Amina Aitsi-Selmi

The Sendai Framework for Disaster Risk Reduction: renewing the global commitment to people's resilience, health, and well-being.

The Sendai Framework for Disaster Risk Reduction 2015–2030 (SFDRR) is the first global policy framework of the United Nations’ post-2015 agenda. It represents a step in the direction of global policy coherence with explicit reference to health, development, and climate change. To develop SFDRR, the United Nations Office for Disaster Risk Reduction (UNISDR) organized and facilitated several global, regional, national, and intergovernmental negotiations and technical meetings in the period preceding the World Conference on Disaster Risk Reduction (WCDRR) 2015 where SFDRR was adopted. UNISDR also worked with representatives of governments, UN agencies, and scientists to develop targets and indicators for SFDRR and proposed them to member states for negotiation and adoption as measures of progress and achievement in protecting lives and livelihoods. The multiple efforts of the health community in the policy development process, including campaigning for safe schools and hospitals, helped to put people’s mental and physical health, resilience, and well-being higher up the disaster risk reduction (DRR) agenda compared with the Hyogo Framework for Action 2005–2015. This article reviews the historical and contemporary policy development process that led to the SFDRR with particular reference to the development of the health theme.

Alarming predictions for obesity and non-communicable diseases in the Middle East

OBJECTIVE The present study aimed to model obesity trends and future obesity-related disease for nine countries in the Middle East; in addition, to explore how hypothetical reductions in population obesity levels could ameliorate anticipated disease burdens. DESIGN A regression analysis of cross-sectional data v. BMI showed age- and sex-specific BMI trends, which fed into a micro simulation with a million Monte Carlo trials for each country. We also examined two alternative scenarios where population BMI was reduced by 1 % and 5 %. SETTING Statistical modelling of obesity trends was carried out in nine Middle East countries (Bahrain, Egypt, Iran, Jordan, Kuwait, Lebanon, Oman, Saudi Arabia and Turkey). SUBJECTS BMI data along with disease incidence, mortality and survival data from national and sub-national data sets were used for the modelling process. RESULTS High rates of overweight and obesity increased in both men and women in most countries. The burden of incident type 2 diabetes, CHD and stroke would be moderated with even small reductions in obesity levels. CONCLUSIONS Obesity is a growing problem in the Middle East which requires government action on the primary prevention of obesity. The present results are important for policy makers to know the effectiveness of obesity interventions on future disease burden.

Interaction between Education and Household Wealth on the Risk of Obesity in Women in Egypt

Background Obesity is a growing problem in lower income countries particularly among women. There are few studies exploring individual socioeconomic status indicators in depth. This study examines the interaction of education and wealth in relation to obesity, hypothesising that education protects against the obesogenic effect of wealth. Methods Four datasets of women of reproductive age from the Egyptian Demographic and Health Surveys spanning the period 1992–2008 are used to examine two distinct time periods: 1992/95 (N = 11097) and 2005/08 (N = 23178). The association in the two time periods between education level and household wealth in relation to the odds of being obese is examined, and the interaction between the two socioeconomic indicators investigated. Estimates are adjusted for age group and area of residence. Results An interaction was found between the association of education and wealth with obesity in both time periods (P-value for interaction <0.001). For women with the lowest education level, moving up one wealth quintile was associated with a 78% increase in the odds of obesity in 1992/95 (OR; 95%CI: 1.78; 1.65,1.91) and a 33% increase in 2005/08 (OR; 95%CI: 1.33; 1.26,1.39). For women with the highest level of education, there was little evidence of an association between wealth and obesity (OR; 95%CI: 0.82; 0.57,1.16 in 1992/95 and 0.95; 0.84,1.08 in 2005/08). Obesity levels increased most in women who were in the no/primary education, poorest wealth quintile and rural groups (absolute difference in prevalence percentage points between the two time periods: 20.2, 20.1, and 21.3 respectively). Conclusion In the present study, wealth appears to be a risk factor for obesity in women with lower education levels, while women with higher education are protected. The findings also suggest that a reversal in the social distribution of obesity risk is occurring which can be explained by the large increase in obesity levels in lower socioeconomic groups between the two time periods.

