteristics, program designs, and risk ratio (RR) were extracted. A two-stage network meta-analysis pooled and ranked intervention effects. RESULTS There were 35 eligible RCTs. For diet-weight control, standard FI, deposit contract (deposit), lottery-based incentive (lottery), and standard-FI + lottery increased goal achievement compared to no-FI but only deposit was statistically significant with pooled RRs and 95% confidence intervals (CI) of 1.21 (0.94, 1.56), 1.79 (1.04, 3.05), 1.45 (0.99, 2.13), and 1.73 (0.83, 3.63). For physical activity, standard-FI, deposit, and lottery significantly increased goal achievement compared to no-FI, with pooled RRs of 1.38 (1.13, 1.68), 1.63 (1.24, 2.14) and 1.43 (1.14, 1.80), respectively. In a follow-up period for physical activity, only deposit significantly increased goal achievement compared to no-FI, with pooled RRs of 1.39 (1.11, 1.73). CONCLUSION Deposit, followed by lottery, were best for motivating healthy diet, weight control and physical activity at program end. Post-intervention, deposit then standard-FI were best for motivating physical activity. Behavioral insights can improve incentivization effectiveness, although lottery-based approaches may offer only short-term benefit regarding physical activity. However, the imprecise intervention effects were major concerns.
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Affiliation(s)
- Suparee Boonmanunt
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Pyathai, Bangkok 10400, Thailand
| | - Oraluck Pattanaprateep
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Pyathai, Bangkok 10400, Thailand
| | - Boonsong Ongphiphadhanakul
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Pyathai, Bangkok 10400, Thailand
| | - Gareth McKay
- Centre for Public Health, School of Medicine, Dentistry, and Biomedical Sciences, Queen’s University Belfast, 97 Lisburn Road, Whitla Medical Building, BT9 7BL Belfast, UK
| | - John Attia
- School of Medicine and Public Health, University of Newcastle, Kookaburra Circuit, John Hunter Hospital Campus, New Lambton, NSW 2305, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, John Hunter Hospital Campus, New Lambton, NSW 2305, Australia
| | - Ivo Vlaev
- Warwick Business School, University of Warwick, Coventry CV4 7AL, UK
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Pyathai, Bangkok 10400, Thailand
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Guglielmin M, Shankardass K, Bayoumi A, O’Campo P, Kokkinen L, Muntaner C. A Realist Explanatory Case Study Investigating How Common Goals, Leadership, and Committed Staff Facilitate Health in All Policies Implementation in the Municipality of Kuopio, Finland. Int J Health Policy Manag 2022; 11:2651-2659. [PMID: 35247936 PMCID: PMC9818123 DOI: 10.34172/ijhpm.2022.6355] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 02/05/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Health in All Policies (HiAP) encompasses collaboration across government and the consideration of health in various governmental sector's policies and decisions. Despite increasing advocacy, interest, and uptake in HiAP globally, empirical and evaluative studies are underrepresented in this growing literature, particularly literature on HiAP implementation at the local level. Finland has been a pioneer in and champion for HiAP. METHODS A realist explanatory case study design was used to test hypotheses about how HiAP is implemented in Kuopio, Finland. Semi-structured interviews with ten government employees from various sectors were conducted. Data from interviews and literature were analyzed with the aims of uncovering explanatory mechanisms in the form of context-strategy-mechanism-outcome (CSMO) configurations related to implementation strategies. Evidence was evaluated for quality based on triangulation of sources and strength of evidence. We hypothesized that having or creating a common goal between sectors and having committed staff and local leadership would facilitate implementation. RESULTS Strong evidence supports our hypothesis that having or creating a common goal can aid in positive implementation outcomes at the local level. Common goals can be created by the strategies of having a city mandate, engaging in cross-sectoral discussions, and/or by working together. Policy and political elite leadership led to HiAP implementation success because leaders supported HiAP work, thus providing justification for using time to work intersectorally. How and why the wellbeing committee facilitated implementation included by providing opportunities for discussion and learning, which led to understanding of how non-health decisions impact community wellbeing, and by acting as a conduit for the communication of wellbeing goals to government employees. CONCLUSION At the municipal level, having or creating a common goal, leadership from policy and political elites, and the presence of committed staff can facilitate HiAP implementation. Inclusion of not only strategies for HiAP, but also the explanatory mechanisms, aids in elucidating how and why HiAP is successfully implemented in a local setting.
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Affiliation(s)
- Maria Guglielmin
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Ketan Shankardass
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ahmed Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Patricia O’Campo
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Lauri Kokkinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Carles Muntaner
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Bloomberg School of Nursing University of Toronto, Toronto, ON, Canada
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Dunn M, Rushton AB, Soundy A, Heneghan NR. Individuals' beliefs about the biopsychosocial factors that contribute to their chronic musculoskeletal pain: protocol for a qualitative study in the UK. BMJ Open 2022; 12:e062970. [PMID: 35863841 PMCID: PMC9310156 DOI: 10.1136/bmjopen-2022-062970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Chronic musculoskeletal pain (CMP) is described as pain that persists for longer than 3 months. At present, no research is available that understands why CMP develops and continues from the perspective of the individual. Research is needed to establish if there are any consistent biopsychosocial factors perceived as contributing to CMP and what informs such beliefs. Understanding individual beliefs will inform more effective communication between clinicians and patients about their CMP, as well as informing future research into the epidemiology of CMP. Interpretative phenomenological analysis will be used as a methodological framework as it explores how individuals make sense of their world through personal experiences and perceptions while preserving individual nuance. The aim of this study is to understand individuals' beliefs and perceptions about the biological, psychological and social factors, which contribute to the development and maintenance of their CMP. METHODS AND ANALYSIS A qualitative study informed by the Consolidated Criteria for Reporting Qualitative Research using interpretative phenomenological analysis and semistructured interviews. A maximum variation purposive sample of 6-12 adults with CMP will be recruited from the general public in the UK. One semistructured interview will be conducted with each participant via an online video platform with interviews transcribed verbatim. The interview schedule (codesigned with expert patients and informed by existing evidence) identifies three domains of important questions; (1) patient beliefs on why they developed and continue to experience CMP; (2) the relationship between their biopsychosocial experiences and CMP; and (3) the origin of their beliefs. Strategies such as 'member checking' will be employed to ensure trustworthiness. ETHICS AND DISSEMINATION Ethical approval was granted by the Research Ethics Office at the University of Birmingham (reference ERN_21-0813). Informed consent will be obtained from all participants. The study findings will be submitted for publication in a peer-reviewed journal and for presentation at conferences.
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Affiliation(s)
- Michael Dunn
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Physiotherapy Outpatients, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Alison B Rushton
- School of Physical Therapy, Western University Faculty of Health Sciences, London, Ontario, Canada
| | - Andrew Soundy
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Nicola R Heneghan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Turck D, Bohn T, Castenmiller J, de Henauw S, Hirsch-Ernst KI, Knutsen HK, Maciuk A, Mangelsdorf I, McArdle HJ, Naska A, Peláez C, Pentieva K, Thies F, Tsabouri S, Vinceti M, Bresson JL, Siani A. Scientific advice related to nutrient profiling for the development of harmonised mandatory front-of-pack nutrition labelling and the setting of nutrient profiles for restricting nutrition and health claims on foods. EFSA J 2022; 20:e07259. [PMID: 35464873 PMCID: PMC9016720 DOI: 10.2903/j.efsa.2022.7259] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver scientific advice related to nutrient profiling for the development of harmonised mandatory front‐of‐pack nutrition labelling and the setting of nutrient profiles for restricting nutrition and health claims on foods. This Opinion is based on systematic reviews and meta‐analyses of human studies on nutritionally adequate diets, data from the Global Burden of Disease framework, clinical practice guidelines, previous EFSA opinions and the priorities set by EU Member States in the context of their Food‐Based Dietary Guidelines and associated nutrient/food intake recommendations. Relevant publications were retrieved through comprehensive searches in PubMed. The nutrients included in the assessment are those likely to be consumed in excess or in inadequate amounts in a majority of European countries. Food groups with important roles in European diets have been considered. The Panel concludes that dietary intakes of saturated fatty acids (SFA), sodium and added/free sugars are above, and intakes of dietary fibre and potassium below, current dietary recommendations in a majority of European populations. As excess intakes of SFAs, sodium and added/free sugars and inadequate intakes of dietary fibre and potassium are associated with adverse health effects, they could be included in nutrient profiling models. Energy could be included because a reduction in energy intake is of public health importance for European populations. In food group/category‐based nutrient profiling models, total fat could replace energy in most food groups owing to its high‐energy density, while the energy density of food groups with low or no fat content may be well accounted for by the inclusion of (added/free) sugars. Some nutrients may be included in nutrient profiling models for reasons other than their public health importance, e.g. as a proxy for other nutrients of public health importance, or to allow for a better discrimination of foods within the same food category.
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Yeh PG, Reininger BM, Mitchell-Bennett LA, Lee M, Xu T, Davé AC, Park SK, Ochoa-Del Toro AG. Evaluating the Dissemination and Implementation of a Community Health Worker-Based Community Wide Campaign to Improve Fruit and Vegetable Intake and Physical Activity among Latinos along the U.S.-Mexico Border. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4514. [PMID: 35457382 PMCID: PMC9025101 DOI: 10.3390/ijerph19084514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 11/17/2022]
Abstract
This study evaluated the dissemination and implementation of a culturally tailored community-wide campaign (CWC), Tu Salud ¡Si Cuenta! (TSSC), to augment fruit and vegetable (FV) consumption and physical activity (PA) engagement among low-income Latinos of Mexican descent living along the U.S.-Mexico Border in Texas. TSSC used longitudinal community health worker (CHW) home visits as a core vehicle to enact positive change across all socioecological levels to induce behavioral change. TSSC's reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) was examined. A dietary questionnaire and the Godin-Shepherd Exercise Questionnaire measured program effectiveness on mean daily FV consumption and weekly PA engagement, respectively. Participants were classified based on CHW home visits into "low exposure" (2-3 visits) and "high exposure" (4-5 visits) groups. The TSSC program reached low-income Latinos (n = 5686) across twelve locations. TSSC demonstrated effectiveness as, compared to the low exposure group, the high exposure group had a greater FV intake (mean difference = +0.65 FV servings daily, 95% CI: 0.53-0.77) and an increased PA (mean difference = +185.6 MET-minutes weekly, 95% CI: 105.9-265.4) from baseline to the last follow-up on a multivariable linear regression analysis. Multivariable logistic regression revealed that the high exposure group had higher odds of meeting both FV guidelines (adjusted odds ratio (AOR) = 2.03, 95% CI: 1.65-2.47) and PA guidelines (AOR = 1.36, 95% CI: 1.10-1.68) at the last follow-up. The program had a 92.3% adoption rate, with 58.3% of adopting communities meeting implementation fidelity, and 91.7% of communities maintaining TSSC. TSSC improved FV consumption and PA engagement behaviors among low-income Latinos region wide. CHW delivery and implementation funding positively influenced reach, effectiveness, adoption, and maintenance, while lack of qualified CHWs negatively impacted fidelity.
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Affiliation(s)
- Paul Gerardo Yeh
- Division of Health Promotion & Behavioral Sciences, Brownsville Regional Campus, School of Public Health, University of Texas Health Science Center, 80 Fort Brown, Brownsville, TX 78520, USA; (B.M.R.); (L.A.M.-B.)
- Department of Physician Assistant, College of Health Professions, University of Texas Rio Grande Valley, 1201 West University Blvd., Edinburg, TX 78539, USA
- Postdoctoral Fellow, National Cancer Institute Cancer Control Research Training Program, School of Public Health, University of Texas Health Science Center, 1200 Pressler Street, Houston, TX 77030, USA
| | - Belinda M. Reininger
- Division of Health Promotion & Behavioral Sciences, Brownsville Regional Campus, School of Public Health, University of Texas Health Science Center, 80 Fort Brown, Brownsville, TX 78520, USA; (B.M.R.); (L.A.M.-B.)
| | - Lisa A. Mitchell-Bennett
- Division of Health Promotion & Behavioral Sciences, Brownsville Regional Campus, School of Public Health, University of Texas Health Science Center, 80 Fort Brown, Brownsville, TX 78520, USA; (B.M.R.); (L.A.M.-B.)
