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1 1 1 MAIN ACTIVITIES ON THE PROMOTION OF HEALTH - ENHANCING PHYSICAL ACTIVITY IN MACEDONIA HEPA MACEDONIA, 2001 - 2007 HEPA MACEDONIA, 2001 - 2007 SIMOVSKA VERA, MD., PhD., spec. of sports medicine, subspec. of hygiene nutrition; E-mail:

2 2 H E P A M A C E D O N I A HEPA Macedonia National Organization for the Promotion of Health - Enhancing Physical Activity is established on 11 October 2005. The aim was to develop the steps to implement national policy, startegy and programme on the key health determinant, physical activity in accordance to the new EU Health Strategy (2007-2016). In February 2006 HEPA Macedonia was accepted as temporary member by the Steering Committee of the WHO HEPA EUROPE until confirmation by the network at 2nd Annual meeting on 14 June in Tampere, Finland. Also it,s is a member of the World Move for Health network. There is a need for quick action to implement this strategy associated with the implementation of the WHO Resolution WHA 57.16 on Health Promotion and Healthy Lifestyle and WHA 57.17 on Global Srategy on Diet, Physical Activity and Health as well as with the A/RES/58/5 on Sport as a means to promote Education, Health, Development and Peace.

3 3 IN TRANSITION 1991-2003 There is a strong evidence for the Macedonian physical activity initiative/strategy and programme. During last decade, statistic showed very bad public health situation. The major cause of death and disability are CVD, cancer, diabetes, obesity and respiratory diseases. CVD with predominant CHD mortality is continuosly increasing up to 57% of all deaths in 2002.

4 4 Figure 1. Mortality rate from noncommunicable diseases in Macedonia for the period 1991-2001 up to 100.000 population

5 5 Map 1. Deaths by causes in Macedonia, 2000

6 6 Figure 2. Morbidity rate from circulatory diseases in Macedonia up to 100.000 population.

7 7 PUBLIC HEALTH APPROACH RISK FACTOR IDENTIFICATION IN MACEDONIA RISK FACTOR IDENTIFICATION IN MACEDONIA High important public health problem are high prevalence of biological (morphfunctional), behavioural (lifestyle) and envoronmental risk factors responsible for development of the leading NCD in Macedonia. 41.2% of Macedonian adult population was increasingly overweight and obese in 1988 and the percentage was increased up to 58.3% in 2000 (fig. 3) High prevalence of other major biological risk factors such as high total serum cholesterol, high blood presure and hyperglicaemia (fig. 5). The health of 64.5% of adult population was at risk from physical inactivity in 2002. PA are declined in 50% of school-age girls from 7-12 years old. Application of a standard questionnaire for PA such as IPAQ, periodically used was never undertaken. Assessment and comparison of socio-economic differences in PA levels and food habits included level of education were never done.

8 8 Figure 3. BMI Distribution in adult population in Skopje during the last 10 years (1990-2000)

9 9

10 10 WHO/FIMS PHYSICAL ACTIVITY RELATED ACTIVITIES, 1996-2006 WHO/FIMS PHYSICAL ACTIVITY RELATED ACTIVITIES, 1996-2006 Sedentary lifestyle with reduced level of physical activity (PALs) and cardiorespiratory fitness under the recommended minimum (VO 2 max ml -1 kg -1 min -1 ) is clearly kay risk factors for major NCD. 1986 - WHO CINDI Programme: Protocol for Integrated preventive interventions are aimed to those risk factors that can be modified and are common for several NCD such as lifestyle risk factors: physical inactivity, unhealthy diet, smoking and stress. 1996 - The FIMS and WHO had increased efforts toward PA. 2000 - WHO estimates that physical inactivity leads to more than 2 million deaths/yrs. Worldwide, it is estimated that at least 60% of the population is not active enough to benefit their health. 7 April 2002 - World Health Day Move for Health - Reduce the Risk; 10 May 2003 - WHO Move for Health Initiatives Around the World 2004 - Move for health - Active Youth, 2005 - Move for health - Supportive Environments, 2005 - Starting the WHO HEPA EUROPEAN NETWORK 2005 - WHO strategy on PA recommendations: implementation of an integrated, comprehensive and coordinated approach with stable intersectoral partnership. 2006 Move for Health - Active Communities"

11 11 The vision and main goal of HEPA Macedonia The vision and main goal of HEPA Macedonia People in Macedonia should enjoy to achieve better health through increasing physical activity. To strengthen and support efforts and actions that increase participation and improve the conditions favourable to a healthy lifestyle, in particular with respect to health - enhancing physical activity (HEPA). To initiate national approache and network for physical activity promotion, inter-ministerial and -sectoral approache and a general framework for physical activity promotion policy.

