Prof. Emeritus Kraisid Tontisirin Healthy aging Prof. Emeritus Kraisid Tontisirin Presentation at Karasin Province 2 August 2017

Thai’s elderly population* แนวโน้มการเปลี่ยนแปลงในอนาคต *ที่มา : สำรวจข้อมูลประชากรสูงอายุไทย ปี 2545, 2554 และ 2557 สำนักงานสถิติแห่งชาติ Office of the National Statistic of Thailand concluded that Thailand has been an aging society since 2005 (2548) as the elderly population was more than 10.4 % of the total population. It has also been forecasted that Thailand will be an aged society in 2021 (2564) when elderly population will be greater than 20 %. Kraisid Tontisirin, Mahidol University

Thai’s elderly population Office of the National Statistic of Thailand concluded that Thailand has been an aging society since 2005 (2548) as the elderly population was more than 10.4 % of the total population. It has also been forecasted that Thailand will be an aged society in 2021 (2564) when elderly population will be greater than 20 %. Kraisid Tontisirin, Mahidol University

Dimensions of health Physical Health status Mental Spiritual Social ” Kraisid Tontisirin, Mahidol University

Factors influencing health and wellbeing 1. Genetics 2. Nutrition: the link between food and health 3. Physical activity and exercise 4. Mental and spiritual health 5. Avoidances of tobacco, alcoholic beverages and other addictive substances 6. Environment: physical, chemical, biological, economics, social and political Kraisid Tontisirin, Mahidol University

Ecological factors for good health Genetics Health status Environment Health behaviors Health services Kraisid Tontisirin, Mahidol University

Good Nutrition & Well-being for All Agriculture/ Food supply/ Service Promotion Protection Treatment Food Nutrition Health Nutrition is a link between food and health, regarding the fulfillment of energy, protein and micronutrient requirements and non-nutrients from food in human life course Ultimate Goals Good Nutrition & Well-being for All Kraisid Tontisirin, Mahidol University

Major health challenges in Thai Low birth weight ~ 9 % Underweight of underfive ~ 6 % Stunting of underfive ~ 10 % Overweight & obesity in children10-15 % Adult overweight &obesity ~ 40 % Adult with high blood pressure 25-30 % Diabetes mellitus type2 ~ 7-10 % Rising trends of cardiovascular diseases (heart and brain attacks) and cancers which are leading causes of dealth Accidents Nutrition and NCDs High sugar, fat and salt diets Vegetable and fruit consumption less than 400 g./person/day Inadequate physical activity and exercise Tobacco and alcoholic consumption Other undesirable health behaviors Kraisid Tontisirin, Mahidol University

Improvement of maternal & child nutrition, Thailand 1980 1990 2006 ANC coverage (%) 35 75 95 Anemia in pregnancy (%) 50-75 18.8 ?10 LBW % 16 10 <10 Underweight of under 5 (%) 51 20 Recent trend of nutritional status of under 5* * Source: NHES 2; Holistic Development of Thai Children; NFNS 5; NHES 4; and NHES 5 Kraisid Tontisirin, Mahidol University

Courtesy from; Napaphan Viriyautsahakul Director of Bureau of Nutrition

Kraisid Tontisirin, Mahidol University

for normal weight and height in human life course Anthropometric goals of health promotion aiming for normal weight and height in human life course Age range Goals/indicators Newborn infants   - Normal birth weight 2.5 - 3.5 kg. Children underfive - Underweight ≤ 5 % - Stunting - Overweight & obesity School children ≤ 10% and be ≤ 5 % (after 5 years) Adolescents and adults ≤ 20% and be ≤ 15 % (after 5 ปี) Elderly - Normal BMI 18.5 - 25.0 Kraisid Tontisirin, Mahidol University

Goals of community health promotion Family and community well being indicated by normal wt. and ht., B.P, blood sugar, eat adequate vegetables and fruits with low sugar, fat and salt; no tobacco and no/less alcoholic consumption, physical activity and exercise regularly. Cares of NCDs including: Obesity, high B.P., diabetes mellitus and others to be under controlled. Community and setting approaches in health promotion: with full functions and support by health services (Community and Tambon hospitals) and Local Administrative Organizations, and others. Create healthy environment for health promotion: including recreation areas for physical activity, exercise and other social functions Kraisid Tontisirin, Mahidol University

Community-based approaches Is an integrated program implemented at local level (district level and below) National commitment with sound nutrition improvement strategies and goals Community actions: basic services, mass mobilization, mutual efforts/actions to reach all people and to prevent malnutrition Kraisid Tontisirin, Mahidol University

: Community Based Program for Health Promotion Minimum Basic Services (Health, Education, Agricultural Extension) Supportive System Menu (Activities) Antenatal care Growth monitoring /promotion Nutrition in school Elderly cares Cares of NCDs Food production Nutrition education Food sanitation & safety Other activities (Tobacco and alcoholic consumption control) Recreation and physical activities) Etc. Training Funding Problem Solving Supervision Facilitators Interface (service providers and community leaders) Plan/goals Implementation Monitoring/evaluation : Community Leaders Family Individual Volunteers (1:10 households) Minimum Indicators of well-being & NCDs 15 Kraisid Tontisirin, Mahidol University 15

Health cares in human life course Antenatal cares Healthy behaviors & life styles Breast and complementary feedings Nutrition and health promotion in school children Growth and development monitoring & promotion Kraisid Tontisirin, Mahidol University

Menu Activity on ANCs 4 ANC visits for all pregnant mothers High risk check up and treatment monitoring wt. gain Food, Nutrition and health education Food supplementation MTV, iron and folate supplementation Two tetanus toxoids Referral system and safe delivery service Kraisid Tontisirin, Mahidol University

Menu on Growth Monitoring and Promotion (GMP) Growth monitoring (wt.& ht.) and remedial actions Child growth education and cares Breastfeeding and complementary feeding Immunization Village based complementary food production for infants and young children Health and nutrition education Cooking and feeding demonstration Treatment of malnourished child Referral of severe illness and malnutrition Kraisid Tontisirin, Mahidol University

Menu on Nutrition in School Monitor weight and height regularly and take remedial actions based on growth monitoring Food services-school lunch and milk programs Food, personal and environmental hygiene Nutrition education Promotion of physical activity and exercise Positive school environment for healthy diets Plan to set up a “Nutri-teacher” post School gardens Kraisid Tontisirin, Mahidol University

School milk program in Thailand Based on Food Nutrition Plan aiming to provide daily 200 ml of milk to children in kindergartens and primary school 200 days/ year The program has been implemented since 1992 along with school lunch program in kindergartens and gradually stepped up to cover 6 grade-students in 2009 School milk program has created demand for local dairy industry Kraisid Tontisirin, Mahidol University

Conclusion: Healthy aging 1. With healthy behaviors in human life course 2. Good nutrition: Eat a variety of food emphasis on unpolished rice, fish, egg, low fat milk, vegetables, fruits, legumes and adequate water consumption 3. Adequate physical activity and exercise regularly 4. Good mental health and happiness: compassion, mindfulness, willing to learn, ethic and morality 5. Avoid tobacco, alcoholic and other addictive substances 6. Healthy family, good friends and nice social environment Kraisid Tontisirin, Mahidol University

Thanks for your attention