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Read this month’s featured article from our monthly newsletter, Health Promotion Connection/ Conexiones para la Promoción de la Salud/Connexion pour la Promotion de la Santé- Enjoy!

Physical Inactivity- contributor to non-communicable diseases in the EM region

By Sridevi Adivi, MPHN

Physical inactivity, a major risk factor for non-communicable diseases (NCDs), causes an estimated 3 to 5 million deaths globally every year. As per the WHO estimates, in 2008 a global population of 31% did not undertake recommended physical activity thereby denying themselves of the health benefits of regular physical activity.1 The WHO, in 2004 advised member states to develop strategies and programs for promotion of physical activity and renewed this statement in 2013. The goal of the program is to reduce physical inactivity to 10% by 2025 among the member states. Although many factors contribute to lack of physical activity, an intake of junk food, an increasing use of technology and cars, as well as environmental factors are all primary deterrents to physical activity.

Data from eight countries in the Eastern Mediterranean region depict inactivity ranges from 30% to as high as 70%. Egypt, Bahrain, Jordan, Kuwait, Saudi Arabia and United Arab Emirates have very high prevalence of obesity in the region with 74-86% among women and 77% among men. 2 Diabetes, cardiovascular disease (CVD), cancer, depression and respiratory diseases are increasing an added burden to the public health expenditure. Promoting physical activity to maintain normal weight and reduce prevalence of lifestyle diseases has been recently emphasized in the region. For example, United Arab Emirates, Bahrain, and Saudi Arabia have launched campaigns from schools through different life stages to promote walking, cycling and other sports.

Efforts to reduce NCD’s by Nation

United Arab Emirates shows a high rate of childhood obesity with only 17.2% of pupils being active for 60 minutes a day.3 71% of adults are overweight and obesity among Emirati women is expected to rise to 81%. With the aim to reduce obesity and inactivity, campaigns targeting different age groups have been launched. For example, “Get Active 2014”, a health promotion campaign focuses on healthy eating habits and exercise and targets children in schools from grade 1-10. Developing competency among teachers, incentives, sports-related activities and healthy lifestyle through media campaigns are the objectives. Various activities are planned for the four-year campaign that will spread to other Emirates from Dubai. Another campaign named “Schools for Health” to promote healthy eating and physical activity was launched by the emirate of Abu Dhabi. Health promotion among children and adolescents, improving access to school health services and developing health behaviors are the program’s objectives. The Health Authority of Abu Dhabi has partnered with parents, schools, teachers and the health sector to active the goal. Food Frequency, oral health questionnaires, and health assessment in schools are the evaluation tools and appropriate training material is available on their website.4 Dubai Sports Council started the “Dubai Pulse” in 2009 exclusively to promote physical activity and the program is still ongoing with community events like employee sports competition, cycle rides, walks and marathons. Resource materials like activity booklets, leaflets and flyers etc. are used to educate the community.5

The UAE also conducted a campaign for summer that began in 2013 and continued in the summer of 2014, named “Your Weight in Gold”. Families were invited to register and participate in this contest that included lifestyle modification aspects like healthy eating, exercise, nutrition classes and diet recommendation. Children were allowed to participate in the year 2014.6

Bahrain started a mass media campaign in 2012 for health promotion among their population. Components for physical activity were shared by the ministry on social media like twitter, Instagram, facebook and websites, print and electronic media like television and radio. Messages like “Healthy foods is very useful for patients with heart problems”, “Smoking may increase the risk of the most common type of breast cancer”, “TVs and cars in developing countries increase obesity risk, and “Exercising in free time may keep blood pressure healthy” were shared with the public encouraging them to adopt healthy lifestyles. Educational programs in schools and workshops for medical professional trainees were conducted in 2014.7 An interesting drive to promote physical activity among school children in Bahrain was the “Amal Health Bus”. The Bus visits schools encouraging children from low socio-economic groups to try trampoline, bicycles, skipping, balls, ropes, weight lifting etc. The Bus visits public spaces like parts and community settings on public holidays to educate families. Dr. Amal, health promotion specialist in the bus educates the children and parents on physical activity. Dr. Amal received the Sasakawa prize for Health Development in 2009 to fund the drive from 2010-2011. The private sector funded the bus in 2012-2013 and the Ministry of Health sponsored it in 2014.8

Oman’s estimates indicate NCDs account for 83% of total deaths. Obesity and diabetes are on the rise and the largest proportion of hospital visits in Oman was linked to CVDs. In 2012, two health promotion campaigns were started in Oman, one in collaboration with Oasis Water Company named “Oman’ Health, Oman’s Wealth” and the other for promoting physical activity, “Let’s Rise”. Families and organizations are encouraged to adopt healthier approaches to their everyday life and the campaign is part of the 2050 vision for healthy populations.9 Omantel, mobile service provider in coordination with the ministry started the mobile health service to deliver healthy lifestyle guidance messages on SMS and MMS. This is in sync with “Let’s Rise” campaign.10

Qatar’s Weill Cornel Medical College began “The Challenge” in 2013 to educate children, teachers and families on physical activity on the banner of health and fitness. Young people are encouraged to take up sports and school children also participated in the challenge to complete a series of physical activities. The campaign also encourages everyone to adopt a healthier lifestyle among families for healthy future generations.11 Summer temperatures in the Middle East are very high and a deterrent to outdoor activities. Aspetar, a sports medical hospital in Qatar implemented the innovative “Beat the Heat” in 2013 to encourage community to be active with precautionary measures in summer. Social media is the means used to share the messages to the community.12 Messages of advice consisted of appropriate clothing, techniques to keep hydrated during exercise and warming up carefully. Organizations are encouraged to provide air-condition in meeting and locker rooms and appropriate emergency plans. Both these campaigns encourage physical activity among all populations irrespective of age and gender and are aligned with a larger vision of Qatar’s healthy nation by 2030.

