Between 2002 and 2008, the World Health Organisation shows that the the price of tobacco declined dramatically, and uptake in consumption increased in tandem. Not only is smoking increasing substantially in Indonesia, the number of young smokers is rising disproportionately. In addition, child labour laws are often broken as young children participate in much of the processing and harvesting of tobacco in this, Southeast Asia’s largest economy. The product is then sold on to global brands, including British American Tobacco and Philip Morris.

In addition, restrictions in advertising and declining rates of smoking in the west appear to be linked to increasingly aggressive and targeted smoking campaigns in Asia. Channel 4′s Unreported World reports that Indonesia is now the world’s fastest growing cigarette market. 90 million Indonesians smoke and there are over 200,000 tobacco-related deaths each year.

The WHO Report on the Global Tobacco Epidemic 2011 (here >>) suggests that Indonesia is lagging behind in smoking prevention and cessation efforts, with no national toll-free smoking quitline in place. It is crucial that a whole-of-society approach  is used to tackle tobacco use in Indonesia, particularly among children.

Sources: Financial Times, 9 May 2013; Channel 4 television, Unreported World, ‘Indonesia’s tobacco children’, 9 November 2012; WHO, Report on the Global Tobacco Epidemic 2011.

The Children’s Food Campaign (click here >>) – which is backed by the British Medical Association, Diabetes UK and the National Obesity Forum, and with this campaign supported by The Soil Association (a promoter of organic farming) and Organix (a brand of alternative children’s snacks) – is criticising the Advertising Standards Authority (ASA) for not closing the loopholes in the broadcasting regulations. According to the co-ordinator of the Children’s Food Campaign, Malcolm Clark, the loopholes allow food companies ‘to exploit loopholes and advertise junk foods to children online’.

An example of an ‘embedded game’ (a game on a company’s own website) is a Pac-Man-style game in which children to guide a Honey Monster through a maze of Sugar Puffs. This was not covered by the regulations because it represented Sugar Puffs consumption ‘in an abstract way’ with players being ‘unlikely to associate the Honey Monster’s consumption with their own’, and Honey Monster Foods Ltd added that a cup of coffee is picture on the entry page to the game in order to make it ‘more adult-orientated’. There are also TV-style adverts embedded in some of the websites.

Official complaints have been filed against 54 websites by the Children’s Food Campaign, but were rejected by the ASA, who denied that there was any need for a change in laws. The ASA stated that they did not encourage irresponsible consumption, adding that they were ‘not a social engineer’ – but, according to Michael Clark, the ASA ‘is struggling to get to grips with its new role and is failing.’

Sources: The Guardian, 29 April 2013; Children’s Food Campaign website.

It has long been acknowledged that the physical environment has a major impact on psychological and mental health and wellbeing. Now this large, longitudinal study dissects the relationship between green space in cities and improved wellbeing or mental and emotional distress. Using self-reported data from almost two decades of panel data drawn from over 10,000 participants, the study looks at mental health and wellbeing over 18 years. The research points strongly to the tremendous benefit that urban green space provides to city dwellers. Previous studies have suggested this link but have not controlled for time-invariant heterogeneity, and rather than focusing on mental wellbeing and resilience, focused on poor psychological health instead.

The conclusion of the study clearly suggests that people who reside in areas with a greater amount of green space experience both lower emotional distress and a higher experience of well-being. Although impacts at the individual level were small, impact at the community level is compounded and helps to demonstrate the significance of open green space to health.

Sources: M. P. White et al., ‘Would you be happier living in a greener urban area? A fixed-effects analysis of panel data’, Psychological Science, 23 April 2013; BBC News online, 22 April 2013.

Please join C3 as a supporter of NCDFREE – we have sponsored the attendance of a change-maker at the Boston symposium, and will be attending the event. And be quick: crowd-sourced funding closes on Saturday 27 April.

For more information on NCDFREE, see the website here or you can join the movement on Facebook (here >>) and follow progress on Twitter (here >> – and Dr Alessandro Demaio, co-founder of NCDFREE, here >>).

For those based in London, Sandro Demaio will be giving a C3 International Breakfast Seminar on 28 May, talking about his work with NCDFREE. Please contact Egle at C3 [email] if you are interested in attending.

Source: NCDFREE.

The number of minutes that an average person would need to walk (at a brisk 3.5mph) was printed on menus – brisk walking was chosen as a good physical activity to use, as most people can relate to it. In the study, 300 people aged 18–30 were offered the same choice of food and drink, but a third received a menu without any calorie information, another third a menu with the calories displayed, and the final group menus with both calories and the amount of exercise equivalent – for example, a double cheeseburger would take about two hours to walk off. The researchers found that those in the latter group chose to eat an average of about 100kcal fewer than the group with no calorie information.

New ways to encourage behaviour change are needed – and nudges like the work of Meena Shah and Ashlei James, authors of this study, may be one way to do it. Further, larger studies are planned by the team, including with older populations.

Sources: BBC News Online, 24 April 2013; Stone Hearth News, 23 April 2013.

During the Cuban economic crisis – which was due to a tight US embargo on imports and the collapse of the USSR (which had been supporting the country) – there were food and fuel shortages.  The resulting fall in ‘energy in’ and an increase in ‘energy out’ (the government distributed more than 1 million bicycles to compensate for the severe fuel shortages) led to an average weight-loss of 4–5kg (8–11lb) – and about five years later there was a corresponding decline in deaths from coronary heart disease of 34.4 per cent and diabetes by 50 per cent.

