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					           Creating a tipping point to stop the epidemic of chronic
               diseases in Chile: the need for transformational
           partnership(s) between government, private sector, and
                                 civil society
             Presentation to the Cumbre de nutricion y
              Salud, Valparaiso, Chile, Marzo 25, 2008
Pan American
Health
Organization               C. James Hospedales
                                                               2005
                           Jefe, ENT, OPS/OMS
        THANK YOU!

        GRACIAS!




Pan American
Health
Organization
                     2005
Pan American
Health
Organization
               2005
                     Vision General

• Sufficiency of evidence regarding the chronic disease
  epidemic – perspectiva global

• Why we need everyone together and how do we do it

• Regional Strategy and Partners’ Forum on the
  Prevention and Control of Chronic Diseases

      Pan American
      Health
      Organization
                                                   2005
Suficiencia de la evidence –
     perspectiva global




Pan American
Health
Organization
                               2005
               “Planet Doctor”




Pan American
Health
Organization
                                 2005
Pan American
Health
Organization
               2005
               Planet has a fever (global warming)

               Population: about 7 billion humans -
               dangerously close to the limit of the
               Earth’s available resources

               About 1 billion are living in desperate
               poverty, with most in the middle, while
               relatively few are very rich – very unjust,
               unfair

               …Y otros problemas

               An amazing amount of new knowledge,
               technology and information systems,
               military powers invented

Pan American
Health
Organization
                                                    2005
                How did this happen?
• One species that is very intelligent (at least in some ways), has
  become the dominant species. They emerged about 10,000 years
  ago, having invented agriculture, and the villages and political
  systems that soon followed. Up to that point, people had wiped out a
  few of the Earth’s largest animals, but left most of the land surface
  and all the oceans intact. People then used all means they could to
  convert the resources of the Earth and the seas into wealth, and they
  did so at an amazing rate, consuming the hydrocarbon fuels, land,
  forests, water, fish, food, destroying completely thousands of
  species in the process. And as a Planet doctor, realizing this made
  me feel very sad, because you see we are taught that the Creator
  God made the Earth, and when He did so, “He saw that it was good”.
     Pan American
     Health
     Organization
                                                                 2005
             How did this happen?
• They invented ways of overcoming various epidemics
  and problems like small pox, plague, tuberculosis,
  through vaccines, water and sanitation, housing, etc. In
  the last 100 years or so, they became much less
  physically-active, with urbanization and the invention of
  cars and mechanized things. And even where some
  wanted to be more active, they could not because the
  environment was not safe anymore, or had become very
  polluted. And the continued increase in the use of fossil
  fuels has begun to warm the planet.
  Pan American
  Health
  Organization
                                                      2005
                   Que Pasa?
• They invented ways of producing nitrogenous
  fertilizer (double the capacity of nature) to force the
  Earth to produce even more food, and invented
  pesticides, and other chemicals to control the
  pests. In the last 100 years, a large percentage took
  up smoking tobacco (and for this crazy habit, you
  see why I question their intelligence). Harmful use
  of alcohol also became more widespread and
  contributed to much chronic disease and injury and
  social harm.
  Pan American
  Health
  Organization
                                                            2005
                  Que Pasa?

• And excessive consumption habits spread to food
  where high fat, high sugar, high salt foods became
  widespread and cheap, marketed and distributed by
  an efficient private sector so that even the children
  are now becoming often becoming fat and
  unhealthy. And ironically, more and more of the
  cheap, calorie dense, non nutritious food became
  consumed by the poor, worsening the gaps in the
  society.
  Pan American
  Health
  Organization
                                                          2005
                   Muy Importante

• This set of circumstances (global warming, pollution,
  deforestation, over fishing, over-population, intensive
  agriculture, urbanization, despeciation) is all happening
  at the same time, and is all inter-connected, unlike our
  tendency to study or focus on one thing at a time. And
  the consequences of the interactions we cannot predict
  from our reductionist approach to science.


    Pan American
    Health
    Organization
                                                         2005
                   Conclusion 1

• The epidemics of obesity and cardiovascular disease, diabetes,
  cancer, respiratory diseases, are symptoms of our development
  paradigm gone astray

• Costs to governments, families, and business are huge and
  increasing, and no sostenible

• Symptoms of the deeper problems of a sick planet.

