Tackling Non Communicable Diseases in African...

Tackling Non‐Communicable Diseases in African Businesses

A Practical Guide on

Raising Awareness on lifestyle‐related Diseases among Employees

For Human Resources Managers and Officers, Workplace Programme Coordinators, Practitioners and Peer Educators

Commissioned by: Pan‐African Business Coalition on HIV and Health (PABC) Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) – Regional Project Support of the Private Sector in Africa to Fight AIDS (SPAA) Compilation: Norbert Roesch (GIZ/PABC, South Africa) Review: Dr. Valentine Douala‐Mouteng (PABC, South Africa) Ute Papkalla (GIZ, Germany) Judith Fischer (GIZ, Germany) Martin Weihs (GIZ, AWiSA/AIDC, South Africa) Josiane Robiarivony (CECM, Madagascar) December 2011

Tackling Non‐Communicable Diseasesin African Businesses

Table of Contents

1 Introduction ..................................................................................................................................... 4

2 Non‐Communicable Diseases (NCDs) – The Silent Pandemic ......................................................... 5

2.1 What are NCDs? ...................................................................................................................... 5

2.2 Main NCDs ............................................................................................................................... 5

2.3 Main Risk Factors .................................................................................................................... 5

2.4 Economic and Business Impact of NCDs ................................................................................. 6

3 Understanding Non‐Communicable Diseases ................................................................................. 8

3.1 Cardiovascular Diseases .......................................................................................................... 8

3.2 Diabetes ................................................................................................................................... 9

3.3 Cancer .................................................................................................................................... 10

3.4 Chronic Respiratory Diseases ................................................................................................ 11

4 Understanding Causes and Risk Factors ........................................................................................ 12

4.1 Smoking (Tobacco) ................................................................................................................ 12

4.2 Excessive Alcohol Consumption ............................................................................................ 13

4.3 Unhealthy Diet ...................................................................................................................... 14

4.4 Physical Inactivity .................................................................................................................. 15

4.5 Obesity (Overweight) ............................................................................................................ 16

5 Company Action and Staff Awareness .......................................................................................... 17

5.1 Creating Healthy Workplaces ................................................................................................ 17

5.2 Raising Staff Awareness ........................................................................................................ 17

5.3 The Toolbox and its Application ............................................................................................ 18

6 Toolbox for Workplace Action on NCDs ........................................................................................ 20

6.1 General Information on NCDs ............................................................................................... 20

6.2 Guidance for Company Action and Awareness Creation ...................................................... 23

6.3 Training Manuals ................................................................................................................... 24

6.4 Information and Awareness Material: Fact Sheets, Posters, Leaflets… ............................... 24

6.5 Self‐Assessment Tools (Online and Sheets) .......................................................................... 28

6.6 Reference Institutions ........................................................................................................... 29

6.7 Websites ................................................................................................................................ 29

6.8 World Days ............................................................................................................................ 30

GIZ and PABC do not warrant that the information contained in this guide is complete and correct and shall not be liable whatsoever for any damages incurred as a result of its use.


1 Introduction Non‐Communicable Diseases (NCDs) are the new global threat to health and its impact will

slowly, but steadily rise during the next years and decades to come. The negative effects will also be increasingly felt in the African private sector in the near future.

The purpose of this document is to raise awareness among African companies on NCDs, to provide an understanding of their causes and risk factors, and to come up with approaches how companies can contribute to the fight against NCDs. The focus of this guide is on prevention (i.e. not on treatment). It is written to Human Resources managers and officers, Workplace Programme coordinators, practitioners and peer educators who are concerned about the long‐term health of staff members.

Chapters 2‐4 provide important background information and are aimed at increasing your level of understanding with regard to the overall context (chapter 2), the medical aspects of NCDs (chapter 3) and their causes (chapter 4). The purpose is to sensitize the reader about the long‐term effects of NCDs on employees, the businesses and the need for action.

Chapters 5‐6 aim at enabling companies to take action against NCDs. Chapter 5 introduces into two workplace approaches and provides ideas how businesses can carry out activities in accordance to their company infrastructure and capacity. Chapter 6 (toolbox) is a compilation of Internet resources where information, instruments and tools can be viewed and downloaded from.

As NCDs is a relatively new health focus in Africa, much of the information and material presented in this guide derives from high‐ and middle‐income countries. Nonetheless, the patterns of NCDs and their risk factors are generally applicable worldwide. In the near future we hope that there will be more material available from and suitable to the African context.

The focus of this guide and its attached toolbox is on practicality. It is explorative in nature and provides hands‐on tools rather than scientific literature. The toolbox is not comprehensive, but serves as a good starting point for workplace action, in particular with regard to information, education and communication. Other tools and information products might still be ‘out there’, waiting to be discovered and to be applied.

Most of the tools and information provided in this guide origin from the WHO website, for various reasons: The multinational organisation is the major global reference institution with regard to health issues, its website is well‐structured, the information is easy to find, and all health topics are comprehensively covered and geographically presented in a balanced way. Moreover, most of the information is also available in French, and to some extent in Portuguese.


Figure 1: NCDs and their lifestyle‐related risk factors Source: WHO Global Status Report on NCDs, 2010

2 NonCommunicable Diseases (NCDs) – The Silent Pandemic

2.1 What are NCDs? Unlike infectious (= communicable) diseases such as HIV, TB or malaria, non‐communicable diseases are not contagious and cannot be transmitted from one person to the next. They involve changes in the body that lead to chronic ailment and are characterized by long duration and slow progression. NCDs, also referred to as chronic diseases, are most of all lifestyle–related, caused by human behaviour.

2.2 Main NCDs Four types of NCDs are very common and relevant in terms of their negative impact on health:

• Cardiovascular (heart and vessels) diseases

• Cancer

• Chronic respiratory diseases

• Diabetes

NCDs are on the rise, both globally and in Africa. They are by far the leading cause of death in the world, representing over 60% of all annual deaths. Approximately 36 million people die prematurely from NCDs every year, and are therefore regarded largely as preventable deaths. The majority of NCD deaths (80%) occur in developing countries (WHO).

2.3 Main Risk Factors There are four main factors that contribute to the development of NCDs. These are:

• Physical inactivity

• Smoking

• Unhealthy diet

• Excessive alcohol consumption

Overweight/obesity and high blood pressure are intermediate risk factors: they are first caused by one or more of the four risk factors above, and then continue to cause a NCD. For example, a lack of physical activity and/or an unhealthy diet can lead to overweight and then to heart disease.

NCDs are mainly, but not exclusively caused by lifestyle related behaviour: To some, but minor extent, they are also caused by environmental factors (e.g. indoor smoke in kitchens, exposure to chemicals in the workplace) or the genetic predisposition of an individual.


