Creating a tipping point to stop the epidemic of chronic diseases in Chile: the need for transformat

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Creating a tipping point to stop the epidemic of
chronic diseases in Chile the need for
transformational partnership(s) between
government, private sector, and civil
society Presentation to the Cumbre de nutricion y
Salud, Valparaiso, Chile, Marzo 25, 2008 C.
James Hospedales Jefe, ENT, OPS/OMS
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THANK YOU! GRACIAS!
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(No Transcript)
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Vision General

• Sufficiency of evidence regarding the chronic
  disease epidemic perspectiva global
• Why we need everyone together and how do we do it
• Regional Strategy and Partners Forum on the
  Prevention and Control of Chronic Diseases

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Suficiencia de la evidence perspectiva global
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Planet Doctor
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Planet has a fever (global warming) Population
about 7 billion humans - dangerously close to the
limit of the Earths available resources About 1
billion are living in desperate poverty, with
most in the middle, while relatively few are very
rich very unjust, unfair Y otros
problemas An amazing amount of new knowledge,
technology and information systems, military
powers invented
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How did this happen?

• One species that is very intelligent (at least in
  some ways), has become the dominant species. They
  emerged about 10,000 years ago, having invented
  agriculture, and the villages and political
  systems that soon followed. Up to that point,
  people had wiped out a few of the Earths largest
  animals, but left most of the land surface and
  all the oceans intact. People then used all means
  they could to convert the resources of the Earth
  and the seas into wealth, and they did so at an
  amazing rate, consuming the hydrocarbon fuels,
  land, forests, water, fish, food, destroying
  completely thousands of species in the process.
  And as a Planet doctor, realizing this made me
  feel very sad, because you see we are taught that
  the Creator God made the Earth, and when He did
  so, He saw that it was good.

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How did this happen?

• They invented ways of overcoming various
  epidemics and problems like small pox, plague,
  tuberculosis, through vaccines, water and
  sanitation, housing, etc. In the last 100 years
  or so, they became much less physically-active,
  with urbanization and the invention of cars and
  mechanized things. And even where some wanted to
  be more active, they could not because the
  environment was not safe anymore, or had become
  very polluted. And the continued increase in the
  use of fossil fuels has begun to warm the planet.

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Que Pasa?

• They invented ways of producing nitrogenous
  fertilizer (double the capacity of nature) to
  force the Earth to produce even more food, and
  invented pesticides, and other chemicals to
  control the pests. In the last 100 years, a large
  percentage took up smoking tobacco (and for this
  crazy habit, you see why I question their
  intelligence). Harmful use of alcohol also became
  more widespread and contributed to much chronic
  disease and injury and social harm.

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Que Pasa?

• And excessive consumption habits spread to food
  where high fat, high sugar, high salt foods
  became widespread and cheap, marketed and
  distributed by an efficient private sector so
  that even the children are now becoming often
  becoming fat and unhealthy. And ironically, more
  and more of the cheap, calorie dense, non
  nutritious food became consumed by the poor,
  worsening the gaps in the society.

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Muy Importante

• This set of circumstances (global warming,
  pollution, deforestation, over fishing,
  over-population, intensive agriculture,
  urbanization, despeciation) is all happening at
  the same time, and is all inter-connected, unlike
  our tendency to study or focus on one thing at a
  time. And the consequences of the interactions we
  cannot predict from our reductionist approach to
  science.

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Conclusion 1

• The epidemics of obesity and cardiovascular
  disease, diabetes, cancer, respiratory diseases,
  are symptoms of our development paradigm gone
  astray
• Costs to governments, families, and business are
  huge and increasing, and no sostenible
• Symptoms of the deeper problems of a sick planet.
  
• The roots of obesity and chronic disease problem
  lie deep, deep in the way the species, our
  species, lives on this planet.

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Conclusion 2

• Although our entry point in this Summit is
  obesity and chronic diseases, the discussions
  will lead to the fight against poverty, the fight
  to restore environmental balance, the fight to
  stabilize the population.
• It is a very complex problem.
• The evidence is compelling that we need to
  redesign our social and economic policies before
  we completely wreck this planet and the future of
  the people, and our children.
• And thus we must come together, politicians,
  business, media, academia, etc., in a new way.

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Faith, Hope and Love

• I have Faith in the science.
• I have Hope at the awakening awareness, as
  evidenced by this Summit, and tools and partners
  available.
• What we need is Love

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Sufficiency of Evidence

• Preventability 80 heart disease and diabetes
  preventable, 40 cancer preventable and another
  30 curable the challenge is in the
  application
• Discovery-delivery gap or 20, 30, 50 years
  how to shorten? How to apply the evidence? What
  policies? What changes in Global and regional
  market forces?

