Yasmin Williams, Contributor
THIS WEEK, I thought that we could review the Medscape conference report on 'Obesity and the built environment: improving public health through community design'. This conference was hosted in May by the National Institute of Environmental Health Sciences (NIEHS) of the U.S. National Institutes of Health in Washington.
We are told that the 'built environment' was broadly defined as the environment modified by human; school, home, work, highways, air pollution, public policy, political action, access to food, physical activity and leisure activity are all included.
The presence or absence of pavements on which people can walk or the lack of shops with affordable fruits and vegetables in poor neighbourhoods were included as part of the 'built environment' and the conference stressed that the physical design of a community could prevent or motivate physical activity. It was also stressed that the actual mix of residential, commercial and non-commercial land use was important for increasing physical activity and decreasing obesity.
OBESITY EPIDEMIC
One speaker, Dr. James Hill, reportedly told participants that in trying to address the obesity epidemic, we must focus on the sociocultural environment, the commercial environment and the policy environment in developing our model of the built environment.
I definitely agree. I like the reported recommendations of Dr. Hill's non-governmental organisation, 'America on the Move', for decreasing an individual's one-to-two-pounds weight gain per year. The recommendations are daily, each individual should drink one glass of water instead of a sugary drink and take 2,000 steps on a pedometer (instrument which measures the distance walked). These are small changes, however, if sustained by a supportive environment and if this behaviour becomes a social norm, then we will make headway in preventing and controlling diseases such as diabetes, hypertension and the risk factor, obesity, which has now attained disease status!
The Caribbean Charter for Health Promotion (CCH) is a framework from the Caribbean Co-operation in Health Initiative - a concept introduced in 1984 at the meeting of the CARICOM conference of ministers responsible for health. It was redefined and reformulated in 1996 with eight health priority areas:- environmental health, strengthening health systems, chronic non-communicable diseases, mental health and substance abuse, family health, prevention and control of communicable diseases, food and nutrition and human resource development.
Whereas in former years there was a focus on curative services to contain the spread of infectious diseases which were the major cause of mortality, the current epidemiological profile of disease demands a new strategy to contain problems such as diabetes, hypertension, obesity, STDs/ HIV, violence and substance abuse. Health promotion is the strategy. Health promotion in its widest sense must be intersectoral, focusing on policies that will prevent disease, improve well being and most importantly, productivity. Health education and an intersectoral approach will enable communities and individuals to devise initiatives to assist them to engage in daily activities important for good health.
SIX PILLARS
The framework for the Caribbean Charter for Health Promotion has six pillars: formulating health public policy, reorienting health services, creating supportive environments, empowering communities, developing/increasing personal health skills and building alliances with special emphasis on the media.
Numerous benefits of the CCH initiative are anticipated such as improved collaboration with regional institutions and sharing of expertise between countries. This regional integration in the health sector should augur well for improving the health of individuals in the region.
Dr. Yasmin Williams is a family doctor and public health specialist; email: yourhealth@gleanerjm.com.