Are estimates of socioeconomic inequalities in chronic disease artefactually narrowed by self-reported measures of prevalence in low-income and middle-income countries? Findings from the WHO-SAGE survey

Background The use of self-reported measures of chronic disease may substantially underestimate prevalence in low-income and middle-income country settings, especially in groups with lower socioeconomic status (SES). We sought to determine whether socioeconomic inequalities in the prevalence of non-communicable chronic diseases (NCDs) differ if estimated by using symptom-based or criterion-based measures compared with self-reported physician diagnoses. Methods Using population-representative data sets of the WHO Study of Global Ageing and Adult Health (SAGE), 2007–2010 (n=42 464), we calculated wealth-related and education-related concentration indices of self-reported diagnoses and symptom-based measures of angina, hypertension, asthma/chronic lung disease, visual impairment and depression in three ‘low-income and lower middle-income countries’—China, Ghana and India—and three ‘upper-middle-income countries’—Mexico, Russia and South Africa. Results SES gradients in NCD prevalence tended to be positive for self-reported diagnoses compared with symptom-based/criterion-based measures. In China, Ghana and India, SES gradients were positive for hypertension, angina, visual impairment and depression when using self-reported diagnoses, but were attenuated or became negative when using symptom-based/criterion-based measures. In Mexico, Russia and South Africa, this distinction was not observed consistently. For example, concentration index of self-reported versus symptom-based angina were: in China: 0.07 vs −0.11, Ghana: 0.04 vs −0.21, India: 0.02 vs −0.16, Mexico: 0.19 vs −0.22, Russia: −0.01 vs −0.02 and South Africa: 0.37 vs 0.02. Conclusions Socioeconomic inequalities in NCD prevalence tend to be artefactually positive when using self-report compared with symptom-based or criterion-based diagnostic criteria, with greater bias occurring in low-income countries. Using standardised, symptom-based measures would provide more valid estimates of NCD inequalities.

Education modifies the association of wealth with obesity in women in middle-income but not low-income countries: an interaction study using seven national datasets, 2005-2010.

Background Education and wealth may have different associations with female obesity but this has not been investigated in detail outside high-income countries. This study examines the separate and inter-related associations of education and household wealth in relation to obesity in women in a representative sample of low- and middle-income countries (LMICs). Methods The seven largest national surveys were selected from a list of Demographic and Health Surveys (DHS) ordered by decreasing sample size and resulted in a range of country income levels. These were nationally representative data of women aged 15–49 years collected in the period 2005–2010. The separate and joint effects, unadjusted and adjusted for age group, parity, and urban/rural residence using a multivariate logistic regression model are presented Results In the four middle-income countries (Colombia, Peru, Jordan, and Egypt), an interaction was found between education and wealth on obesity (P-value for interaction <0.001). Among women with no/primary education the wealth effect was positive whereas in the group with higher education it was either absent or inverted (negative). In the poorer countries (India, Nigeria, Benin), there was no evidence of an interaction. Instead, the associations between each of education and wealth with obesity were independent and positive. There was a statistically significant difference between the average interaction estimates for the low-income and middle-income countries (P<0.001). Conclusions The findings suggest that education may protect against the obesogenic effects of increased household wealth as countries develop. Further research could examine the factors explaining the country differences in education effects.

Under-reporting of tobacco use among Bangladeshi women in England

BACKGROUND This study investigates the prevalence of under-reported use of tobacco among Bangladeshi women and the characteristics of this group. METHODS The 1999 and 2004 Health Survey for England included 996 Bangladeshi women aged 16 years and above, 302 with a valid saliva sample and 694 without. The main outcome measure was the prevalence of under-reported tobacco use. RESULTS Fifteen per cent of Bangladeshi women with a saliva sample under-reported their personal tobacco use. Under-reporters were very similar to self-reported users except for being much more likely to report chewing paan without tobacco (47% versus 9%, P < 0.001). Under-reporters differed significantly from cotinine-validated non-users in most respects. Regression analyses confirmed that under-reporters and self-reported users were similar in age, education level and exposure to passive smoking. Under-reporters were older and less educated than cotinine-validated non-users. Both self-reported users [odds ratio (OR): 0.11, 95% confidence interval (CI): 0.04-0.30] and cotinine-validated non-users (OR: 0.42, 95% CI: 0.20-0.89) were far less likely to report chewing paan without tobacco compared with under-reporters. CONCLUSIONS Contrary to our a priori hypothesis, under-reporters were not young, British-born, English-speaking women likely to be concealing smoking but resembled self-reported tobacco users except for being much more likely to report chewing paan without tobacco.