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Sufficiency of Evidence

• Importance of comprehensive, integrated action
  combining population-based and individual
  measures small changes in levels of several risk
  factors can have major impact.
• Lancet, December 2007 32 million deaths can be
  avoided over the next 10 years by a combination
  of 15 reduction in salt consumption and
  comprehensive tobacco control (14 million deaths
  avoided) at a cost of 0.40 per person per year,
  and scaling-up of treatment with aspirin, and
  drugs to lower high blood pressure and
  cholesterol (18 million avoided) at a cost of
  1.10 per person per year.

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Why we need everyone together and
how do we do it
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Transformational Partnerships
Niveles Local National Regional Global
Public Sector
Private Sector
Civil Society
Science-Based
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Why do we need everyone together?

• Creating Tipping points
• From physics, popularized by Gladwells book
  seeks to explain and describe enormous and
  "mysterious" sociological changes that mark
  everyday life
• Tipping Points are "the levels at which the
  momentum for change becomes unstoppable
• A sociological term "the moment of critical mass,
  the threshold, the boiling point
• "Ideas and products and messages and behaviors
  spread like viruses do. Examples of such changes
  in his book

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Creating positive social epidemics

• "The success of any kind of social epidemic is
  heavily dependent on the involvement of people
  with a particular set of social skills."
• Connectors are people who "link us up with the
  world ... people with a gift for bringing the
  world together"
• Mavens are "information specialists", or "people
  we rely upon to connect us with new information."
  They accumulate knowledge, especially about the
  marketplace, and know how to share it with others
• Salesmen are "persuaders", charismatic people
  with powerful negotiation skills. They tend to
  have an trait that goes beyond what they say,
  that makes others want to agree with them
• From the book, Tipping Point, by Malcolm Gladwell

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Why do we need everyone together?

• The problem is very complex
• Many countries and organizations have developed
  many initiatives, policies, promotion and
  prevention programs. But the response is
  fragmented
• Partnership/collaborations are the stage that
  everyone needs for action, to create needed
  synergy between initiatives, to create a tipping
  point(s) for the epidemic in the short to medium
  term

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Why do we need everyone together?

• Governments can make policies that help reduce
  risks, scale up provision for those affected and
  minimize final catastrophe for families and
  individuals, but they need the support of the
  private sector and an empowered civil society
• Regional and global market forces are major
  determinants of chronic diseases and health, but
  private sector needs government policies to level
  the playing field, and informed consumers to
  generate markets for healthier products
• Civil society cannot do it alone they need an
  environment that makes the healthy choice the
  easy choice, which flows from government and
  private sector policies.

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No es facil!

• We chose to go to the moon and do other things,
  not because they are easy, but because they are
  hard, because the goal will serve to organize
  and measure the best of our energies and skills,
  because that challenge is one we are willing to
  accept, on we are unwilling to postpone, and one
  which we intend to win, and others, too. (John
  Kennedy)

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How do we do it?

• Global perspective, with local actions
• Inclusive
• Cooperative
• Environmentally aware
• Science-based
• Jeffrey D. Sachs Common Wealth Economics for a
  Crowded Planet Penguin Press, 2008

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How do we do it?

• Inclusive
• Who is not here at this Summit that will feel
  that they should be here, and who we need to
  have on board for success?
• What happened that the private sector is not well
  represented?
• Which is the biggest NGO in the world very
  important in Chile? Are they at the Summit?
• Who feels that they should have been part of the
  planning of the Summit, and were not?

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And if you were not involved or invited?

• Maybe it was not intentional
• Forgive the organizers and join the effort!
• En la Biblia "Lord, how many times shall I
  forgive my brother when he sins against me? Up to
  seven times?"  Jesus answered, "I tell you, not
  seven times, but seventy-seven times Matt 18
  20-21

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How do we do it?

• Cooperative
• Each of you should seek not only to your own
  interests, but seek also to the interests of
  others. Philippians 24

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Some Useful Tools
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Some Useful Tools
Interest-Based Negotiation Conflict
Management Group, Cambridge, Mass, USA Mercy
Corps Intl, Seattle
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Some Useful Tools
Communication Relationship Keys to the circle
of power Clarify Interests Identify Options
for mutual success Criteria of
Fairness Agreement Commitment
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How to do it?

