Rob Moodie

Priority actions for the non-communicable disease crisis

The UN High-Level Meeting on Non-Communicable Diseases (NCDs) in September, 2011, is an unprecedented opportunity to create a sustained global movement against premature death and preventable morbidity and disability from NCDs, mainly heart disease, stroke, cancer, diabetes, and chronic respiratory disease. The increasing global crisis in NCDs is a barrier to development goals including poverty reduction, health equity, economic stability, and human security. The Lancet NCD Action Group and the NCD Alliance propose five overarching priority actions for the response to the crisis--leadership, prevention, treatment, international cooperation, and monitoring and accountability--and the delivery of five priority interventions--tobacco control, salt reduction, improved diets and physical activity, reduction in hazardous alcohol intake, and essential drugs and technologies. The priority interventions were chosen for their health effects, cost-effectiveness, low costs of implementation, and political and financial feasibility. The most urgent and immediate priority is tobacco control. We propose as a goal for 2040, a world essentially free from tobacco where less than 5% of people use tobacco. Implementation of the priority interventions, at an estimated global commitment of about US

Profits and pandemics: prevention of harmful effects of tobacco, alcohol and ultra processed food and drink industries

9 billion per year, will bring enormous benefits to social and economic development and to the health sector. If widely adopted, these interventions will achieve the global goal of reducing NCD death rates by 2% per year, averting tens of millions of premature deaths in this decade.

UN High-Level Meeting on Non-Communicable Diseases: addressing four questions

The 2011 UN high-level meeting on non-communicable diseases (NCDs) called for multisectoral action including with the private sector and industry. However, through the sale and promotion of tobacco, alcohol, and ultra-processed food and drink (unhealthy commodities), transnational corporations are major drivers of global epidemics of NCDs. What role then should these industries have in NCD prevention and control? We emphasise the rise in sales of these unhealthy commodities in low-income and middle-income countries, and consider the common strategies that the transnational corporations use to undermine NCD prevention and control. We assess the effectiveness of self-regulation, public-private partnerships, and public regulation models of interaction with these industries and conclude that unhealthy commodity industries should have no role in the formation of national or international NCD policy. Despite the common reliance on industry self-regulation and public-private partnerships, there is no evidence of their effectiveness or safety. Public regulation and market intervention are the only evidence-based mechanisms to prevent harm caused by the unhealthy commodity industries.

Eat, drink and gamble: marketing messages about ‘risky’ products in an Australian major sporting series

Non-communicable diseases (NCDs), principally heart disease, stroke, cancer, diabetes, and chronic respiratory diseases, are a global crisis and require a global response. Despite the threat to human development, and the availability of affordable, cost-effective, and feasible interventions, most countries, development agencies, and foundations neglect the crisis. The UN High-Level Meeting (UN HLM) on NCDs in September, 2011, is an opportunity to stimulate a coordinated global response to NCDs that is commensurate with their health and economic burdens. To achieve the promise of the UN HLM, several questions must be addressed. In this report, we present the realities of the situation by answering four questions: is there really a global crisis of NCDs; how is NCD a development issue; are affordable and cost-effective interventions available; and do we really need high-level leadership and accountability? Action against NCDs will support other global health and development priorities. A successful outcome of the UN HLM depends on the heads of states and governments attending the meeting, and endorsing and implementing the commitments to action. Long-term success requires inspired and committed national and international leadership.

Mental Health Promotion

BackgroundTo investigate the alcohol, gambling, and unhealthy food marketing strategies during a nationally televised, free to air, sporting series in Australia.Methods/approachUsing the Australian National Rugby League 2012 State of Origin three-game series, we conducted a mixed methods content analysis of the frequency, duration, placement and content of advertising strategies, comparing these strategies both within and across the three games.ResultsThere were a total of 4445 episodes (mean = 1481.67, SD = 336.58), and 233.23 minutes (mean = 77.74, SD = 7.31) of marketing for alcoholic beverages, gambling products and unhealthy foods and non-alcoholic beverages during the 360 minutes of televised coverage of the three State of Origin 2012 games. This included an average per game of 1354 episodes (SD = 368.79) and 66.29 minutes (SD = 7.62) of alcohol marketing; 110.67 episodes (SD = 43.89), and 8.72 minutes (SD = 1.29) of gambling marketing; and 17 episodes (SD = 7.55), and 2.74 minutes (SD = 0.78) of unhealthy food and beverage marketing. Content analysis revealed that there was a considerable embedding of product marketing within the match play, including within match commentary, sporting equipment, and special replays.ConclusionsSport is increasingly used as a vehicle for the promotion of range of ‘risky consumption’ products. This study raises important ethical and health policy questions about the extent and impact of saturation and incidental marketing strategies on health and wellbeing, the transparency of embedded marketing strategies, and how these strategies may influence product consumption.

I'm from the government and you want me to invest in mental health promotion. Well why should I?

Mental health is a set of positive attributes intrinsic to the health of individuals and communities. Poor mental health is associated with relative social disadvantage in whole populations and vulnerable subgroups. Adverse conditions such as poverty, discrimination, and violence have a powerful influence on mental health in high- and low-income countries. Conversely, mental health is linked with human, social, and economic development. Mental health promotion is integral to the new public health and health promotion. Evidence is available on the effectiveness of public health and social interventions for enhancing the mental health of populations in locally devised and culturally appropriate ways.

