1. Health Behaviours A Global Perspective Andrew Murray GP, runner Health Behaviours A Global Perspective Andrew Murray GP, runner

2. Background GP- locum Interest in public health and promoting behaviour change Love travelling (often as a GP)

3. Global Mortality = constant

4. Global Health Behaviour = Different

5. Public Health at the North Pole

6. Run The World

7. Antarctica- Healthy Diet Note WHO guidelines Excessive saturated fat intake Massive salt intake (preservative, and flavour) (global average 9-12 grams)

8. South America- Drugs and income inequality Life expectancy Increasing rapidly in South America, as are NCD’s One-fifth of Brazil's 173 million people account for only a 2.2% share of the national income. Brazil is second only to South Africa in a world ranking of income inequality

10. North America- Obesity North America and obesity More than one-third of U.S. adults (35.7%) and approximately 17% (or 12.5 million) of children and adolescents aged 2—19 years are obese (Obesity in America) CIA World Fact Book: America ranks 6 th and the UK 16 th in the world for Adult Prevalence of Obesity (out of 70 countries)

11. World Obesity Charts- WHO

12. Solutions?

13. Europe- UK- Physical Inactivity

14. Africa, sexual health and alcohol Over ½ the world’s population havent drunk alcohol in the last year Varies predominantly with -Income -Religion -culture

16. Alcohol- Uk vs Egypt

17. Sexual Health Scotland- 4201 cases, MSM, Migration

18. Asia Road safety Travel safety

19. Lessons from Asia Japan ?example of good practice Long life expectancy Public health parameters -Nutrition -Obesity -Physical activity Bhutan ?example of good practice Gross national happiness Income low Gross national happiness high

20. Australasia

21. Targeted public health campaigns

22. Life expectancy trends Portugal Scotland

23. Trends in male life expectancy: Scotland Richest 20% Poorest 20%

24. Triple aim Increase happiness Increase health and life expectancy Address health inequalities

25. Albert Einstein Insanity “is doing the same thing over and over again and expecting different results”

26. Health Behaviour Change- Scotland

28. Smokadiabesity

29. Risk Factors- mortality Blair et al BJSM 2009

30. Fat and Fit!!

31. Risk reduction associated with physical activity Chronic conditionRisk reduction All cause mortality30% risk reduction CVD, stroke20-35% reduction Diabetes30-40% reduction Hip fractures36-68% reduction Colon cancer30% reduction Breast cancer20% reduction Loss of function30% reduction Depression/dementia20-30% reduction

32. CMO guidelines 30 mins 5x per weeks (or 150 mins total) moderate exercise- adults 60 mins daily for kids Known by 13% GP’s 9% PN, 7% HV

33. Lessons from East Africa

34. How are we doing Scotland (males) 25-34yo- 63% active 65-74yo- 24% active 75yo plus- 13% active Female population even worse

35. Primary Care Assessment Brief Advice/ Intervention Signposting

36. Assessment Ask the question?? “How many days a week do you do physical activity, and for how long” ??150 mins

37. Brief Advice/ Intervention GP PN HV Physio Any staff

38. Brief interventions in Primary Care Physical Activity £20-440 Smoking £8-9000 Statin £10k

39. Life expectancy trends Portugal Scotland

40. Life expectancy trends

41. It’s in our gift “Primary care AND secondary care vital” WHO “Gamechanging- prevention is the direction of travel”- CMO Highly effective, and cost effective The best for every patient, every time

42. Resources Physical Activity pathway Physical Activity wheel Every Step Counts- DVD and online Raising the issue of PA- e learning module PAHA

43. 3 good, 3 bad

44. Call to Action Ask the question Brief advice and intervention Share knowledge and resources Be a champion for physical activity

45. Top tips Everything counts!!! Find something you enjoy Pedometers/ walking Encourage through relatives

46. Thanks docandrewmurray@gmail.com www.docandrewmurray.com @docandrewmurray Book- Running Beyond Limits