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June 2014

Rates are significantly higher in Samoa and Tonga; more women than men are overweight

SEATTLE—Rates of being either overweight or obese have climbed in Fiji since 1980, according to a new, first-of-its-kind analysis of trend data from 188 countries. The adult overweight and obesity rate in the country is 51%, up from 41% in 1980. Among children in Fiji, 19% are either obese or overweight, up from 13%.

Published in The Lancet on May 29, the study, “Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013,” was conducted by an international consortium of researchers led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

Overweight is defined as having a Body Mass Index (BMI), or weight-to-height ratio, greater than or equal to 25 and lower than 30, while obesity is defined as having a BMI equal to or greater than 30.

In Fiji, 42% of men and 61% of women are overweight or obese. When just looking at obesity – which has the most serious health consequences -- 15% of Fijian men are obese, up from 11% in 1980. Obesity rates for Fijian women are more than double at 35%, up from 28% in 1980.

Obesity among children has increased slightly in the past 33 years from 4% to 5%.

By age group, more than half of men were overweight or obese men at age 45 to 49, 50 to 54, 55 to 59, and 60 to 64. The same was true for women in all age groups from 30 to 84.

Boys 1 to 4 and 10 to 14 are the most overweight or obese at 14% and the same is true for girls aged 5 to 9 at 27%.

The problem of obesity and its linkage to Non-communicable diseases makes targeting obesity in young children and adolescent priority. Adapting Health lifestyles now really has become an imperative”says Dr Nand who is part of the group of experts for the Global Burden of Disease study and is a co author of this paper.

When examining data across Oceania, 44% of men and 52% of women were found to be overweight or obese. These rates are lower than overweight and obesity prevalence in Australia and New Zealand, and the gender gap is reversed. For children, obesity prevalence was also lower in Oceania (5%) than in Australia (7%) and New Zealand (10%).

Some ocean nations had extremely high rates of obesity. In Kiribati, the Federated States of Micronesia, and Samoa, the prevalence of obesity for women exceeds 50%. In Tonga, both men and women have obesity prevalence over 50%.

“Obesity is an issue affecting people of all ages and incomes, everywhere,” said Dr. Christopher Murray, director of IHME and a co-founder of the Global Burden of Disease (GBD) study. “In the last three decades, not one country has achieved success in reducing obesity rates, and we expect obesity to rise steadily as incomes rise in low- and middle-income countries in particular, unless urgent steps are taken to address this public health crisis.”

Globally, while the percentage of people worldwide who are either overweight or obese has risen substantially over the last 30 years, there have been marked variations across regions and countries. In developed countries, increases in obesity that began in the 1980s and accelerated from 1992 to 2002 have slowed since 2006. Conversely, in developing countries, where almost two-thirds of the world’s obese people currently live, increases are likely to continue.

Between 1980 and 2013, the prevalence of overweight/obese children and adolescents globally increased by nearly 50%. In 2013, more than 22% of girls and nearly 24% of boys living in developed countries were found to be overweight or obese. Rates are also on the rise among children and adolescents in the developing world, where nearly 13% of boys and more than 13% of girls are overweight or obese. Particularly high rates of child and adolescent obesity were seen in Middle Eastern and North African countries, notably among girls.

Key findings:• Today,2.1billionpeople–nearlyone-thirdoftheworld’spopulation–are

overweight or obese. The number of overweight and obese individuals in the world has increased from 857 million (20%) in 1980 to 2.1 billion (30%) in 2013.

• Inhigh-incomecountries,someofthelargestincreasesinadultobesityhave been in the US (where one-third of adults are obese), Australia (where nearly 30% of men and women are obese), and the UK (where around a quarter of the adult population is obese).

• Morethan50%oftheworld’s671millionobeselivein10countries(rankedbeginning with the countries with the most obese people): US, China, India, Russia, Brazil, Mexico, Egypt, Germany, Pakistan, and Indonesia.

• Looking at individual countries, the highest proportion of the world’sobese people (13%) live in the US. China and India together represent 15% of the world’s obese population.

