Yasmin Williams - HEALTH-WISETHE PREVALENCE of diabetes was 17.5 per cent in 1993 for the Jamaican population older than 15 years (Jamaica Diabetes Survey) and in the Spanish Town Study among adults 25-74 years, a prevalence of 12 per cent for non-insulin dependent diabetes mellitus was found (Wilks et al,1999). In the same Spanish Town Study, 29.1 per cent females and 20 per cent males were hypertensive. Also, 30.7 per cent and 7.2 per cent of men were overweight and obese respectively, while among women, 64.7 per cent were overweight and 31.5 per cent were obese.
The evidence is that the prevalence of diabetes and associated risk factors, especially obesity, has reached epidemic proportions in the Caribbean (Wilks et al,1999). Rates, at least among women, exceed those for most European-origin populations (King et al 1993).
Other relevant data for the prevalence of the risk factors are from the Jamaican national behaviour risk survey (Figueroa et al, 1999) which found that 36 per cent males and 11 per cent females never smoked, 59 per cent males and 40 per cent females had regular exercise and 3.9 per cent males and 15.9 per cent females were obese.
There is clearly a need to develop appropriate worksite health promotion strategies targeting the risk factors for the chronic non-communicable diseases. Employees at worksites will be in different stages with respect to healthy lifestyle behaviour change. While some will be knowlegeable about healthy practices, many will be unaware about the importance of nutrition and physical activity as well as health-seeking behaviour.
Some employees will have acted on the knowledge and will be practising appropriate behaviour, for example, physical activity during leisure time. Others will have acted but were not able to sustain the behaviour change. Even though these persons failed to maintain the required behaviour, they showed a readiness to change which must be recognised. A wellness programme should be designed to facilitate the movement of each person through each step of the behaviour change process towards the ultimate goal which is the maintenance of healthy lifestyle behaviour.
The programme organisation and processes will need to be designed to reach each employee at whatever stage of the process that he or she is at and facilitate movement to the next step as appropriate.
THE WELLNESS PROGRAMME SHOULD FOCUS ON:
1) Nutrition to maintain or decrease weight as needed, with emphasis on appropriate eating behaviour, appropriate intake of fat, fruits and vegetables. To support this, a facilitative environment will be necessary through ensuring that healthy food choices are available and attractive in the worksite canteens with training of all the canteen staff in the basics of good nutrition as well as menu planning.
2) Physical activity on the job and during leisure time as prescribed.
3) Moderation of alcohol use/cessation of smoking.
4) Health-seeking behaviour to identify early cases of hypertension, diabetes, breast and cervical cancers and prostate cancer.
There must be ongoing monitoring and evaluation of programme components so that it can be modified as necessary.
Dr. Yasmin Williams is a family doctor and public health specialist
