Health Behaviours A Global Perspective Andrew Murray GP, runner Health Behaviours A Global Perspective Andrew Murray GP, runner

Background GP- locum Interest in public health and promoting behaviour change Love travelling (often as a GP)

Global Mortality = constant

Global Health Behaviour = Different

Public Health at the North Pole

Run The World

Antarctica- Healthy Diet Note WHO guidelines Excessive saturated fat intake Massive salt intake (preservative, and flavour) (global average 9-12 grams)

South America- Drugs and income inequality Life expectancy Increasing rapidly in South America, as are NCD’s One-fifth of Brazil's 173 million people account for only a 2.2% share of the national income. Brazil is second only to South Africa in a world ranking of income inequality

North America- Obesity North America and obesity More than one-third of U.S. adults (35.7%) and approximately 17% (or 12.5 million) of children and adolescents aged 2—19 years are obese (Obesity in America) CIA World Fact Book: America ranks 6 th and the UK 16 th in the world for Adult Prevalence of Obesity (out of 70 countries)

World Obesity Charts- WHO

Solutions?

Europe- UK- Physical Inactivity

Africa, sexual health and alcohol Over ½ the world’s population havent drunk alcohol in the last year Varies predominantly with -Income -Religion -culture

Alcohol- Uk vs Egypt

Sexual Health Scotland cases, MSM, Migration

Asia Road safety Travel safety

Lessons from Asia Japan ?example of good practice Long life expectancy Public health parameters -Nutrition -Obesity -Physical activity Bhutan ?example of good practice Gross national happiness Income low Gross national happiness high

Australasia

Targeted public health campaigns

Life expectancy trends Portugal Scotland

Trends in male life expectancy: Scotland Richest 20% Poorest 20%

Triple aim Increase happiness Increase health and life expectancy Address health inequalities

Albert Einstein Insanity “is doing the same thing over and over again and expecting different results”

Health Behaviour Change- Scotland

Smokadiabesity

Risk Factors- mortality Blair et al BJSM 2009

Fat and Fit!!

Risk reduction associated with physical activity Chronic conditionRisk reduction All cause mortality30% risk reduction CVD, stroke20-35% reduction Diabetes30-40% reduction Hip fractures36-68% reduction Colon cancer30% reduction Breast cancer20% reduction Loss of function30% reduction Depression/dementia20-30% reduction

CMO guidelines 30 mins 5x per weeks (or 150 mins total) moderate exercise- adults 60 mins daily for kids Known by 13% GP’s 9% PN, 7% HV

Lessons from East Africa

How are we doing Scotland (males) 25-34yo- 63% active 65-74yo- 24% active 75yo plus- 13% active Female population even worse

Primary Care Assessment Brief Advice/ Intervention Signposting

Assessment Ask the question?? “How many days a week do you do physical activity, and for how long” ??150 mins

Brief Advice/ Intervention GP PN HV Physio Any staff

Brief interventions in Primary Care Physical Activity £ Smoking £ Statin £10k

Life expectancy trends Portugal Scotland

Life expectancy trends

It’s in our gift “Primary care AND secondary care vital” WHO “Gamechanging- prevention is the direction of travel”- CMO Highly effective, and cost effective The best for every patient, every time

Resources Physical Activity pathway Physical Activity wheel Every Step Counts- DVD and online Raising the issue of PA- e learning module PAHA

3 good, 3 bad

Call to Action Ask the question Brief advice and intervention Share knowledge and resources Be a champion for physical activity

Top tips Everything counts!!! Find something you enjoy Pedometers/ walking Encourage through relatives

Thanks Book- Running Beyond Limits