Once the crisis was over, weight rebounded by 9kg – and, as the population began to regain the weight, so the rates of diabetes and CHD increased. Between 2006 and 2009, new cases of diabetes increased by 140 per cent, and diabetes prevalence rose by 116 per cent increase in diabetes prevalence, and from 2002 to 2010 diabetes mortality increased by almost a half (from 9.3 deaths to 13.9 deaths per 10,000 people). In 1995, 33.5 per cent of the population were overweight or obese; this increased to 52.9 per cent by 2010.

The information for the study was gleaned from a number of national and local surveys between 1980 and 2010, and in particular, four cross-sectional surveys of around 1,500 15- to 74-year-olds in the city of Cienfuegos. The authors have extrapolated from the data to suggest that a 5kg population-wide weight loss ‘would reduce diabetes mortality by half and CHD mortality by a third’. The increases in physical activity and other lifestyle changes during the crisis (it coincided with a fall in smoking), as well as the weight-loss may also have played a part. But the effects of the crisis were striking.

Of course, individual autonomy is limited in Cuba, and no one is suggesting that such drastic measures are either possible or desirable in other countries – but it does show the health effects that can accrue following a population-wide change in lifestyle.

Sources: M. Franco et al., ‘Population-wide weight loss and regain in relation to diabetes burden and cardiovascular mortality in Cuba 1980-2010: repeated cross sectional surveys and ecological comparison of secular trends’ BMJ, 9 April 2013; NHS Choices, 10 April 2013.

Barcelona’s programme is far from the only health initiative using sport as the hook to enthuse fans – there is a Europe-wide ‘Healthy Stadia Network’ (click here >>), which ‘supports sports stadia across Europe to promote lifestyle, social and environmental initiatives that contribute to improved levels of public health amongst fans, stadia workforces and local communities’. The Network held its second conference in Manchester in March 2013, at which many programmes were showcased. Because of the demographic of football fans, these programmes are particularly good at engaging men, who are often hard to reach with traditional health campaigns. St Helen’s Rugby Football Club (Saints) trained volunteers to give anti-smoking advice to supporters when showing them to their seats – in three months, over 2,000 stop-smoking packs were handed out, and 47 people were referred for smoking-cessation services.

In Scotland, the 12-week Football Fans in Training scheme, funded by the Scottish Government and the Football Pools, is an initiative consisting of weekly meetings with exercise training from team coaches based in 15 Premier League clubs (such as Celtic). It is aimed at 38–65-year-old men with high BMI, and footballers themselves appear at the meetings to encourage fans. The project is currently being evaluated by Glasgow University – and, as Dr Cindy Gray, one of the researchers, noted, ‘The secret of this success is that men have a strong loyalty to their football club and feel they are in the same boat as the others on the programme.’

Source: The Guardian ‘Health Innovation Hub’ blog, 8 April 2013.

Of the 2,484 interventional trials registered with ClinicalTrials.gov, the authors of the study found that almost two-thirds of trials (63 per cent) were looking at drug therapy for those already with the disease, and just one in ten is on prevention or behavioural therapy. Very few trials targeted under-18s – and, while relatively few in this agegroup have diabetes, there are worrying increases both in type 1 diabetes and also type 2 occurring in much younger agegroups than in the past, driven by high rates of obesity. And fewer than 1 per cent of the trials specifically targeted the over-65s – despite nearly 1 in 5 of this agegroup having the disease worldwide. There is also a shortfall of trials in some countries where the burden of diabetes is particularly high – notably in the Middle East, the Russian Federation and Brazil.

Sources: W.C. Lakey et al., ‘Are current clinical trials in diabetes addressing important issues in diabetes care’, Diabetologia (April 2013); Stone Heart News, 6 April 2013; International Diabetes Federation; Department of Health.

The true extent of air pollution in China is unclear – a recent study, by the Beijing Institute of Public and Environmental Affairs and the Washington Natural Resources Defense Council, found that Chinese cities are not releasing enough data regarding air pollution, and so evidence-led research is being increasingly sought by officials. The need for action is urgent; last month a warning was issued by the Organization for Economic Cooperation and Development last year, which stated that ‘urban air pollution is set to become the top environmental cause of mortality worldwide by 2050, ahead of dirty water and lack of sanitation’. It has been estimated that up to 3.6 million people could die prematurely from air pollution, the majority in India and China.

Sources: New York Times, 1 April 2013; OECD, Environmental Outlook to 2050: The Consequences of Inaction (March 2012)

The European Research Council is funding further research and trials of the work which is led by Professors Chris Toumazou and Sir Stephen Bloom. The process will involve an ‘intelligent implantable modulator’, or data chip, measuring just a few micrometres across, which will be attached using cuff electrodes to the vagus nerve inside of the peritoneal cavity in the abdomen.

The chip and cuffs are designed to read and process electrical and chemical signatures of appetite within the nerve. The chip can then act upon these readings and send electrical signals to the brain, altering the urge to eat, as the chip is attached to the vagus nerve, which plays a huge role in appetite and an array of other functions within the body. Makers of the chip believe that human trials can begin within three years.

Prof. Christofer Toumazou, chief scientist of the Institute of Biomedical Engineering and professor of circuit design at Imperial, explained that the chip will model neural signs responsible for controlling appetite, enabling people who need to lose weight to be more thoughtful about food. This might result in eating more slowly and/or making more healthy food selection. This project has received almost £6 million in funding from the European Research Council.

Sources: ABC News, 30 March 2013; BBC Health News, 28 March 2013; ‘Scientists design microchip which may reduce obesity’, Digital Journal, 30 March 2013.

http://www.digitaljournal.com/article/346881