World Health Organisation Internship Tara Purcell 27 September 2012

A little about myself... Doctor of Medicine (MD) Bachelor Exercise & Sport Science (BAppSc) Registered Exercise Scientist (ESSA) Certificate III & IV Fitness Basketball referee Monty resident Melb Uni

Noncommunicable Disease (NCD) Non-infectious and non-transmissible between persons Cardiovascular diseases Cancer Chronic respiratory diseases Diabetes CVD: AMI / Stroke Resp: COPD / Asthma Hearing and visual impairment, Neurological, Renal dx, autoimmune

Risk factors for NCDs Tobacco Alcohol Physical Inactivity Unhealthy Diet Hypertension Overweight & Obesity Raised Cholesterol NCDs are strongly influenced by smoking, EtOH, PA, diet. NCDs are caused, to a large extent, by four behavioural risk factors that are pervasive aspects of economic transition, rapid urbanization and 21st-century lifestyles - Smoking: kills 6 million per year - PA: ↓ CVD, HTN, DM, Breast/colon cancer, Depression - Diet: Salt, cholesterol - Obesity: 1.5 billion adults overweight (7 billion on earth) If the major risk factors for chronic disease were eliminated, at around three-quarters of heart disease, stroke and type 2 diabetes would be prevented; and 40% of cancer would be prevented.

NCDs: Worlds biggest killers Causing ~35 million deaths each year 60% of deaths globally 80% middle income countries 9 million NCD deaths occur < 60 yrs Leading cause of death globally Source Alwan et al. 2010

Breaking it Down Cardiovascular disease represents 39% of NCD deaths Cancers represent 27% Diabetes 4% Text Source AIHW 2010a

Cardiovascular Disease All diseases of heart and blood vessels Leading cause of death & disability in the world 17% Australians have CVD Increases with age 19% 45-54 yrs 62% >75 yrs Coronary heart dx, stroke, HF, A large proportion are preventable, but continues to rise due to inadequate preventive measures Source AIHW 2010a

A Rising Epidemic The burden of NCDs will ↑ by 17% in 10 yrs Source WHO 2008

The Role of Physical Activity Decreased exercise ↑ the mortality for people with risk factors for CHD Exercise capacity should be given as much attention by clinicians as other major risk factors Physical activity reduces all cause mortality (measured in METS, when 1 MET = rest) (hypertension, COPD, diabetes, smoking, BMI > 30, high total cholesterol) As increasing activity significantly reduces mortality, exercise capacity should be given as much attention by clinicians as other major Source Kokkinos et al. 2008

The Role of Physical Activity Exercise significantly reduces CVD events and associated risk factors to a degree comparable to that of not smoking Source Mora et al. 2007

The Role of Physical Activity Exercise interventions provide better outcomes in T2DM than Metformin the best pharmacological treatment, Source Diabetes Prevention Program 2002

The Role of Physical Activity There are protective effects of exercise across all ages Source Blair & Wei 2000

Physical Activity Guidelines Be active in every way At least 30 mins of moderate intensity physical activity on most, preferably all, days Include regular vigorous activity, weight bearing and stretching

Australian’s Inactivity PA is independent of sitting time Although some people are meeting the exercise requirements, sedentary time is still 70% of waking hours It is better to be a breaker than a prolonger Over past five decades moderate exercise has decreased, whilst light and sedentary activity has increased. -> technology era Active people who have a similar sitting time during a day, as a sedentary person, had a very similar increased risk More breaks from sitting time were associated with lower average waist circumference, BMI, triglycerides and glucose tolerance test Source Mora et al. 2007

World Health Organisation (WHO) Directing body for health within United Nations Provide leadership on global matters Guide health research Develop policies and standards Heavily relies on voluntary contributions All member states pay assessed contributions (the dues calculated relative to a country's wealth and population), which, since 2006, make up around 25 percent of the WHO's revenues. The second source of funding indeed comes from voluntary contributions. These make up about 75 percent of WHO's annual income. Eighty percent of WHO's budget now comes from governments