Health risks such as cardiovascular disease, cancer, diabetes, osteoarthritis, and chronic kidney disease increase when a person’s BMI exceeds 23. In 2010, obesity and overweight were estimated to have caused 3.4 million deaths globally, most of which were from cardiovascular causes. Research indicates that if left unaddressed, the rise in obesity could lead to future declines in life expectancy in countries worldwide.

The Institute for Health Metrics and Evaluation (IHME) is an independent global health research organization at the University of Washington that provides rigorous and comparable measurement of the world’s most important health problems and evaluates the strategies used to address them. IHME makes this information widely available so that policymakers have the evidence they need to make informed decisions about how to allocate resources to best improve population health.

(This is an abstract of a paper presented at the Global Burden of Diseases (The Lancet) co- authored by Dr. Devina Nand of Ministry of Health Fiji .

She is one of the local experts for GDB)

GLOBAL BURDEN OF DISEASE STUDYMore than half of adults in Fiji are overweight or obese

The Health Ministry is fully committed to safeguarding the well-being of all children and young people in Fiji.

To this effect, a new child protection guideline was recently launched in an attempt to prevent and reduce illnesses and social problems by identifying risk factors at an earlier stage. Particularly, as one third of Fiji’s population is made up of children.

The guidelines were launched by the Permanent Secretary for Social Welfare; Dr Josefa Koroivueta who stated that child protection begins even before a child is born and as long as a person lives protection is needed.

“Child abuse and neglect occurs in every society, culture and country. Children who are abused or neglected are a significant public health issue”, said Dr Koroivueta

The Child Protection Guideline looks at the definition of child abuse, the roles of health care workers in regards to child protection. Apart from this is also map out the pathway and action that is needed to be undertaken when a case is presented to the health facility.

This guideline will now allow health care workers an opportunity to undergo training in the area of child protection.

In 2010 the Child Welfare Decree (CWD) was developed by the Health Ministry while the Ministry of Social Welfare remained the enforcers.

This new Child Protection Guidelines is in response to the CWD to enable health workers to know their roles and how to manage child abuse.

This is the first kind of its program as it brings all stake holders, the Social Welfare, the Sexual offences Unit and the Director Public Prosecution (DPP) to share a common interest.

There is an inter-agency committee that enables case discussions that impede the management of these cases.

The Health Ministry is grateful to the support received from UNICEF for funding the project as there is a need for Public Private Partnership in addressing health issues in the country.

HEALTH: ELECTRONIC CIGARETTES NOW REGULATED

HEALTH MINISTRY FOCUSES ON CHILD PROTECTION

The Health Ministry has achieved another milestone as for the first time electronic cigarette (e-cigarettes) retailers will now have to be registered and licensed.

This call comes after the Cabinet has endorsed the Health Ministry’s Amendments made to the

Tobacco Control Decree 2010 to regulate e-cigarettes on Tuesday (17th June 2014).

The Cabinet Meeting on the 14th of October, 2013 reflected its full support and agreed that e-cigarette be regulated with special emphasis on the following areas; manufacturers, importers and retailers to be registered and licensed annually, ban on advertising and promotion of the product, ban the sales to persons under the age of 18years, and ban the use of these products in certain public places.

The need to regulate e-cigarettes came about as it was

aggressively entering into global, regional and domestic markets with unproven claims of safety and efficacy as smoking cessation aids.

This had also prompted all states that are Party to the Convention known as the Framework Convention on Tobacco Control to regulate e-cigarettes.

The World Health Organization (WHO) is currently reviewing the existing evidence around e-cigarettes and other electronic nicotine delivery system (ENDS) to determine their safety and efficacy. WHO is also working with national regulatory bodies to look at regularity options as well as toxicology experts to understand more about the impact e-cigarettes may have on health.

“E-cigarettes” are defined as any electronic device consisting of a battery-powered heating element, cartridge and atomizer that is shaped like a cigarette, cigar or pipe designed to deliver nicotine or other substances to a user in the form of a vapor.