- Hispanic Health Research Center, School of Public Health, University of Texas Health Science Center, 1 West University Blvd., Brownsville, TX 78520, USA; (A.C.D.); (A.G.O.-D.T.)
| | - Minjae Lee
- Division of Biostatistics, Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA;
| | - Tianlin Xu
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center, 1200 Pressler Street, Houston, TX 77030, USA; (T.X.); (S.K.P.)
| | - Amanda C. Davé
- Hispanic Health Research Center, School of Public Health, University of Texas Health Science Center, 1 West University Blvd., Brownsville, TX 78520, USA; (A.C.D.); (A.G.O.-D.T.)
| | - Soo Kyung Park
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center, 1200 Pressler Street, Houston, TX 77030, USA; (T.X.); (S.K.P.)
| | - Alma G. Ochoa-Del Toro
- Hispanic Health Research Center, School of Public Health, University of Texas Health Science Center, 1 West University Blvd., Brownsville, TX 78520, USA; (A.C.D.); (A.G.O.-D.T.)
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Reininger BM, Mitchell-Bennett LA, Lee M, Yeh PG, Davé AC, Park SK, Xu T, Ochoa-Del Toro AG. Scaling a Community-Wide Campaign Intervention to Manage Hypertension and Weight Loss. Front Med (Lausanne) 2021; 8:661353. [PMID: 34881250 PMCID: PMC8645688 DOI: 10.3389/fmed.2021.661353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 11/01/2021] [Indexed: 12/14/2022] Open
Abstract
Public health impacts can be achieved when evidence-based interventions are implemented to those most in need. Too often implementation never or slowly occurs. The community-wide campaign intervention Tu Salud ¡Si Cuenta! has evidence of improving health outcomes related to chronic disease among low-income, Latinos. Using the RE-AIM Framework, this study examined if the scaled-up version of the intervention is associated with improvements in hypertension and obesity in 12 locations. Each element of the RE-AIM framework was examined. For "Effectiveness," we examined outcomes overall and by implementing location. We used linear and logistic regression to assess if exposure in the intervention was associated with improvement in hypertension and weight loss. Participants were stratified into "low exposure" (2-3 outreach visits) vs. "high exposure" (4-5 outreach visits). Based on the RE-AIM Framework, the intervention "reached" its intended population of low-income Latinos, demonstrated "effectiveness" in improving hypertension and obesity, was "adopted" at a high level in all but one site, was "implemented" with fidelity to the intervention model with moderate success across locations, and showed high "maintenance" over time. For effectiveness specifically, we found that out of 5,019 participants, 2,508 (50%) had a baseline hypertensive blood pressure (BP) reading. Of the 2,508, 1,245 (49.9%) recovered to normal blood pressure or pre-hypertension stage by last follow-up. After adjusting for baseline BP and potential confounders in multivariable linear regression models, the high exposure group had significantly more reduction in systolic BP (adjusted mean difference in % change = -0.96; p = 0.002) and diastolic BP (adjusted mean difference in % change = -1.61; p < 0.0001) compared to the low exposure group. After controlling for baseline weight and other confounders, the high exposure group had significantly greater decrease in weight compared to the low exposure group (adjusted mean difference in % change = -1.28; p < 0.0001). Results from the multivariable logistic regression models indicated that compared to the low exposure group the high exposure group was more likely to achieve a clinically significant minimum 5% weight loss [adjusted odds ratio (OR) = 2.97; p < 0.0001). This study contributes evidence that a Community-Wide Campaign model holds promise for addressing hypertension and obesity among low-income Latinos.
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Affiliation(s)
- Belinda M. Reininger
- Health Promotion and Behavioral Sciences, Hispanic Health Research Center, University of Texas School of Public Health in Brownsville, Brownsville, TX, United States
| | - Lisa A. Mitchell-Bennett
- Health Promotion and Behavioral Sciences, Hispanic Health Research Center, University of Texas School of Public Health in Brownsville, Brownsville, TX, United States
| | - MinJae Lee
- Division of Biostatistics, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Paul G. Yeh
- Health Promotion and Behavioral Sciences, Hispanic Health Research Center, University of Texas School of Public Health in Brownsville, Brownsville, TX, United States
- Department of Physician Assistant Studies, College of Health Professions, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Amanda C. Davé
- Health Promotion and Behavioral Sciences, Hispanic Health Research Center, University of Texas School of Public Health in Brownsville, Brownsville, TX, United States
| | - Soo Kyung Park
- Department of Biostatistics and Data Science, University of Texas Health Science Center, University of Texas School of Public Health at Houston, Houston, TX, United States
| | - Tianlin Xu
- Department of Biostatistics and Data Science, University of Texas Health Science Center, University of Texas School of Public Health at Houston, Houston, TX, United States
| | - Alma G. Ochoa-Del Toro
- Health Promotion and Behavioral Sciences, Hispanic Health Research Center, University of Texas School of Public Health in Brownsville, Brownsville, TX, United States
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Dunn M, Rushton AB, Mistry J, Soundy A, Heneghan NR. Which biopsychosocial factors are associated with the development of chronic musculoskeletal pain? Protocol for an umbrella review of systematic reviews. BMJ Open 2021; 11:e053941. [PMID: 34635532 PMCID: PMC8506872 DOI: 10.1136/bmjopen-2021-053941] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Recent systematic reviews have identified many biopsychosocial factors associated with the development of chronic musculoskeletal pain (CMP). Despite often being specific to a particular musculoskeletal condition, findings are similar across systematic reviews. Research is needed to aggregate these findings to identify consistent factors across musculoskeletal disorders that are associated with the development of CMP. The objective of this study is to provide a meta-level synthesis of all biopsychosocial factors associated with the development of CMP. METHODS AND ANALYSIS An umbrella review and meta-level narrative synthesis±meta-analysis has been designed informed by Joanna Briggs Institute and Cochrane guidance. This protocol is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-P. Sources will include Ovid Medline, Embase, Web of Science Core Collection, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, PsycINFO, CINAHL, PEDro, PROSPERO, Google Scholar and grey literature. INCLUSION CRITERIA any systematic review which investigates biopsychosocial factors which may be associated with the development of CMP through prospective longitudinal methods. The outcome is musculoskeletal pain lasting beyond 3 months. Two independent reviewers will be involved in all stages; screening, selection, data extraction and risk of bias evaluation using the Assessing the Methodological Quality of Systematic Reviews-2 guidelines. A meta-level narrative synthesis will be conducted based on (a) factors associated with development of CMP, (b) the range of musculoskeletal disorders for which the same/similar findings have been established and (c) the quality of studies informing these findings. Where possible, meta-analysis will be performed. The Grading of Recommendations, Assessment, Development and Evaluation guidelines will be followed to determine the level of evidence for each biopsychosocial factor. ETHICS AND DISSEMINATION This umbrella review does not require ethical approval. Findings will be presented at conferences and published in a peer reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020193081.
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Affiliation(s)
- Michael Dunn
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Musculoskeletal Physiotherapy, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Alison B Rushton
- School of Physical Therapy, Western University Faculty of Health Sciences, London, Ontario, Canada
| | - Jai Mistry
- Musculoskeletal Physiotherapy, St George's University Hospitals NHS Foundation Trust, London, UK
- School of Physical Therapy, Western University Faculty of Health Sciences, London, Ontario, Canada
| | - Andrew Soundy
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Nicola R Heneghan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Trein P, Fuino M, Wagner J. Public opinion on health care and public health. Prev Med Rep 2021; 23:101460. [PMID: 34285870 PMCID: PMC8273192 DOI: 10.1016/j.pmedr.2021.101460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/13/2021] [Accepted: 06/17/2021] [Indexed: 12/02/2022] Open
Abstract
In the health policy literature, scholars and practitioners distinguish broadly between health care and public health interventions. Both types of policies are indispensable to deal with pressing health problems. Nevertheless, we know very little about how individuals support the principle logic behind these two approaches to health policy. In this paper, we analyze empirically whether individuals prefer either a health care-oriented or a public health-oriented approach to health policy. In addition, we explore political and socio-demographic factors explaining individuals' choices. To conduct this analysis, we use multivariate regression analysis based on data ( N = 5 442 ) from the 2018 wave of the Swiss Household Panel Survey. The survey contains high-quality data from a representative sample of the population living in Switzerland. Our results demonstrate that a majority of citizens prefers public health policies rather than policies ensuring access to health care. Especially, individuals with higher out-of-pocket payments in their health insurance plan support a public health over health care policy approach. Furthermore, those who prefer environmental protection over economic growth support public health over health care policy.
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Affiliation(s)
- Philipp Trein
- University of Geneva, Department of Political Science and International Relations, Switzerland
| | - Michel Fuino
- University of Lausanne, Department of Actuarial Science, Switzerland
| | - Joël Wagner
- University of Lausanne, Department of Actuarial Science, Switzerland
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Cairney P, St Denny E, Mitchell H. The future of public health policymaking after COVID-19: a qualitative systematic review of lessons from Health in All Policies. OPEN RESEARCH EUROPE 2021; 1:23. [PMID: 37645203 PMCID: PMC10445916 DOI: 10.12688/openreseurope.13178.2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 08/31/2023]
Abstract
Background: 'Health in All Policies' (HiAP) describes the pursuit of health equity. It has five main elements: treat health as a human right; identify evidence of the 'social determinants' of health inequalities, recognise that most powers to affect health are not held by health departments, promote intersectoral policymaking and collaboration inside and outside of government, and generate political will. Studies describe its potential but bemoan a major implementation gap. Some HiAP scholars learn from policymaking research how to understand this gap, but the use of policy theories is patchy. In that context, our guiding research question is: How does HiAP research use policy theory to understand policymaking? It allows us to zoom-out to survey the field and zoom-in to identify: the assumed and actual causes of policy change, and transferable lessons to HiAP scholars and advocates. Methods: Our qualitative systematic review (two phases, 2018 and 2020) identified 4972 HiAP articles. Of these, 113 journal articles (research and commentary) provide a non-trivial reference to policymaking (at least one reference to a policymaking concept). We use the 113 articles to produce a general HiAP narrative and explore how the relatively theory-informed articles enhance it. Results: Most articles focus on policy analysis (identifying policy problems and solutions) rather than policy theory (explaining policymaking dynamics). They report a disappointing gap between HiAP expectations and policy outcomes. Theory-informed articles contribute to a HiAP playbook to close that gap or a programme theory to design and evaluate HiAP in new ways. Conclusions: Few HiAP articles use policy theories for their intended purpose. Policy theories provide lessons to aid critical reflection on power, political dilemmas, and policymaking context. HiAP scholars seek more instrumental lessons, potentially at the cost of effective advocacy and research.
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Affiliation(s)
- Paul Cairney
- History, Heritage, and Politics, University of Stirling, Stirling, FK94LA, UK
| | - Emily St Denny
- Department of Political Science, University of Copenhagen, Copenhagen, DK-1353, Denmark
| | - Heather Mitchell
- History, Heritage, and Politics, University of Stirling, Stirling, FK94LA, UK
- Faculty of Health Sciences, University of Stirling, Stirling, FK94LA, UK
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Cairney P, St Denny E, Mitchell H. The future of public health policymaking after COVID-19: a qualitative systematic review of lessons from Health in All Policies. OPEN RESEARCH EUROPE 2021; 1:23. [PMID: 37645203 PMCID: PMC10445916 DOI: 10.12688/openreseurope.13178.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 08/31/2023]
Abstract
Background: 'Health in All Policies' (HiAP) describes the pursuit of health equity. It has five main elements: treat health as a human right; identify evidence of the 'social determinants' of health inequalities, recognise that most powers to affect health are not held by health departments, promote intersectoral policymaking and collaboration inside and outside of government, and generate political will. Studies describe its potential but bemoan a major implementation gap. Some HiAP scholars learn from policymaking research how to understand this gap, but the use of policy theories is patchy. In that context, our guiding research question is: How does HiAP research use policy theory to understand policymaking? It allows us to zoom-out to survey the field and zoom-in to identify: the assumed and actual causes of policy change, and transferable lessons to HiAP scholars and advocates. Methods: Our qualitative systematic review (two phases, 2018 and 2020) identified 4972 HiAP articles. Of these, 113 journal articles (research and commentary) provide a non-trivial reference to policymaking (at least one reference to a policymaking concept). We use the 113 articles to produce a general HiAP narrative and explore how the relatively theory-informed articles enhance it. Results: Most articles focus on policy analysis (identifying policy problems and solutions) rather than policy theory (explaining policymaking dynamics). They report a disappointing gap between HiAP expectations and policy outcomes. Theory-informed articles contribute to a HiAP playbook to close that gap or a programme theory to design and evaluate HiAP in new ways. Conclusions: Few HiAP articles use policy theories for their intended purpose. Policy theories provide lessons to aid critical reflection on power, political dilemmas, and policymaking context. HiAP scholars seek more instrumental lessons, potentially at the cost of effective advocacy and research.