Figure 3: Economic Loss from the top 15 Global Causes of Death Source: The Global Economic Cost of Cancer, American Cancer Society, 2010

Figure 2: Proportion of NCD mortality under 60 years by income group of countries

Source: WHO Global Status Report on Non‐Communicable Diseases, 2010

The focus of this guide is on lifestyle related factors, as they account for the vast majority of all NCD‐related deaths.

2.4 Economic and Business Impact of NCDs The negative impact of NCDs is increasingly felt in the private sector, both globally and in Africa. Although communicable diseases like HIV, Malaria and TB remain the major health threats in Sub‐Saharan Africa for the near future, the NCD burden will start to increase significantly in this ongoing decade, in particular in urban settings and among population groups that are economically better off.

Because NCDs are most of all lifestyle related, the economic burden is mostly felt in sectors where qualified workforce and higher income groups are employed: in the formal and large business sectors, which is the membership base of National Business Coalitions in Africa.

According to a WHO NCD Surveillance Strategy report the burden of disease from NCDs for developing and newly industrialized countries is expected to rise by 60% by the year 2020. The vast increase will take place in Africa (World Economic Forum Report 2010 on Global Risks). The WHO


Global Status Report on NCDs 2010 associates a 10% rise in NCDs with 0.5% lower rates of annual economic growth. This negative impact of NCDs at the economic level will also be increasingly felt in the business sector, and needs to be addressed.

During the previous decade Workplace Programme initiatives in Africa were focusing on the three infectious diseases, HIV/AIDS, TB and Malaria. The fight against non‐communicable diseases will become a priority of the ongoing decade. Some Occupational Safety and Health (OSH) and Wellness programmes have already started to include NCDs in their workplace programmes, but a more comprehensive, systematic and Africa wide approach is needed.


Figure 4: Types of Cardiovascular Diseases Source: WHO (www.who.int/entity/cardiovascular_diseases/en /cvd_atlas_01_types.pdf)

3 Understanding NonCommunicable Diseases

3.1 Cardiovascular Diseases Cardiovascular diseases (CVD) are caused by disorders of the heart and blood vessels, and include coronary heart disease leading to heart attacks, cerebrovascular disease leading to strokes, raised blood pressure (hypertension), peripheral artery disease, rheumatic heart disease, congenital heart disease and heart failure.

The most important behavioural risk factors of heart disease and stroke are unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol. Behavioural risk factors are responsible for about 80% of coronary heart disease and cerebrovascular disease (WHO).

Key Facts • CVDs are the number one cause of

death globally: more people die annually from CVDs than from any other cause.

• An estimated 17.1 million people died from CVDs in 2004, representing 29% of all global deaths. Of these deaths, an estimated 7.2 million were due to coronary heart disease and 5.7 million were due to stroke.

• Low‐ and middle‐income countries are disproportionally affected: 82% of CVD deaths take place in low‐ and middle‐income countries and occur almost equally in men and women.

• By 2030, almost 23.6 million people are estimated to die from CVDs, mainly from heart disease and stroke. These are projected to remain the leading causes of death.

Preventive Action • Eat a healthy diet, reduce overweight

• Be physically active

• Don’t smoke

• Check the following body parameters regularly: blood pressure and blood lipids

Main source of this chapter: WHO (http://www.who.int/topics/cardiovascular_diseases/en/)


Figure 5: Diabetes Prevalence and Trends Source: WHO (www.who.int/entity/cardiovascular_diseases/en/ cvd_atlas_10_diabetes.pdf)

3.2 Diabetes Diabetes is a chronic disease, which occurs when either the pancreas does not produce enough insulin, or when the body cannot effectively use the produced insulin. This leads to an increased concentration of glucose in the blood (hyperglycaemia). Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves.

Type 1 diabetes (previously known as insulin‐dependent or childhood‐onset diabetes) is characterized by a lack of insulin production.

Type 2 diabetes (formerly called non‐insulin‐dependent or adult‐onset diabetes) is caused by the body’s ineffective use of insulin. It often results from excess body weight and physical inactivity.

Gestational diabetes is hyperglycaemia that is first recognized during pregnancy.

Key Facts • More than 220 million people worldwide have diabetes.

• In 2004, an estimated 3.4 million people died from consequences of high blood sugar.

• More than 80% of diabetes deaths occur in low‐ and middle‐income countries.

• WHO projects that diabetes deaths will double between 2005 and 2030.

• Type 2 diabetes accounts for well over 90% of diabetes in Sub‐Saharan Africa, and population prevalence proportions ranged from 1% in rural Uganda to 12% in urban Kenya.

Preventive Action To prevent or delay the onset of type 2 diabetes, simple lifestyle measures are effective:

• Achieve and maintain healthy body weight;


• Eat healthy (fruit, vegetables, reduce sugar and saturated fats intake)

• Don’t smoke

• Check the following body parameters regularly: blood sugar

Main source of this chapter: WHO (http://www.who.int/topics/diabetes_mellitus/en/)


Figure 6: New cases of cancer annually Source : African Health Monitor Newsletter, January‐June 2008

3.3 Cancer Cancer is the uncontrolled growth and spread of cells. It can affect almost any part of the body. The growths often invade surrounding tissue and can metastasize to distant sites. Cancer arises from a change in one single cell. The change may be started by external agents and inherited genetic factors. Many cancers can be prevented by avoiding exposure to common risk factors, such as tobacco smoke, excessive alcohol use, unhealthy diet and physical inactivity.

A significant proportion of cancers can be cured, by surgery, radiotherapy or chemotherapy, especially if they are detected early.

Key Facts • Cancer accounted for 7.6 million deaths worldwide in 2008 (around 13% of all deaths). The

most frequent types of cancer occur in the organs: lung (1.4 million deaths), stomach (740 000 deaths), liver (700 000 deaths), colorectal system (610 000 deaths), breast (460 000 deaths).

• More than 70% of all cancer deaths occurred in low‐ and middle‐income countries

• More than 30% of cancer deaths can be prevented.

• Deaths from cancer worldwide are projected to continue to rise to over 11 million in 2030.

Preventive Action • Avoid tobacco use


• Eat healthy (fruit, vegetables, reduce sugar and saturated fats intake)

• Achieve and maintain a healthy body weight;

• Reduce alcohol consumption

Action to detect cancer early to increase the chances for successful treatment • If locally available, use regular screening offers for certain types of common cancers such as

colorectal cancer, breast cancer and cervix cancer)

• Attend a doctor if you notice unusual body signs and symptoms, since many cancers cannot be detected by screening methods.

