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


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

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
(No Transcript)
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

Suficiencia de la evidence perspectiva global
Planet Doctor
(No Transcript)
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
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.

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.

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.

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.

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

Conclusion 1
  • The epidemics of obesity and cardiovascular
    disease, diabetes, cancer, respiratory diseases,
    are symptoms of our development paradigm gone
  • 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.

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.

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
  • What we need is Love

Sufficiency of Evidence
  • Preventability 80 heart disease and diabetes
    preventable, 40 cancer preventable and another
    30 curable the challenge is in the
  • 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?

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.

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

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

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
  • 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

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.

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

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

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
  • 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?

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

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

Some Useful Tools
Some Useful Tools
Interest-Based Negotiation Conflict
Management Group, Cambridge, Mass, USA Mercy
Corps Intl, Seattle
Some Useful Tools
Communication Relationship Keys to the circle
of power Clarify Interests Identify Options
for mutual success Criteria of
Fairness Agreement Commitment
How to do it?
  • We have to connect our interests to the interests
    of others
  • Learn to speak the language of other groups
  • Connect our health metrics to social justice, to
    profits and productivity, to environmental
    concerns, to security interests, to spiritual
    interests, etc

How do we do it? Some useful tools
  • Habit 5 -- Seek First to Understand
  • Then to be Understood
  • Principles of Empathic Communication
  • Stephen Covey, and the Covey Leadership Institute

Some Useful Tools
Some Useful Tools
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
  • 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

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

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
  • .

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

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

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
  • Insurance companies healthy populations can pay
  • Auto industry
  • Farming and agriculture fruits and veg, low fat

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!

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

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?

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
  • What can we learn here from a Univision
    perspective? An issue in health is good for

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
  • 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

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
  • Preventing sins of gluttony and sloth and
  • 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

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
  • Case study of Critical success factors
  • Partnership PAHO-CARICOM Secretariat
  • Evidence of human and economic cost from
    Caribbean regional health institutions and
  • Involvement of countries in planning and
    preparing for the Summit
  • Involvement of the media in raising awareness

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

Regional Strategy and Partners Forum on the
Prevention and Control of Chronic Diseases
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
Policy Advocacy
Health Promotion Prevention
Integrated Management of NCD
4 Lines of Action
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

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
Prospective Members Honduras, Suriname, Venezuela
Collaborating membersSLU,USF,NHLBI,CDC,PHAC AMNE
  • Special Projects
  • USA-Mexico (border)
  • CARLI (English/Dutch Caribbean)

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

  • BRA, COR
  • (Banco Mundial, Banco Interamericano)
  • (Subregional Banks)
  • (Universities)
  • WHO CC on evidence-based public health
  • CDC- BRFs and DDT
  • WHO- STEPS and InfoBase
  • PHAC Canada
  • U of Nicaragua- Leon
  • Others

CARMEN Network Countries and Institutions (PAHO
  • PAHO/WHO CC on Physical Activity
  • 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
  • (Healthy Cities)
  • (Ovations)
  • (Private Enterprise)
  • Others
  • NCDs and RFs
  • WHO CC in diabetes- CENEXA, INEN, Indiana U, IDC
  • WHO CC at U of Newcastle
  • WDF
  • Novo Nordisk
  • Gates Foundation
  • FIP
  • IAEA
  • IARC
  • CFNI
  • Others

  • 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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