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The United Nations heard calls today for an all-out attack on non-communicable diseases (NCDs) such as cancer and diabetes with a summit meeting devoted to curbing the factors, like tobacco and alcohol use, behind the often preventable scourge that causes 63 per cent of all deaths.
The two-day high-level General Assembly meeting, attended by more than 30 heads of State and Government and at least 100 other senior ministers and experts, is discussing a draft declaration calling for a multi-pronged campaign by governments, industry and civil society to set up by 2013 the plans needed to curb the risk factors behind the four groups of NCDs – cardiovascular diseases, cancers, chronic respiratory diseases and diabetes.
Steps proposed range from price and tax measures to reduce tobacco consumption to curbing the extensive marketing to children, particularly on television, of foods and beverages that are high in saturated fats, trans-fatty acids, sugars, or salt. Other measures would cut the harmful consumption of alcohol, promote overall healthy diets and increase physical activity. The overall toll of NCDs is estimated at 36 million out of a total of 57 million annually.
“This will be a massive effort, but I am convinced we can succeed,” Secretary-General Ban Ki-moon told the opening session of the landmark summit, only the second ever to deal with health (the first was HIV/AIDS), noting that over a quarter of all people who die from NCDs succumb in the prime of their lives, the vast majority of them in developing countries.
“Our collaboration is more than a public health necessity. Non-communicable diseases are a threat to development. NCDs hit the poor and vulnerable particularly hard, and drive them deeper into poverty,” he said, with millions of families pushed into poverty each year when a member becomes too weak to work or when the costs of medicines and treatments overwhelm the family budget.
“The prognosis is grim. According to the (UN) World Health Organization (WHO), deaths from NCDs will increase by 17 per cent in the next decade. In Africa, that number will jump by 24 per cent.”
He called on governments, individuals, civic groups and businesses to all play their part. “There is a well-documented and shameful history of certain players in industry who ignored the science, sometimes even their own research, and put public health at risk to protect their own profits,” he said.
“There are many, many more industry giants which acted responsibly. That is all the more reason we must hold everyone accountable, so that the disgraceful actions of a few do not sully the reputation of the many which are doing such important work to foster our progress,” he added, calling on corporations that profit from selling processed foods to children, including manufacturers, media, marketing and advertising companies, to act with the utmost integrity.
General Assembly President Nassir Abdulaziz Al-Nasser stressed the need for international cooperation to tackle the problem. “The global community must work together to monitor, reduce exposure to risks, and strengthen health care for people with non-communicable diseases,” he said.
“The impact of this loss, this tragedy, goes beyond individuals, beyond families. NCDs are altering demographics. They are stunting development. And they are impacting economic growth.”
The draft summit declaration calls for greater measures at global, regional and national levels to prevent and control NCDs, stresses that about 9 million of the deaths occur before the age of 60, with nearly 80 per cent of those in developing countries, and cites “the vicious cycle whereby non-communicable diseases and their risk factors worsen poverty, while poverty contributes to rising rates of non-communicable diseases.”
Noting that “the rising prevalence, morbidity and mortality” of NCDs can be largely prevented and controlled through collective and multisectoral action by all Member States and other relevant stakeholders, it highlights the need for universal national health coverage and strengthened international cooperation to provide technical assistance and capacity-building to developing countries.
It calls on WHO, as the lead UN specialized agency for health and the vanguard of the global effort, to set up a comprehensive global monitoring framework and prepare recommendations for voluntary global targets before the end of 2012.
For more details go to the UN News Centre.The HRC has funded a range of research on non-communicable diseases. Read the Research Profiles, Case Studies and Media Release below.
The Clinical Trials Research Unit (CTRU) is part of The University of Auckland’s School of Population Health.
The CTRU’s research programmes, funded by the HRC and a number of other sources, focus on investigating the causes, prevention and treatment of cardiovascular disease and other major health problems. Established in 1989, the CTRU has coordinated clinical trials involving tens of thousands of people in Australasia, Asia and Europe.
The CTRU’s research into mobile phone-based health interventions is world-leading. Access to communications technology is increasing rapidly. According to the International Telecommunications Union, global mobile phone subscriptions far outstrip any other form of communications technology (e.g. fixed phone lines and the internet) at 86.7/100 population, and is still increasing rapidly . ‘mHealth’ has been defined as the use of mobile communications devices in health services. According to Dr Robyn Whittaker, Programme Leader of Health Technology research at the CTRU, mobile phones offer a portable personal method of delivering health-related services and information directly to individuals.
“This means that ‘mHealth’ programmes can be integrated into daily life, can be proactive and there at the ‘right’ times, can be personalised and interactive, and can be used to provide social support. This makes them ideal for supporting healthy behaviour change and self-management of chronic diseases. Also, as there appears to be very little socioeconomic ‘digital divide’ in the use of mobile phones, they provide a means to increase reach into disadvantaged population groups, who may not be accessing traditional services and health information,” says Dr Whittaker.