Main source of this chapter: WHO (http://www.who.int/topics/cancer/en/)


Figure 7: Causes of chronic respiratory diseases Source: WHO, Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach (2007)

3.4 Chronic Respiratory Diseases Chronic respiratory diseases, or chronic obstructive pulmonary diseases (COPD), are chronic diseases of the airways and other structures of the lung. Some of the most common ones are asthma, respiratory allergies, occupational lung diseases and pulmonary hypertension. The most important risk factors for preventable chronic respiratory diseases are:

• Tobacco smoking (primary cause)

• Indoor air pollution (smoke, dust…)

• Outdoor pollution

• Allergens

• Occupational hazards (e.g. chemicals)

Key Facts • Hundreds of millions of people suffer every day from chronic respiratory diseases.

• According to the WHO estimates (2004), 235 million people have asthma, 64 million people have chronic obstructive pulmonary disease (COPD) while millions have allergic rhinitis and other often under‐diagnosed chronic respiratory diseases.

• More than 3 million people died of COPD in 2005 (5% of all deaths globally that year).

• Almost 90% of COPD deaths occur in low‐ and middle‐income countries.

Preventive Action • Reduce tobacco consumption

• Reduce exposure to outdoor and indoor air pollution

• Consult the doctor in case of symptoms of a chronic cough, sputum production, dyspnoea (difficult or laboured breathing) or/and a history of exposure to risk factors for the disease. A person at risk of chronic respiratory disease will then be referred to undergo spirometry, a method that measures how deeply a person can breathe and how fast air can move into and out of the lungs.

Main source of this chapter: WHO (http://www.who.int/respiratory/en/index.html)


Figure 8: Risk of smoking over time Source: www.thinkcopdifferently.com/About%20COPD/ Risk%20factors%20for%20COPD/Smoking.aspx

4 Understanding Causes and Risk Factors

4.1 Smoking (Tobacco) Tobacco smoking is the leading preventable cause of death in the world. Tobacco products are products made entirely or partly of leaf tobacco as raw material, which are smoked, sucked, chewed or snuffed. All contain the highly addictive psychoactive ingredient nicotine. Tobacco use is one of the main risk factors for a number of chronic diseases, including cancer, lung diseases, and cardiovascular diseases.

Countries in the African region are experiencing an increasing rate of tobacco use. The fast growth of the population in Sub‐Saharan Africa is leading to larger and more accessible markets and an increasing of the African consumers’ purchasing power. In addition to that there are the intensive efforts by the tobacco industry to expand to African markets. Convincing individuals to quit smoking is clearly the most cost‐effective prevention measure. Quitting smoking leads to body function improvements no matter how long a person had been smoking. However, the earlier a person quits, the better are the results (see figure above).

Key Facts • Tobacco kills up to half of its users.

• Tobacco kills nearly 6 million people per year (one person every six seconds), of whom more than 5 million are users and ex users and more than 600 000 are non‐smokers (exposed to second‐hand smoke). More than 5 million are users and ex‐users, and more than 600 000 are non‐smokers exposed to second‐hand smoke (passive smoking).

• 63 % of all deaths are caused by NCDs, for which tobacco use is the greatest risk factor, after high blood pressure.

• Nearly 80% of the world's one billion smokers live in low‐ and middle‐income countries.

• Consumption of tobacco products is increasing globally, though it is decreasing in some high‐income and upper middle‐income countries.

Preventive Action Company • Ban/ discourage smoking in the workplace

Personally

• Quit (best) or reduce smoking (note: lighter cigarettes are not ‘safer’) • As a non‐smoker: avoid passive smoking • As a smoker: don’t expose others to your smoking (in particular children)

Main source of this chapter: WHO (http://www.who.int/topics/tobacco/en/)


Figure 9: Model of Alcohol Consumption Source: WHO, Global Status Report on Alcohol (2004)

4.2 Excessive Alcohol Consumption The harmful use of alcohol is a global problem which compromises both individual and social development. It results in 2.5 million deaths each year. It also causes harm far beyond the physical and psychological health of the drinker. It also harms the well‐being of the social network of the person drinking, in particular his or her family. An intoxicated person can harm others or put them at risk of traffic accidents or violent behaviour, or negatively affect co‐workers, relatives, friends or strangers. Thus, the impact of the harmful use of alcohol reaches deep into society.

Harmful drinking is a major determinant for neuropsychiatric disorders, such as alcohol use disorders, epilepsy and other non‐communicable diseases such as cardiovascular diseases, cirrhosis of the liver and various cancers. The harmful use of alcohol is also associated with higher transmission risks of several infectious diseases like HIV/AIDS, tuberculosis and sexually transmitted infections (STIs). Furthermore, excessive alcohol consumption weakens the immune system and has a negative effect on patients’ adherence to antiretroviral treatment.

In addition to the chronic diseases that may develop in those who drink large amounts of alcohol over a number of years, alcohol use is also associated with an increased risk of acute health conditions, such as injuries, including from traffic accidents.

Key Facts • The harmful use of alcohol results in 2.5 million deaths each year.

• 320 000 young people between the age of 15 and 29 die from alcohol‐related causes, resulting in 9% of all deaths in that age group.

• Alcohol is the world’s third largest risk factor for disease burden,

• Alcohol is associated with many serious social and developmental issues, including violence, child neglect and abuse, and absenteeism in the workplace.

Preventive Action • Reduce your alcohol consumption.

• Discourage others from excessive alcohol consumption (in particular when driving).

Main source of this chapter: WHO (http://www.who.int/topics/alcohol_drinking/en/#main)


Figure 10: The Eatwell Plate Source: NHS (www.nhs.uk/Livewell/Goodfood/Pages/eatwell‐plate.aspxf)

4.3 Unhealthy Diet An unhealthy diet is one of the major risk factors for a range of chronic diseases, including cardiovascular diseases, cancer, diabetes and other conditions linked to overweight and obesity.

Nutrition is the intake of food, considered in relation to the body’s dietary needs. Good nutrition – an adequate, well balanced diet combined with regular physical activity – is a cornerstone of good health. Poor nutrition can lead to reduced immunity, increased susceptibility to disease, impaired physical and mental development, and reduced productivity.

Improving dietary habits is a societal, not just an individual challenge. Therefore it demands a population‐based, multi‐sectoral, multi‐disciplinary, and culturally relevant approach.

Key Facts • Unhealthy eating is associated with increased risk for many diseases, including several of the

leading causes of death: heart disease, cancer, stroke, and diabetes.

