POLICY BRIEF: REDUCTION OF OBESITY IN BOTSWANA - PowerPoint Presentation

1. POLICY BRIEF: REDUCTION OF OBESITY IN BOTSWANAMinistry of Health

2. Executive SummaryThe analysis of obesity using the layered structure on the social determinants of health shows that obesity denotes obesity as a “wicked problem”. Obesity cannot be linked to a single cause or solution and addressed by one sector. This means that there are multiple factors that are attributed towards the rising numbers of the occurrence of obesity ranging from individual factors, structural etcIndividual choices such as unhealthy diets, physical inactivity are causes of obesity.

3. Executive summaryUnhealthy diets may be due to either low or high economic status of which poverty is a strong indicator for the former. Physical inactivity may be due to sedentary lifestyles which are eminent in Botswana and unconducive environments/roads or recreational facilities (parks & playgrounds) for physical activity, for examples roads with no walkways or cycling lanes. Unhealthy diets maybe due to issues of food security and trade. Obesity ultimately results in non communicable diseases such as cardiovascular diseases, diabetes, 40% of cancers, chronic respiratory diseases such as Asthma. Data collated by WHO indicates that in Botswana 37% of deaths are due to NCDs and from 2010-2012 there were 16 000 deaths due to NCDs

4. Executive SummaryThere are a number of researches conducted in Botswana to gauge obesity levels, for example the a study conducted in 2007 among adults 25-64 years which revealed low levels of physical activity (73% of inactivity), 22% and 53% of males and females respectively were overweight/obese, low intake of recommended servings of fruits and vegetables (n=96%) , 12% and 5% of school going children were overweight and obese respectively.

5. Executive summaryThis policy brief recommends a robust intersectoral action or multisectoral approach to addressing obesity (HiAP) approach. There are sector Workplace Wellness Programs which are not well coordinated. It is recommended that there be robust workplace wellness policy. MOESD and MOH through health promoting school initiative should formulate dietary guidelines and monitoring framework to monitor its implementation. Physical activity should be promoted by means of engagement with local authorities by facilitating outdoor gym parks, construction of user friendly roads with walkways, lights and cycling paths. Though the MOA is promoting horticulture (backyard gardens) as a way of increasing accessibility of vegetables, water should be subsidized to promote sustainability of this initiative. A lot needs to be done with regard to personal behaviours that cause obesity. Behaviour change communication strategies needs to be implemented across sectors and civil society should be engaged on a larger scale (supported by government, technically and financially

6. IntroductionThere are evident successes in preventing NCD risk factors : Tobacco, Alcohol consumptionIf obesity is addressed there will be more economic gain productivity,less of your population spending time accessing care.The health and social care bill will be increased and divert resources to other developments that the city have prioritizedReduce the widening inequalities that may be due to failure to provide appropriate social servicesReduced social impacts such as discrimination, social exclusion and reduced earnings : Happy people

7. Context and importance of problemThe economic cost of obesity Total costs of NCD curative services are estimated at $674,901,517 according to the EHSP 2013–2017.The NCD program is the second most expensive under the EHSP program, accounting for 26 percent of the total costs. The cost of obesity translated into deathsNCDs account to 37% of total deaths in Botswana, which translates to1600 deaths per year. Thousands of days lost to productivity

8. context and importance of problemHow much is overweight/obesity in Botswana1 in 10 and 5 in 10 males and females are overweight/obese.Low levels of vegetable intake:9 in 10 people eat less of the recommended servings of fruits and vegetables 5 in 10 of school going children are obese.5 in 10 people do not engage in physical activity

9. Critique of Policy options Roads and infrastructureThe way roads are currently structured has inadequate cycling paths and walkways that can promote physical activity. There are several private gym facilities in towns and cities and major villages. However physical activity can be promoted through cost effective ways such as through establishment of outdoor gym parks in open spaces that can affordably and easily accessed. Currently in Botswana there is only one such park.Workplace Wellness ProgramsEmpirically and through data collected during workplace wellness days, there are high cases of overweight and obesity. The workplace wellness Program came into being with the advent of HIV/AIDS and was since expanded to look at overall employee health. It is inadequately coordinated and narrow in its workplace wellness mandate

10. Critique of Policy options School Health environments and Nutrition feeding programmesIn many public schools, there are vendors, outside schools doing small business mostly selling snack items high in calories. There are no school based policies to control the type of activities happening around schools. In relation to nutrition feeding programmes there are still some inadequacies as what is being provided in primary public schools dietary wise and safety issues. The diet that is provided is still questionable as to whether it meets the standards of a balanced healthy diet. Knowledge and skills development and community actionThere is still a lag in investing on communication and social marketing which are the foundations towards behaviour change communication. There are still myths and misconceptions about healthy eating, overweight and obesity and low perceived susceptibility to having NCDs due to a big body. There are still constraints in relation to investing in community action and knowledge and skills development as behaviour change communication is expensive. 

11. Policy RecommendationsDevelopment of a Strategy on reduction of Obesity coordinated at the mayor officeShort term strategies may include establishment of outdoor gym parks, development of national dietary guidelines for schools, strengthening behaviour change communication across sectors, water subsidies to promote horticulture at family level.Self help projects/income generating projects for women who do vending around schoolsFat and salt reduction projectEstablishment of an interdepartmental structure/committee at DC level to facilitate intersectoral actions needed for reduction of Obesity.

12. Key stakeholdersDistrict Education Office: HagglingDepartment of Road, Transport and safety: CooperativeDepartment of Social and Community development: CooperativeDepartment of Town planning and Development: CooperativeCivil society: CooperativeFast Food Outlets: CooperativeBusiness community: Cooperative

13. Engaging Policy makersEngaging policy-makersResearch evidence is most likely to be used by policy-makers when it meets the following needs:Relevance - addresses questions of interest to policy-makersAccessibility - can be easily found and understood by policy-makersImmediacy - evidence is provided in a timely manner for current problemsUsefulness - information provides solutions to problemsQuality - information is credible and scientifically rigorousCollaborative - early and sustained engagement with policy-makers will increase their understanding of the research and their confidence in using itTargeted - identifies a specific audience and key messages

14. Cont’dFrame evidence according to the following questions to facilitate the uptake of research evidence in policy-making:- What is the problem?Why does it matter?What can be done about it?How should we do something?How will we know it worked?

15. Use of evidence to engage decision makersUse an evidence-based approach to engage decision-makersA comprehensive list of facts, tips and resources for effectively presenting evidence to decision-makers and policy-makers . Some facts highlighted include the following:Provide concrete, tangible policy implications of your evidence that provide a solution to a policy issue.Evidence that can be piloted on a small scale can be more readily adopted.Use plain, non-technical language.Tailor evidence to meet the needs of the organizational context.Foster relationships with decision-makers to understand their needs.

16. ContdCreate effective messagesSeveral approaches for creating effective messages, such as social marketing;John Lavis model with four versions of your message (headline, sentence, one-paragraph and full-text version)

17. StrategiesMedia advocacyUse of civil society by championing a causeDevelopment of policy briefsDevelopment of advocacy tool kitsLegislators as icons or champions

18. Strengths and weaknessesPolicy brief componentstrengthweaknessStructure: length and clarityRecommended number of pagesStruggling with use of language. EvidenceData on obesity is available, nonetheless is NationalLimited evidence on the social causes of obesity, PresentationNo Logos, other graphic enhancers

19. Final DecisionDevelopment of Multisectoral National Strategy on Obesity. Establishment of the National Social Council