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Affiliation(s)
- Paul Cairney
- History, Heritage, and Politics, University of Stirling, Stirling, FK94LA, UK
| | - Emily St Denny
- Department of Political Science, University of Copenhagen, Copenhagen, DK-1353, Denmark
| | - Heather Mitchell
- History, Heritage, and Politics, University of Stirling, Stirling, FK94LA, UK
- Faculty of Health Sciences, University of Stirling, Stirling, FK94LA, UK
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Ron S, Dimitri N, Ginzburg SL, Reisner E, Martinez PB, Zamore W, Echevarria B, Brugge D, Martinez LS. Health Lens Analysis: A Strategy to Engage Community in Environmental Health Research in Action. SUSTAINABILITY 2021; 13. [PMID: 33981451 DOI: 10.3390/su13041748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Health Lens Analysis is a tool to facilitate collaboration among diverse community stakeholders. We employed HLA as part of a community based participatory research (CBPR) and action study to mitigate the negative health effects of TRAP and ultrafine particles (UFPs) in Somerville, MA. HLA is a Health in All Policies tool with previously limited implementation in a North American context. As part of the HLA, community and academic partners engaged residents from across near-highway neighborhoods in a series of activities designed to identify health concerns and generate recommendations for policies and projects to improve health over an 18-month planning period. Noise barriers, which may reduce TRAP exposure among residents in addition to reducing traffic noise, were seen as an acceptable solution by community stakeholders. We found HLA to be an effective means to engage stakeholders from across sectors and diverse community residents in critical discourse about the health impacts of near-roadway exposures. The iterative process allowed the project team to fully explore the arguments for noise barriers and preferred health interventions, while building a stakeholder base interested in the mitigation of TRAP, thus, creating a shared language and understanding of the issue.
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Affiliation(s)
- Sharon Ron
- Metropolitan Area Planning Council 60 Temple Place, Boston, MA, 02111, USA
| | - Noelle Dimitri
- Boston University School of Social Work 264 Bay State Rd., Boston, MA 02215, USA
| | - Shir Lerman Ginzburg
- UConn Health, Department of Public Health Sciences 263 Farmington Ave., Farmington, CT 06032, USA
| | - Ellin Reisner
- Somerville Transportation Equity Partnership, Somerville, MA 02145, USA
| | - Pilar Botana Martinez
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Ave., Boston, MA 02118, USA
| | - Wig Zamore
- Somerville Transportation Equity Partnership, Somerville, MA 02145, USA
| | - Ben Echevarria
- The Welcome Project, 530 Mystic Ave., Somerville, MA, 02145, USA
| | - Doug Brugge
- Department of Public Health Sciences, University of Connecticut School of Medicine 263 Farmington Ave., Farmington, CT 06030, USA
| | - Linda Sprague Martinez
- Macro Department, Boston University School of Social Work, 264 Bay State Rd., Boston, MA 02215, USA
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Ndubuisi NE. Noncommunicable Diseases Prevention In Low- and Middle-Income Countries: An Overview of Health in All Policies (HiAP). INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:46958020927885. [PMID: 34420412 PMCID: PMC8385577 DOI: 10.1177/0046958020927885] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Noncommunicable disease (NCD) causes about 35 million deaths and accounts for 60% of all deaths, of which 80% is in low- and middle-income countries (LMIC). NCDs will account for 80% of the global burden of disease by 2020 and account for 7 out of every 10 deaths in LMIC. NCD is no longer an emerging problem in developing countries, it's assuming an alarming dimension, and taking on the proportion of an epidemic. Several literatures document the known risk factors for significant NCDs. The critical risk factors are tobacco usage, unhealthy diet, physical inactivity, and detrimental usage of alcohol. To reverse the trend that leads to an increase in poor dietary patterns, sedentary lifestyle, tobacco use, and harmful alcohol use will need policies that transcend the health sector and policy change in different areas such as finance, urban planning, education, agriculture, and transportation.
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Boonmanunt S, Pattanaprateep O, Ongphiphadhanakul B, McKay G, Attia J, Thakkinstian A. Evaluation of the effectiveness of behavioural economic incentive programmes for the promotion of a healthy diet and physical activity: a protocol for a systematic review and network meta-analysis. BMJ Open 2020; 10:e046035. [PMID: 33371052 PMCID: PMC7754655 DOI: 10.1136/bmjopen-2020-046035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Obesity and being overweight are major risk factors for metabolic syndrome and non-communicable diseases. Despite the recommendation that a healthy diet and physical activity can reduce the severity of these diseases, many fail to adhere to these measures. From a behavioural economic perspective, adherence to such measures can be encouraged through financial incentives. However, additional related behavioural economic approaches may improve the effectiveness of an incentive programme. As such, we have developed a protocol for a systematic review and network meta-analysis to summarise the current evidence from financial incentive programmes with and without behavioural economic insights for promoting healthy diet and physical activity. METHODS AND ANALYSIS Previous systematic reviews, meta-analyses and individual studies were identified from Medline and Scopus in June 2020 and will be updated until December 2020. Individual studies will be selected and data extracted by two reviewers. Disagreement will be resolved by consensus or adjudicated by a third reviewer. A descriptive analysis will summarise the effectiveness of behavioural economic incentive programmes for promoting healthy diet and physical activity. Moreover, individual studies will be pooled using network meta-analyses where possible. I2 statistics and Cochran's Q test will be used to assess heterogeneity. Risk of bias and publication bias, if appropriate, will be evaluated, as well as the overall strength of the evidence. ETHICS AND DISSEMINATION Ethics approval for a systematic review and meta-analysis is not required. The findings will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020198024.
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Affiliation(s)
- Suparee Boonmanunt
- Department of Clinical Epidemiology and Biostatistics, Mahidol University, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
| | - Oraluck Pattanaprateep
- Department of Clinical Epidemiology and Biostatistics, Mahidol University, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
| | | | - Gareth McKay
- Centre for Public Health, Queen's University Belfast Faculty of Medicine Health and Life Sciences, Belfast, UK
| | - John Attia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Mahidol University, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
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Digital Public Health – Hebel für Capacity Building in der kommunalen Gesundheitsförderung. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:729-740. [DOI: 10.1007/s00103-020-03148-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ZusammenfassungMit der Ottawa-Charta von 1986 wurde ein Paradigmenwechsel vollzogen, der alle Public-Health-Anstrengungen auf die Stärkung kommunaler Aktivitäten und die Schaffung gesundheitsförderlicher Lebensumstände orientiert. Ein Schlüssel hierfür ist „capacity building“ (CB), verstanden als die Entwicklung und möglichst nachhaltige Implementierung von strukturellen Kapazitäten – wie koordinierte Datenerhebung, Abstimmungsprozesse über Sektorengrenzen hinweg, dauerhafte Bereitstellung grundständiger Ressourcen – in allen Bereichen der Gesundheitsförderung „vor Ort“.Vielfältige Anstrengungen und dreieinhalb Jahrzehnte später sehen wir uns noch viel zu oft Infrastrukturdefiziten, fragmentierten Public-Health-Landschaften und Hemmnissen für die intersektorale Zusammenarbeit gegenüber. Während der theoretische Konsens über das Notwendige breit erscheint, bleibt es eine Herausforderung, diese theoretischen Einsichten in die Praxis umzusetzen. In dieser Situation kann Digital Public Health (DPH) dazu beitragen, Barrieren zu überwinden und „Daten für Taten“ sichtbarer und zugänglicher zu machen. Durch DPH können Daten auf neuartige Weise integriert, strukturiert und disseminiert werden.In diesem Beitrag wird erörtert, wie die Kapazitätsentwicklung auf lokaler und kommunaler Ebene von technologischen Entwicklungen profitieren und was DPH für die Bereitstellung von Informationsservices im Bereich Public Health Capacity tun kann. Der Fokus liegt auf der webbasierten, interaktiven Repräsentation von Gesundheitsförderungsdaten, die für Informations‑, Steuerungs- und Benchmarkingzwecke genutzt werden können. Als Beispiel aus der Public-Health-Praxis wird das Tool „TEAviisari“ (National Institute for Health and Welfare, Finnland) vorgestellt.Die EU-Ratspräsidentschaft Deutschlands 2020 – u. a. mit den Themen Digitalisierung und gemeinsamer Gesundheitsdatenraum – bietet die Gelegenheit, die Kapazitätsentwicklung in der kommunalen Gesundheitsförderung auch hierzulande entscheidend voranzubringen.
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Abstract
The importance of the global climate crisis requires linking physical activity promotion and climate action. This article provides a first overview of interconnections between physical activity promotion and climate action, potential synergies and discrepancies, aiming to stimulate further discussion about this topic. The analysis is based on the World Health Organization’s Global Action Plan on Physical Activity 2018-2030 (GAPPA). The GAPPA covers five perspectives that are of particular relevance with respect to potential links with climate policy: (1) Infrastructures supporting active transport, (2) green spaces and recreational/exercise facilities, (3) exercise programs, (4) mass communication campaigns and mass participation events and (5) training of professionals. Our analysis demonstrates a considerable alignment between strategies for physical activity promotion and efforts for the reduction of greenhouse gas emissions. However, in some of the areas, this alignment could still be improved. Additionally, more climate-conscious policies, research and surveillance need to be developed in the field of physical activity promotion.
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Affiliation(s)
- Karim Abu-Omar
- Department for Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, 91054, Germany
| | - Peter Gelius
- Department for Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, 91054, Germany
| | - Sven Messing
- Department for Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, 91054, Germany
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Kokkinen L, Freiler A, Muntaner C, Shankardass K. How and why do win-win strategies work in engaging policy-makers to implement Health in All Policies? A multiple-case study of six state- and national-level governments. Health Res Policy Syst 2019; 17:102. [PMID: 31864364 PMCID: PMC6925500 DOI: 10.1186/s12961-019-0509-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 11/13/2019] [Indexed: 11/21/2022] Open
Abstract
Background Much of the research about Health in All Policies (HiAP) implementation is descriptive, and there have been calls for more evaluative evidence to explain how and why successes and failures have occurred. In this cross-case study of six state- and national-level governments (California, Ecuador, Finland, Norway, Scotland and Thailand), we tested hypotheses about win–win strategies for engaging policy-makers in HiAP implementation drawing on components identified in our previous systems framework. Methods We used two sources of data — key informant interviews and peer-reviewed and grey literature. Using a protocol, we created context–mechanism–outcome pattern configurations to articulate mechanisms that explain how win–win strategies work and fail in different contexts. We then applied our evidence for all cases to the systems framework. We assessed the quality of evidence within and across cases in terms of triangulation of sources and strength of evidence. We also strengthened hypothesis testing using replication logic. Results We found robust evidence for two mechanisms about how and why win–win strategies build partnerships for HiAP implementation — the use of shared language and the value of multiple outcomes. Within our cases, the triangulation was strong, both hypotheses were supported by literal and contrast replications, and there was no support against them. For the third mechanism studied, using the public-health arguments win–win strategy, we only found evidence from Finland. Based on our systems framework, we expected that the most important system components to using win–win strategies are sectoral objectives, and we found empirical support for this prediction. Conclusions We conclude that two mechanisms about how and why win–win strategies build partnerships for HiAP implementation — the use of shared language and the value of multiple outcomes — were found as relevant to the six settings. Both of these mechanisms trigger a process of developing synergies and releasing potentialities among different government sectors and these interactions between sectors often work through sectoral objectives. These mechanisms should be considered when designing future HiAP initiatives and their implementation to enhance the emergence of non-health sector policy-makers’ engagement.