• A poor or imbalanced diet can increase the risk for lung, esophageal, stomach, colorectal, and prostate cancers

• Individuals who eat fast food one or more times per week and/or drink sugar‐sweetened beverages are at increased risk for weight gain, overweight, and obesity

Preventive Action Company • Provide healthy food at company’s canteen and reduce unhealthy food

• Reduce selling sweets or sugar‐sweetened drinks (‘fizzy drinks’) and/or ban vending machines

Personally

• Eating more fruit, vegetables, nuts and grains • Cut down on salt, sugar and fats. • Choose unsaturated (instead of saturated) fats

Main source of this chapter: WHO (http://www.who.int/topics/diet/en/) CDC (http://www.cdc.gov/healthyyouth/nutrition/facts.htm)


4.4 Physical Inactivity Physical inactivity has been identified as the fourth leading risk factor for global mortality causing an estimated 3.2 million deaths globally. Increasing levels of physical inactivity are seen worldwide, in high‐income countries as well as low‐ and middle‐income countries.

Regular moderate intensity physical activity – such as walking, cycling, or participating in sports – has significant benefits for health. For instance, it can reduce the risk of cardiovascular diseases, diabetes, colon and breast cancer, and depression. Moreover adequate levels of physical activity will decrease the risk of a hip or vertebral fracture and help control weight.

The term "physical activity" should not be mistaken with "exercise". Exercise is a subcategory of physical activity that is planned, structured, repetitive, and purposeful in the sense that the improvement or maintenance of one or more components of physical fitness is the objective. Physical activity includes exercise as well as other activities which involve bodily movement and are done as part of playing, working, active transportation, house chores and recreational activities.

Key Facts • Lack of physical activity is the fourth leading risk factor for global mortality (6% of all deaths

worldwide).

• Physical inactivity is estimated to be the main cause for 21–25% of breast and colon cancers, 27% of diabetes and approximately 30% of ischaemic heart disease burden

• Regular physical activity helps reduce the risk of developing obesity and chronic diseases, such as diabetes, cardiovascular disease, and colon cancer

• Reduces feelings of depression and anxiety and promotes psychological well‐being

Preventive Action Company • Provide gym facilities or offer support on gym memberships

• Encourage sports groups

Personally

• Do sports • Be physically active wherever possible in your day‐to‐day routine, e.g.

o Walk or cycle to work or for shopping o Take stairs instead of using elevator or escalators o During office work, make short breaks and move

Main source of this chapter:

WHO (http://www.who.int/topics/physical_activity/en/) CDC (http://www.cdc.gov/healthyyouth/physicalactivity/facts.htm)

Figure 11: Equivalents of Physical Activity Source: WHO www.who.int/entity/cardiovascular _diseases/en/cvd_atlas_08_physical_inactivity.pdf


Figure 12: Trends in global food consumption Source: WHO (www.who.int/entity/cardiovascular_diseases /en/cvd_atlas_09_obesity.pdf)

4.5 Obesity (Overweight) Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. They are closely linked to unhealthy food and lack of physical activity, considered as intermediate factors that contribute to the development of NCDs.

A crude population measure of obesity is the body mass index (BMI), a person’s weight (in kilograms) divided by the square of his or her height (in metres). A person with a BMI of 30 or more is generally considered obese. A person with a BMI equal to or more than 25 is considered overweight.

Overweight and obesity are major risk factors for a number of chronic diseases, including diabetes, cardiovascular diseases and cancer. Once considered a problem only in high income countries, overweight and obesity are now dramatically on the rise in low‐ and middle‐income countries, particularly in urban settings.

Obesity has reached epidemic proportions globally, with at least 2.6 million people dying each year as a result of being overweight or obese. Once associated with high‐income countries, obesity is now also prevalent in low‐ and middle‐income countries.

Key Facts • Worldwide obesity has more than doubled since 1980.

• In 2008, 1.5 billion adults, 20 and older, were overweight. Of these over 200 million men and nearly 300 million women were obese.

• 65% of the world's population live in countries where overweight and obesity kills more people than underweight.

• Obesity is preventable.

Preventive Action • Do physical exercises

• Eat healthy (see chapter 4.3)

• Participate in weight reduction programmes

• Join local sports or weight reduction groups (e.g. weight watchers)

Source of this chapter: WHO (http://www.who.int/topics/obesity/en/)


5 Company Action and Staff Awareness Companies can play a vital role in disease prevention, as the workplace is a conducive environment to reach a substantial proportion of a population with targeted interventions. This applies particularly to NCDs, because of their slow and silent progression and the fact that their negative long‐term effects only become visible when it is often too late to reverse the condition.

Basically, there are two preventive workplace approaches how companies can contribute to the reduction of lifestyle related risks that cause NCDs:

1. Creating healthy workplaces (supply‐side measures) to facilitate the consumption of healthy products and services (and vice versa: impede the access to ‘unhealthy’ goods), and

2. Raise employees’ awareness on NCDs (demand‐side measures) to increase their knowledge on NCDs, to achieve a change in attitude and increase their demand for healthier goods (and vice versa: to lower their demand for unhealthy goods and activities)

5.1 Creating Healthy Workplaces The company can reduce unhealthy life‐style of its employees by actively taking action in its own realms:

• Assessing NCD‐related risks and hazards in the company and of employees’ lifestyle, and developing a plan of action

• Formulating a policy that promotes employee health and regular medical check‐ups to respond to the often silent progressing of NCDs

• Discouraging unhealthy behaviour e.g. through a ban on smoking at the workplace or reducing the number of vending machines that sugar‐sweetened food products or beverages (‘fizzy drinks’)

• Encouraging healthy behaviour i.e. by supporting a company sports group or membership in a gym

• Providing or subsidizing health oriented services such as healthy food in the canteen

• Checking employees‘ individual workplace conditions and provide advice to reduce adverse long‐term effects on fitness and health, e.g. by an external health expert during health campaigns or events.

5.2 Raising Staff Awareness The company can use its influence and the workplace as a setting to contribute to an increased awareness regarding healthy and harmful behaviour of the individual. This can be done in different ways:

• Informing thoroughly about the company’s health policy

• Disseminating information through posters, leaflets, etc.

• Communicating health messages and facts on NCDs via emails and other communication channels (payment slips, etc.) to employees

• Conducting awareness days or aligning NCD campaigns to other company events

• Inviting external health specialists to give talks on specific topics

• Supporting health education during work time possibly by special health champions or peer educators


5.3 Applying this Guide and the Toolbox Both approaches as described in chapter 5 complement each other and should be pursued concurrently. The toolbox in chapter 5 provides links to a wide range of material, instruments and tools that can be used to pursue these strategies and to implement activities in the workplace. From a more practical oriented perspective, the information and instruments from the toolbox can be applied in following ways.

Dissemination of Information Noticeboards: Print information sheets, posters, etc. and hang them at notice boards and other public places like canteens, change rooms, etc.

Leaflets and flyers: Print and copy information sheets (if appropriate/necessary, adapt them to your country‐specific situation) and distribute among staff. institutions like the World Heart Federation also offer to send information material to organisations on request.