• We have to connect our interests to the interests
  of others
• Learn to speak the language of other groups
  sectors
• Connect our health metrics to social justice, to
  profits and productivity, to environmental
  concerns, to security interests, to spiritual
  interests, etc

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How do we do it? Some useful tools

• THE SEVEN HABITS OF HIGHLY EFFECTIVE PEOPLE
• Habit 5 -- Seek First to Understand
• Then to be Understood
• Principles of Empathic Communication
• Stephen Covey, and the Covey Leadership Institute

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Some Useful Tools
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Some Useful Tools
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How do we do it?

• If your colleague does something to offend you,
  go and show him his fault, just between the two
  of you.
• If he listens to you, you have won your colleague
  over.
• If he will not listen, take one or two others
  along, so that the matter may be established by
  the testimony of two or three witnesses..
• Matthew 18 15-16

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How do we do it?

• Persevere the most important thing
• See the movie Amazing Grace about how the
  British slave trade was ended through the efforts
  of Member of Parliament, 1789-1906, William Pitt
• After the final No, there comes a Yes, and on
  that Yes the future depends, Poet, Wallace
  Stevens

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People will say, No

• No, we need not change we have always done this
• No, we cannot change it is too hard
• No, we will lose profits or prestige
• No, we cannot make peace with that group
• .

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Private sector interests

• Profits and productivity
• Customer satisfaction
• Increasing share holder value
• Quality and competitiveness
• Controlling costs (workplace wellness)
• New market opportunities
• Avoiding future litigation
• Image and reputation
• Corporate Social Responsibility
• Etc

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Private Sector not homogenous

• Food Companies
• Media and telecommunications
• Arts and entertainment
• Travel and tourism
• Finance and banking
• Insurance companies
• Auto industry
• Farming and agriculture
• Etc

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Private Sector business opportunities in health

• Food Companies 5-a-day frutas y verduras
• Sports companies Ciclorecreovias bicycles,
  sports drinks
• Media, Arts and entertainment wellness programs
• Telecommunications cellphones for RF surveys?
  For health education with text messages?
• Arts and entertainment integrate good health
  behavior into telenovelas?
• Travel and tourism health spas, health tourism
• Finance and banking - healthy people earn and
  save
• Insurance companies healthy populations can pay
  premiums
• Auto industry
• Farming and agriculture fruits and veg, low fat
  meats

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Private sector and cholera

• In 1991, cholera threatened to spread to the
  Caribbean islands from Col, Ven, Guyana and
  governments, private sector and NGOs responded
• Private Sector Response against the Cholera
  Threat in Trinidad Tobago.
• Hospedales J, Holder Y, Deyalsingh I, et al. Bull
  Pan Am Health Org 1993 27331-6
• Private sector had spent five times more than the
  government in education the public about
  preventing cholera!

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Steps to establish a Tourism and Health
Partnership in Caribbean

• 1995 Prevention of diarrheal disease in travel
  industry ?
• 1996 Prevention of foodborne disease ?
• 1996 Reducing cost impacts of health and disease
  problems ?
• 1997 Improving profitability through attention
  to health and hygiene ?!! (Inter-American
  Travel Congress, Costa Rica)
• Quality Tourism for the Caribbean (QTC) joint
  public-private partnership Caribbean Hotel
  Association-Caribbean Epidemiology Center
  (CAREC/PAHO), 1998 BID CDB

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A private Sector Perspective

• Dr Hospedales, we have demand for healthy food
  products from Europe and North America, but we
  have no demand from South America why should we
  change? We will lose money to our competitors and
  I dont want to commit financial suicide
  (Vice President, XXXX Foods en la casa de Don
  Franscisco, Miami, 2007)
• What are the interests and concerns in this
  statement? What options for working together?

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A private Sector Perspective

• Dear Dr Roses, I want to congratulate you on the
  work of your team in diet and physical activity.
  It has inspired me to do a special show on
  obesity. You will be pleased to hear that the
  show broke viewership records
• Don Franscisco, letter to Director, PAHO, January
  2008
• What can we learn here from a Univision
  perspective? An issue in health is good for
  business!

