1. World Health Organisation Internship
Tara Purcell
27 September 2012

2. 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

3. 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

5. 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.

6. 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

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

8. 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% 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

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

10. 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

11. 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

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

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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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.

23. 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)

24. References
Alwan, A. et al 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 Fitness, ageing and mortality. American Journal of Health Promotion. 15: 1-8
Diabetes Prevention Program Research Group Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. The New England Journal of Medicine, 346:
Kokkinos, P. et al Exercise capacity and mortality. Circulation. 117:
Mathers, C & Loncar, D Projections of Global Mortality and Burden of Disease from 2002 to PLOS Medicine
Mora, S., Cook, N., Buring, J., Ridker, P. & Lee, I Physical Activity and Reduced Risk of Cardiovascular Events: Potential Mediating Mechanisms. Circulation, 116(19):
The global burden of disease: 2004 update Geneva, World Health Organization

25. Thank You