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Affiliation(s)
- Lauri Kokkinen
- Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, 33014, Tampere, Finland.
| | - Alix Freiler
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, 209 Victoria Street, Toronto, Ontario, M5B 1T8, Canada
| | - Carles Muntaner
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.,Bloomberg School of Nursing, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada
| | - Ketan Shankardass
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, 209 Victoria Street, Toronto, Ontario, M5B 1T8, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.,Department of Health Sciences, Wilfrid Laurier University, 75 University Ave W, Waterloo, Ontario, N2L 3C5, Canada
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Storm I, Post N, Verweij A, Leenaars K. A toolkit with nine district types to support municipalities in taking an integrated approach to prevention. ACTA ACUST UNITED AC 2019; 77:56. [PMID: 31890205 PMCID: PMC6921489 DOI: 10.1186/s13690-019-0378-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 11/14/2019] [Indexed: 11/10/2022]
Abstract
Background Not only do people differ in their health, so do districts within municipalities. For example, city centres have different characteristics and health issues than villages or post-war neighbourhoods. This is why the Dutch National Institute for Public Health and the Environment has developed a toolkit, 'Prevention in the district', based on nine different types of district. Methods The aim of the toolkit is to help municipalities implement an integrated approach to prevention by providing tailored, practical information. We therefore looked at the best way to improve the connection between the available knowledge and local needs. Based on data analysis, expert opinion and working sessions with professionals and local policymakers, we developed a toolkit with three related tools. Results The following tools were developed: 1) nine district types with their prominent characteristics and 14 themes for prevention (ranging from loneliness to overweight); 2) a data guide containing a set of indicators to assess the district health profile; 3) a prevention guide containing a mix of evidence-based interventions for the 14 themes. The tools are presented in a toolkit (a clickable PDF) to emphasise the fact that they form a coherent whole. The link between data and interventions is considered to be particularly innovative. Conclusion The three tools support the improvement of the health and well-being of residents in a district. The first indications are that the toolkit empowers municipalities and lets them work towards an integrated approach. An integrated approach in both district health profiles and district plans could also serve as an example for other countries.
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Affiliation(s)
- Ilse Storm
- National Institute for Public Health and the Environment, Centre for Health and Society, PO Box 1, 3720 Bilthoven, BA Netherlands
| | - Nikkie Post
- National Institute for Public Health and the Environment, Centre for Health and Society, PO Box 1, 3720 Bilthoven, BA Netherlands
| | - Antonia Verweij
- National Institute for Public Health and the Environment, Centre for Health and Society, PO Box 1, 3720 Bilthoven, BA Netherlands
| | - Karlijn Leenaars
- National Institute for Public Health and the Environment, Centre for Health and Society, PO Box 1, 3720 Bilthoven, BA Netherlands
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Puska P, Daube M. Impact assessment of the WHO Framework Convention on Tobacco Control: introduction, general findings and discussion. Tob Control 2019; 28:s81-s83. [PMID: 30181384 PMCID: PMC6589462 DOI: 10.1136/tobaccocontrol-2018-054429] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Pekka Puska
- National Institute for Health and Welfare, Helsinki, Finland
| | - Mike Daube
- Curtin University, Perth, Western Australia, Australia
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24
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Kokkinen L, Muntaner C, O'Campo P, Freiler A, Oneka G, Shankardass K. Implementation of Health 2015 public health program in Finland: a welfare state in transition. Health Promot Int 2019; 34:258-268. [PMID: 29149295 DOI: 10.1093/heapro/dax081] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Our study sought to examine the implementation of Health 2015 [a public health programme prepared following the principles of Health in All Policies (HiAP)] between 2001 and 2015 in the context of welfare state restructuring. We used data from the realist multiple explanatory case study by HARMONICS, which focused on political factors (processes) that lead to the (un)successful implementation of programmes following the principles of HiAP. We analyzed data-key informant interviews, grey and scholarly literature-from our Finnish case to examine how Health 2015 implementation has been affected by the changing role of the state. We find that the dismantling of formal funding allocation decreased the capacity of national authorities to exert control over municipalities' health promotion work, diluting the financial arrangements regarding municipal obligations. As a result, most municipalities failed to contribute to Health 2015, resulting in losses for health promotion activities. Our results also point to joining the EU. Whereas the procedures for preparing Finland's unanimous positions on EU matters were useful in harmonizing ideologies on various policy issues between different ministries, joining the EU also increased commercial interests and the strength of the lobby system, leading to the prioritization of economic objectives over public health objectives. Finally, our informants also highlighted the changing relationship between the state and the market, manifested in market deregulation and increasing influence of pro-growth arguments during the implementation of Health 2015.
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Affiliation(s)
- Lauri Kokkinen
- Faculty of Social Sciences, University of Tampere, Tampere, Finland.,Finnish Institute of Occupational Health, Tampere, Finland
| | - Carles Muntaner
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Patricia O'Campo
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Alix Freiler
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Golda Oneka
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Ketan Shankardass
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Canada.,Wilfrid Laurier University, Waterloo, Canada
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25
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Willett W, Rockström J, Loken B, Springmann M, Lang T, Vermeulen S, Garnett T, Tilman D, DeClerck F, Wood A, Jonell M, Clark M, Gordon LJ, Fanzo J, Hawkes C, Zurayk R, Rivera JA, De Vries W, Majele Sibanda L, Afshin A, Chaudhary A, Herrero M, Agustina R, Branca F, Lartey A, Fan S, Crona B, Fox E, Bignet V, Troell M, Lindahl T, Singh S, Cornell SE, Srinath Reddy K, Narain S, Nishtar S, Murray CJL. Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet 2019; 393:447-492. [PMID: 30660336 DOI: 10.1016/s0140-6736(18)31788-4] [Citation(s) in RCA: 4020] [Impact Index Per Article: 670.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/02/2018] [Accepted: 07/27/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Walter Willett
- Harvard T H Chan School of Public Health, Harvard Medical School, Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Johan Rockström
- Potsdam Institute for Climate Impact Research, Potsdam, Germany; Stockholm Resilience Centre, Stockholm, Sweden
| | - Brent Loken
- Stockholm Resilience Centre, Stockholm, Sweden; EAT, Oslo, Norway.
| | - Marco Springmann
- Oxford Martin Programme on the Future of Food and Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Tim Lang
- Centre for Food Policy, City, University of London, London, UK
| | - Sonja Vermeulen
- World Wide Fund for Nature International, Gland, Switzerland; Hoffmann Centre for Sustainable Resource Economy, Chatham House, London, UK
| | - Tara Garnett
- Food Climate Research Network, Environmental Change Institute and Oxford Martin School, University of Oxford, Oxford, UK
| | - David Tilman
- Department of Ecology, Evolution and Behavior, University of Minnesota, St Paul, MN, USA; Bren School of Environmental Science and Management, University of California, Santa Barbara, CA, USA
| | - Fabrice DeClerck
- Stockholm Resilience Centre, Stockholm, Sweden; EAT, Oslo, Norway; Bioversity International, CGIAR, Montpellier, France
| | - Amanda Wood
- Stockholm Resilience Centre, Stockholm, Sweden; EAT, Oslo, Norway
| | | | - Michael Clark
- Natural Resources Science and Management, University of Minnesota, St Paul, MN, USA
| | | | - Jessica Fanzo
- Nitze School of Advanced International Studies, Berman Institute of Bioethics and Bloomberg School of Public Health, Johns Hopkins University, MD, USA
| | - Corinna Hawkes
- Centre for Food Policy, City, University of London, London, UK
| | - Rami Zurayk
- Department of Landscape Design and Ecosystem Management, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Juan A Rivera
- Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Wim De Vries
- Wageningen University and Research, Environmental Systems Analysis Group, Wageningen, Netherlands
| | | | - Ashkan Afshin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Abhishek Chaudhary
- Institute of Food, Nutrition and Health, ETH Zurich, Switzerland; Department of Civil Engineering, Indian Institute of Technology, Kanpur, India
| | - Mario Herrero
- Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD, Australia
| | - Rina Agustina
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia; Human Nutrition Research Center, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Francesco Branca
- Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
| | - Anna Lartey
- Nutrition and Food Systems Division, Economic and Social Development Department, Food and Agriculture Organization of the UN, Rome, Italy
| | - Shenggen Fan
- International Food Policy Research Institute, Washington DC, USA
| | | | - Elizabeth Fox
- Berman Institute of Bioethics, Johns Hopkins University, MD, USA
| | | | - Max Troell
- Stockholm Resilience Centre, Stockholm, Sweden; The Beijer Institute of Ecological Economics, at the Royal Swedish Academy of Sciences, Stockholm, Sweden
| | - Therese Lindahl
- Stockholm Resilience Centre, Stockholm, Sweden; The Beijer Institute of Ecological Economics, at the Royal Swedish Academy of Sciences, Stockholm, Sweden
| | - Sudhvir Singh
- EAT, Oslo, Norway; University of Auckland, Auckland, New Zealand
| | | | | | - Sunita Narain
- Centre for Science and Environment, New Delhi, India
| | - Sania Nishtar
- Heartfile, Islamabad, Pakistan; WHO High Level Commission on NCDs, Geneva Switzerland; Chairperson Benazir Income Support Program, Islamabad, Pakistan
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Kretowicz H, Hundley V, Tsofliou F. Exploring the Perceived Barriers to Following a Mediterranean Style Diet in Childbearing Age: A Qualitative Study. Nutrients 2018; 10:E1694. [PMID: 30404231 PMCID: PMC6266554 DOI: 10.3390/nu10111694] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 11/01/2018] [Accepted: 11/02/2018] [Indexed: 12/16/2022] Open
Abstract
A considerable amount of research has focused on interventions in pregnancy to promote health in current and future generations. This has yielded inconsistent results and focus has turned towards improving health in the preconception period. Promotion of healthy dietary patterns similar to a Mediterranean diet in the preconception years has been suggested as a dietary strategy to prevent maternal obesity and optimize offspring health. However, it is uncertain whether adoption is acceptable in women of childbearing age. This qualitative study aims to investigate the perceived barriers to following a Mediterranean diet in women of childbearing age. Semi-structured focus groups were used to generate deep insights to be used to guide the development of a future intervention. Nulliparous women aged between 20 and 47 years were recruited (n = 20). Six focus groups were digitally audio recorded and transcribed verbatim by the researcher. Thematic analysis was used to analyze data, which occurred in parallel with data collection to ascertain when data saturation was reached. Five core themes were identified: Mediterranean diet features, perceived benefits, existing dietary behavior and knowledge, practical factors, and information source. The present study highlights that a Mediterranean diet is acceptable to childbearing-aged women, and the insights generated will be helpful in developing an intervention to promote Mediterranean diet adoption.
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Affiliation(s)
- Harriet Kretowicz
- Department of Human Science and Public Health, Centre for Midwifery, Maternal and Perinatal Health, Faculty of Health and Social Sciences, Bournemouth University, Poole BH1 3LT, UK.
| | - Vanora Hundley
- Department of Human Science and Public Health, Centre for Midwifery, Maternal and Perinatal Health, Faculty of Health and Social Sciences, Bournemouth University, Poole BH1 3LT, UK.
| | - Fotini Tsofliou
- Department of Human Science and Public Health, Centre for Midwifery, Maternal and Perinatal Health, Faculty of Health and Social Sciences, Bournemouth University, Poole BH1 3LT, UK.