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http//www.dpaslac.org/
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Partnership between Prevention and Treatment
comprehensive approach

• The value of medical care to health promotion,
  Sir Douglas Black, President, UK Royal College of
  Physicians, 1974
• Integrating prevention into medical care,
  preventive exams screening for smoking, BMI,
  cervical cancer, etc., es muy importante.
  Clinical and Public Health Ethical responsibility
• Largest decrease in Relative Risk of all cause
  mortality due to physical activity is in patients
  who have diabetes, hypertension, overweight (3-5
  fold)
• In a diabetes quality-of-care project, advice to
  patients to eat healthy more likely to succeed if
  we to make healthy foods more accessible and
  affordable

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Interests of the Church

• Spiritual health
• Salvation of peoples souls
• Spreading the kingdom of Jesus Christ
• Caring for the sick and disabled
• Fostering reconciliation between people peace
  making
• Preventing sins of gluttony and sloth and
  drunkeness
• Do you not know that your body is a temple of
  the Holy Spirit, who is in you, whom you have
  received from God?
• -gt Look after your body take care not to pollute
  it with tobacco and drunkeness

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Partnership Government-Civil society-PAHO

• CARICOM Heads of State special summit on chronic
  diseases, September 2007 resulted in high level
  political commitment and healthy public policy
  directions
• Case study of Critical success factors
• Partnership PAHO-CARICOM Secretariat
• Evidence of human and economic cost from
  Caribbean regional health institutions and
  Universities
• Involvement of countries in planning and
  preparing for the Summit
• Involvement of the media in raising awareness

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Opportunities for Advocacy

• Ibero-American Cumbre 2008, El Salvador
• Cumbre de las Americas 2009, Trinidad y Tobago
• Cumbres sub-regional Mercosur, Communidad
  Andina, Sistem Integracion de Central America

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Regional Strategy and Partners Forum on the
Prevention and Control of Chronic Diseases
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Regional Strategy and Plan of Action for an
Integrated Approach to the Prevention and Control
of Chronic Diseases, including Diet, Physical
Actvity and Health September 2006
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Policy Advocacy
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Surveillance
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Health Promotion Prevention
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Integrated Management of NCD
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4 Lines of Action
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Regional Strategy Key Elements

• Policy Monitoring, dialogues and advocacy
• STEPs surveillance system InfoBase
• DPAS
• FCTC
• Chronic Care Model
• Partners Forum
• CARMEN Network
• Capacity building Escuela CARMEN
• Disease specific plans CVD, Diabetes, Cancer

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CARMEN Network 2007
MembersArgentina, Anguilla, Aruba, Bolivia,
Brazil, Canada, Colombia, Costa Rica, Cuba,
Curacao, Chile, El Salvador, Guatemala, Mexico,
Nicaragua, Panama, Paraguay, Peru, Puerto
Rico,Trinidad Tobago, Uruguay
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Prospective Members Honduras, Suriname, Venezuela
Collaborating membersSLU,USF,NHLBI,CDC,PHAC AMNE
T, RAFA,ILSI,FV,IDB

• Special Projects
• USA-Mexico (border)
• CARLI (English/Dutch Caribbean)

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Regional Partners Forum for Chronic Disease
Prevention and Control

• Including public sector, private sector and civil
  society
• Platform for bringing everyone together
• OPS/OMS as convener and catalyst honest broker
• Objectives 10 X 2010
• Awareness and communication Policy makers and
  public
• Healthy diet Americas Pledge on advertising to
  children
• Physical Activity 100 Ciclovias by 2010
• Tobacco control
• Increased access health promotion and disease
  prevention services Workplace wellness and PHC

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PartnershipsMAP

• POLICY ADVOCACY
• PAHO/WHO CC on NCD, PHAC
• BRA, COR
• (Banco Mundial, Banco Interamericano)
• (Subregional Banks)
• (Universities)

• SURVEILLANCE
• WHO CC on evidence-based public health
• CDC- BRFs and DDT
• WHO- STEPS and InfoBase
• PHAC Canada
• CAREC
• U of Nicaragua- Leon
• Others

CARMEN Network Countries and Institutions (PAHO
Secretariat)

• H PROMOTION DISEASE PREVENTION
• PAHO/WHO CC on Physical Activity
• RAFA PANA
• Ciclovías cycle ways
• 5- a- day cinco al día
• U of South Florida- Social Marketing
• Univisión
• Fundación FES Colombia
• Fundación Ciudad Humana
• International Life Sciences Institute (Healthy
  Schools)
• (Healthy Cities)
• (Ovations)
• (Private Enterprise)
• (CFNI, INCAP)
• Others

• MANAGEMENT
• NCDs and RFs
• WHO CC on CVD NIH/NHLBI
• WHO CC in diabetes- CENEXA, INEN, Indiana U, IDC
• UWI-UDOP
• WHO CC at U of Newcastle
• WDF
• Novo Nordisk
• Gates Foundation
• FIP
• IAEA
• IARC
• CFNI
• Others

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Review

• Sufficiency of evidence regarding the chronic
  disease epidemic perspectiva global
• Why we need everyone together and how do we do it
• Regional Strategy and Partners Forum on the
  Prevention and Control of Chronic Diseases

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THANK YOU! GRACIAS!