Health Communication and Reminders Staff emails: Send regular health messages to staff, copying pictures and short text (keep short and concise, 50‐100 words)

Messages on payment slips, etc.: Copy and paste short messages, facts etc. on payment slips (max. 10 words, e.g. smoking causes cancer).

Promotion Material: Distribute T‐Shirts, pens etc. with NCD‐related messages.

Health Campaigns and Events Awareness days: conduct special days in your companies on certain health issues, ideally in line with respective World Days (e.g. World Cancer Day on 4th February, World Heart Day on 29th September, World Diabetes Day on 14th November, etc., see also Chapter 6.7).

Sports events: conduct, support or promote local sports events (5, 10, 20 km walks, etc.) and encourage staff to join them, individually or as a company team, also useful for team‐building purposes. In large companies: provide gym facilities in the workplace.

Healthy canteen days: Set aside one day on which all of the food served in the company canteen will be nutritionally balanced. Organize an external dietician for this day. Provide recipes on home‐made healthy lunches, you can promote these on a company intranet. And/or conduct a team building competition with different groups trying to cook the healthiest food.

Educational Sessions Internal expert: include NCD topics into your educational workplace programme (if any). Alternatively or additionally, develop an NCD‐focused agenda with peer educators, focal persons or medical staff (from your company’s in‐house clinic) and conduct educational staff meetings (sessions in workplace ergonomics are very popular, in particular in office settings).

External experts: Invite external (medical) experts or health service providers, for examples from local clinics, health NGOs, health insurances, etc., in particular in combination with other activities like awareness days.

There are still more activities and ideas that can be applied than the ones suggested above. Thinking out‐of‐the‐box and developing innovative ideas (competitions, raffles…) is important in order to bring the message to the people more effectively and to achieve a change in behaviour. The toolbox in 5 provides more ideas in this regard.


Case Study: Automotive Industry Development Centre tackling NCDs in the Workplace

The Automotive Industry Development Centre (AIDC), Eastern Cape, supports South African automotive supplier companies in the areas of skills development, training and supply chain development to help in increasing the global competitiveness of the South African automotive industry.

AIDC with support of the GIZ AWiSA programme offers health‐oriented workplace programme solutions and has assisted 12 companies in setting up and/or improving their HIV/AIDS and wellness workplace programmes. Since 2009 they reached out to over 3000 employees. Their comprehensive wellness approach includes health topics like high blood pressure, diabetes, cancer, overweight and alcohol abuse.

Wellness workplace coordinators and peer educators, trained in the AIDC workplace programme, conduct health campaigns and address health issues and risk factors like high blood pressure, diabetes, unhealthy diet, smoking, physical inactivity and excessive alcohol consumption in their awareness sessions, ideally in line with the official Health Calendar.

When wellness days are conducted in supplier companies usually blood pressure and glucose is measured, BMI tests are conducted and HIV Counselling and Testing is also included (see Health Passport below). Two companies also carry out PAP smears to diagnose cervical cancer during their wellness days. In 2010 and 2011 more than 90% of staff participated in the comprehensive testing package.

The AIDC/AWiSA case shows that comprehensive workplace programmes that follow a holistic health approach are more likely to be successful than stand‐alone HIV&AIDS Workplace Programmes.

Box 1: AIDC Health Passport for employees in the automotive supply chain industry Source: AIDC 2011


6 Toolbox for Workplace Action on NCDs The lists below are sorted by category; therefore multiple mentioning of tools is possible. All information is available in English. It is highlighted where it is also available in French ( ), which applies to most WHO material (simply click on the language link on top of the WHO website).

6.1 General Information on NCDs Target Group: Workplace Programme Coordinators

Item Organisation Internet Source Comment

General information on NCDs

Introduction WHO http://www.who.int/nmh/en/index.html

http://www.who.int/topics/chronic_diseases/en/

Good overview and introduction into the topic

Preventing NCDs in the Workplace through Diet and Physical Activity

WHO & World Economic Forum

https://members.weforum.org/pdf/Wellness/WHOWEF_report.pdf

http://www.who.int/dietphysicalactivity/workplace/en/index.html

Provides research data and rationale for why tackling NCDs in companies

Introduction Public Health Agency of Canada

http://www.phac‐aspc.gc.ca/cd‐mc/index‐eng.php (EN)

http://www.phac‐aspc.gc.ca/cd‐mc/index‐fra.php (FR)

Article on NCDs News from Africa, April 2011

http://www.newsfromafrica.org/newsfromafrica/articles/art_12523.html

NCDs: An overview of Africa’s new silent killers

African Health Monitor, Jan.‐June 2008

indexmedicus.afro.who.int/iah/fulltext/Ahm/an‐overview.pdf

Global status report on NCDs 2010

WHO http://www.who.int/nmh/publications/ncd_report2010/en/index.html

http://whqlibdoc.who.int/publications/ 2011/9789240686458_eng.pdf

NCD country profiles WHO http://www.who.int/entity/nmh/publications/ncd_profiles_report.pdf

http://www.who.int/nmh/countries/en/index.html (by countries)

Global InfoBase on NCDs WHO https://apps.who.int/infobase/ NCD Data per country and risk factor *

Cardiovascular Diseases (CVDs)

General Information WHO http://www.who.int/topics/cardiovascular_diseases/en/ Good overview and introduction into the topic

The Atlas of Heart Disease and Stroke

WHO http://www.who.int/cardiovascular_diseases/resources/atlas/en/

Very good resource with informative (1‐page) sheets on CVDs and its causes

Types of Cardiovascular Diseases

WHO http://www.who.int/entity/cardiovascular_diseases/en/cvd_atlas_01_types.pdf

Very informative and illustrative 1‐page sheet !!

Employer's resource guide and Workplace Wellness Engagement Ideas

World Heart Federation

http://www.world‐heart‐federation.org/what‐we‐do/awareness/world‐heart‐day/engaging‐employers/employers‐resource‐guide/

Extremely useful guide on what can be done in the workplace

Q&A: What can I do to avoid a heart attack or a stroke?

WHO http://www.who.int/features/qa/27/en/index.html

Resources for health

professionals

Blood Pressure Association (UK)

http://www.bpassoc.org.uk/HealthProfessionals/Resources (EN) http://www.bpassoc.org.uk/HealthProfessionals/Otherlanguages#liVc (FR)

Broad range of resources on high blood pressure (UK‐oriented, but technically good material)

Information leaflets for downloading

High Blood Pressure Foundation (UK)

http://www.hbpf.org.uk/downloads.php UK‐oriented, but technically good material, detailed



Diabetes

General Information WHO http://www.who.int/topics/diabetes_mellitus/en/ Good overview and introduction into the topic

General Information CDC http://www.cdc.gov/diabetes/ Vast collection of material, although focus on USA

Risk Factor: Diabetes WHO http://www.who.int/entity/cardiovascular_diseases/en/cvd_atlas_10_diabetes.pdf


Q&A: What are the risks of

diabetes in children?