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27
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Springmann M, Wiebe K, Mason-D'Croz D, Sulser TB, Rayner M, Scarborough P. Health and nutritional aspects of sustainable diet strategies and their association with environmental impacts: a global modelling analysis with country-level detail. Lancet Planet Health 2018; 2:e451-e461. [PMID: 30318102 PMCID: PMC6182055 DOI: 10.1016/s2542-5196(18)30206-7] [Citation(s) in RCA: 407] [Impact Index Per Article: 58.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/05/2018] [Accepted: 09/13/2018] [Indexed: 05/03/2023]
Abstract
BACKGROUND Sustainable diets are intended to address the increasing health and environmental concerns related to food production and consumption. Although many candidates for sustainable diets have emerged, a consistent and joint environmental and health analysis of these diets has not been done at a regional level. Using an integrated health and environmental modelling framework for more than 150 countries, we examined three different approaches to sustainable diets motivated by environmental, food security, and public health objectives. METHODS In this global modelling analysis, we combined analyses of nutrient levels, diet-related and weight-related chronic disease mortality, and environmental impacts for more than 150 countries in three sets of diet scenarios. The first set, based on environmental objectives, replaced 25-100% of animal-source foods with plant-based foods. The second set, based on food security objectives, reduced levels of underweight, overweight, and obesity by 25-100%. The third set, based on public health objectives, consisted of four energy-balanced dietary patterns: flexitarian, pescatarian, vegetarian, and vegan. In the nutrient analysis, we calculated nutrient intake and changes in adequacy based on international recommendations and a global dataset of nutrient content and supply. In the health analysis, we estimated changes in mortality using a comparative risk assessment with nine diet and weight-related risk factors. In the environmental analysis, we combined country-specific and food group-specific footprints for greenhouse gas emissions, cropland use, freshwater use, nitrogen application, and phosphorus application to analyse the relationship between the health and environmental impacts of dietary change. FINDINGS Following environmental objectives by replacing animal-source foods with plant-based ones was particularly effective in high-income countries for improving nutrient levels, lowering premature mortality (reduction of up to 12% [95% CI 10-13] with complete replacement), and reducing some environmental impacts, in particular greenhouse gas emissions (reductions of up to 84%). However, it also increased freshwater use (increases of up to 16%) and had little effectiveness in countries with low or moderate consumption of animal-source foods. Following food-security objectives by reducing underweight and overweight led to similar reductions in premature mortality (reduction of up to 10% [95% CI 9-11]), and moderately improved nutrient levels. However, it led to only small reductions in environmental impacts at the global level (all impacts changed by <15%), with reduced impacts in high-income and middle-income countries, and increased resource use in low-income countries. Following public health objectives by adopting energy-balanced, low-meat dietary patterns that are in line with available evidence on healthy eating led to an adequate nutrient supply for most nutrients, and large reductions in premature mortality (reduction of 19% [95% CI 18-20] for the flexitarian diet to 22% [18-24] for the vegan diet). It also markedly reduced environmental impacts globally (reducing greenhouse gas emissions by 54-87%, nitrogen application by 23-25%, phosphorus application by 18-21%, cropland use by 8-11%, and freshwater use by 2-11%) and in most regions, except for some environmental domains (cropland use, freshwater use, and phosphorus application) in low-income countries. INTERPRETATION Approaches for sustainable diets are context specific and can result in concurrent reductions in environmental and health impacts globally and in most regions, particularly in high-income and middle-income countries, but they can also increase resource use in low-income countries when diets diversify. A public health strategy focused on improving energy balance and dietary changes towards predominantly plant-based diets that are in line with evidence on healthy eating is a suitable approach for sustainable diets. Updating national dietary guidelines to reflect the latest evidence on healthy eating can by itself be important for improving health and reducing environmental impacts and can complement broader and more explicit criteria of sustainability. FUNDING Wellcome Trust, EAT, CGIAR, and British Heart Foundation.
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Affiliation(s)
- Marco Springmann
- Oxford Martin Programme on the Future of Food and Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Keith Wiebe
- Environment and Production Technology Division, International Food Policy Research Institute, Washington, DC, USA
| | - Daniel Mason-D'Croz
- Environment and Production Technology Division, International Food Policy Research Institute, Washington, DC, USA; Global Food and Nutrition Security Group, Commonwealth Scientific and Industrial Research Organisation, St Lucia, QLD, Australia
| | - Timothy B Sulser
- Environment and Production Technology Division, International Food Policy Research Institute, Washington, DC, USA
| | - Mike Rayner
- Oxford Martin Programme on the Future of Food and Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Peter Scarborough
- Oxford Martin Programme on the Future of Food and Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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28
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Juma PA, Mapa-tassou C, Mohamed SF, Matanje Mwagomba BL, Ndinda C, Oluwasanu M, Mbanya JC, Nkhata MJ, Asiki G, Kyobutungi C. Multi-sectoral action in non-communicable disease prevention policy development in five African countries. BMC Public Health 2018; 18:953. [PMID: 30168391 PMCID: PMC6117629 DOI: 10.1186/s12889-018-5826-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The rise of non-communicable diseases (NCDs) in Africa requires a multi-sectoral action (MSA) in their prevention and control. This study aimed to generate evidence on the extent of MSA application in NCD prevention policy development in five sub-Saharan African countries (Kenya, South Africa, Cameroon, Nigeria and Malawi) focusing on policies around the major NCD risk factors. METHODS The broader study applied a multiple case study design to capture rich descriptions of policy contents, processes and actors as well as contextual factors related to the policies around the major NCD risk factors at single- and multi-country levels. Data were collected through document reviews and key informant interviews with decision-makers and implementers in various sectors. Further consultations were conducted with NCD experts on MSA application in NCD prevention policies in the region. For this paper, we report on how MSA was applied in the policy process. RESULTS The findings revealed some degree of application of MSA in NCD prevention policy development in these countries. However, the level of sector engagement varies across different NCD policies, from passive participation to active engagement, and by country. There was higher engagement of sectors in developing tobacco policies across the countries, followed by alcohol policies. Multi-sectoral action for tobacco and to some extent, alcohol, was enabled through established structures at national levels including inter-ministerial and parliamentary committees. More often coordination was enabled through expert or technical working groups driven by the health sectors. The main barriers to multi-sectoral action included lack of awareness by various sectors about their potential contribution, weak political will, coordination complexity and inadequate resources. CONCLUSION MSA is possible in NCD prevention policy development in African countries. However, the findings illustrate various challenges in bringing sectors together to develop policies to address the increasing NCD burden in the region. Stronger coordination mechanisms with clear guidelines for sector engagement are required for effective MSA in NCD prevention. Such a mechanisms should include approaches for capacity building and resource generation to enable multi-sectoral action in NCD policy formulation, implementation and monitoring of outcomes.
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Affiliation(s)
- Pamela A. Juma
- African Population and Health Research Center, Nairobi, Kenya
| | - Clarisse Mapa-tassou
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Health of Population in Transition Research Group (HoPiT), Yaoundé, Cameroon
| | | | | | | | | | - Jean-Claude Mbanya
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Health of Population in Transition Research Group (HoPiT), Yaoundé, Cameroon
| | - Misheck J. Nkhata
- Anthropology Department, Catholic University of Malawi, Chiradzulu, Malawi
- Department of Anthropology, Durham University, Durham, England
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
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Puska P, Vartiainen E, Nissinen A, Laatikainen T, Jousilahti P. Background, Principles, Implementation, and General Experiences of the North Karelia Project. Glob Heart 2018; 11:173-8. [PMID: 27242083 DOI: 10.1016/j.gheart.2016.04.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/26/2016] [Indexed: 11/18/2022] Open
Abstract
The extremely high mortality of cardiovascular diseases in the 1960s in Finland, particularly in the Eastern Province of North Karelia and especially that of coronary heart disease in men, caused great concern among the local population. Action to reduce the problem was demanded in a petition signed in 1971 by the representatives of the population. In response, the North Karelia Project was launched in 1972 to carry out a comprehensive preventive project, first only in North Karelia as a national pilot (1972 to 1977), and thereafter continuing in North Karelia but at the same time transferring the experiences to a national level. The intervention was based on the at-that-time relatively new scientific information on the main causal risk factors. A comprehensive population-based intervention was carried out, aiming especially at the reduction of the high levels of serum cholesterol, blood pressure, and tobacco use, emphasizing general dietary changes and smoking reduction. A comprehensive monitoring and evaluation program was designed and implemented to learn from the experience in preparation for national and international use. Presented here are the background, principles, and general experiences of this project, which has made major contributions both to the contemporary public health work for the prevention and control of heart disease and noncommunicable diseases and for research in the area.
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Affiliation(s)
- Pekka Puska
- Department of Health, National Institute for Health and Welfare (THL), Helsinki, Finland.
| | - Erkki Vartiainen
- Department of Health, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Aulikki Nissinen
- Department of Health, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Tiina Laatikainen
- National Institute for Health and Welfare, Chronic Disease Prevention Unit, Helsinki, Finland; University of Eastern Finland, Institute of Public Health and Clinical Nutrition, Kuopio, Finland; Hospital District of North Karelia, Joensuu, Finland
| | - Pekka Jousilahti
- Department of Health, National Institute for Health and Welfare (THL), Helsinki, Finland
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Struja T, Eckart A, Kutz A, Huber A, Neyer P, Kraenzlin M, Mueller B, Meier C, Bernasconi L, Schuetz P. Metabolomics for Prediction of Relapse in Graves' Disease: Observational Pilot Study. Front Endocrinol (Lausanne) 2018; 9:623. [PMID: 30386302 PMCID: PMC6199355 DOI: 10.3389/fendo.2018.00623] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 10/01/2018] [Indexed: 12/12/2022] Open
Abstract
Background: There is a lack of biochemical markers for early prediction of relapse in patients with Graves' disease [GD], which may help to direct treatment decisions. We assessed the prognostic ability of a high-throughput proton NMR metabolomic profile to predict relapse in a well characterized cohort of GD patients. Methods: Observational study investigating patients presenting with GD at a Swiss hospital endocrine referral center and an associated endocrine outpatient clinic. We measured 227 metabolic markers in the blood of patients before treatment initiation. Main outcome was relapse of hyperthyroidism within 18 months of stopping anti-thyroid drugs. We used ROC analysis with AUC to assess discrimination. Results: Of 69 included patients 18 (26%) patients had a relapse of disease. The clinical GREAT score had an AUC of 0.68 (95% CI 0.63-0.70) to predict relapse. When looking at the metabolomic markers, univariate analysis revealed pyruvate and triglycerides in medium VLDL as predictors with AUCs of 0.73 (95% CI 0.58-0.84) and 0.67 (95% CI 0.53-0.80), respectively. All other metabolomic markers had lower AUCs. Conclusion: Overall, metabolomic markers in our pilot study had low to moderate prognostic potential for prediction of relapse of GD, with pyruvate and triglycerides being candidates with acceptable discriminatory abilities. Our data need validation in future larger trials.
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Affiliation(s)
- Tristan Struja
- Division of Endocrinology, Diabetes and Metabolism, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
- *Correspondence: Tristan Struja
| | - Andreas Eckart
- Division of Endocrinology, Diabetes and Metabolism, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Alexander Kutz
- Division of Endocrinology, Diabetes and Metabolism, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Andreas Huber
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Peter Neyer
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Beat Mueller
- Division of Endocrinology, Diabetes and Metabolism, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| | - Christian Meier
- Endonet, Basel, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| | - Luca Bernasconi
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Philipp Schuetz
- Division of Endocrinology, Diabetes and Metabolism, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
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Puska P. WHO FCTC as a Pioneering and Learning Instrument Comment on "The Legal Strength of International Health Instruments - What It Brings to Global Health Governance?". Int J Health Policy Manag 2018; 7:75-77. [PMID: 29325405 PMCID: PMC5745870 DOI: 10.15171/ijhpm.2017.63] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 05/16/2017] [Indexed: 11/23/2022] Open
Abstract
The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) is a unique global health instrument, since it is in the health field the only instrument that is international law. After the 10 years of its existence an Independent Expert Group assessed the impact of the FCTC using all available data and visiting a number of countries interviewing different stakeholders. It is quite clear that the Treaty has acted as a strong catalyst and framework for national actions and that remarkable progress in global tobacco control can be seen. At the same time FCTC has moved tobacco control in countries from a pure health issue to a legal responsibility of the whole government, and on the international level created stronger interagency collaboration. The assessment also showed the many challenges. The spread of tobacco use, as well as of other risk lifestyles, is related to globalization. FCTC is a pioneering example of global action to counteract the negative social consequences of globalization. A convention is not an easy instrument, but the FCTC has undoubtedly sparked thinking and development of other stronger public health instruments and of needed governance structures.