Trans-disciplinary education and training for NCD prevention and control

Non-communicable, chronic diseases (NCDs) account for 70% of morbidity and over 60% of mortality worldwide [1]. Previously thought to be simply a normative consequence of aging, NCDs are largely preventable through maintenance of healthy behaviors and optimizing risk factors such as smoking, body weight, blood pressure, cholesterol, and glucose throughout the lifespan. However, in current modern environments, few individuals are able to maintain an ideal set of health behaviors and the subsequent optimal risk factor profile throughout their lives. In fact, precursors of cardiovascular disease, diabetes, and certain cancers are increasingly common in children, adolescents, and young adults [2]. Upstream social determinants that influence behaviors which can lead to NCDs are complex and include individual-level drivers such as gender, education, and socioeconomic position; populationlevel drivers such as the level of urbanization, the built environment, and the food system; and macro-level drivers such as trade agreements and taxation policies [3]. Given such complex inputs, there is growing realization that NCD prevention and control requires trans-disciplinary efforts to achieve real change [4]. This awareness, particularly the realization that NCD burdens are an overlooked barrier to development towards achieving the Millennium Development Goals [5], has prompted the United Nations to schedule a

The Chernobyl Disaster and Beyond: Implications of the Sendai Framework for Disaster Risk Reduction 2015–2030

On the 30th anniversary of the Chernobyl disaster, Amina Aitsi-Selmi and Virginia Murray reflect on the importance of disaster preparedness.

Global challenges in addressing the social determinants of smoking and obesity: comparison of England with six emerging economies

Abstract Background The prevalence rates of obesity and smoking are increasing globally and behave like epidemics. There is evidence that the social distribution of risk factors changes as countries develop, with risk spreading down the social gradient over time. However, how or why this occurs is not clear, and there is a scarcity of consensus between academic disciplines over interventions to address these epidemics, particularly for obesity. Multicountry studies can help to elucidate how the social gradient of risk factors changes over time, identify target groups, and generate hypotheses regarding the causes of these epidemics, including how individual-level factors interact with large-scale economic change. This study examines income inequalities in these two key non-communicable disease risk factors (smoking and obesity), comparing England with six middle-income countries to identify common and specific patterns. Methods We used nationally representative data from the Health Survey for England (HSE) 2009 (n=3740), and the WHO Study on Global Ageing and Adult Health 2010 (SAGE). SAGE is unique in providing standardised data for six low-income and middle-income countries (LMICs): China (n=14 888), Ghana (n=5565), India (n=12 198), Mexico (n=2737), Russia (n=4670), and South Africa (n=4225). In both studies, body-mass index (BMI) was calculated from anthropometric measurements as weight/height 2 and smoking was based on self-reported smoking status (present smoker: yes or no). Income was derived from household earnings (HSE) or wealth (SAGE), which is a reasonable alternative to income in LMICs. Individuals were classified into income quintiles on the basis of their country-specific distribution of income. Relative and absolute inequalities in total household income for smoking (present or non-smoker) and obesity (BMI ≥30 kg/m 2 ) were calculated, respectively, as the age-adjusted relative index of inequality and the slope index of inequality (RII and SII) by sex and country for adults aged at least 18 years. Findings In terms of obesity, England was the only country where poor women were at a disadvantage, with a large magnitude of relative inequality in obesity (RII 1·90, 95% CI 1·41–2·59; p Interpretation Although the specific pattern of inequality in obesity among women in England suggests that strategies might need to be tailored to a high-income setting, the similarity in patterns of inequality in smoking across countries suggests that the social determinants are universal. Why smoking levels are higher among the poor across a sample of countries with very different levels of economic development needs further investigation. An alarming implication is that the smoking gradient seems to reverse before the obesity gradient, suggesting that low-income groups might forego essential needs (food) before non-essential needs (cigarettes). This raises questions as to the potentially harmful nature of the global consumer environment. Funding The first author completed the work under funding from the Wellcome Trust (Research Training Fellowship grant number WT088536MA). SAGE surveys are funded by WHO. HSE is funded by the Health and Social Care Information Centre, UK.

Reducing risks to health and wellbeing at mass gatherings: the role of the Sendai Framework for Disaster Risk Reduction

Summary Mass gatherings of people at religious pilgrimages and sporting events are linked to numerous health hazards, including the transmission of infectious diseases, physical injuries, and an impact on local and global health systems and services. As with other forms of disaster, mass gathering-related disasters are the product of the management of different hazards, levels of exposure, and vulnerability of the population and environment, and require comprehensive risk management that looks beyond single hazards and response. Incorporating an all-hazard, prevention-driven, evidence-based approach that is multisectoral and multidisciplinary is strongly advocated by the Sendai Framework for Disaster Risk Reduction 2015–2030. This paper reviews some of the broader impacts of mass gatherings, the opportunity for concerted action across policy sectors and scientific disciplines offered by the year 2015 (including through the Sendai Framework), and the elements of a 21st century approach to mass gatherings.