The Oxford Health Alliance

1. www.oxha.org Confronting the Epidemic of Chronic Disease Community Interventions for Health (CIH) Sponsored by the PepsiCo Foundation The Oxford Health Alliance The Oxford Health Alliance

2. Background Non-communicable diseases (NCDs) account for 60% of all deaths globally, with 80% occurring in low and middle income countries Four NCDs are largely responsible; cardiovascular disease, chronic respiratory disease, cancer and diabetes These diseases are preventable. Approximately 80% could be prevented by addressing the main risk factors The three main risk factors are tobacco use, unhealthy diet and physical inactivity 2008-2013 Action Plan, WHO 2010

3. Individual or Community Interventions? • Traditionally, medical research investigating risk of NCD targets the at-risk individual • Randomised controlled trail are conducted, comparing an intervention group with a control group • Effective interventions at the individual level are identified • These individual-level behaviour change interventions are often unsuccessful at community or population level • The challenge is to find a way to change the environment to promote health and reduce risk of disease

4. Community Interventions for Health (CIH) CIH is the largest and most comprehensive multinational collaborative study for community interventions ever undertaken The long-term goal of the CIH study is to create sustainable interventions that prevent and control the leading chronic diseases by addressing the three main risk factors CIH aims to develop, evaluate and showcase sustainable interventions in addressing tobacco use, unhealthy diet and physical inactivity in communities

5. CIH sites and target population Leicester, UK 150,00 Hangzhou, China 300,000 Mexico City 150,00 Kerala, India 150.00

6. Study design • In each study area, an intervention and control site has been selected for comparison • Baseline data have been collected from all sites and comprise: • Questionnaires from a sample of the population • Biometrics from a sub-sample • Environmental scans • Interventions have been implemented • Final data collection for comparison with baseline will be collected at the end of 2011

7. Inputs for change Knowledge, attitudes and behaviors for healthy eating, physical activity and tobacco use Strategies for change Social marketing Community mobilization Structural change Health education Locus of change Individual Family Community Society Assessment of change Questionnaires Environmental scan Policy reviews Process system for CIH

8. International CIH management board National China India Mexico UK Local Workplaces Workplaces Workplaces Workplaces Schools Schools Schools Schools Health Centers Health Centers Health Centers Health Centers Neighborhoods Neighborhoods Neighborhoods Neighborhoods Organisation of CIH

9. Evaluation: Research Study Sample

10. Streets Stores and kiosks Information Cigarette vending School 400m (0.25m) Street vending Recreationalfacilities Restaurants and food services Parks and gardens Evaluation: Environmental scanning for CIH

11. Examples of baseline data • Tobacco use in China • Overweight and obesity among schoolchildrenin Mexico • Physical activity among schoolchildrenin India • BMI of study population in all sites

12. www.oxha.org Tobacco Use - China Current smoking tobacco Men: 42.9% Women: 1.4% The Oxford Health Alliance The Oxford Health Alliance

13. Childhood obesity - Mexico

14. Frequency of Physical Activity in Indian Schoolchildren

15. Rates of overweight and obesity (BMI>25)

16. Interventions – tobacco control in China • Extensive health education programme • Smoking banned in worksites and public places

17. Interventions – improving diets to reduce obesity in Mexican school children • School meals are not routinely provided in Mexican schools • Many children eat snacks and fast food from vendors • Parents in some schools have begun to cook and provide healthy meals

18. Interventions – increasing physical activity in girls in India • Culturally, girls in India are not encouraged to take exercise • CIH provides bicycles for school girls and organises cycling lessons

19. Summary – achievements to date Community Interventions for Health has: • Been operating since 2008 • Involved 750,000 people in 4 countries • Been established as the largest global trial of community intervention so far • Generated much world-wide interest • Published a methodology paper 1 • Agreed publication of a manual with Oxford University Press • O’Connor Duffanyet al. Community Interventions for Health (CIH): a novel approach to tackling the worldwide epidemic of chronic diseases. CVD Prevention and Control (2011) 6: 47-56

20. Challenges ahead • Data collection is due to be completed by the end of 2011 • Analysis of the data will involve: • organisation and collation • support for the statistical team • one year’s duration (2012) to allow reports from each country individually and then to combine data to give overview results and messages • papers to be prepared for publication

21. Thanks from the team