Dr Susie PereraDirector Organization Development

And Policy Analysis, Ministry of Health

Bishops College 31st October 2013

Outline of presentation

NCD problem in the country Common risk factors and lifestyle

change Social marketing tool- Super Eight lifestyle change within the School

This is for...

YOU and

Your Organization

Why? Hypertension Ischemic Heart Diseases Diabetes Stroke Chronic Respiratory Diseases Cancer

70% of deaths in Sri Lanka due to

NCDs!

In Sri LankaThere are

350 Deaths per day

250Deaths due to NCD per day

100Deaths per day due to Heart Disease

40Deaths due to Stroke

Prevalence of chronic NCD

• Prevalence of hypertension 20-25% (wijewardana et al 2005 , risk factor study 2006)

One in FIVE

• Prevalence of diabetes –( age over 20 ) around 10% (katulanda et al 2006)

One in TEN

Determinants of Non Communicable Diseases

Aging population

Lifestyle change

• Occupation • Transportation • Day to day work at home• Housing and limitation in

space • Dietary pattern • Smoking / alcohol • Leisure time activities

Prevalence of NCD risk factors among adult population (18-65 Years)

22.80% 26.00%

81.40%

18% 20%

0.30% 1.20%

83.30%

31.90% 30.40%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

Current smokers Alcohol users Unhealthy diet Physical inactivity Over weight and Obese

Per

cen

tag

e

Present situation on major risk factors

Male

Female

In Sri Lanka - rise in NCD burden is due to

Aging population

AND Increase prevalence of NCD risk factors

(Changes in lifestyle )

Main 4 risk factors – for NCDs Smoking Alcohol Physical inactivity Unhealthy diet

Every street corner

Smoking

Alcohol!

Ideal weight for heightWaist circumference !

How figure conscious are you?

Your BMI is a good predictor of Health risk!

It is a net result of your lifestyleWhat you eat!Drink – including alcohol!How much physical activity you engage in!

Fruit and vegetables

Typical Sri Lankan diet A mountain of rice with some vegetables

SALT!

Adding Salt to the rice pot?

An average Sri Lankan consumes more than twice the daily recommended amount of salt.

1. Spreads on bread 2. Sauces with rice 3. Several rice pullers [lunudehi, chillipaste,karawala jadi]

4. Added salt at the table

Are you in the habit of using...

ADDED SUGAR!

Milo pack – 3 tsp Sprite (buddy bottle) – 4.2tsp EGB (buddy) – 5 tsp Smack mix fruit pkt – 5.2 tsp Pepsi (buddy) – 5.2 tsp Fanta (buddy) – 5.4 tsp Elephant House Cream Soda (buddy) – 6.0tsp Elephant House Necto (buddy) – 6.3 tsp Mirinda (buddy) – 6.8 tsp Coca-cola (buddy) – 9.5 tsp

(see poster for further information)

Do you know that popular beverages contain high sugar levels?

Are you in the habit of having:

Cool drinks (high sugar) for thirst?

Common myths about sugar intake• I am not a diabetic, you can add some more sugar to

my tea. • We do not have diabetics in our family, so I can enjoy

more sugar. • Drinking any amount of “no-added sugar drinks” is

okay!

Trans fat

Fatty food

Trans fats are formed…….• High heat for stir frying• Repeated use of the same oil for frying

Even if sunflower oil, corn oil and olive oil are used.

Trans fats are also found in…….• Cakes, Biscuits, Pastries (worse is flaky and

puff pastry!)• Some Salad dressings (eg. mayonnaise) • READ FOOD Labels!

Physical Activity- do you look for opportunity or take the easy way out ?

Prevention is better than cure

Impact of prevention

Health Planners point of view : The Need for a Population wide strategy – WHY ? Increasing NCDs in rapidly aging population

Increasing NCDs even at a younger age Significant level of unhealthy practicesSame cardiovascular risk factors are

determinants of several common chronic NCDs in Sri Lanka

Low level of awareness on modifiable risk factorsLesser Emphasis on synergy of several

modifiable risk factors – often awareness programs mention one at a time

A strategy is needed to address DEMAND and SUPPLY towards healthier lifestyles

The Need for Majority to adopt good practices Lifestyle change is needed across

board for all START early! – changes

take place over a long time All risk factors need to be addressed in a collective

manner

The message for collectiveness is important

Super eight formulated

Scientific evidence based approach to identify Eight health targets

Social marketing principles were used to identify the eight health targets in a branded form

– Super eight: A simple way for a better life

Determinants of Non Communicable Diseases

Common Risk Factor Approach

SALT

1 level tea spoon of salt per person per day

A 400 g pack of salt should be sufficient for a family of 4 for 20 days

Target

SUGAR

Target

Avoid excess added sugar not more than 6 teaspoons of sugar per non-diabetic person per day

Trans fat

TargetLimit food with Trans Fats found in some commercially baked and fried food such as short eats, pastries, cakes and re-heated oil

Fruit & Vegetables

TargetConsume 5 servings of Fruit & Vegetables per day (the recommended amount is 400 gms of Fruit and Vegetables per person per day). Remember variety is good.