Factors Influencing Receipt of Iron Supplementation by Young Children and their Mothers in Rural India: Local and National Cross-Sectional Studies

At a societal level, good mental health is an important resource for individuals, families and communities. Mental health is an indivisible part of public health, contributes to the functions of society and has an effect on overall productivity. Mental health contributes to human, social and economic capital. As introduced by Williams and colleagues in this volume (Marshall Williams, Saxena and McQueen, 2005), neuropsychiatric disorders account for 13% of the Global Burden of Disease, with depression alone currently

Where different worlds collide: expanding the influence of research and researchers on policy.

BackgroundIn India, 55% of women and 69.5% of preschool children are anaemic despite national policies recommending routine iron supplementation. Understanding factors associated with receipt of iron in the field could help optimise implementation of anaemia control policies. Thus, we undertook 1) a cross-sectional study to evaluate iron supplementation to children (and mothers) in rural Karnataka, India, and 2) an analysis of all-India rural data from the National Family Health Study 2005-6 (NFHS-3).MethodsAll children aged 12-23 months and their mothers served by 6 of 8 randomly selected sub-centres managed by 2 rural Primary Health Centres of rural Karnataka were eligible for the Karnataka Study, conducted between August and October 2008. Socioeconomic and demographic data, access to health services and iron receipt were recorded. Secondly, NFHS-3 rural data were analysed. For both studies, logistic regression was used to evaluate factors associated with receipt of iron.ResultsThe Karnataka Study recruited 405 children and 377 of their mothers. 41.5% of children had received iron, and 11.5% received iron through the public system. By multiple logistic regression, factors associated with childrens receipt of iron included: wealth (Odds Ratio (OR) 2.63 [95% CI 1.11, 6.24] for top vs bottom wealth quintile), male sex (OR 2.45 [1.47, 4.10]), mother receiving postnatal iron (OR 2.31 [1.25, 4.28]), mother having undergone antenatal blood test (OR 2.10 [1.09, 4.03]); Muslim religion (OR 0.02 [0.00, 0.27]), attendance at Anganwadi centre (OR 0.23 [0.11, 0.49]), fully vaccinated (OR 0.33 [0.15, 0.75]), or children of mothers with more antenatal health visits (8-9 visits OR 0.25 [0.11, 0.55]) were less likely to receive iron. Nationally, 3.7% of rural children were receiving iron; this was associated with wealth (OR 1.12 [1.02, 1.23] per quintile), maternal education (compared with no education: completed secondary education OR 2.15 [1.17, 3.97], maternal antenatal iron (2.24 [1.56, 3.22]), and child attending an Anganwadi (OR 1.47 [1.20, 1.80]).ConclusionIn rural India, public distribution of iron to children is inadequate and disparities exist. Measures to optimize receipt of government supplied iron to all children regardless of wealth and ethnic background could help alleviate anaemia in this population.

An approach to health system strengthening in the Democratic Peoples Republic of Korea (North Korea).

In 2003 in Melbourne, Australia, several key thinkers, policy makers, and advocates interested in decreasing violence against women got together with a group of researchers. They wanted to know the magnitude of the problem and its impact on womens health. They worked together, the researchers explaining the methodologies and the limitations of the results and the policy makers refining the questions they needed solved. Twelve months later they got the shocking answer: that violence against women is the largest cause of preventable illness in adult women (1,2). This piece of work has had a major impact on providing considerably more planning and resources to programs for reducing violence against women. Down the road from my office, researchers at the Cancer Council have a long tradition of providing leads for legislative and regulatory reform in tobacco control and for social marketing campaigns. Similarly, practitioners and advocates ask the researchers to discover the levels of community support for potential reforms a kind of virtuous circle (3). There is nothing more disheartening for researchers than to see their research metaphorically (and sometimes literally) thrown in the

Reducing Cardiovascular Mortality Through Tobacco Control: A World Heart Federation Roadmap.

BACKGROUND The Democratic Peoples Republic of Korea (DPRK), under the leadership of the Ministry of Public Health (MOPH), undertook the development of a Health System Strengthening (HSS) proposal through the support of the Global Alliance for Vaccines and Immunization (GAVI). The aim of this paper is to outline the approach to the development of the HSS strategy in DPRK, and describe opportunities and challenges associated with its development and future implementation. Sources of information for this review have included national programme plans, in country social sector reviews, information generated through HSS proposal developments and the international literature. FINDINGS Updated assessments in DPRK indicate some recent improvements in the health situation for women and children, but there remain ongoing concerns regarding health management, human resource and physical infrastructure barriers to health services access. In response to this situation, the DPRK developed a health system strengthening strategy, the main elements of which are the strengthening of health management and service delivery systems at the implementing agency levels of county (district) and Ri (sub district). Three success factors were associated with the reaching of consensus on HSS strategy in DPRK. These were partnerships formed between system planners and programme planners, the identification of an overall health sector strategic framework, and high-level leadership of the MOPH. CONCLUSION Although DPRK is in the very early stages of health system reconstruction, there are significant and new opportunities to alleviate the health conditions of women and children in DPRK, through implementation of health system strengthening strategies that are nationally coordinated and internationally supported.