Adolescence and young adulthood offer opportunities and great challenges in public health.  Results of international study show increases in risk factors for NCDs in lower- and middle-income nations and increasing rates of smoking, overweight and obesity and declining levels of physical activity. The decline in the number of deaths in early childhood in some nations and the ’shifting emphasis’ to NCD risks suggest that there is a growing need to accurately assess health information of – and for – young people.  The state of knowledge of adolescent health outside high-income nations is limited at best. In spite of the difficulty of inadequate data collection methods, it is apparent that there is a critical need for development strategies to incorporate better data collection across nations, including the school surveys. It is also recommended that all nations produce regular status updates on adolescent health.

Meanwhile, as Robert Blum writes, it is clear that unhealthy behaviours combine with unhealthy environments to increase the risk of NCDs and diminish improvements in public health attained as once fatal infectious diseases are contained.

As the NCD Alliance writes in its ‘Focus on Children and NCDs’ on its website, adolescents and young adults are particularly vulnerable to the risk factors that lead to NCDs in adulthood like poor nutrition, exposure to tobacco and low levels of physical activity, and notes that rates of obesity and Type 2 diabetes are increasing across the world.  Reducing exposure to common risk factors earlier in life can improve the future health of entire populations.

Sources: Blum, ‘Adolescent Health in the 21^st Century’, and Patton, ‘Health of the World’s adolescents: a synthesis of internationally comparable data’, The Lancet, 28 April 2012.

According to a study released this month, the number of severely obese Americans – people with a BMI over 40 who are 45 kgs or more overweight – is predicted to increase from 5 per cent in 2010 to 11 per cent by 2030.  Obesity is the engine driving the increase in many chronic diseases and conditions. When we add to this the enormous economic burden of obesity, the result is staggering. Our ‘obesogenic environment’ adds billions in healthcare and insurance costs and also in diminished productivity and absenteeism.

Although recent studies suggest the rate of increase in obesity has slowed down over the past 10 years, it is estimated that merely keeping the number of obese Americans stable rather than increasing, as predicted, by 33 per cent, could save $550 billion during the next 20 years and reduce immeasurable suffering from diabetes, cardiovascular disease and other chronic conditions.

The Weight of the Nation conference held in the US in early May (click here >>) was sponsored by the Centers for Disease Control and Prevention’s Division of Nutrition, Physical Activity and Obesity.  The conference aimed to offer a cross-sector forum to share information and demonstrate the inroads that some policies and environmental strategies have made on reducing obesity, framed around intervention settings – workplaces, schools, medical care arenas, and communities.  The meetings, aimed at cross-pollinating strategies for innovation, brought together representatives from business, child-care settings and schools, policymakers, public-health leaders and research partners.  78 million adults and 12.5 million young people in the US are currently obese.

The CDC conference presented research conducted by the team led by Dr Eric Finkelstein, from the Duke University Global Health Institute, using  data from over 100,000 people involved in the 2008 Behavioral Risk Factor Surveillance System (BRFSS), a cross-sectional telephone survey conducted by the CDC and US state health departments.

Concurrently, the Institute of Medicine of the National Academies of Science, have released a report evaluating strategies to fight obesity.

The Institute of Medicine Report,  Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation (click here >>) looked at existing strategies to prevent obesity and made several recommendations for a national strategy to accelerate progress toward reducing obesity, including

• integrating physical activity into everyday life in every way possible
• increasing the availability of healthy foods and beverages everywhere
• strengthening schools and out of home child care facilities as the ‘heart of health’ through both nutrition and physical activity
• engaging employers and  health care professionals in the fight against obesity and
• engaging business to ‘market what matters’ for a healthy lifestyle.

These findings present a cross-sector, national, call to action. The 478-page report shifts focus away from the individual responsibility and willpower to schools, the food industry and policy making, which help shape the environment and create an ‘obesogenic’ world.

Sources: Time, 7 May 2012; Reuters, 8 May 2012.

NHS London will manage the process for the competition, and more information and the application form is here >>. The deadline for applications is 1 June 2012.

Source: Department of Health (UK), 28 March 2012.