• The roots of obesity and chronic disease problem lie deep, deep
  in the way the species, our species, lives on this planet.
   Pan American
   Health
   Organization
                                                              2005
                      Conclusion 2

• Although our entry point in this Summit is obesity and chronic
  diseases, the discussions will lead to the fight against poverty, the
  fight to restore environmental balance, the fight to stabilize the
  population.
• It is a very complex problem.
• The evidence is compelling that we need to redesign our social
  and economic policies before we completely wreck this planet and
  the future of the people, and our children.
• And thus we must come together, politicians, business, media,
  academia, etc., in a new way.
     Pan American
     Health
     Organization
                                                                   2005
                 Faith, Hope and Love

• I have Faith in the science.

• I have Hope at the awakening awareness, as
  evidenced by this Summit, and tools and partners
  available.

• What we need is Love …

  Pan American
  Health
  Organization
                                                     2005
           Sufficiency of Evidence
• Preventability – 80% heart disease and diabetes
  preventable, 40% cancer preventable and another
  30% curable – the challenge is in the application;

• “Discovery-delivery gap” or 20, 30, 50+ years: how
  to shorten? How to apply the evidence? What
  policies? What changes in Global and regional
  market forces?

  Pan American
  Health
  Organization
                                                       2005
              Sufficiency of Evidence
• Importance of comprehensive, integrated action
  combining population-based and individual measures;
  small changes in levels of several risk factors can have
  major impact.

• Lancet, December 2007: 32 million deaths can be
  avoided over the next 10 years by a combination of 15%
  reduction in salt consumption and comprehensive
  tobacco control (14 million deaths avoided) at a cost of
  $0.40 per person per year, and scaling-up of treatment
  with aspirin, and drugs to lower high blood pressure and
  cholesterol (18 million avoided) at a cost of $1.10 per
     Pan American
  person per year.
     Health
     Organization
                                                         2005
Why we need everyone
    together and
  how do we do it



Pan American
Health
Organization
                       2005
    Transformational Partnerships




                                       Niveles:
                                       Local
                                       National
                      Public           Regional
                                       Global
                      Sector

                           Private Sector
           Civil Society
Pan American
Health
Organization
                                             2005

                   Science-Based
  Why do we need everyone together?


• Creating Tipping points
• From physics, popularized by Gladwell’s book; seeks to
  explain and describe enormous and "mysterious"
  sociological changes that mark everyday life
• Tipping Points are "the levels at which the momentum for
  change becomes unstoppable”
• A sociological term "the moment of critical mass, the
  threshold, the boiling point“
• "Ideas and products and messages and behaviors spread
  like viruses do.“ Examples of such changes in his book …
  Pan American
  Health
  Organization
                                                             2005
     Creating positive social “epidemics”

• "The success of any kind of social epidemic is heavily
  dependent on the involvement of people with a particular
  set of social skills."
   – Connectors are people who "link us up with the world ...
     people with a gift for bringing the world together"
   – Mavens are "information specialists", or "people we rely
     upon to connect us with new information." They
     accumulate knowledge, especially about the
     marketplace, and know how to share it with others
   – Salesmen are "persuaders", charismatic people with
     powerful negotiation skills. They tend to have an trait
     that goes beyond what they say, that makes others want
     to agree with them
      • From the book, Tipping Point, by Malcolm Gladwell
     Pan American
     Health
     Organization
                                                            2005
   Why do we need everyone together?

• The problem is very complex

• Many countries and organizations have developed many
  initiatives, policies, promotion and prevention
  programs…. But the response is fragmented

• Partnership/collaborations are the stage that everyone
  needs for action, to create needed synergy between
  initiatives, to create a “tipping point(s)” for the epidemic
  in the short to medium term
    Pan American
    Health
    Organization
                                                           2005
   Why do we need everyone together?

• Governments can make policies that help reduce risks, scale up
  provision for those affected and minimize final catastrophe for
  families and individuals, but they need the support of the private
  sector and an empowered civil society

• Regional and global market forces are major determinants of
  chronic diseases and health, but private sector needs government
  policies to level the playing field, and informed consumers to
  generate markets for healthier products

• Civil society cannot do it alone; they need an environment that
  makes the healthy choice the easy choice, which flows from
  government and private sector policies.
      Pan American
      Health
      Organization
                                                                    2005
                 No es facil!

• “We chose to go to the moon and do other things,
  not because they are easy, but because they are
  hard, because the goal will serve to organize and
  measure the best of our energies and skills,
  because that challenge is one we are willing to
  accept, on we are unwilling to postpone, and one
  which we intend to win, and others, too.” (John
  Kennedy)

  Pan American
  Health
  Organization
                                                      2005
                   How do we do it?