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Affiliation(s)
- Pekka Puska
- National Institute for Health and Welfare (THL), Helsinki, Finland
- National Public Health Institutes (IANPHI), Helsinki, Finland
- National Parliament, Helsinki, Finland
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Peñalvo JL, Cudhea F, Micha R, Rehm CD, Afshin A, Whitsel L, Wilde P, Gaziano T, Pearson-Stuttard J, O'Flaherty M, Capewell S, Mozaffarian D. The potential impact of food taxes and subsidies on cardiovascular disease and diabetes burden and disparities in the United States. BMC Med 2017; 15:208. [PMID: 29178869 PMCID: PMC5702980 DOI: 10.1186/s12916-017-0971-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 11/01/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Fiscal interventions are promising strategies to improve diets, reduce cardiovascular disease and diabetes (cardiometabolic diseases; CMD), and address health disparities. The aim of this study is to estimate the impact of specific dietary taxes and subsidies on CMD deaths and disparities in the US. METHODS Using nationally representative data, we used a comparative risk assessment to model the potential effects on total CMD deaths and disparities of price subsidies (10%, 30%) on fruits, vegetables, whole grains, and nuts/seeds and taxes (10%, 30%) on processed meat, unprocessed red meats, and sugar-sweetened beverages. We modeled two gradients of price-responsiveness by education, an indicator of socioeconomic status (SES), based on global price elasticities (18% greater price-responsiveness in low vs. high SES) and recent national experiences with taxes on sugar-sweetened beverages (65% greater price-responsiveness in low vs. high SES). RESULTS Each price intervention would reduce CMD deaths. Overall, the largest proportional reductions were seen in stroke, followed by diabetes and coronary heart disease. Jointly altering prices of all seven dietary factors (10% each, with 18% greater price-responsiveness by SES) would prevent 23,174 (95% UI 22,024-24,595) CMD deaths/year, corresponding to 3.1% (95% UI 2.9-3.4) of CMD deaths among Americans with a lower than high school education, 3.6% (95% UI 3.3-3.8) among high school graduates/some college, and 2.9% (95% UI 2.7-3.5) among college graduates. Applying a 30% price change and larger price-responsiveness (65%) in low SES, the corresponding reductions were 10.9% (95% UI 9.2-10.8), 9.8% (95% UI 9.1-10.4), and 6.7% (95% UI 6.2-7.6). The latter scenario would reduce disparities in CMD between Americans with lower than high school versus a college education by 3.5 (95% UI 2.3-4.5) percentage points. CONCLUSIONS Modest taxes and subsidies for key dietary factors could meaningfully reduce CMD and improve US disparities.
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Affiliation(s)
- José L Peñalvo
- Friedman School of Nutrition Science & Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA.
| | - Frederick Cudhea
- Friedman School of Nutrition Science & Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA
| | - Renata Micha
- Friedman School of Nutrition Science & Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA
| | - Colin D Rehm
- Montefiore Medical Center, New York, NY, 10467, USA
| | - Ashkan Afshin
- Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle, WA, 98121, USA
| | - Laurie Whitsel
- American Heart Association (AHA), Washington, DC, 20036, USA
| | - Parke Wilde
- Friedman School of Nutrition Science & Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA
| | - Tom Gaziano
- Divisions of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Jonathan Pearson-Stuttard
- School of Public Health, Imperial College London, London, W2 1PG, UK
- Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GL, UK
| | - Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GL, UK
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GL, UK
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science & Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA
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Andersen JB, Gulis G. Community maturity to implement Health in All Policies. Int J Public Health 2017; 62:605-612. [DOI: 10.1007/s00038-017-0951-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 11/24/2022] Open
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Browne GR, Rutherfurd ID. The Case for "Environment in All Policies": Lessons from the "Health in All Policies" Approach in Public Health. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:149-154. [PMID: 27352407 PMCID: PMC5289911 DOI: 10.1289/ehp294] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 04/06/2016] [Accepted: 05/31/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Both public health, and the health of the natural environment, are affected by policy decisions made across portfolios as diverse as finance, planning, transport, housing, education, and agriculture. A response to the interdependent character of public health has been the "health in all policies" (HiAP) approach. OBJECTIVES With reference to parallels between health and environment, this paper argues that lessons from HiAP are useful for creating a new integrated environmental management approach termed "environment in all polices" (EiAP). DISCUSSION This paper covers the theoretical foundations of HiAP, which is based on an understanding that health is strongly socially determined. The paper then highlights how lessons learned from HiAP's implementation in Finland, California, and South Australia might be applied to EiAP. It is too early to learn from evaluations of HiAP, but it is apparent that there is no single tool kit for its application. The properties that are likely to be necessary for an effective EiAP approach include a jurisdiction-specific approach, ongoing and strong leadership from a central agency, independent analysis, and a champion. We then apply these properties to Victoria (Australia) to demonstrate how EiAP might work. CONCLUSIONS We encourage further exploration of the feasibility of EiAP as an approach that could make explicit the sometimes surprising environmental implications of a whole range of strategic policies. Citation: Browne GR, Rutherfurd ID. 2017. The case for "environment in all policies": lessons from the "health in all policies" approach in public health. Environ Health Perspect 125:149-154; http://dx.doi.org/10.1289/EHP294.
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Affiliation(s)
- Geoffrey R. Browne
- McCaughey VicHealth Community Wellbeing Unit, Centre for Health Equity, School of Population and Global Health, and
| | - Ian D. Rutherfurd
- School of Geography, University of Melbourne, Parkville, Victoria, Australia
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de Leeuw E. Engagement of Sectors Other than Health in Integrated Health Governance, Policy, and Action. Annu Rev Public Health 2017; 38:329-349. [PMID: 28125390 DOI: 10.1146/annurev-publhealth-031816-044309] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Health is created largely outside the health sector. Engagement in health governance, policy, and intervention development and implementation by sectors other than health is therefore important. Recent calls for building and implementing Health in All Policies, and continued arguments for intersectoral action, may strengthen the potential that other sectors have for health. This review clarifies the conceptual foundations for integral health governance, policy, and action, delineates the different sectors and their possible engagement, and provides an overview of a continuum of methods of engagement with other sectors to secure integration. This continuum ranges from institutional (re)design to value-based narratives. Depending on the lens applied, different elements can be identified within the continuum. This review is built on insights from political science, leadership studies, public health, empirical Health in All Policy research, knowledge and evidence nexus approaches, and community perspectives. Successful integration of health governance, policy, and action depends on integration of the elements on the continuum.
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Affiliation(s)
- Evelyne de Leeuw
- Centre for Health Equity Training, Research and Evaluation (CHETRE), Part of the UNSW Australia Research Centre for Primary Health Care & Equity, A Unit of Population Health, South Western Sydney Local Health District, NSW Health, A Member of the Ingham Institute, Liverpool Hospital, Liverpool, New South Wales 1871, Australia;
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Abstract
Public health practice in the twenty-first century is in a state of significant flux. Several macro trends are impacting the current practice of governmental public health and will likely have effects for many years to come. These macro trends are described as forces of change, which are changes that affect the context in which the community and its public health system operate. This article focuses on seven such forces of change: the Patient Protection and Affordable Care Act, public health agency accreditation, climate change, health in all policies, social media and informatics, demographic transitions, and globalized travel. Following the description of each of these, this article then turns to possible approaches to measuring, tracking, and understanding the impact of these forces of change on public health practice, including the use of evidence-based public health, practice-based research, and policy surveillance.
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Affiliation(s)
- Paul Campbell Erwin
- Department of Public Health, University of Tennessee, Knoxville, Tennessee 37996;
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School; and Division of Public Health Sciences and Alvin J. Siteman Cancer Center, School of Medicine, Washington University in St. Louis, St. Louis, Missouri 63130-4838;
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Malta DC, Gosch CS, Buss P, Rocha DG, Rezende R, Freitas PC, Akerman M. [Chronic Non Communicable Diseases and the support of intersectorial action to tackle them]. CIENCIA & SAUDE COLETIVA 2016; 19:4341-50. [PMID: 25351301 DOI: 10.1590/1413-812320141911.07712014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 08/05/2014] [Indexed: 11/22/2022] Open
Abstract
The study seeks to analyze the topic of Chronic Non Communicable Diseases (NCDs) and the role of intersectorial actions in tackling these diseases. It involved a narrative review through searches on Medline, Pubmed and Lilacs databases, and documents from the World Health Organization (WHO), the Pan American Health Organization (PAHO) and the Brazilian government. The link between the theme of intersectoriality and NCD is reviewed in the Global Conferences and Agendas on Health Promotion, and the role of other sectors in relation to effective interventions for NCDs. Some experiences of intersectorial activities for tackling NCDs are presented. The conclusion drawn is that the implementation of intersectorial action in conjunction with sectorial health policies in tackling NCDs has become a political priority, involving coordinated actions, negotiations forums, integrated planning and sustainable funding. It is necessary to seek the active participation of social actors in the advocacy, monitoring and accountability process, coupled with training processes for managers and other professionals, which will give sustainability to the social processes and required changes. Intersectorial partnerships are fundamental.
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Affiliation(s)
- Deborah Carvalho Malta
- Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, DF, Brasil,
| | - Cristiane Scolari Gosch
- Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, DF, Brasil,
| | - Paulo Buss
- Centro de Relações Internacionais em Saúde, Fundação Oswaldo Cruz
| | | | | | - Paula Carvalho Freitas
- Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, DF, Brasil,
| | - Marco Akerman
- Departamento de Prática de Saúde Pública, Faculdade de Saúde Pública, Universidade de São Paulo
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Diem G, Brownson RC, Grabauskas V, Shatchkute A, Stachenko S. Prevention and control of noncommunicable diseases through evidence-based public health: implementing the NCD 2020 action plan. Glob Health Promot 2016; 23:5-13. [PMID: 25758171 PMCID: PMC4762750 DOI: 10.1177/1757975914567513] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 10/02/2014] [Indexed: 10/23/2022]
Abstract
The control of noncommunicable diseases (NCDs) was addressed by the declaration of the 66th United Nations (UN) General Assembly followed by the World Health Organization's (WHO) NCD 2020 action plan. There is a clear need to better apply evidence in public health settings to tackle both behaviour-related factors and the underlying social and economic conditions. This article describes concepts of evidence-based public health (EBPH) and outlines a set of actions that are essential for successful global NCD prevention. The authors describe the importance of knowledge translation with the goal of increasing the effectiveness of public health services, relying on both quantitative and qualitative evidence. In particular, the role of capacity building is highlighted because it is fundamental to progress in controlling NCDs. Important challenges for capacity building include the need to bridge diverse disciplines, build the evidence base across countries and the lack of formal training in public health sciences. As brief case examples, several successful capacity-building efforts are highlighted to address challenges and further evidence-based decision making. The need for a more comprehensive public health approach, addressing social, environmental and cultural conditions, has led to government-wide and society-wide strategies that are now on the agenda due to efforts such as the WHO's NCD 2020 action plan and Health 2020: the European Policy for Health and Wellbeing. These efforts need research to generate evidence in new areas (e.g. equity and sustainability), training to build public health capacity and a continuous process of improvement and knowledge generation and translation.