The FT’s coverage is timely, coming just a few days after reports that diabetes is threatening to ‘bankrupt’ the National Health Service within a generation. A report by the York Health Economics Consortium, published in Diabetic Medicine, estimated that the costs of treating diabetes could rise from £9.8 billion a year today to £16.9 billion by 2035, if the number of people with the disease rises on a trajectory from today’s 3.8 million to 2035’s 6.25 million. The great majority – 79 per cent – of the expenditure goes on treating complications of the disease. The report also looked at the costs to the wider economy (loss of working days, premature death and costs of informal care), and estimated that this will also rise steeply, from £7.7 billion to £13.5 billion by 2035.

Recently, C3, in partnership with Novo Nordisk and with the assistance of Diabetes UK, published a book on the extent of diabetes in Scotland, Diabetes in Scotland: The Human, Social and Economic Challenge (here >>). As the book notes, Scotland has one of the highest obesity rates of any OECD country: in 2010 65.1 per cent of adults aged 16 and over were overweight or obese, and 28.2 per cent of adults were obese – and the number of people with type 2 diabetes is growing by about 4 per cent per year.

Sources: Financial Times, 4 May 2012; The Guardian, 25 April 2012; and C3, Diabetes in Scotland: The Human, Social and Economic Challenge.

The study also looked at the optimum level of jogging, which follows a ‘U’-curve – i.e. the benefits increase up to a certain amount of jogging, and then falls back. Joggers were asked to define whether they run at a slow, average or fast speed (taking this subjective approach was felt to be sensible, because the age of those in the survey ranges from their 20s to their 90s, and a set speed for each would be inappropriate). The maximum benefit was found for those who run at a ‘slow’ or ‘average’ speed, over two to three sessions (between 1 and 2½ hours a week).

The lead author, Peter Schnohr, commented, ‘The relationship appears much like alcohol intakes. Mortality is lower in people reporting moderate jogging, than in non-joggers or those undertaking extreme levels of exercise.’

Source: The Independent, 3 May 2012.

The Diabetes Education and Self Management for Ongoing and Newly Diagnosed (DESMOND) programme is a one-off education programme for people who have recently been diagnosed with diabetes, and had previously been shown to be effective in improving health and changing attitudes over the course of a year. This study, however, looked at the longer-term impact of the initiative. It assessed the majority of the people with diabetes who had taken part in the one-year trial, and found no differences after three years in biomedical data (e.g. HbA1c levels and body weight etc.) or lifestyles between the DESMOND group and the control group (although improvements in some ‘illness beliefs’ – a greater understanding of diabetes, its seriousness and their ability to affect the course of the disease – were sustained). The study will help to determine the optimal contact time and frequency of educations sessions to sustain the improvements seen in the first year, and the BMJ editorial additionally suggests that we should ‘focus again on the setting of appropriate targets by professionals who care for patients with diabetes and the patients themselves’.

The other study, published in the New England Journal of Medicine, followed obese adults with type 2 diabetes over four years, following an initial lifestyle intervention to encourage weight loss and improve fitness. This was found to have slowed the decline in mobility among the group – a relative reduction in the risk of loss of mobility of 48 per cent.

Sources: Khunti et al., BMJ, 26 April 2012 and Snoek, Editorial, BMJ, 26 April 2012; ; Rejeski et al., NEJM, 29 March 2012; Stone Hearth News, 28 April 2012.

• the proportion of pupils who ate chips for lunch fell from 43 per cent in 2004 to 7 per cent in 2011;
• almost all schools no longer sell chocolate, sweets or crisps as part of the lunch menu;
• 98 per cent of schools had vegetables or salad on offer every day – up from just 59 per cent in 2004;
• the average school meal has around a third less saturated fat, fat, salt and sugar than in 2004;
• the proportion of schools serving only water at lunchtime has risen from 68 per cent to  98 per cent.

There is still a way to go, as many teenagers are not eating a combination of food that provides enough energy and nutrition, and the majority do not eat the recommended five portions of fruit and vegetables each day (just 0.8 portions are consumed at school on average)

In 2010 the Trust also published a report on primary school food (children surveyed in 2009) http://www.schoolfoodtrust.org.uk/school-cooks-caterers/reports/primary-school-food-survey-2009

Source: School Food Trust, 28 April 2012.

The event discussed ways in which Europe can rethink its management of diabetes and provide sustainable solutions to the diabetes epidemic, and there was a real focus on prevention (including workplace health – click here >> for C3’s briefing paper on diabetes in the workplace), and on partnership with the private sector.