•   Global perspective, with local actions
•   Inclusive
•   Cooperative
•   Environmentally aware
•   Science-based

Jeffrey D. Sachs: “Common Wealth; Economics for a Crowded
   Planet” Penguin Press, 2008
    Pan American
    Health
    Organization
                                                            2005
                   How do we do it?
• Inclusive
   – Who is not here at this Summit that will feel that they should
     be here, and who we need to have on board for success?

   – What happened that the private sector is not well represented?

   – Which is the biggest NGO in the world; very important in
     Chile? Are they at the Summit?

   – Who feels that they should have been part of the planning of
     the Summit, and were not?

    Pan American
    Health
    Organization
                                                                  2005
      And if you were not involved or
                  invited?

• Maybe it was not intentional

• Forgive the organizers and join the effort!

• En la Biblia: "Lord, how many times shall I forgive
  my brother when he sins against me? Up to seven
  times?" Jesus answered, "I tell you, not seven
  times, but seventy-seven times” Matt 18: 20-21
  Pan American
  Health
  Organization
                                                        2005
                 How do we do it?


• Cooperative

• “Each of you should seek not only to your
  own interests, but seek also to the interests
  of others”. Philippians 2:4


  Pan American
  Health
  Organization
                                                  2005
               Some Useful Tools




Pan American
Health
Organization
                                   2005
               Some Useful Tools


                    Interest-Based Negotiation



                    Conflict Management Group,
                    Cambridge, Mass, USA

                    Mercy Corps Int’l, Seattle

Pan American
Health
Organization
                                                 2005
               Some Useful Tools
                      Communication & Relationship

                       Keys to the “circle of power”

                             Clarify Interests

                    Identify Options for mutual success

                            Criteria of Fairness

                        Agreement & Commitment
Pan American
Health
Organization
                                                   2005
                   How to do it?

• We have to connect our interests to the interests of others

• Learn to speak the language of other groups sectors

• Connect our health metrics to social justice, to profits and
  productivity, to environmental concerns, to security
  interests, to spiritual interests, etc



  Pan American
  Health
  Organization
                                                                 2005
  How do we do it? Some useful tools


• THE SEVEN HABITS OF HIGHLY EFFECTIVE
  PEOPLE
• Habit 5 -- Seek First to Understand
• Then to be Understood
• Principles of Empathic Communication

• Stephen Covey, and the Covey Leadership Institute
  Pan American
  Health
  Organization
                                                      2005
               Some Useful Tools




Pan American
Health
Organization
                                   2005
               Some Useful Tools




Pan American
Health
Organization
                                   2005
                   How do we do it?

• “If your colleague does something to offend you, go
  and show him his fault, just between the two of you.
• If he listens to you, you have won your colleague
  over.
• If he will not listen, take one or two others along, so
  that the matter may be established by the testimony
  of two or three witnesses..”
                 Matthew 18: 15-16
  Pan American
  Health
  Organization
                                                            2005
                 How do we do it?
• Persevere: the most important thing

• See the movie “Amazing Grace” about how the
  British slave trade was ended through the efforts of
  Member of Parliament, 1789-1906, William Pitt

• “After the final No, there comes a Yes, and on that
  Yes the future depends”, Poet, Wallace Stevens
  Pan American
  Health
  Organization
                                                         2005
             People will say, “No”

•   No, we need not change; we have always done this
•   No, we cannot change; it is too hard
•   No, we will lose profits… or prestige
•   No, we cannot make peace with that group…
•   ….



    Pan American
    Health
    Organization
                                                       2005
        Private sector interests

•   Profits and productivity
•   Customer satisfaction
•   Increasing share holder value
•   Quality and competitiveness
•   Controlling costs (workplace wellness)
•   New market opportunities
•   Avoiding future litigation
•   Image and reputation
•   Corporate Social Responsibility
•   Etc
    Pan American
    Health
    Organization
                                             2005
     Private Sector; not homogenous
•   Food Companies
•   Media and telecommunications
•   Arts and entertainment
•   Travel and tourism
•   Finance and banking
•   Insurance companies
•   Auto industry
•   Farming and agriculture
•   Etc
    Pan American
    Health
    Organization
                                   2005
             Private Sector: business
              opportunities in health
•   Food Companies – “5-a-day” frutas y verduras
•   Sports companies – Ciclorecreovias – bicycles, sports drinks
•   Media, Arts and entertainment – wellness programs
•   Telecommunications – cellphones for RF surveys? For health
    education with text messages?
•   Arts and entertainment – integrate good health behavior into
    telenovelas?
•   Travel and tourism – health spas, health tourism
•   Finance and banking - healthy people earn and save
•   Insurance companies – healthy populations can pay premiums
•   Auto industry
•   Farming and agriculture – fruits and veg, low fat meats
    Pan American
    Health
    Organization
                                                             2005
   Private sector and cholera
• In 1991, cholera threatened to spread to the Caribbean
  islands from Col, Ven, Guyana and governments,
  private sector and NGOs responded

