Next Step 2014 presentation by Imran Agus Nurali from Ministry of Health of Indonesia

IMRAN AGUS NURALI

Tackling the Non Communicable Diseases (NCD) Burden using

Sports and Activities’.

OUTLINE PRESENTATIONIntroductionPrevalence NCD’s and Risk factorsPhysical Activity and Sports approachFITT of Physical ActivityPrinciple of ExercisePromote PartnershipConclusion

WHO Global health Risks report, 2004.

Deaths attributed to 19 leading factors,by country income level, 2004

Percentage of deaths, by cause, South-East Asia Region, 2008

Percentage of deaths, by cause, IndonesiaNBHS 2007

26.9

12.3

10.210.29.3

31.1

StrokeHypertensionDiabetesCancerHeart D'sOthers

4 major of NCD’s in Indonesia

Cardiovascular disease- CHD : 0.9%- Decomp. Cordis : -

- Hypertension : 31.7% Diabetes Mellitus 1,1% COPD : - Asthma : 3.5% Tumour/Cancer : 4.3‰ Stroke 0,83% Central Obesity 18,8%

Cardiovascular disease- CHD : 1.5%- Decomp. Cordis : 0.3%- Hypertension : 25.8%

Diabetes Mellitus 2,1% COPD : 3.8% ; Asthma 4.5% Cancer : 1.4‰ Stroke 1,21% Central Obesity 26,6%

NBHS 2007 NBHS 2013

NBHS : National Basic Health Survey

POPULATION AGED +10 YEARS OF PHYSICAL INACTIVITY by PROVINCE, NBHS 2013

The NCDs Iceberg

Behavioral risk factors

-Tobacco-Physical inactivity-Lack of fruits-Lack of vegetables-Excess alcohol

Early diagnosis

Rx of hypertension, hyperglycemia, dyslipidemia, diabetes

Prevention of premature deaths and disability

Management of stroke, coronary heart disease, diabetes complications

Health promotion anddisease prevention

Adoption of healthy lifestyle by individual,community and family

Biological risk factors-Hypertension-Hyperglycemia-Dyslipidemia-Obesity

Chronic/life threatening conditions-Stroke-Coronary heart disease-Diabetic nephropathy

Interventions Risk factors/diseases

SOCIAL DETERMINANTS

PRIMARYHEALTHFACILITY

HOSPITAL - COPDand COPD

Hypertension,

10

LEVEL OF PHYSICAL CONDITION

PEAK PERFORMANCE

PRODUCTIVITY

F I T N E S S

H E A L T H Y

12

PHYSICAL ACTIVITY

EXERCISE

SPORT

Good, Right, Measure and Regular

Pregnancy and

PostpartumChildren Adolescents Adults Older

Adults

CONTINUUM PERIOD OF PHYSICAL ACTIVITY

ATHLETEs PILGRIMS

IMPLEMENTATION PROGRAM SPORTS HEALTH of MoH-Indonesia based on :

1. Guidelines of exercise during pregnancy and post delivery in Primary Health Centre

2. Guidelines to develop physical fitness of school age through Health Promotion School (UKS)

3. Guidelines to develop physical fitness for employee at workplace

4. Guidelines to develop physical fitness for pilgrims

5. Guidelines to build physical fitness for athletes6. Guidelines of physical activity for elderly

Benefit of Regular physical activity:

TO REDUCE :• the risk of dying prematurely• the risk of dying from heart disease or stroke• the risk of developing heart disease, colon cancer and type 2 diabetes• the risk of developing lower back pain can help in the management of painful

conditions, like back pain or knee pain

HELPS TO :• prevent/reduce hypertension• control weight and lower the risk of becoming obese• prevent/reduce osteoporosis, reducing the risk of hip fracture in women• build and maintain healthy bones, muscles, and joints and makes people with

chronic, disabling conditions improve their stamina• prevent or control risky behaviours, especially among children and young

people, like tobacco, alcohol or other substance use, unhealthy diet or violence• promotes psychological well-being, reduces stress, anxiety and depression

Regular Physical Activity at The Correct Intensity

Reduces the risk of death by 40% Lowers the risk of stroke by 27% Reduces the incidence of diabetes by almost 40% Reduces the incidence of high blood pressure by almost 50% Can reduce mortality and the risk of recurrent breast cancer by

almost 50% Can lower the risk of Colon Cancer by 60% Can reduce the risk of developing of Alzeimer’s disease by one-

third Can decrease depression as effectively as medications or

behavioral therapy

Mechanism for Cancer Reduction with Exercise

• Physical activity lowers levels of biologically available sex hormones– Decreased lifetime exposure to endogenous sex hormones -> decreased risk of

hormone-related cancers

• Breast, endometrial, ovaries, prostate, testes

• Exercise decreases endogenous insulin production– Higher levels of circulating insulin linked with several cancers