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Affiliation(s)
- Günter Diem
- Vorarlberg Public Health Society, Vorarlberg, Austria ()
| | - Ross C. Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis ()
- Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri USA
| | - Vilius Grabauskas
- Department of Preventive Medicine, Lithuanian Health Science University, Kaunas, Lithuania ()
| | - Aushra Shatchkute
- Former Regional Adviser, Chronic Diseases, CINDI Coordinator, WHO Regional Office for Europe ()
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Lu Y, Ezzati M, Rimm EB, Hajifathalian K, Ueda P, Danaei G. Sick Populations and Sick Subpopulations: Reducing Disparities in Cardiovascular Disease Between Blacks and Whites in the United States. Circulation 2016; 134:472-85. [PMID: 27324491 PMCID: PMC5001154 DOI: 10.1161/circulationaha.115.018102] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/06/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) death rates are much higher in blacks than whites in the United States. It is unclear how CVD risk and events are distributed among blacks versus whites and how interventions reduce racial disparities. METHODS We developed risk models for fatal and for fatal and nonfatal CVD using 8 cohorts in the United States. We used 6154 adults who were 50 to 69 years of age in the National Health and Nutrition Examination Survey 1999 to 2012 to estimate the distributions of risk and events in blacks and whites. We estimated the total and disparity impacts of a range of population-wide, targeted, and risk-based interventions on 10-year CVD risks and event rates. RESULTS Twenty-five percent (95% confidence interval [CI], 22-28) of black men and 12% (95% CI, 10-14) of black women were at ≥6.67% risk of fatal CVD (almost equivalent to 20% risk of fatal or nonfatal CVD) compared with 10% (95% CI, 8-12) of white men and 3% (95% CI, 2-4) of white women. These high-risk individuals accounted for 55% (95% CI, 49-59) of CVD deaths among black men and 42% (95% CI, 35-46) in black women compared with 30% (95% CI, 24-35) in white men and 18% (95% CI, 13-22) in white women. We estimated that an intervention that treated multiple risk factors in high-risk individuals could reduce black-white difference in CVD death rate from 1659 to 1244 per 100 000 in men and from 1320 to 897 in women. Rates of fatal and nonfatal CVD were generally similar between black and white men. In women, a larger proportion of women were at ≥7.5% risk of CVD (30% versus 19% in whites), and an intervention that targeted multiple risk factors among this group was estimated to reduce black-white differences in CVD rates from 1688 to 1197 per 100 000. CONCLUSIONS A substantially larger proportion of blacks have a high risk of fatal CVD and bear a large share of CVD deaths. A risk-based intervention that reduces multiple risk factors could substantially reduce overall CVD rates and racial disparities in CVD death rates.
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Affiliation(s)
- Yuan Lu
- From Center for Outcomes Research and Evaluation (CORE), Yale/Yale-New Haven Hospital, New Haven, CT (Y.L.); MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK (M.E.); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.B.R.); Departments of Epidemiology (E.B.R., G.D.), Nutrition (E.B.R.), and Global Health and Population (P.U., G.D.), Harvard TH Chan School of Public Health, Boston, MA; and Department of Internal Medicine, Cleveland Clinic, Cleveland, OH (K.H.)
| | - Majid Ezzati
- From Center for Outcomes Research and Evaluation (CORE), Yale/Yale-New Haven Hospital, New Haven, CT (Y.L.); MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK (M.E.); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.B.R.); Departments of Epidemiology (E.B.R., G.D.), Nutrition (E.B.R.), and Global Health and Population (P.U., G.D.), Harvard TH Chan School of Public Health, Boston, MA; and Department of Internal Medicine, Cleveland Clinic, Cleveland, OH (K.H.)
| | - Eric B Rimm
- From Center for Outcomes Research and Evaluation (CORE), Yale/Yale-New Haven Hospital, New Haven, CT (Y.L.); MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK (M.E.); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.B.R.); Departments of Epidemiology (E.B.R., G.D.), Nutrition (E.B.R.), and Global Health and Population (P.U., G.D.), Harvard TH Chan School of Public Health, Boston, MA; and Department of Internal Medicine, Cleveland Clinic, Cleveland, OH (K.H.)
| | - Kaveh Hajifathalian
- From Center for Outcomes Research and Evaluation (CORE), Yale/Yale-New Haven Hospital, New Haven, CT (Y.L.); MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK (M.E.); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.B.R.); Departments of Epidemiology (E.B.R., G.D.), Nutrition (E.B.R.), and Global Health and Population (P.U., G.D.), Harvard TH Chan School of Public Health, Boston, MA; and Department of Internal Medicine, Cleveland Clinic, Cleveland, OH (K.H.)
| | - Peter Ueda
- From Center for Outcomes Research and Evaluation (CORE), Yale/Yale-New Haven Hospital, New Haven, CT (Y.L.); MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK (M.E.); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.B.R.); Departments of Epidemiology (E.B.R., G.D.), Nutrition (E.B.R.), and Global Health and Population (P.U., G.D.), Harvard TH Chan School of Public Health, Boston, MA; and Department of Internal Medicine, Cleveland Clinic, Cleveland, OH (K.H.)
| | - Goodarz Danaei
- From Center for Outcomes Research and Evaluation (CORE), Yale/Yale-New Haven Hospital, New Haven, CT (Y.L.); MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK (M.E.); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.B.R.); Departments of Epidemiology (E.B.R., G.D.), Nutrition (E.B.R.), and Global Health and Population (P.U., G.D.), Harvard TH Chan School of Public Health, Boston, MA; and Department of Internal Medicine, Cleveland Clinic, Cleveland, OH (K.H.).
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Storm I, den Hertog F, van Oers H, Schuit AJ. How to improve collaboration between the public health sector and other policy sectors to reduce health inequalities? - A study in sixteen municipalities in the Netherlands. Int J Equity Health 2016; 15:97. [PMID: 27334297 PMCID: PMC4918104 DOI: 10.1186/s12939-016-0384-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 06/16/2016] [Indexed: 11/19/2022] Open
Abstract
Background The causes of health inequalities are complex. For the reduction of health inequalities, intersectoral collaboration between the public health sector and both social policy sectors (e.g. youth affairs, education) and physical policy sectors (e.g. housing, spatial planning) is essential, but in local practice difficult to realize. The aim of this study was to examine the collaboration between the sectors in question more closely and to identify opportunities for improvement. Method A qualitative descriptive analysis of five aspects of collaboration within sixteen Dutch municipalities was performed to examine the collaboration between the public health sector and other policy sectors: 1) involvement of the sectors in the public health policy network, 2) harmonisation of objectives, 3) use of policies by the relevant sectors, 4) formalised collaboration, and 5) previous experience. Empirical data on these collaboration aspects were collected based on document analysis, questionnaires and interviews. Results The study found that the policy workers of social sectors were more involved in the public health network and more frequently supported the objectives in the field of health inequality reduction. Both social policy sectors and physical policy sectors used policies and activities to reduce health inequalities. More is done to influence the determinants of health inequality through policies aimed at lifestyle and social setting than through policies aimed at socioeconomic factors and the physical environment. Where the physical policy sectors are involved in the public health network, the collaboration follows a very similar pattern as with the social policy sectors. All sectors recognise the importance of good relationships, positive experiences, a common interest in working together and coordinated mechanisms. Conclusion This study shows that there is scope for improving collaboration in the field of health inequality reduction between the public health sector and both social policy sectors and physical policy sectors. Ways in which improvement could be realised include involving physical policy sectors in the network, pursuing widely supported policy goals, making balanced efforts to influence determinants of health inequalities, and increasing the emphasis on a programmatic approach.
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Affiliation(s)
- Ilse Storm
- National Institute for Public Health and the Environment, Centre for Health and Society, PO Box 1, 3720 BA, Bilthoven, The Netherlands.
| | - Frank den Hertog
- National Institute for Public Health and the Environment, Centre for Health and Society, PO Box 1, 3720 BA, Bilthoven, The Netherlands
| | - Hans van Oers
- Tilburg University, Tranzo Scientific Center for Care and Welfare, PO 90153, 5000 LE, Tilburg, The Netherlands.,National Institute for Public Health and the Environment, Executive Office, PO Box 1, 3720 BA, Bilthoven, The Netherlands
| | - Albertine J Schuit
- Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands.,National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, PO Box 1, 3720 BA, Bilthoven, The Netherlands
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CVD Prevention Through Policy: a Review of Mass Media, Food/Menu Labeling, Taxation/Subsidies, Built Environment, School Procurement, Worksite Wellness, and Marketing Standards to Improve Diet. Curr Cardiol Rep 2016; 17:98. [PMID: 26370554 PMCID: PMC4569662 DOI: 10.1007/s11886-015-0658-9] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Poor diet is the leading cause of cardiovascular disease in the USA and globally. Evidence-based policies are crucial to improve diet and population health. We reviewed the effectiveness for a range of policy levers to alter diet and diet-related risk factors. We identified evidence to support benefits of focused mass media campaigns (especially for fruits, vegetables, salt), food pricing strategies (both subsidies and taxation, with stronger effects at lower income levels), school procurement policies (for increasing healthful or reducing unhealthful choices), and worksite wellness programs (especially when comprehensive and multicomponent). Evidence was inconclusive for food and menu labeling (for consumer or industry behavior) and changes in local built environment (e.g., availability or accessibility of supermarkets, fast food outlets). We found little empiric evidence evaluating marketing restrictions, although broad principles and large resources spent on marketing suggest utility. Widespread implementation and evaluation of evidence-based policy strategies, with further research on other strategies with mixed/limited evidence, are essential “population medicine” to reduce health and economic burdens and inequities of diet-related illness worldwide.
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Huovila J, Saikkonen S. Establishing credibility, constructing understanding: The epistemic struggle over healthy eating in the Finnish dietetic blogosphere. Health (London) 2015. [DOI: 10.1177/1363459315595849] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
What constitutes healthy eating is experiencing ongoing public debate, and this debate is increasingly taking place on the Internet. In this article, using a dialectical approach to analyse rhetorical discourse, we investigated how six highly popular Finnish nutrition counselling bloggers construct dietetic credibility and understanding. Their argumentation is compared to that of two academic experts contributing to the blog of the National Institute for Health and Welfare. Theoretically, we draw on Michael Billig’s notions on how thinking and understanding are pervasively argumentative and reflect wider socio-cultural contexts, and on the dilemmatic nature of common sense. We demonstrate how the popular Finnish nutrition counselling bloggers rhetorically constructed a more particularistic and individualistic understanding of healthy eating in their argumentation in critical opposition to the universalistic and population-based understanding. In the popular Finnish nutrition counselling bloggers argumentation, practical, subjective and moral knowledge was valued, alongside abstract, scientific knowledge. In contrast, the National Institute for Health and Welfare bloggers typically utilised population-based averages and causalities in their argumentation. We argue that arguing over healthy eating in the public domain is fundamentally an epistemic struggle, in which different forms of knowledge and ways of knowing are valued, and dilemmas related to healthy eating are deliberated.