Internship Program Volunteer program for graduate medical / public health students Enhances educational experience through practical work assignments Exposes students to the role of WHO Develops WHO programmes with the assistance of students specialising in various fields Can apply to work in any department Family, Women and Children’s Health Health Security and Environment Health Systems and Services HIV/AIDS, TB, Malaria

Noncommunicable Disease Department Provide leadership and evidence for international action on prevention and control of NCDs Prevent & reduce disease, disability, morbidity Prevent key risk factors Improve nutrition Provide leadership and the evidence base for international action on prevention and control of noncommunicable disease Prevent & reduce disease, disability, morbidity: Chronic diseases such as diabetes and CVD increase risk of complications leading to disability and death ......... Prevent key risk factors: tobacco, alcohol, drugs, unhealthy diets, physical inactivity Improve nutrition, food safety and food security: promote healthy practices through life, starting with pregnancy, avoid foodborne disease, control of nutritional disorders, and ensure food security Do this through: policy development, health promotion, programs implementation, monitoring & evaluation, strengthening existing health & rehabilitation services, implementing preventative programs

My Position Implementation of the Global Strategy on Diet, Physical Activity and Health The Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases The overall goal of the strategy is to promote and protect health through healthy eating and physical activity. The Global Strategy has 4 main objectives: Reduce risk factors for chronic diseases that stem from unhealthy diets and physical inactivity through public health actions. Increase awareness and understanding of the influences of diet and physical activity on health an the positive impact of preventive interventions. Develop, strengthen and implement global, regional, national policies and action plans to improve diets and increase physical activity that are sustainable, comprehensive and actively engage all sectors. Monitor science and promote research on diet and physical activity. Based at Geneva headquarters for 10 week program

My Position Collate evidence on effective interventions for physical activity Collation of costing information on interventions for physical activity Provision of data for modelling of physical activity interventions to identify cost effective for programs

Personal Goals Enhance my understanding of global health issues and the intricate complexities of these matters Encourage a heightened confidence within myself, to tackle public health issues now and into the future Bestow knowledge and skills upon community members As it is due to family, friends and teachers that I am privileged to have such opportunities today

Benefiting Our Community Collaborate with Nossal Institute and Local Community Groups Address risk factors & social determinant of health for disease prevention and management Health Literacy Education to Empower Social support Community Exercise Programs Food Supply By guiding ourselves alongside these goals, we have an opportunity to contribute to the task at hand and to encourage international understanding. As it is through the promotion of international understanding that a global perspective can be achieved to foster peace and instil the Rotary Foundations legacy.

old before their natural time.” “… All parts of the body which are designed to be used, will stay healthy, will grow well and will remain young if they are used in the right way and if they are trained sufficiently, each of them in the manner in which they are used; but if you do not use them, they will become ill, they will shrink and will grow old before their natural time.” Hippocrates (460 – 377 BC)

References Alwan, A. et al. 2010. Monitoring and surveillance of chronic noncommunicable diseases: progress and capacity in high-burden countries. The Lancet, 376:1861–1868. AIHW 2010b. Cardiovascular disease mortality, trends at different ages. Cat. no. CVD 47. Canberra: AIHW. Blair, S.N. & Wei, M. 2000. Fitness, ageing and mortality. American Journal of Health Promotion. 15: 1-8 Diabetes Prevention Program Research Group. 2002. Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. The New England Journal of Medicine, 346: 393-403 Kokkinos, P. et al. 2008. Exercise capacity and mortality. Circulation. 117: 614-622 Mathers, C & Loncar, D. 2006. Projections of Global Mortality and Burden of Disease from 2002 to 2030. PLOS Medicine Mora, S., Cook, N., Buring, J., Ridker, P. & Lee, I. 2007. Physical Activity and Reduced Risk of Cardiovascular Events: Potential Mediating Mechanisms. Circulation, 116(19): 2110-2118 The global burden of disease: 2004 update. 2008. Geneva, World Health Organization

Thank You