Key messages included that 1 in 12 EU citizens (1 in 10 in Portugal and 1 in 11 Germany) have diabetes, and it costs €1 in every €10 of the public health budgets. We need to face diabetes not individually, but as a society. 300,000 in EU die every year from complications of diabetes – and, additionally, there are mental-health implications: a third of people with diabetes have depression (people with depression are also twice as likely to have diabetes). Diabetes can be seen as an exemplar for how to prevent and manage other NCDs. Paul Burstow (the English minister of state for care services) noted that bad care costs more than good care: 15 per cent of hospital beds in the UK are occupied by people with diabetes.

The session on prevention was chaired by Dr John Nolan, who commented that if diabetes prevention is done well, it can prevent up to 60 per cent of type 2 diabetes – and even if it is not prevented it can be delayed by 10 years. Presentations in the session were given by, among others, Torbjørn Christensen (a consultant at the Danish Ministry of Taxation), who talked about the tax that Denmark has put on saturated fat, which is expected to raise DKK 1.4 billion, and is expected to reduce consumption by 4 per cent.

Prof Peter Schwarz from the University of Dresden presented on the IMAGE Project and its Diabetes Prevention Toolkit.

Kofi Annan, former UN secretary-general, gave a keynote speech. He stated that diabetes and NCDs are a threat to a fairer and better world, and that it is essential that NCDs are recognised as a development challenge and become a priority. Health is a human right, and we cannot let the poorest pay the price of problems they played no part in. He gave an example: in Sierra Leone, 58 per cent of women who die from NCDS are under 60; in Denmark it is just 9 per cent.

As well as the Road Map that will be developed following the meeting, delegates were urged to submit examples of good practice that could be shared on the EDLF website. For more information, click here >>

The day-long event featured a range of interesting speakers, including Richard Horton of the Lancet and Ruth Bonita, who focused on the global reach of NCDs – she commented that it is a ‘scandal’ that we did not act to put in place the model that would have averted 32 million deaths from NCDs by 2015. In a session on NCD prevention, Modi Motswama spoke about conflicts of interest (while also calling for partnership) and Sir Andy Haines spoke on the links between NCDs and low-carbon policies (for example, reducing meat and dairy consumption would have environmental benefits, and a reduction of animal-source saturated fats by 30 per cent in the UK could reduce heart disease deaths by about 15 per cent).

A particularly interesting talk was that by David Leon, on alcohol and CVD in Russia, who focused on hazardous drinking (where he believes more effort should be focused). Life expectancy has wildly fluctuated since 1950 (falling below that of Bangladesh in 1994) – and has correlated remarkably closely with alcohol consumption (which rose dramatically after the fall of Communism – as death rates rose). ‘Russians believe they can drink.. It is an aspect of their identity.’ Hazardous drinking is the cause of 43 per cent of deaths among men aged 25–54 in Izhevsk, where a major study has taken place.

A further session was on ‘applying what we know’ to the various NCDs, including mental health (which, according to Martin Prince, accounts for 28 per cent of the global burden of NCDs, compared to 11 per cent for cancer and 21 per cent for CVD) and injuries (there are 5.8 million deaths a year from injuries, 32 per cent more than TB, HIV and malaria combined).

There was also a session on ‘global action on NCDs’, at which Johanna Ralston spoke about the NCD Alliance (including a nice shout-out for ‘my friend from C3’ when mentioning the 2,000 organisations in the Common Interest Group). She talked about the “25×25” aim – a 25 per cent reduction in NCD deaths by 2025 – which has been taken up by the WHO after the UN HLM, and that there are currently targets under construction: reduced in number from 10 to 5 in March, but now including physical activity, which was omitted from the original set. She also noted that the next important milestone is the expiration of the MDGs in 2015. She pointed out the difference in mindset that has happened over the last few years, quoting the Economist in 2006 (that WHO has an ‘addiction to noisy campaigns’ on the risk factors) to 2011 (‘NCDs kill people earlier in poor countries… [which has a] grave impact not just on health, but on growth’).

The programme will provide around $4 million to each of five groups of academic institutions, each of which will, in turn, support the training activities of partner institutions, developing and supporting global health research training programmes providing mentoring and clinical research experience. NCDs, as well as HIV, TB, malaria and maternal/child health, will be addressed.

Source: NIH news release, 4 April 2012 (here >>)