Advocacy and Information Material: Posters, Campaignbook, Booklets and

Web‐banners

International Diabetes Foundation

http://www.idf.org/worlddiabetesday/2009‐2013/materials

Very useful material, available in many languages

Country Data on Diabetes WHO http://www.who.int/diabetes/facts/world_figures/en/ Note that it is average national data. The data need to be contextualised: NCD rates correlate positively with income level.

Strategies to raise employees’ awareness and encourage participation

Diabetes at Work http://diabetesatwork.org/NextSteps/AwarenessAndParticipation.cfm

Chronic Obstructive Pulmonary Disease (COPD

General Information WHO http://www.who.int/respiratory/en/index.html

General Information CDC http://www.cdc.gov/copd/

General information British Lung Foundation

http://www.lunguk.org/you‐and‐your‐lungs/conditions‐and‐diseases/copd.htm

Chronic obstructive pulmonary disease (COPD)

WHO http://www.who.int/respiratory/copd/en/

General Information on

Asthma

WHO http://www.who.int/topics/asthma/en/index.html

Website of Global Initiative for COPD with Guidelines, resources…

Global Initiative for COPD

http://www.goldcopd.org/ General information on COPD

World COPD Day Materials International COPD Coalition

http://www.internationalcopd.org/wcdmaterials/WCD_Materials.aspx

Useful tool how to conduct COPD Day (Media) and information material

Cancer

General Information WHO http://www.who.int/topics/cancer/en/ Good overview and introduction into the topic

Smoking

General Information WHO http://www.who.int/topics/tobacco/en/

http://www.afro.who.int/en/clusters‐a‐programmes/hpr/health‐risk‐factors/tobacco.html

Alcohol

General Information WHO http://www.who.int/topics/alcohol_drinking/en/#main

Global Status Report on Alcohol and Health 2011

Global data

WHO http://www.who.int/substance_abuse/publications/ global_alcohol_report/en/index.html

http://www.who.int/entity/substance_abuse/publications/ global_alcohol_report/msbgsruprofiles.pdf (global data)



Global Status Report on Alcohol and Health 2011

(Africa country sheets)

WHO http://www.who.int/entity/substance_abuse/publications/ global_alcohol_report/msbgsrafr.pdf (Africa data)

http://www.who.int/substance_abuse/publications/ global_alcohol_report/profiles/en/index.html

Quite interesting,

Global maps on alcohol consumption

WHO http://gamapserver.who.int/mapLibrary/app/searchResults.aspx

Unhealthy Diet see also at obesity

General Information WHO http://www.who.int/topics/diet/en/

http://www.who.int/gho/ncd/risk_factors/unhealthy_diet_text/en/index.html

The Eatwell Plate NHS http://www.nhs.uk/Livewell/Goodfood/Pages/eatwell‐plate.aspx

Illustrative information on how to eat healthier, with many additional useful links for more in‐depth information

Physical Inactivity

General Information WHO http://www.who.int/topics/physical_activity/en/

Risk factor: physical inactivity WHO http://www.who.int/entity/cardiovascular_diseases/en/cvd_atlas_08_physical_inactivity.pdf




http://www.world‐heart‐federation.org/fileadmin/user_upload/images/world‐heart‐day/2010/WHD_Employers_resource_guide/Employers%20Engagement%20Ideas%20FINAL.pdf

Very useful ideas how to carry out activities in the workplace

Obesity

General Information WHO http://www.who.int/nmh/en/index.html Good overview and introduction into the topic

Risk Factor: Obesity WHO http://www.who.int/entity/cardiovascular_diseases/en/cvd_atlas_09_obesity.pdf


Map on worldwide obesity prevalence

International Obesity Taskforce

http://www.iaso.org/iotf/obesity/ Click on a country for national prevalence data *

High Blood Pressure Risk Factor: High Blood Pressure

WHO http://www.who.int/entity/cardiovascular_diseases/en/cvd_atlas_05_HBP.pdf


Material is also available in French


6.2 Guidance for Company Action and Awareness Creation Target Group: Workplace Programme Coordinators


Cardiovascular Diseases (CVDs) Employer's resource guide and Workplace Wellness Engagement Ideas


http://www.world‐heart‐federation.org/what‐we‐do/awareness/world‐heart‐day/engaging‐employers/employers‐resource‐guide/

Extremely useful guide on what can be done in the workplace

Diabetes Advocacy and Information Material: Posters, Campaignbook, Booklets and Web‐banners




Strategies to raise employees’ awareness and encourage participation

Diabetes at Work http://diabetesatwork.org/NextSteps/AwarenessAndParticipation.cfm

Chronic Obstructive Pulmonary Disease (COPD) Website of Global Initiative for OPCD with Guidelines, resources…

Global Initiative for COPD

http://www.goldcopd.org/ General information on COPD

Unhealthy Diet and Physical Inactivity Employer's resource guide and Workplace Wellness Engagement Ideas




Preventing NCDs in the Workplace through Diet and Physical Activity

WHO & World Economic Forum

https://members.weforum.org/pdf/Wellness/WHOWEF_report.pdf

http://www.who.int/dietphysicalactivity/workplace/en/index.html

Provides research data and rationale for why tackling NCDs in companies





A guide for employer: Promoting healthy eating at work (2008)

Public Health Agency HSC (UK/Northern Ireland)

http://www.healthpromotionagency.org.uk/Resources/workwell/workwellhealthyeating08.html

http://www.healthpromotionagency.org.uk/Resources/workwell/pdfs/promoting%20healthy%20eating%20at%20work08.pdf (PDF, A5, 8p.)

Useful booklet on how employers can take simple action on promoting or providing healthier food, with or without company canteens.


6.3 Training Manuals Item Organisation Internet Source Comment

Training manual for health volunteers (here part 4 on NCDs, draft)

WHO www.emro.who.int/cbi/pdf/trainers_guide_module4_en.pdf

Developed for Eastern Mediterranean region

Employee Wellness Programme ‐ Peer Educator’s Manual (1.2 MB)

GIZ http://german‐practice‐collection.org/en/links/other‐gdc‐related‐publications/employee‐wellness‐programme

Tackles Hypertension

Training Manual for Peer Educators on Cervical cancer

IUHPE http://www.iuhpe.org/uploaded/Activities/Scientific_Affairs/CDC/TrainingManual_PeerEducators_WEB.pdf

Developed in Zambia

Diabetes Education Training Manual for sub‐Saharan Africa (2007)

World Diabetes Foundation

http://www.worlddiabetesfoundation.org/media(3813,1033)/IDF_Diabetes_Education_Training_Manual.pdf

234 pages (!), very in‐depth

Blood Pressure Training Guide

www.welchallyn.com/documents/.../7171WAWorkbook_AUG5.pdf

For health professionals and nurses

6.4 Information and Awareness Material: Fact Sheets, Posters, Leaflets… Target Group: Workplace Programme Coordinators, but in particular staff. Check also for more material at World Day websites (see category further down).