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The Healthcare Ecosystem and Biomedical Research Funding. Nanomedicine (Lond) 2015. [DOI: 10.1201/b18615-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Tang KC, Ståhl T, Bettcher D, De Leeuw E. The Eighth Global Conference on Health Promotion: Health in all policies: from rhetoric to action. Health Promot Int 2015; 29 Suppl 1:i1-8. [PMID: 25217344 DOI: 10.1093/heapro/dau051] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kwok Cho Tang
- Health Promotion, World Health Organization, Geneva, Switzerland
| | - Timo Ståhl
- National Institute for Health and Welfare, Helsinki, Finland
| | - Douglas Bettcher
- Department of Prevention of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Evelyne De Leeuw
- Health Promotion International, Melbourne, Australia and Oxford, United Kingdom
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Del Gobbo LC, Khatibzadeh S, Imamura F, Micha R, Shi P, Smith M, Myers SS, Mozaffarian D. Assessing global dietary habits: a comparison of national estimates from the FAO and the Global Dietary Database. Am J Clin Nutr 2015; 101:1038-46. [PMID: 25788002 PMCID: PMC4409685 DOI: 10.3945/ajcn.114.087403] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 02/20/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Accurate data on dietary habits are crucial for understanding impacts on disease and informing policy priorities. Nation-specific food balance sheets from the United Nations FAO provided the only available global dietary estimates but with uncertain validity. OBJECTIVES We investigated how FAO estimates compared with nationally representative, individual-based dietary surveys from the Global Dietary Database (GDD) and developed calibration equations to improve the validity of FAO data to estimate dietary intakes. DESIGN FAO estimates were matched to GDD data for 113 countries across the following 9 major dietary metrics for 30 y of data (1980-2009): fruit, vegetables, beans and legumes, nuts and seeds, whole grains, red and processed meats, fish and seafood, milk, and total energy. Both absolute and percentage differences in FAO and GDD mean estimates were evaluated. Linear regression was used to evaluate whether FAO estimates predicted GDD dietary intakes and whether this prediction varied according to age, sex, region, and time. Calibration equations were developed to adjust FAO estimates to approximate national dietary surveys validated by using randomly split data sets. RESULTS For most food groups, FAO estimates substantially overestimated individual-based dietary intakes by 74.5% (vegetables) and 270% (whole grains) while underestimating beans and legumes (-50%) and nuts and seeds (-29%) (P < 0.05 for each). In multivariate regressions, these overestimations and underestimations for each dietary factor further varied by age, sex, region, and time (P < 0.001 for each). Split-data set calibration models, which accounted for country-level covariates and other sources of heterogeneity, effectively adjusted FAO estimates to approximate estimates from national survey data (r = 0.47-0.80) with small SEs of prediction (generally 1-5 g/d). CONCLUSIONS For all food groups and total energy, FAO estimates substantially exceeded or underestimated individual-based national surveys of individual intakes with significant variation depending on age, sex, region, and time. Calibration models effectively adjusted the comprehensive, widely accessible FAO data to facilitate a more-accurate estimation of individual-level dietary intakes nationally and by age and sex.
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Affiliation(s)
- Liana C Del Gobbo
- From the Departments of Nutrition (LCDG), Epidemiology (RM, PS, and DM), and Environmental Health (MS and SSM), Harvard School of Public Health, Boston, MA; the Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom (FI); and the Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece (RM)
| | - Shahab Khatibzadeh
- From the Departments of Nutrition (LCDG), Epidemiology (RM, PS, and DM), and Environmental Health (MS and SSM), Harvard School of Public Health, Boston, MA; the Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom (FI); and the Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece (RM)
| | - Fumiaki Imamura
- From the Departments of Nutrition (LCDG), Epidemiology (RM, PS, and DM), and Environmental Health (MS and SSM), Harvard School of Public Health, Boston, MA; the Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom (FI); and the Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece (RM)
| | - Renata Micha
- From the Departments of Nutrition (LCDG), Epidemiology (RM, PS, and DM), and Environmental Health (MS and SSM), Harvard School of Public Health, Boston, MA; the Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom (FI); and the Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece (RM)
| | - Peilin Shi
- From the Departments of Nutrition (LCDG), Epidemiology (RM, PS, and DM), and Environmental Health (MS and SSM), Harvard School of Public Health, Boston, MA; the Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom (FI); and the Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece (RM)
| | - Matthew Smith
- From the Departments of Nutrition (LCDG), Epidemiology (RM, PS, and DM), and Environmental Health (MS and SSM), Harvard School of Public Health, Boston, MA; the Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom (FI); and the Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece (RM)
| | - Samuel S Myers
- From the Departments of Nutrition (LCDG), Epidemiology (RM, PS, and DM), and Environmental Health (MS and SSM), Harvard School of Public Health, Boston, MA; the Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom (FI); and the Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece (RM)
| | - Dariush Mozaffarian
- From the Departments of Nutrition (LCDG), Epidemiology (RM, PS, and DM), and Environmental Health (MS and SSM), Harvard School of Public Health, Boston, MA; the Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom (FI); and the Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece (RM)
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Bao J, Bhalla K, Bennett S. Evidence to inform intersectoral policies: a comparison of health and transport sector evidence in support of road traffic injury prevention. Health Res Policy Syst 2015; 13:19. [PMID: 25888886 PMCID: PMC4393583 DOI: 10.1186/s12961-015-0008-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 02/26/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Health is influenced by determinants beyond the traditional conception of the health sector. Increasingly, global actors are targeting policymakers at global and national levels to take an intersectoral approach to health issues. Multilateral organizations in the health and transport communities have published policy reports targeting policymakers to address the burden of road traffic injuries. However, these reports stem from sectors grounded in different disciplinary perspectives. We investigate whether sectors have differing evidentiary traditions by analyzing differences regarding author networks, type of evidence cited, recommendations, and indicators. METHODS We selected global policy reports on road traffic injury prevention based upon expert opinion and categorized them by sector according to their institutional publisher. For each report, we i) conducted an authorship analysis by sectoral affiliation; ii) analyzed the types of research evidence cited and categorized the evidence type and institutional nature of the publisher; iii) analyzed key recommendations by extracting recommendations presented in the concluding sections of the documents; and iv) examined the use of indicators. Descriptive statistics were used to determine whether dimensions differed by the sectoral affiliation of the policy report. RESULTS Authorship was dominated by the sector from which the report was published, while reports that involved both sectors often showed clustering of authors in one sector or another, depending on the subject addressed. Reports originating from different sectors preferentially cited different types of evidence; notably, health sector reports emphasized observational studies and reviews, while transport sector reports drew heavily on government agency reports. There were no differences in recommendations and indicators used. CONCLUSIONS Notions of knowledge validity and valuations of evidence vary depending on the field's historical development. Such differences in valuing evidence within sectors may have the potential to undermine the application of evidence in intersectoral policymaking. Strategies to address this challenge include the identification of key individuals to connect separate sectors, knowledge translation activities that take account of sectoral differences, and the tailoring of messages to different audiences. Future analyses on other intersectoral issues may provide clarity on points of tension and differing types of evidence used in intersectoral work.
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Affiliation(s)
- James Bao
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Kavi Bhalla
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Sara Bennett
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
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Crino M, Sacks G, Vandevijvere S, Swinburn B, Neal B. The Influence on Population Weight Gain and Obesity of the Macronutrient Composition and Energy Density of the Food Supply. Curr Obes Rep 2015; 4:1-10. [PMID: 26627085 DOI: 10.1007/s13679-014-0134-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Rates of overweight and obesity have increased dramatically in all regions of the world over the last few decades. Almost all of the world's population now has ubiquitous access to low-cost, but highly-processed, energy-dense, nutrient-poor food products. These changes in the food supply, rather than decreases in physical activity, are most likely the primary driver of population weight gain and obesity. To-date, the majority of prevention efforts focus on personalised approaches targeting individuals. Population-wide food supply interventions addressing sodium and trans fat reduction have proven highly effective and comparable efforts are now required to target obesity. The evidence suggests that strategies focusing upon reducing the energy density and portion size of foods will be more effective than those targeting specific macronutrients. Government leadership, clearly specified targets, accountability and transparency will be the key to achieving the food supply changes required to address the global obesity epidemic.
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Affiliation(s)
- Michelle Crino
- The George Institute for Global Health, University of Sydney, Level 10, King George V Building, 83-117 Missenden Rd, Camperdown, NSW, 2050, Sydney, Australia.
| | - Gary Sacks
- WHO Collaborating Centre for Obesity Prevention, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
| | - Stefanie Vandevijvere
- School of Population Health, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand.
| | - Boyd Swinburn
- WHO Collaborating Centre for Obesity Prevention, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
- School of Population Health, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand.
| | - Bruce Neal
- The George Institute for Global Health, University of Sydney, Level 10, King George V Building, 83-117 Missenden Rd, Camperdown, NSW, 2050, Sydney, Australia.
- The Royal Prince Alfred Hospital, Sydney, Australia.
- Imperial College, London, UK.
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Savolainen J, Kautiainen H, Niskanen L, Mäntyselkä P. Decreasing cholesterol levels in the community--lifestyle change with statin? BMC FAMILY PRACTICE 2015; 16:29. [PMID: 25879518 PMCID: PMC4356061 DOI: 10.1186/s12875-015-0240-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 02/13/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Lapinlahti 2005-2010 study was carried out to explore cardiovascular disease risk factors and changes in lifestyle in Lapinlahti residents in eastern Finland. Our aim was to analyse factors influencing the level of cholesterol in the community. METHODS In 2005, 480 subjects aged 30-65 years underwent a complete health survey (baseline study) that consisted of a structured questionnaire and a health examination. The follow-up was carried out five years later in 2010. The present study population included 326 individuals who did not use lipid-lowering medication at the baseline. A trained research nurse measured weight, height, waist circumference and blood pressure at the baseline and follow-up. Respectively, lifestyle factors (nutrition, exercise, smoking and alcohol use) were examined with a structured questionnaire. Each lifestyle item was valued as -1, 0 or 1, depending on how closely it fitted to the recommendations. Cholesterol level analyses at the baseline and follow-up were performed according to the protocol of the Kuopio University Hospital's medical laboratory. Based on their baseline cholesterol levels, the participants were divided into tertiles. The age- and sex-adjusted linear trend between the tertiles was tested. RESULTS The change in cholesterol level was associated with lipid-lowering medication (P < 0.001). Lifestyle improvement was associated with the cholesterol level change but did not reach statistical significance (P = 0.061), although the interaction of lipid-lowering medication and lifestyle change was associated with the change in cholesterol level (P = 0.018). In multivariate analysis, a favourable change in fat consumption (P = 0.007) and lipid-lowering medication (P < 0.001) were associated with decreasing cholesterol levels. CONCLUSIONS At the population level, dyslipidaemia is one of the most easily modifiable risk factors of CHD. Lipid-lowering medication may have the most significant impact on cholesterol level in communities with primary health care with good coverage. On the other hand, the potential of health-promoting and population-based prevention strategies may be underused.
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Affiliation(s)
- Jorma Savolainen
- Institute of Public Health and Clinical Nutrition, Primary Health Care, School of Medicine, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland.
- Primary Health Care Unit, Kuopio University Hospital, P.O. Box 100, FI-72009 KYS, Kuopio, Finland.
| | - Hannu Kautiainen
- Department of General Practice, Helsinki University Central Hospital, Unit of Primary Health Care and University of Helsinki, P.O. Box 20, FI-00014, Helsinki, Finland.
| | - Leo Niskanen
- Endocrinology, Abdominal Center, Helsinki University Central Hospital, P.O. Box 55, FI- 00014, Helsinki, Finland.
| | - Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, Primary Health Care, School of Medicine, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland.
- Primary Health Care Unit, Kuopio University Hospital, P.O. Box 100, FI-72009 KYS, Kuopio, Finland.
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Spears BA, Taddeo CM, Daly AL, Stretton A, Karklins LT. Cyberbullying, help-seeking and mental health in young Australians: implications for public health. Int J Public Health 2015; 60:219-26. [PMID: 25572385 DOI: 10.1007/s00038-014-0642-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 12/15/2014] [Accepted: 12/17/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES To examine the relationship between young Australians' cyberbullying experiences, their help-seeking practices and associated mental well-being and social connectedness, with a view to informing national health and well-being agendas. METHODS An online survey was administered to young people aged 12-18 years (n = 2,338), recruited across Australia in year 2 of a larger 4-year study. RESULTS Youth with no experience of cyberbullying had better well-being profiles and mental health overall. Conversely, cyberbully victims, had poorer well-being and mental health and tended not to engage with online support services, in spite of being more likely to be online after 11 pm. Parents and peers were identified as key sources of help for most young people when dealing with problems. CONCLUSIONS Cyberbullying is a public health issue particularly for vulnerable youth whose mental health and well-being is impacted more than those not involved. As youth are spending increasing time in the 24/7 online environment, there is a need to develop initiatives that engage young people and encourage help-seeking online, whilst concomitantly building capacity of parents and peers to support their well-being.
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Affiliation(s)
- Barbara A Spears
- School of Education, University of South Australia, Magill Campus, Magill, Adelaide, SA, Australia,
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Chokshi DA, Farley TA. Health. Changing behaviors to prevent noncommunicable diseases. Science 2014; 345:1243-4. [PMID: 25214590 DOI: 10.1126/science.1259809] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Dave A Chokshi
- Departments of Population Health and Medicine, New York University Langone Medical Center, New York, NY 10016, USA.
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