COMBATING OBESITY

Current Situation in St. Kitts & Nevis: Trends, Drivers, Barriers, Solutions, Recommendations

Patrick MartinChief Medical Officer

@ PACO III, ArubaJune 2013

THE CARIBBEAN

ABOUT ST. KITTS & NEVIS

• 52, 300 pop; LE: 75 years• Total Health Expenditure ~ US$ 600 per capita

• Epidemiology Profile– 2/3 deaths = CHD; Stroke; Cancer; Diabetes

• NCDs costs ~ 2% of GDP– Diversion from growth and development activities

OVERWEIGHT PREVALENCE

2005 2008 2011Birth - 5 years 9 11

13-15Total 19 32.5Males 17.3 32.6Females 20.9 32.5

25-64

Percent

From 1/5 to 1/3 in 6 years

OBESITY PREVALENCE2005 2008 2011

Birth - 5 years

13-15Total 14.4Males 16.6Females 12.1

25-64Total 45Males 37.9Females 52.5

Percent

10 year boy

71Kg

BMI » 30

WHY COME TO PACO III

Health is

• “Intrinsic to human dignity”

• A pre-condition of– Sustainable Economic Growth and Development– Social Stability and National Security

Epidemic Childhood Obesity: A threat to All

• Children learn by imitation (they behave like the people around them)

• Obesity Continuum

Health Sector$$$,$$$,$$$

Obesity = Energy Equation manipulation/distortion

FOCUS # 1: THE ENERGY EQUATION

EQUATION OUTCOME

Energy Intake = Energy Output Weight Same

Energy Intake < Energy Output Weight Loss

Energy Intake > Energy Output Weight Gain

Obesity = Energy Equation manipulation/distortion

EQUATION OUTCOME

Energy Intake = Energy Output Weight Same

Energy Intake < Energy Output Weight Loss

Energy Intake > Energy Output Weight Gain

Obesity = Energy Equation manipulation/distortion

EQUATION OUTCOME

Energy Intake = Energy Output Weight Same

Energy Intake < Energy Output Weight Loss

Energy Intake > Energy Output Weight Gain

Obesity = Energy Equation manipulation/distortion

EQUATION OUTCOME

Energy Intake = Energy Output Weight Same

Energy Intake < Energy Output Weight Loss

Energy Intake > Energy Output Weight Gain

Obesity = Energy Equation manipulation/distortion

EQUATION OUTCOME

Energy Intake = Energy Output Weight Same

Energy Intake < Energy Output Weight Loss

Energy Intake > Energy Output Weight Gain

Influenced by Price & Mindset

EQUATION OUTCOME

Energy Intake = Energy Output Weight Same

Energy Intake < Energy Output Weight Loss

Energy Intake > Energy Output Weight Gain

How to Reduce Price of Unhealthy Foods

Subsidies Low Wages

Mass production No/Low Border Tariffs

EQUATION OUTCOME

Energy Intake = Energy Output Weight Same

Energy Intake < Energy Output Weight Loss

Energy Intake > Energy Output Weight Gain

How to Shape Mindset of A People

Marketing/Advertising Perception Body Image

Perception of Social Status

OBESITY VECTORS ARE IMPORTED

• Vectors 1. Energy-Dense Food2. Energy-Sparing Gadgets & Games

• Importation driven by supply and demand.

• In SKN, demand stimulates supply.

• Therefore, Focus # 2 is DEMAND REDUCTION

BARRIERS

SOLUTIONSRECOMMENDATION

PROGRESS

DEMAND REDUCTION

BARRIER: FOOD IS A STATUS SYMBOL

• Shopping in air-conditioned comfort means I have arrived!

• Root Vegetables are “Poor people food” I now eat Pizza ...

BARRIER: FATNESS IS AN ASSET• A healthy child is “nice and fat”

• Slimness attributed to HIV/AIDS and other illnesses

• Fatness (females) is sexy

BARRIERS

SOLUTIONSRECOMMENDATIONS

PROGRESS

DEMAND REDUCTION

COMPETITIVE PRICING• Make Healthy Food More Affordable– Increase Food Security– Subsidize local production – Limited by tight fiscal space

• Make Unhealthy Food More Expensive– Higher VAT: Proposed by MoH– Not enacted: Unhealthy foods are popular

RE-SHAPE MINDSET

• Prohibit advertising– Need policy & legislation (regional template)

• Social Marketing Strategy – PSAs promoting Healthy Diet & Physical Activity

(regional action)

• Junk-Food Free schools– Alliance Building with Education Sector

RE-SHAPE MINDSET & HABITS

• “Eat Local Day” and “Caribbean Wellness Day”– High Level Political Support

• Food Service Menus– Reduce salt, refined sugar and fat content– Alliance Building with Private Sector and School Meals

Program

• Off-Road exercise trails – Alliance Building with Physical Planning

SOLIDARITY IS KEY• Global– “Champion of Change” (e.g. WHO’s FCTC)

• Regional– CARPHA/PAHO : Support for

• National research• Translation of Research to Policy• Regional SMS + Production of PSAs• Performance Monitoring & Evaluation

• PACO – Best Practices; Lessons Learned; Progress Assessment

CONCURRENCE

• Obesity is fundamentally a Social Determinants of Health issue– Genetics plays a minor role

• Multi-factorial/sectorial Interventions• Trade, Education, Agriculture, Tax, Health

OBESITY DRIVING FACTORS

1. CHOICES PEOPLE MAKE (price & mindset)

2. CHOICES MADE FOR PEOPLE (manipulation)

“Although obesity has profound health outcomes and impacts, combating Childhood Obesity requires healthy public policy action on several fronts including the sectors responsible for international trade rules, national taxation, education, and food security.”