12 12 1. To promote health through PA using population-based approach. 2. To formulate National strategy and programme for the promotion of health-enhancing PA - HEPA Programme: - the main objective is to reduce major chronic disease morbidity/mortality - the intermediate objectives are to reduce the population levels of biological risk factors for chronic disease by introduction changes in the lifestyle: increased PA, balanced nutrition and smoking cessation. 3. In addition to provide the background for the identification and development of an overview of relevant HEPA Action Plan for implementation of HEPA startegy/programme in Macedonia (2005-2010). 4. To strengthen cooperation, partnership and collaboration with other relevant programmes, sectors, NGOs e.t.c in promotion of HEPA. 5. To formulate organizational structure and establishement a national network. 6. To prepare annual work programme for the main planned activities and events 7. To establish specific outcomes, monitoring and evaluation, and deliverables for HEPA Europe. The a i m s

13 13 START OF HEPA PROMOTION WITHIN THE NATIONAL CINDI PROGRAMME IN MACEDONIA (2001 - 2004) In September 2001- National PA startegy is initiated as part of CINDI conceptual model: The health promotion and NCD prevention/control dimensions of the PA strategy. In 2001/02 - Formulation of the Action Plan for development, implementation and monitoring the PA programme within the contex of the first Draft-Plan of Action for CINDI Programme in Macedonia, 2002-2007. Action Plan is based on: - the best scientific evidence on health, social and economic benefit of PA - intersectoral and multidisciplinary 2001 - Planning CINDI coordinative centre in Skopje with an information base and organization structure for implementation of the CINDI programme. 2001 - Realised pylot study CINDI Health Monitor survey on demonstration level; - Planning a national register for NCD risk factors focused on PA 2001 - Planning seminar/lecture in Skopje Modern aspects of NCD primary prevention: programmed PA and dietary interventions

14 14 START OF THE PROMOTION OF HEPA WITHIN THE NATIONAL CINDI PROGRAMME IN MACEDONIA (2001-2003) II part 2002 - Initiation of preventive interventions and national quidelines for reduction of lifestyle risk factors: PA and diet. 2003 - Move for Health 2003 Initiative Around the World The first step was made in collaboration with the WHO Department for NCD prevention and health promotion (Puska P, WHO/HQ, Geneva). 10 May 2003 - Establishing a national coordination with Executiv Counsil Move for Health within Macedonian CINDI Programme. 2003 - The website was developed Macedonia on the Move

15 15 Annual Move for Health Day was organized on 10 May as part of a larger and sustained Move for Health initiative, policy and programme to promote physical activity and related healthy lifestyle within the Macedonian population throughtout 2003. Used as vehicles to get the message of the importance of PA for health and well-being to political leaders. It was a polivalent programme and part of a larger campaign in Macedonia to develop a national programme on PA and health with goals and specific targets in partnership with main concerned sectors. NATIONAL MOVE FOR HEALTH DAY PROGRAMME IN MACEDONIA, 2003

16 16 Ongoing activities on national level, 2004 - 2007: 10 May 2004 - Mass media campaign Move for Health - Active Youth. The Macedonian Move for Health Declaration was adopted. 11October 2005 - Establishing a National Public Health Organization HEPA MACEDONIA. 2006 - Member of the WHO HEPA Europe and World Move for Health network. 2006 - Collaborative Partner of the EU network and research project for PA and Aging - EUNAAPA. May 2006 - WHO Quit & Win Programme for smoking cessation in Macedonia with title Tobacco - Free Sport; 22 September 2007 - European day without cars - Ohrid.