• Adiposity and Cancer Risk– Increased fat associated with increased risk of cancers of colon, kidney,

esophagus, endometrium, thyroid, post-menopausal breast

• Physical activity decreases colon transit time– Decreases colonic exposure to carcinogens in stool

• Level of physical activity inversely related to levels of C-reative protein

04/10/2023 19

SITE PLACE OF PHYSICAL ACTIVITY

1. AT HOME2. DURING TRAVEL

3. WORKSITE PLACE4. AT SCHOOL

5. PUBLIC PLACE

INTERVENTION :1. INDIVIDUALLY BEHAVIOUR PROGRAM2. SCHOOL BASED PHYSICAL EDUCATION3. ENVIRONMENTAL APPROACHES4. COMMUNITY CAMPAIGNS5. SOCIAL SUPPORT INTERVENTIONS IN

COMMUNITY6. POLICY APPROACHES

PRESCRIPTION OF EXERCISE :

1. FREQUENCY2. INTENSITY3. TEMPO4. TYPE

PRINCIPLES OF EXERCISE

1. OVERLOAD2. PROGRESSIF3. INDIVIDUAL

Promote Partnerships for The Prevention and Control of NCD’s

1. Promote agreement between the government and other relevant partners in the implementation of national strategy of diet and physical activity for NCD’s prevention

2. Reorient the role and existence of a national network of NCD’s control

3. Strengthen the role of existing networking in province and district of NCD’s control

4. Develop national action plan for implementation of diet and physical actiivty for NCD’s prevention

NATIONAL STRATEGY

• Strengthen legislation on healthy diet and physical activity.

• Multi-sector and stakeholders partnerships include strengthen National Networking of NCDs Control.

• Resource development for the implementation of activities /actions.

• Address equity and equality and eliminating disparities among social groups.

• Increase the effective evidence-based interventions by place settings (households, schools, public places, workplaces and health care facilities)

• Conduct operational research and development of policy and long-term strategy for sustainable NCDs community-based prevention.

PROGRAM IMPLEMENTATION

• Strengthen regulation of low salt, low sugar and low saturated fat of food products

• Strengthen the role of networking in province and district on NCDs control

• Increase budget allocation and the means to support the activities

• Integrate activities to control risk factors of NCDs related to diet and physical activity into Social Security System

• Adopt community-based interventions adaptive to local social and culture wisdom

• Conduct research on the impact of behavior changes in consumption of sugar, salt, fat and physical activity on NCDs prevalence reduction

INPUT & PROCESS

INDICATOR

• Regulation of low salt, low sugar and low saturated fat of food products

• Effective NCDs control networking

• Budget allocation for program implementation

• NCDs control of vulnerable group incl. the poor

• Community-based interventions adaptive to local social and culture wisdom

• Research on the impact of behavior changes in consumption of sugar, salt, fat and physical activity on NCDs prevalence reduction

NATIONAL POLICY

• Food availability and access

• Improved quality of food consumption

• Improve d physical activity

• Public Health and Community Nutrition

OUTPUT INDICATOR

Increased percentage of family with healthy life style behavior of low sugar, salt, fat consumption and regular and adequate physical activity

REDUCTION OF NCDs

PREVALENCE

Linkage between Components of Diet and Physical Activity

DIET AND PHYSICAL ACTIVITY

ECONOMY AND GLOBALIZATION

ENVIRONMENT AND INFRA

STRUCTURE

FOOD AND NUTRITION

SOCIO-CULTURE,

TOURISM AND LOKAL WISDOM

KNOWLEDGE, GENDER & LIFESTYLE

LEGISLATION, BUDGET AND

CONTROL

MEDIA ADVERTICEMENT

AND SOCIAL NETWORK

Stakeholders of National Network of NCD’s Control

1. Bappenas (National Development Planning Agency)

2. Home Affairs3. The House of People

Representatives4. Province and District Government5. Health6. Agency For Drugs and Food7. Education8. Religious Affairs9. Youth and Sports10.Agriculture11.Marine and Fisheries12.Labor13.Trade

14. Industry15. Tourism16. Fiscal17. Industrialist and Businessman18. Woman empowerment and Child

Protection19. Social and Human Rights20. Non Government Organization21. Mass Media22. Professional Organizations23. Universities24. UN Agencies and International

Develeopment Partners

8/29/2013

PHYSICAL ACTIVITY OF SCHOOL AGE

IAN 2012

PHYSICAL FITNESS TEST AT WORKPLACE

EXERCISE FOR PILGRIMS

Medical Fitness Centre

CITY PARK

Physical inactivity is part of the problemPhysical activity is part of the solution

Intervention to increasing physical activity

CONCLUSION

THANK YOU