• Private Sector Response against the Cholera Threat in
  Trinidad & Tobago.
   – Hospedales J, Holder Y, Deyalsingh I, et al. Bull Pan Am
     Health Org 1993; 27:331-6

   – Private sector had spent five times more than the
     government in education the public about preventing
     cholera!
  Pan American
  Health
  Organization
                                                                2005
    Steps to establish a Tourism and
    Health Partnership in Caribbean

• 1995 “Prevention of diarrheal disease in travel industry 
• 1996 “Prevention of foodborne disease” 
• 1996 “Reducing cost impacts of health and disease problems” 

• 1997 “Improving profitability through attention to health and
  hygiene” !! (Inter-American Travel Congress, Costa Rica)

• Quality Tourism for the Caribbean (QTC): joint public-private
  partnership Caribbean Hotel Association-Caribbean Epidemiology
  Center (CAREC/PAHO), 1998 $BID $CDB
      Pan American
      Health
      Organization
                                                                  2005
 A private Sector Perspective

• “Dr Hospedales, we have demand for healthy food
  products from Europe and North America, but we
  have no demand from South America; why should
  we change? We will lose money to our competitors
  and I don’t want to commit financial suicide’
  (Vice President, XXXX Foods; en la casa de Don
  Franscisco, Miami, 2007)

• What are the interests and concerns in this
  statement? What options for working together?

  Pan American
  Health
  Organization
                                                     2005
    A private Sector Perspective

• “Dear Dr Roses, I want to congratulate you on the work
  of your team in diet and physical activity. It has inspired
  me to do a special show on obesity. You will be pleased
  to hear that the show broke viewership records”

• Don Franscisco, letter to Director, PAHO, January 2008

• What can we learn here from a Univision perspective?
  An issue in health is good for business!
  Pan American
  Health
  Organization
                                                        2005
         http://www.dpaslac.org/
Pan American
Health
Organization
                                   2005
Partnership between “Prevention and
Treatment” – comprehensive approach

• “The value of medical care to health promotion’, Sir Douglas
  Black, President, UK Royal College of Physicians, 1974
• Integrating prevention into medical care, preventive exams
  screening for smoking, BMI, cervical cancer, etc., es muy
  importante. Clinical and Public Health Ethical responsibility
• Largest decrease in Relative Risk of all cause mortality due to
  physical activity is in patients who have diabetes, hypertension,
  overweight (3-5 fold)
• In a diabetes quality-of-care project, advice to patients to eat
  healthy more likely to succeed if we to make healthy foods more
  accessible and affordable
   Pan American
   Health
   Organization
                                                               2005
             Interests of the Church

• Spiritual health
• Salvation of people’s souls
• Spreading the kingdom of Jesus Christ
• Caring for the sick and disabled
• Fostering reconciliation between people; peace making
• Preventing sins of gluttony and sloth and drunkeness
• “Do you not know that your body is a temple of the Holy
  Spirit, who is in you, whom you have received from God?”
• -> Look after your body; take care not to pollute it with
  tobacco and drunkeness

    Pan American
    Health
    Organization
                                                              2005
Partnership Government-Civil society-PAHO

 • CARICOM Heads of State special summit on chronic
   diseases, September 2007; resulted in high level political
   commitment and healthy public policy directions

 • Case study of Critical success factors:
    – Partnership PAHO-CARICOM Secretariat
    – Evidence of human and economic cost from Caribbean
       regional health institutions and Universities
    – Involvement of countries in planning and preparing for the
       Summit
       Involvement of the media in raising awareness
    –Pan American
     Health
     Organization
                                                                   2005
      Opportunities for Advocacy

• Ibero-American Cumbre 2008, El Salvador

• Cumbre de las Americas 2009, Trinidad y Tobago

• Cumbres sub-regional: Mercosur, Communidad Andina,
  Sistem Integracion de Central America