Jordan implemented the King Abdullah II Prize to promote physical fitness program complementing the regular physical education for children between 9 and 17 years. 5000 schools participated and the program is still ongoing after implementation in 2006. Initially the Royal Court of Jordan sponsored the program, which was later taken up by the Ministry of Education. School children are encouraged to participate in fitness activities with support from families and teachers.13

Saudi Arabia started a National Campaign to educate their citizens on obesity and overweight and the need to be physically active. The Ministry has requested walking tracks to be built in all parks and is advocating the culture of walking and healthy food habits. King Saud University in partnership with Arab Centre for Nutrition started the movement “Al Haraka Barakat” meaning “movement is a blessing” targeting students from 6-12 years in the city of Riyadh. The aim was to provide knowledge and skills on physical activity and health for students and teachers. Implementation lasted for two years beginning in the school year 2004-2005.14

Are these campaigns and programs effective?

The activities of few major countries are listed above but obesity, physical inactivity and associated NCDs are increasing and governments are implementing a multitude of strategies to address the issue. Tackling child obesity is primary for development of the country and schools are partners in all these programs. Adults are targeted to participate through mass media messages and related behavior modification strategies. Availability of world cuisine and junk food at less expense promotes obesity while cars, technology and climate is restricting physical activity. Replication of Saudi Arabia’s walking tracks, community parks and Qatar’s innovative physical activity during summer across the region can support the government efforts.

WHO conducted case studies to evaluate the success of some of these programs. For example, the Health Bus from Bahrain visited 66 places and a survey showed that equipment and activities were satisfactory. Children enjoyed the activities with wide spread support. Challenges were repeated replacing of equipment, the limited number of health promotion specialists to travel, and no forms of sustainable monitoring or evaluation.

Dubai Pulse showed a high participation rate at 15,000 and increase of physical activity from 36% to 42%. Support and cooperation from government departments, engagement of different communities and availability of high-quality public sport facilities were the contributing factors while challenges were delivering the interventions in summer when it was delivered in malls that had space constraints and organizing events in the night.

Evaluation of Haraka Barakat showed involvement of families of students, utilization of existing school facilities and was found to be appealing to students and teachers. Challenges were need of training for teachers, unavailability of funds beyond two years period and deliver of program limited to 4-6 weeks. A longer period is necessary for maximizing the effectiveness of the intervention.

Conclusions

A number of interventions aimed at children, teachers and families have been implemented and are in implementation for the last few years. WHO as an integrating organization evaluated few interventions by experts and listed the successes and barriers. These case studies can be utilized as an educational tool among the countries in EMRO to improvise on the efficiency of existing or new campaigns. The Gulf Cooperation Council can encourage the countries to participate in a common platform for exchange of information on various health issues and in organizing events for health professionals to work collectively and individually for achievement of the 2025 goal to reduce physical inactivity to 25%.

References:

  1. Global Strategy for Diet, Physical activity and Health, WHO; http://www.who.int/dietphysicalactivity/factsheet_inactivity/en/
  2. Obesity in EMRO, WHO; http://www.emro.who.int/health-topics/obesity/
  3. Get Active 2014, Campaign by Dubai, UAE; http://www.diaedu.com/GetActive2014SupportMedia.pdf
  4. Schools for health, Campaign by Health Authority of Abu Dhabi, UAE; http://schoolsforhealth.haad.ae/health-campaigns/eat-right–get-active.aspx
  5. Health Education, Physical activity Case studies in UAE; WHO; http://www.emro.who.int/health-education/physical-activity-case-studies/dubai-pulse-uae.html
  6. Dubai’s 2nd “ Weight for Gold” contest includes kids!; Dogonews; 24 November 2014; http://www.dogonews.com/2014/11/24/dubais-2nd-weight-for-gold-contest-includes-kids
  7. Promotion of physical activity through mass media in Bahrain; WHO;        http://www.emro.who.int/health-education/physical-activity-case-studies/the-promotion-of-physical-activity-through-the-mass-media-bahrain.html
  8. Amal Bus, Physical activity case study in Bahrain; WHO; http://www.emro.who.int/health-education/physical-activity-case-studies/dr-amal-bus-bahrain.html
  9. Ministry of Health supports Oasis Water Campaign; Muscat Daily; 4 June 2012; http://www.muscatdaily.com/Archive/Oman/MoH-supports-Oasis-Water-campaign
  10. The First in Oman, Omantel Mobile launches “Mobile Health Servce”; Samena Dail News; 14 May 2012; http://www.samenacouncil.org/samena_daily_news.php?news=28417
  11. Inspirational day of health and fitness for schools across Qatar, Report by Weill Cornell Medical College in Qatar; March 2014; http://qatar-weill.cornell.edu/media/reports/2014/challenge-2014.html
  12. Re-launching Beat the Heat campaign; Aspetar encourages the community to keep fit and active during summer by re-launching Beat the Heat campaign; Life in Aspire; http://www.lifeinaspire.qa/ArticleDetail.aspx?lang=en&id=34#.VPy5HvmUfi0
  13. King Abdullah II Prize; Jordon; WHO; http://www.emro.who.int/health-education/physical-activity-case-studies/king-abdullah-ii-prize-for-fitness-jordan.html
  14. Al Haraka Barakat, Saudi Arabia; WHO; http://www.emro.who.int/health-education/physical-activity-case-studies/haraka-barakat-saudi.html

 

Published: March 2015, HPC

 

 

 

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