The Ministry of Health therefore aims to support the government in making and enforcing policies that protect the health of present and future generations of Fiji from the devastating health consequences, as well as the economic and social burden of tobacco use.

HEALTH MINISTER OPENS NEW GYM AT FBC

The ministry of health wellness at workplace initiative is now filtering down to the private sector as people have realized the value to engage in healthy life styles.

The Minister for Health Dr. Neil Sharma opened a new Gym at the Fiji Broadcasting Commission which will be used by the staff and visitors to improve their health conditions through physical activity.

A workplace wellness program is a health promotion activity or organization-wide policy designed to support healthy behavior and improve health outcomes while at work.

“People are born healthy but through their life styles, our behavior we end up with diseases”, said Dr. Sharma.

“I am confident that we are now moving in the right direction and are looking after ourselves and I am sure this initiative will attract more private organization.

Effective workplace programs, policies, and environments that are health-focused and worker-centered have the potential to significantly benefit employers, employees, their families, and communities.

This further reduces the financial constraints of the health sector and the economy as a whole.

The ministry of health wellness at workplace initiative is now filtering down to the private sector as people have realized the value to engage in healthy life styles.

The Minister for Health Dr. Neil Sharma opened a new Gym at the Fiji Broadcasting Commission which will be used by the staff and visitors to improve their health conditions through physical activity.

A workplace wellness program is a health promotion activity or organization-wide policy designed to support healthy behavior and improve health outcomes while at work.

“People are born healthy but through their life styles, our behavior we end up with diseases”, said Dr. Sharma.

“I am confident that we are now moving in the right direction and are looking after ourselves and I am sure this initiative will attract more private organization.

Effective workplace programs, policies, and environments that are health-focused and worker-centered have the potential to significantly benefit employers, employees, their families, and communities.

This further reduces the financial constraints of the health sector and the economy as a whole.

HEALTH MINISTRY LAUNCHED THE NEW PEN PROGRAMThe Ministry of Health developed new strategies to cambat the

increasing cases of NCD’S around the country.While launching the program the Chief executive officer of Nasinu

Toun council Mr Mosese Kama said that we are in a multi disciplinary approach in the fight against NCD’s.

NDC’s has intensifird in the last couple of years with huge mobility stretching the health care systems.

The Package of Essential Non-Communicable disease interventions (PEN) was developed comprising a mix of already existing population and individual level interventions which can be used to modify NCD risk factors as well as prevent and treat NCD diseases.

PEN is defined as a minimum set of cost effective interventions for primary care facilities, providing integrated prevention and management of NCDs based on simple and evidence based clinical protocols and risk assessment tools.

Fiji experiences high rates of NCDs; causing premature mortality and negatively affecting economic development and productivity. WHO country level data shows that NCDs accounted for 77% of all deaths in Fiji in 2008 (cardiovascular disease 42%, cancer 12%, respiratory disease 6%, diabetes 4% and other NCDs 13%). Deaths from NCDs totaled 4,200, giving an age standardized death rate from all NCDs of

928.4 (per 100,000) males and 590.0 for females. Some 67% of years of life lost due to premature death were attributable to NCDs. In addition to premature death, NCDs, and in particular, diabetes and stroke, lead to a huge morbidity burden, resulting in huge costs to, and strains on, the health system and the economy generally. The 2011-2012 National Health Accounts for Fiji (5) indicate that NCDs accounted for 40% of the costs of disease in 2012, with the majority of expenditure relating to treatment, and little on prevention. Currently, diabetes accounts for the largest proportion of admissions to medical and surgical wards, as presentations are usually late with serious complications. Fiji urgently needs to implement effective and sustainable approaches for the prevention of diabetes and cardiovascular disease, in particular.

The PEN program will be rolled out to all divisions and will be implemented in all health centres at SOPD clinics. NCD clients will be managed according to their level of risk using clinical protocols. Group therapy will be the core intervention tool in PEN where NCD clients will have to be seen monthly by other health professionals before they see the doctor again. The holistic management focuses more on addressing risk factors and trying to control or change the Blood Chemistry to normal and in this way we can avoid further complications from NCDs.