General Information on NCDs Fact Sheet on NCDs and

Chronic Diseases

WHO http://www.who.int/features/factfiles/noncommunicable_diseases/en/index.html

10 Facts Sheet on NCDs WHO http://www.who.int/features/factfiles/noncommunicable_diseases/en/index.html

http://www.who.int/features/factfiles/ noncommunicable_diseases/facts/en/index.html

Useful information for staff awareness

Cardiovascular Diseases (CVDs)

Fact Sheet on CVDs WHO http://www.who.int/mediacentre/factsheets/fs317/en/index.html

Copy and paste key information for staff awareness

Types of Cardiovascular Diseases

WHO http://www.who.int/entity/cardiovascular_diseases/en/cvd_atlas_01_types.pdf


Case study on stroke: Roberto survives on family

support

WHO http://www.who.int/features/galleries/chronic_diseases/roberto/01_en.html

http://www.who.int/features/2005/ chronic_diseases/en/index.html

Slides; short, illustrative, very useful and touching; (not African story)

Q&A: What can I do to avoid a heart attack or a stroke?


World Heart Day (WHD) 29th September


http://www.world‐heart‐federation.org/what‐we‐do/awareness/world‐heart‐day/

http://www.world‐heart‐federation.org/what‐we‐do/awareness/world‐heart‐day/2011‐campaign‐material/

You can order (electronic) leaflets and posters for WHD activities

Resources for health

professionals

Blood Pressure Association (UK)

http://www.bpassoc.org.uk/HealthProfessionals/Resources (EN) http://www.bpassoc.org.uk/HealthProfessionals/Otherlanguages#liVc (FR)

Broad range of resources on high blood pressure (UK‐oriented, but technically good material)

Information leaflets for downloading

High Blood Pressure Foundation (UK)

http://www.hbpf.org.uk/downloads.php UK‐oriented, but technically good material, detailed



World Stroke Day 29th October

World Stroke Organization

http://www.worldstrokecampaign.org/media/Pages/ AboutWorldStrokeDay2010.aspx

Check for resources on the webpage

High Blood Pressure Fact Sheet

www.aahealth.org/ltl_pdf/highbloodpressure.pdf Useful

Diabetes

Fact Sheet on Diabetes WHO http://www.who.int/mediacentre/factsheets/fs312/en/index.html


Risk Factor: Diabetes WHO http://www.who.int/entity/cardiovascular_diseases/en/cvd_atlas_10_diabetes.pdf


Case study on diabetes: Zahida's story, living with

diabetes

WHO http://www.who.int/features/galleries/chronic_diseases/zahida/01_en.html


Slides; short, illustrative, useful and touching (not African story)

Q&A: What are the risks of

diabetes in children?


Facts & Figures on Diabetes

WHO http://www.who.int/diabetes/facts/en/index.html

Advocacy and Information Material: Posters, Campaignbook, Booklets and Web‐banners




Fact Sheets (>20), e.g.

• Myths • What is it, etc.

Diabetes at Work http://diabetesatwork.org/NextSteps/FactSheets.cfm Useful fact sheets, according to everybody’s needs

Chronic Obstructive Pulmonary Disease (COPD) Fact Sheet: Chronic obstructive pulmonary

disease (COPD)

WHO http://www.who.int/mediacentre/factsheets/fs315/en/index.html

Asthma Fact Sheet WHO http://www.who.int/mediacentre/factsheets/fs307/en/index.html

World COPD Day Materials International COPD Coalition

http://www.internationalcopd.org/wcdmaterials/WCD_Materials.aspx

Useful tool how to conduct COPD Day (Media) and information material

Cancer

Fact Sheet on cancer WHO http://www.who.int/mediacentre/factsheets/fs297/en/index.html


10 Facts about Cancer WHO http://www.who.int/features/factfiles/cancer/01_en.html

http://www.who.int/features/factfiles/cancer/en/index.htm

10 slides; short, illustrative, very useful

Two case studies on cancer

1. Maria’s story (Tanzania) 2. Miriame’s story (Uganda)

WHO http://www.who.int/features/cancer/en/index.html

http://www.who.int/features/galleries/chronic_diseases/ maria/01_en.html

http://www.who.int/features/2006/cancer/ miriame/en/index.html

Slides; short, illustrative, useful and touching

Fact sheets on Cancer (USA)

National Cancer Institute

http://www.cancer.gov/cancertopics/factsheet/ 200 frequently updated fact sheets on a wide array of cancer topics

Smoking (Tobacco) Fact Sheet on Tobacco Use




10 Facts a.) on the tobacco epidemic and its control

WHO http://www.who.int/features/tobacco/en/index.html

http://www.who.int/features/factfiles/tobacco_epidemic/ en/index.html

http://www.who.int/features/factfiles/tobacco_epidemic/ tobacco_epidemic_facts/en/index.html

10 Facts b.) on gender and tobacco

WHO http://www.who.int/features/factfiles/gender_tobacco/ en/index.html

http://www.who.int/features/factfiles/gender_tobacco/ facts/en/index.html

10 Facts c.) on second‐hand (passive) smoke

WHO http://www.who.int/features/factfiles/tobacco/en/index.html

http://www.who.int/features/factfiles/tobacco/ tobacco_facts/en/index.html

Campaign Materials

1.) Poster

2.) Flyer

3.) Sticker

4.) The smoker’s body (4 MB)

WHO http://www.who.int/tobacco/wntd/2011/en/index.html

http://www.who.int/entity/tobacco/wntd/ 2011/poster/en/index.html

http://www.who.int/entity/tobacco/wntd/2011/flyer/en/index.html

http://www.who.int/entity/tobacco/wntd/2011/sticker/en/index.html

http://www.who.int/entity/tobacco/resources/publications/smokersbody_en_fr.pdf

EN and FR

Smoker’s body quite shocking (also genitals exposed)

Fact Sheet on Tuberculosis

and Tobacco

WHO http://www.who.int/tobacco/resources/publications/fact_sheet_set09/en/index.html

Only to be used in areas / sectors with relatively high TB rates

Alcohol

Fact Sheet on Alcohol WHO http://www.who.int/mediacentre/factsheets/fs349/en/index.html

Unhealthy Diet see also obesity Enjoy healthy eating (2008) Public Health

Agency HSC (UK) http://www.healthpromotionagency.org.uk/Resources/nutrition/Enjoy_healthy_eating.html

http://www.healthpromotionagency.org.uk/Resources/nutrition/pdfs/Healthy%20eating%20leaflet%20FINAL.pdf

(PDF, A5, 16 p.)