Dr Robyn Whittaker joined the CTRU as a Research Fellow in 2004. She initially worked on developments arising from the unit’s mobile phone text messaging smoking cessation programme, STop Smoking Over Mobile Phone (STOMP). This was the first ever randomised controlled trial of a purely mobile phone delivered health intervention.
The primary aim of the programme was to investigate whether a package of mobile phone based support could improve smoking cessation rates at six weeks. There were 1,700 participants in the study throughout New Zealand. The intervention group selected a ‘Quit Date’ and then received a personalised chronological package of up to six text messages per day, including cessation advice, motivation and encouragement, diversionary information and feedback while the control group received a less intensive standard series of text messages. Additional text messages were written specifically by Māori investigators for Māori participants.
Some examples of messages included:
Who else r u givng up Smoking 4? Write down 4 people who will get a kick outa u kickng butt. Your son, daughter, mum, dad, m8’s?
Failed 2 QT b4 & believ you’ll fail again? Rewrite ur belief 2 “I have the power 2 stick 2 my plan, I have gr8 support, I am stronger each day”.
Achievement – whakatutu ki tanga. All the things we achieve are things we have first imagined and then made happen, Frnds, whanua, haoura, mana, wairua all gr8 reasons to me mutu (should quit)
Instead of smking, explor ur Kainga tuturu (ur true home on whanau/tribal land). Y not make contact and get in touch wth ur past!
The results of the intervention showed a two-fold increase in self-reported quit rates at six weeks (28 per cent compared to 13 per cent), with the intervention proving to be as effective for Māori as non-Māori. The results were also consistent across subgroups defined by age, sex, income level and geographic location.
Based on these findings, Dr Whittaker worked to implement the intervention as a national programme delivered by The Quit Group as ‘Txt2Quit’. Txt2Quit was funded by the Ministry of Health for three years as a pilot programme. Evaluation of the first year of the programme shows that Txt2Quit had approximately 4,000 clients with very minimal promotion. Six-month quit rates were around 16 per cent. Feedback from the programme was that the texts were timely, relevant, motivating, supportive and easy to read. Some clients thought that there were too many texts, however, most clients were satisfied and would use it again or recommend Txt2Quit to a friend.
STOMP has been licensed to HSAGlobal, a New Zealand health IT company, who provide the intervention for New Zealand and in 2008 won a Telecommunications Users Association of New Zealand Innovations Award. As part of their suite of services, HSAGlobal are providing STOMP to Telus, a large telco in Canada. Telus have been providing STOMP to their employees, and have achieved a similar quit rate of around 16 per cent. In 2009, Telus won an award for this as an employee health and wellness programme.
Dr Whittaker has also worked on a collaboration with the London School of Hygiene and Tropical Medical, to conduct a large randomised controlled trial of STOMP, called ‘txt2stop’, in the UK. In total, 5,800 participants were recruited from across the UK, and the CTRU was able to conduct the intervention from The University of Auckland, with staff based in New Zealand. The findings of this trial were published in The Lancet early this year . They confirmed a doubling of six month verified quit rates in the intervention group in comparison with the control group (10.7 per cent v. 4.9 per cent, RR 2.20 95 per cent CI 1.80-2.68). The publication of these results has stimulated further interest in the programme internationally.
Dr Whittaker says: “We feel that STOMP works because it uses what we know to be effective in helping people to quit smoking, and delivers it directly to them wherever they are. Participants can ask for help when they need it, by texting in a keyword and receiving an immediate text message response with tips for beating cravings depending on their current context.”
In 2008, Dr Whittaker became Programme Leader of the Health Technology Research Programme and has gone on to lead the development of multimedia mobile phone programmes.
STUB IT was an HRC-funded research project involving an intervention designed to capitalise on the novelty factor of video messaging as a means of providing stop smoking support. Through the use of video messaging, role models provide observational learning. STUB IT content included video diary messages of young people quitting smoking, with real life stories and providing effective quitting tips and techniques.
Social cognitive theory uses observational learning to enhance self-efficacy for behaviour change – by watching someone else (like yourself) attempt the behaviour, struggle but succeed, you feel that you may be able to do it, and pick up techniques to use yourself. For example, “if they can do it, then so can I”.
STUB IT also used known effective behaviour change techniques for smoking cessation, such as setting a quit date, goal setting, positive reinforcement, social support, weighing up positive and negative outcome expectations, information on nicotine addiction and withdrawal symptoms, trigger situation and cues to smoking and planning to avoid those situations. Social marketing techniques were used in the identification of interest and distraction possibilities, and in the development of engagement possibilities with the target audience.
Data collection for STUB IT was done entirely online and via SMS. This included a participant self-completion eligibility check, informed consent via a text message and online participant information sheets, text message prompts and reminders to complete web-based follow-up forms, text message data collection questions integrated with the messaging system and a participants’ website.