Physical activity

TargetAt least 30 minutes of moderate physical activity per day for at least 5 days a week

brisk walk, aerobic exercises, cycling

Tobacco & Alcohol

TargetGive up smoking and Alcohol

Body Mass Index (BMI)

Target

Maintain your Body Mass Index (BMI) between 18.5- 24.9 (the ideal is 23)

Blood Pressure

Target

Maintain your Blood Pressure below 140 /90.Check your blood pressure annually

Totality !Those who are exercise fanatics also get heart

attacks!!Those who never smoke also get heart attacks!!!Those who are pure vegetarians ……Those who claim that they never had a sweet

tooth…….

The Combination of Risk factors need to be addressed

Common risks that address the range of NCDs

• BMI ( over weight or obese) • Unhealthy diet( salt, sugar, tans fat,

low intake of fruit and vegetables)• Physical inactivity• Smoking & alcohol

From Health Sector – The Way forward to empower people and institutionalize Super Eight

• Training all MOOHs in the country

• creating greater Community awareness through MOOHs

• Institutionalizing Super Eight through government and private sector

• Taking Super eight to pre schools , schools and youth groups

• Creating super eight conducive market - catering to new demands of

people who want to change lifestyle

• Promoting home gardens to increase fruit and vegetable consumption

Super Eight Reach

Government institutions (166) Universities (11) Hospitals (43) Nurse training schools ( government ) (17) Authorities and Commissions (27) Ministries (60) Other 08)

- Central Bank- Foreign Employment bureau

- Bandaranayaka International Airport

- National Chamber of Commerce- NIHS

Non governmental organizations (09)Private sector (71)Provincial Governors (09)Provincial Health Departments (09)Regional Health departments(24) Hotels (35)Restaurants (11) Schools (14)Tea Factories/ business enterprises (20)

CONT...

List of tools that are developed on SUPER 8

Posters/ leaflets : 1. Super 8 health targets [8 posters in a set]2. Sugar Analysis 3. Jigsaw Poster 4. Myths 5. Super 8 health targets [in Sinhala, English and Tamil]

 

Guidelines:A. Guideline for Institutionalizing Super Eight- to be used by lead agencies attempting to introduce Super

eight to institutionsB. Check list to be used by Head of Institution to mainstream 'Super eight' health targets within the organizationC. Guidelines for provincial/ district health managers for institutionalizing Super eight and empowering

Communities with Super eightD. Guidelines for institutionalizing Super Eight in School settingsE. Guide for a Healthy cafeteria settingF. Quick guide for healthier menu planning- business meetings

 

Presentations: 1. Slideshow2. PPT for Healthcare Workers3. PPT for Government officials/ other institutions4. PPT for Armed forces5. PPT for youth/ schools

Institutionalizing Super Eight –

making it a way of life through

the school

How can the school setting promote healthier lifestyle? YOU Be aware – understand what this means

to you Get to know the Super 8 health targets Assess where you are with your family Discuss how you and your family need

to change

How can the school setting promote healthier lifestyle?Your School Key decision makers must want to take

this change Prefects body, old girls associations,

School development societies, School health clubs, Interactors can get together to discuss how you want to change to create healthier options

How can healthier practices be fostered through school setting? 1. Peer lead activity– Super 8, read food labels, to

make your choice known 2. BMI checks 3. exercise - happy face days 4. healthier options in school canteen display of health targets at school canteen, 5. extending knowledge from school to parents, families

and well wishers – days to check BMI and BP, healthier food festivals,

6. opportunity to demonstrate about their experiences in adopting super eight at school assembly, essay competitions, poster and drama competitions

How can healthier practices be fostered through school setting? Super eight messages in school

newsletters or as foot notes in common letters that are widely circulated

School functions serving healthier options – give a choice

Talk about good practices and commend such practices

Super 8 logo

1.Maintain your Body Mass Index (BMI)

Between 18.5 to 24.9 (ideal is 23)

2. Avoid excess Salt

Limit salt consumption to one teaspoon of salt per person per day.A 400g pack of salt should be sufficient for a family of four, for 20 days.

3. Avoid food with trans fats.

Found in some commercially prepared fried food, short eats, pastries, cakes and re-heated oil.

4. At least 30 minutes of Moderate Physical Activity

Do brisk walking, aerobic exercises, cycling, swimming for at least 30 minutes per day for 5 days a week.

5.Avoid excess added sugar.

Not more than 6 teaspoons of sugar per non-diabetic person per day.

6.Consume 5 servings of fruits and vegetables per day.

Recommended amount is 400 gms of fruits and vegetables per person per day.

Remember variety is good.

7.Avoid smoking and alcohol.

8.Maintain your Blood Pressure below 140/90

Check your blood pressure at least once a year.

Thank you