Useful booklet (suitable for middle and higher income groups).

The Eatwell Plate NHS http://www.nhs.uk/Livewell/Goodfood/Documents/Eatwellplate.pdf

Poster of the Eatwell Plate (rather for middle and high‐income groups)

Physical Inactivity Facts about Physical Activity CDC http://www.cdc.gov/healthyyouth/physicalactivity/facts.

htm

Risk factor: physical inactivity WHO http://www.who.int/entity/cardiovascular_diseases/en/cvd_atlas_08_physical_inactivity.pdf


10 Facts about Physical

Activity

WHO http://www.who.int/features/factfiles/physical_activity/en/

http://www.who.int/features/factfiles/physical_activity/ facts/en/index.html



Information Sheets: Physical

activity

1.) for health

2.) for young people

3.) for adults

4.) for older adults

WHO http://www.who.int/dietphysicalactivity/leaflet‐physical‐activity‐recommendations.pdf

http://www.who.int/dietphysicalactivity/physical‐activity‐recommendations‐5‐17years.pdf

http://www.who.int/dietphysicalactivity/physical‐activity‐recommendations‐18‐64years.pdf

http://www.who.int/dietphysicalactivity/physical‐activity‐recommendations‐65years.pdf

Useful information leaflets

Obesity see also unhealthy diet Fact Sheet on Obesity and

Overweight

WHO www.who.int/dietphysicalactivity/media/en/gsfs_obesity.pdf

Useful information sheet for staff

Risk Factor: Obesity WHO http://www.who.int/entity/cardiovascular_diseases/en/cvd_atlas_09_obesity.pdf


Fact Sheet on Obesity and

Overweight



10 Facts on Obesity WHO http://www.who.int/features/factfiles/obesity/facts/en/index.html

http://www.who.int/features/factfiles/obesity/en/

10 slides; short, illustrative, very useful; copy and paste…

Case study on obesity (5‐ year old child in Tanzania):

Malri's story

WHO http://www.who.int/features/galleries/chronic_diseases/malri/01_en.html


Slides; short, illustrative, useful and touching

High Blood Pressure Risk Factor: High Blood Pressure

WHO http://www.who.int/entity/cardiovascular_diseases/en/cvd_atlas_05_HBP.pdf




6.5 SelfAssessment Tools (Online and Sheets) Type Link

Alcohol

Online self assessment tool

www.nhs.uk/Tools/Pages/Alcoholcalculator.aspx

Blood Pressure You can purchase a self blood pressure measurement device and measure your blood pressure regularly at home

Breast cancer

Online self risk assessment tool

http://calculators.epnet.com/View/Pages/BreastCancer.aspx?&token=d168334d‐e19b‐432f‐a759‐e5d7d5fc1440&DeliveryContext=healthlibrary&CollectionIID=574

Diabetes

Self risk assessment sheet (2 pages)

http://www.lsuagcenter.com/en/food_health/health/ chronic_diseases/diabetes/Diabetes‐Risk‐Assessment‐.htm

http://www.lsuagcenter.com/NR/rdonlyres/ B898B62C‐82A1‐4967‐BD70‐8EE667D5EEAB/67233/ pub3142diabetesriskLOWRES.pdf

Diabetes

Cost calculator for employers

http://www.diabetesincontrol.com/tools/tools‐for‐your‐practice/6586

Diabetes

Online self risk assessment tool

http://www.healthcalculators.org/calculators/diabetes.asp (US)

http://www.nhs.uk/Tools/Pages/Diabetes.aspx (UK)

Fitness


http://www.nhs.uk/Tools/Pages/Fitness.aspx

Healthy Eating


http://www.nhs.uk/Tools/Pages/HealthyEating.aspx

Heart disease

Online risk self assessment tool

http://www.healthcalculators.org/calculators/heart_disease_risk.asp

Obesity

Body Mass Index (BMI) calculator

http://www.healthcalculators.org/calculators/bmi.asp http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi /english_bmi_calculator/bmi_calculator.html

Physical Activity

Online calculator

http://www.healthcoach4me.com/en/asset/s4a026.html

Smoking

Online self assessment

http://www.nhs.uk/Tools/Pages/Smoking.aspx?Tag=Stop+smoking

http://www.healthcalculators.org/calculators/nicotine.asp


6.6 Reference Institutions Following organisations address NCDs in Africa and can be contacted as reference institutions for further information or support.

Institution Description

CNCD‐Africa

Consortium for Non‐communicable Diseases Prevention and Control in sub‐Saharan Africa CNCD‐Africa is a member‐driven and Kenya‐based umbrella organisation that brings together multiple disciplines, sectors and partners in the region to address NCDs in an effective, efficient and sustainable manner.

Currently CNCD‐Africa has 22 members in various countries in Africa who address NCDs (research institutions, health organisations, etc.).

Membership is open to national and international organisations. Newsletter on NCDs can be downloaded from their website.

http://www.aihdint.org/cncd/

IUHPE

The International Union for Health Promotion and Education The International Union for Health Promotion and Education (IUHPE) is an association of individuals and organisations committed to improving the health and wellbeing of the people through education, community action and the development of healthy public policy.

IUHPE started various NCD‐related initiatives such as the NCD Partner Forum and the Africa NCD Expert Group. It is engaged in Capacity building, Education & Training. Membership is open to interested individuals and organisations.

www.iuhpe.org


6.7 Websites Organisation Link

The NCD Alliance www.ncdalliance.org

International Diabetes Foundation www.idf.org

World Diabetes Foundation www.worlddiabetesfoundation.org

World Heart Federation www.worldheart.org

Union for International Cancer Control www.uicc.org

International Union against Tuberculosis and Lung Disease

www.theunion.org

World Chronic Obstructive Pulmonary Disease (COPD) Coalition

www.internationalcopd.org

Global Initiative for COPD http://www.goldcopd.org


6.8 World Days World Day Link

World Cancer Day

4th February

www.worldcancerday.org

World Health Day

7th April

www.who.int/world‐health‐day/en/

World Hypertension Day

17th May

www.worldhypertensionleague.org

World No Tobacco Day

31st May

www.who.int/tobacco/en/

World Heart Day

29th September

http://www.world‐heart‐federation.org/what‐we‐do/awareness/world‐heart‐day/ www.worldheart.org

World Diabetes Day

14th November

www.worlddiabetesday.org http://www.idf.org/worlddiabetesday/

World Chronic Obstructive Pulmonary Disease (COPD) Day

16th November

http://www.internationalcopd.org http://www.goldcopd.org/wcd‐plan‐your‐wcd‐event.html


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