  Pan American
  Health
  Organization
                                                       2005
    Regional Strategy and
    Partners’ Forum on the
   Prevention and Control of
       Chronic Diseases



Pan American
Health
Organization
                               2005
               Regional Strategy and Plan of
               Action for an Integrated
               Approach to the Prevention
               and Control of Chronic
               Diseases, including Diet,
               Physical Actvity and Health
               September 2006



Pan American
Health
Organization
                                               2005
     1        Policy & Advocacy
Surveillance                            2


 3   Health Promotion & Prevention

Integrated Management of NCD                  4

     Pan American
     Health
     Organization
                    4 Lines of Action       2005
    Regional Strategy: Key Elements
•   Policy Monitoring, dialogues and advocacy
•   STEPs surveillance system; InfoBase
•   DPAS
•   FCTC
•   Chronic Care Model
•   Partners’ Forum
•   CARMEN Network
•   Capacity building – Escuela CARMEN
•   Disease specific plans – CVD, Diabetes, Cancer
    Pan American
    Health
    Organization
                                                     2005
               CARMEN Network 2007
                   21   Members
                        Argentina, Anguilla, Aruba,
                        Bolivia, Brazil, Canada,
                        Colombia, Costa Rica, Cuba,
                        Curacao, Chile, El Salvador,
                        Guatemala, Mexico, Nicaragua,
                        Panama, Paraguay, Peru,
                        Puerto Rico,Trinidad & Tobago,
                        Uruguay
                         Prospective Members
                         Honduras, Suriname,
                         Venezuela
                        Collaborating members
                        SLU,USF,NHLBI,CDC,PHAC
                        AMNET, RAFA,ILSI,F&V,IDB
                         Special Projects
                         • USA-Mexico (border)
Pan American
Health
                         • CARLI
Organization               (English/Dutch Caribbean)
                                                2005
    Regional Partners’ Forum for Chronic
      Disease Prevention and Control

•    Including public sector, private sector and civil society
•    Platform for bringing everyone together
•    OPS/OMS as convener and catalyst; honest broker
•    Objectives: “10 X 2010”
      –   Awareness and communication: Policy makers and public
      –   Healthy diet: “Americas Pledge” on advertising to children
      –   Physical Activity: 100 Ciclovias by 2010
      –   Tobacco control
      –   Increased access health promotion and disease prevention
          services: Workplace wellness and PHC
     Pan American
     Health
     Organization
                                                                  2005
                               Partnerships
                                   MAP      POLICY &
SURVEILLANCE                                    ADVOCACY
                                                • PAHO/WHO CC on NCD, PHAC
• WHO CC on evidence-based
                                                •BRA, COR
public health
                                                •(Banco Mundial, Banco
•CDC- BRFs and DDT
                                                Interamericano)
•WHO- STEPS and InfoBase
                                                •(Subregional Banks)
•PHAC Canada
                                                •(Universities)
•CAREC
•U of Nicaragua- Leon
•Others                          CARMEN        H PROMOTION &
                                 Network       DISEASE
MANAGEMENT                       Countries
NCDs and RFs                                   PREVENTION
•WHO CC on CVD NIH/NHLBI
                                    and        • PAHO/WHO CC on Physical Activity
                                               •RAFA PANA
•WHO CC in diabetes- CENEXA,    Institutions   •Ciclovías – cycle ways
INEN, Indiana U, IDC                           •5- a- day – cinco al día
•UWI-UDOP                                      •U of South Florida- Social Marketing
•WHO CC at U of Newcastle         (PAHO        •Univisión
•WDF
•Novo Nordisk
                                Secretariat)   •Fundación FES Colombia
                                               •Fundación Ciudad Humana
•Gates Foundation                              •International Life Sciences Institute
•FIP                                           (Healthy Schools)
•IAEA      Pan American                        •(Healthy Cities)
•IARC      Health
           Organization                        •(Ovations)
•CFNI                                          •(Private Enterprise)
                                                                               2005
•Others                                        •(CFNI, INCAP)
                     Review

• Sufficiency of evidence regarding the chronic disease
  epidemic – perspectiva global

• Why we need everyone together and how do we do it

• Regional Strategy and Partners’ Forum on the
  Prevention and Control of Chronic Diseases

      Pan American
      Health
      Organization
                                                   2005
        THANK YOU!

        GRACIAS!




Pan American
Health
Organization
                     2005

				
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