International Health Assessment Colombia

By: Michelle Coots, Rachel LaGrand, Ryan Mayer, and Xavier Vaughn

About Colombia● Location: Northern tip of South America● Capital: Bogota● Type of Government: Republican● Demographics

○ Nationality: Colombian ○ Ethnicity: Mestizo and White, Afro-Colombian, and Amerindian

● Flag:

About Colombia● Language: Spanish

● Religions

○ Roman Catholic = 90%

○ Other = 10%

● Population: 46, 736, 728

● Life Expectancy

○ Males = 76

○ Females = 83

Colombian Culture● Influenced by Africans, Europeans, and Native Indians● Traditions

○ Express and celebrate culture and diversity through fairs, carnivals, and cultural festivals○ Colombian Music: Cumbia ○ National Sport: Tejo

■ Involves putting an iron quoit into a medal circle surrounded by firecrackers■ Objective of game: Make the biggest explosion

Economic Profile● GNI = $577.8 billion PPP (2013)● GDP = 7,831.22 USD (2013)● GNP = $11,969 PPP (2013)● Gini Index = 53.9 (2013)● Health Sector Expenditure = Upper Middle Income

Health System● Two Legal Processes that frame a comprehensive reform

○ First: Statutory Law: establishes fundamental right to health

○ Second: Ordinary Law: attempts to define structure, operations, competencies, and resources

■ Currently pending in Congress

● First 10-year Public Health Plan (2012-2021)○ Addresses: health as right, social determinants of health, and approaches for different population

groups○ Access: 98% ○ Quality of service still lacks due to inequities, especially in remote parts of country

Health Issues● Top 3 causes of death in adults in Colombia

○ Ischemic Heart Disease

○ Interpersonal Violence

○ Stroke

● Burden of cardiovascular health issues

○ YLL (years of life lost due to premature mortality): 1,250 cases/year

○ YLD (years of healthy life lost due to disability): 250 cases/year

Risk Factors for Cardiovascular Disease● Age● Sex● Family History● Smoking● High blood pressure/cholesterols● Diabetes● Obesity● Physical Inactivity● High stress

No Real Program in Place in Colombia● Physicians and Nurses provide education and support

○ Discuss risk factors

○ Provide tips on how to deal with heart disease

Program in Other Latin American Countries● Salud Para Su Corazón (Health for Your Heart)

○ Currently implemented in Mexico

● Targets heart health by:

○ Focus on entire family

○ Modify health behaviors

● Similar culture to Colombia

○ Latin American background

○ Traditions

Research

● One study asked women what they thought their biggest health threat was

○ Results showed that only 10% correctly thought it was heart disease

○ 62% incorrectly assumed cancer was their biggest threat

Research Cont.

● Colombia piloted a program using Sesame Street characters to teach heart

health

○ Children participated in an educational program focused on cardiovascular health

promotion

○ Children were retested 3 years after the intervention

○ Compared to their scores prior to the program, the children's knowledge improved 15

percent, attitudes 51 percent, and heart-healthy habits 27 percent.

Policy● Almost no legal policy in place in Colombia affecting heart disease

● WHO has some programs guidelines which target risk factors for heart disease

● Program goals include reducing physical inactivity and/or promoting physical

activity, reducing unhealthy diets and/or promoting healthy diets, reducing the

burden of tobacco use, and finally reducing the harmful use of alcohol.

● More research needs to be done to support evidence based policy changes in

order to have a real effect.

Heart and Soul

Program and Lesson Plan ● Lessons

○ Risk factors/ Heart/ Health Assessment

○ Cholesterol, blood pressure, and blood sugar

○ Dietitian

○ Physical Activity for the family/ Health Assessment

● A month later go back to do another assessment

● Festival at the very end

Key Stakeholders and Community Partners ● Alejandro Gaviria Uribe: Minister of Health and Social Protection

● Mariana Garces Cordoba: Minister of Culture

● Maria Fernanda Campo Saaverdra: Minister of National Education

● Lorena Chaparro Diaz, PhD: Director of Nursing Department

● Carlos Caballero Argaez and Sarmiento Andres Rodriguez: PH program

Timeline ● August: Start training the workers

● September-November: Trials runs

● December-May: Out in the field

Resources ● Pre/Post Assessment

● Delicious Heart Healthy Latino Recipe Book

● Your Heart, Your Life Picture Cards for Community Health Workers

● Song to the Beat of Your Heart

● Student Workers

● Traditions ○ Family oriented

● Selecting the right population

● Interpersonal violence ● Working with government

officials ● Workers being students

Ethical and Cultural Considerations Barriers to Consider

Evaluation● Process

○ Record keeping/database○ Attendance and material tracking

● Impact○ Surveys○ Comprehend material from educational lessons

● Outcome○ Physical exams○ Decrease blood pressure by 5%

ResourcesAmerican Heart Association. (2015). Heartorg Home Page. Retrieved December 1, 2015, from http://www.heart.org/HEARTORG

Balcázar, H., Fernández-Gaxiola, A., Pérez-Lizaur, A., Peyron, R., & Ayala, C. (2015, March 2). Improvıng heart healthy lıfestyles among partıcıpants ın a salud para su corazón promotores model: the mexıcan pılot study, 2009-2012. Retrieved October 25, 2015, from http://www.cdc.gov/pcd/issues/2015/14_0292.htm

Central Intelligence Agency: The World Factbook. (n.d.) Colombıa. Retrieved September 5, 2015, from https://www.cia.gov/library/publications/the-world-factbook/geos/co.html

Colombian Embassy. (2012). Colombıan Culture. Retrieved September 5, 2015, from http://www.colombiaemb.org/node/1331

Medical Express. (2013, December 19). Colombıan preschoolers learn heart-healthy lessons wıth sesame street. Retrieved October 8, 2015 from http://medicalxpress.com/news/2013-11-colombian-preschoolers-heart-healthy-lessons-sesame.html

National Institute of Health. (n.d.). Delıcıous heart healthy latıno recıpes/platıllos latınos sabrosos y saludables (bilingual English, Spanish). Retrieved December 1, 2015, from http://www.nhlbi.nih.gov/health/resources/heart/recipes-bilingual

National Institute of Health. (n.d.). Your heart, your lıfe pıcture cards for communıty health workers/dıbujos educatıvos para su corazón, su vıda. Retrieved October 25, 2015, from http://catalog.nhlbi.nih.gov/

Resources ContinuedWorld Heart Federation. (2015). Fact Sheets. Retrieved December 1, 2015, from http://www.world-heart-federation.org/heart-facts/fact-sheets/

World Heart Federation. (2008, October 1). Many women Colombıa awareness survey. Retrieved October 8, 2015, from http://www.world-heart-federation.org/publications/heart-beat-e-newsletter/heart-beat-octobernovember-2008/in-this-issue/colombia-awareness-survey/

World Bank. Colombıa. Retrieved September 5, 2015, from http://data.worldbank.org/country/colombia

World Life Expectancy. (2014, May 1). World Lıfe Expectancy. Retrieved October 8, 2015, from http://www.worldlifeexpectancy.com

World Health Organization. (2015). Colombıa. Retrieved September 27, 2015, from http://www.who.int/countries/col/en/

World Health Organization. (May 2014). Colombıa. Retrieved September 5, 2015 from http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_col_en.pdf

World Health Organization. (2014). Colombıa Non-Communıcable Dısease Country Profıle. Retrieved October 8, 2015, from http://www.who.int/nmh/countries/col_en.pdf