17 17 MAIN ACTIVITIES OF HEPA MACEDONIA NATIONAL PUBLIC HEALTH ORGANIZATION FOR THE PROMOTION OF HEALTH – ENHANCING PHYSICAL ACTIVITY RESEARCH: Effects of applied programmed PA at children, youth and adult population Efficacy of PA on reduction on diet-related risk factors for chronic diseases Researches in area of public health - health promotion through PA and healthier nutrition - monitoring and evaluation of outcomes HEALTH PROMOTION IN GENERAL: Healthy lifestyle Skills for health PROMOTION OF PHYSICAL/SPORT ACTIVITY: On population and individual levels On national, regional and local level in Macedonia

18 18 TEACHING / ADVOCACY ON PHYSICAL ACTIVITY, 2006 - 2007: - Continuing doctoral education - CME, accrediated by Macedonian Medical Association, Faculty of Medicine and Doctor Chamber of Macedonia. - Traening seminars, workshops and teaching courses. - Mass-media campaigns: Move for Health and Quit & Win - Policy and strategy documents: Health strategy of Macedonia including PA Strategy / Programme. - Statute for transformation of Sports medicine institutions countrywide. - Strategy for Sport-decentralization of sport in Macedonia. - Legislation (Low for Sport). - Recommendations and guidelines. - Preparing proposal basic preventive medical services in area of Sports Medicine and Medical dietology. Project Unit at Ministry of Health and Health Insurance Company.

19 19 CONTINUING DOCTORAL EDUCATION, 2006 Workshop: New way of presenting of the reccommendations for physical activity and application in the preventive-therapeutic programmes focused on obesity. Simovska V., MD., PhD. Institute of Sports Medicine, Skopje, 31 May 2006 - Professional - scientific meeting: Non-pharmacological combined therapeutic threatment at obese population. Simovska V., MD., PhD. Faculty of Medicine, Clinic for pediatric disorders, Skopje, 21 April, 2006. The First Annual HEPA Macedonian Conference. Public Health Institute of Sports Medicine, Skopje, 26 December 2006 - Topics: 1. Vision and goals of HEPA Macedonia - National Public Health Organization for the Promotion of Health-Enhancing Physical Activity. Simovska V. MD., PhD, President of HEPA Macedonia. 2. Anthropometric,s characterisitics in patients with M. Cushing. Doc. dr Stratovska - Subevska S, Faculty of Medicine. Clinic of Endocrinology. 3. Startegies in treatment of obesity: dietotherapy in individuals with overweight and obesity. Simovska V.MD., PhD. 4. Annual Report of HEPA Macedonia 2006. 5. Annual HEPA Macedonian Work Programme 2007.

20 20 CONTINUING DOCTORAL EDUCATION, 2007 Annual Conference of the National Organization HEPA Macedonia. Plenary lecture: Simovska V., HEPA Macedonia. National startegy for the promotion of HEPA integrated in multidimanzional health policy - fats and perspectives. Skopje, 29 November 2007 - Worshop: Influence of physical inactivity, obesity and psycho-social stress on process of atherosclerosis and/or diabetes mellitus-type 2: Patophysiology and treatment of Syndrom X. Skopje, 10 January, 2008.

21 21 Physical Activity Promotion Policy Framework Outcomes of Policy Develop and Implement Policy Determinants of Policy Identify Policy Local Regional State National School Worksite Transportation Parks/Public Spaces Health Scale Policy Sector

22 22 HEALTH SECTOR HEALTH SECTOR 1. SPORT 2. EDUCATION 3. TRANSPORT 4. URBAN PLANNING Policy Process Physical Activity Behaviour Determinants Programmes & Activities Knowledge Base Policy Process Physical Activity Behaviour Determinants Programmes & Activities Knowledge Base Policy Process Physical Activity Behaviour Determinants Programmes & Activities Knowledge Base Framework for Physical Activity Promotion within a Multi-Dimensional Health Policy Diet Smoking …… Health Policy Process Physical Activity Behaviour Physical Activity Determinants Programmes & Activities Knowledge Base Physical Activity Framework for Physical Activity Promotion within a Multi-Dimensional Health Policy Leisure Transport Work / School Domestic

23 23 Developing a HEPA PROGRAMME in Macedonia Key point 1. Explore and resolve the potential relationship, role and function between HEPA promotion and two key groups: - Health professionals and HEPA, especially in PHC - Sport and HEPA Key point 2. Cultivate and recruit other potential HEPA organization and professionals groups at the national, regional and local levels - Medical personals in public health - Health promotion staff - Exercise and fitness professionals - Sports pedaqouges and coaches


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