The randomised controlled trial of STUB IT was unable to prove that this intervention was more effective than a control programme of infrequent general health video messages by mobile phone. Although, both intervention and control groups had high quit rates (26.4 per cent v. 27.6 per cent, p=0.8). Feedback from those who received STUB IT reflected the theory behind its development, that is, they felt supported, like they were not quitting alone and felt less isolated than they had on previous quit attempts.
Another HRC-funded project involved a collaboration with Associate Professor Sally Merry and colleagues at the Department of Psychological Medicine and the Werry Centre of Child and Adolescent Mental Health. ‘MEMO’ is a multimedia mobile phone programme that aims to prevent depression in adolescents. This development took key messages from cognitive behavioural therapy and turned them into a mixture of text messages, video diary messages from teens, video messages from celebrities, ‘mobisodes’ of an animated cartoon, and a mobile website. The research team recruited students from Years 9-12 at 15 high schools across Auckland.
Participants were randomised to either receive MEMO or to receive an attention control programme with the same frequency and types of mobile messages. “Due to the likelihood of a placebo effect in depression trials, we felt it necessary for the control group to also receive video and cartoon messages via their mobile phones. To reduce the potential for contamination between the groups, we also ensured that the messages had the same celebrities, teens and cartoon characters. However the control programme included completely different content that was not based on cognitive behavioural therapy”, said Dr Whittaker.
All participants received two messages per day (after school hours) for nine weeks, and were followed with individual interviews at baseline, post-programme and at 12 months.
“This was a monumental research project which relied on a large team of research assistants and staff at the CTRU and the Department of Psychological Medicine. Their hard work has resulted in a well-conducted study and we are looking forward to the results being published within the next few months,” said Dr Whittaker.In the meantime, Dr Whittaker has spent the past 12 months based in Washington DC as the 2010/11 New Zealand Harkness Fellow in Healthcare Policy and Practice. While conducting a research project examining aspects of mobile health in the US, she had the opportunity to participate in several exciting Federal government initiatives. These include the Secretary for Health and Human Services’ Text4Health Taskforce, a Technical Advisory Group for the evaluation of the national text4baby health information service, and as faculty at the National Institute of Health’s mHealth Summer training Institute.
“There was a surge of interest in mHealth in the U.S. in the past year and I was lucky enough to be there at a very exciting time,” said Dr Whittaker. She plans to continue her research and development work in this growing area of mobile health with several national and international collaborations in the planning stages.
For more information about any of these studies please go to the CTRU website: www.ctru.auckland.ac.nz.
Information: Dr Robyn Whittaker
Clinical Trials Research Unit, The University of Auckland
Phone: (09) 923 4766
Email: r.whittaker@ctru.auckland.ac.nzUniversity of Otago researchers have received a Health Research Council of New Zealand and Ministry of Health partnership research grant to conduct an epidemiological study of the former Fruitgrowers Chemical Company site in Mapua.
The project will be conducted over a two-year period and will be the first multidisciplinary exploration of health outcomes associated with soil remediation at a chemically contaminated site in New Zealand.
The Mapua site was classified as a highly contaminated site and soil remediation began in 2004 and was completed in 2008. There have been local health concerns raised about chemical exposure during the remediation work.
Mapua Epidemiological Study Principal Investigator Dr David McBride of Otago’s Department of Preventive and Social Medicine will lead a multidisciplinary team comprising departmental colleagues Drs Kirsten Lovelock, Sarah Lovell and Mr Andrew Gray, the University of Auckland’s Drs Kim Dirks and David Welch and Dr Daniel Shepherd of AUT University.
The study will document the health concerns, perceptions of exposures, comparative exposures and health effects for people living on or close to the remediation site in Mapua.
The researchers will also provide an analysis of blood serum samples to determine exposures of Mapua community members to dioxins, non-dioxin-like PCBs and organochlorine pesticides (OCPs). They will conduct a health outcomes survey and collect serum samples from participants in Mapua and a control group in Nelson.
Dr McBride says health effects induced by exposure to chemicals are multidimensional and for that reason the team is multidisciplinary, comprising a physician, a social anthropologist and health geographer, two epidemiologists, a psychologist and a biostatistician.
“It is important not just to document the biological effects, but also the environmental distress and risk and the psycho-social effects for those living near or on contaminated sites and those living through soil remediation.
“We are looking forward to working with the community of Mapua and a control group in Nelson and generating some meaningful results that will address any concerns community members have about health conditions related to exposure during the remediation process,” says Dr McBride.
The research team will hold a public meeting at the Mapua Community Hall on Thursday 29 September to explain what the study will involve and to answer questions.
For more information, please contact:
Dr Kirsten Lovelock
Project Manager, Mapua Epidemiological Study
Telephone (03) 479 8298Dr David McBride
Principal Investigator
Mapua Epidemiological Study
