The Oxford Health Alliance The Oxford Health Alliance Community Interventions for Health (CIH) Sponsored by the PepsiCo Foundation Confronting the Epidemic of Chronic Disease

The Oxford Health Alliance Background Non-communicable diseases (NCDs) account for 60% of all deaths globally, with 80% occurring in low and middle income countries Four NCDs are largely responsible; cardiovascular disease, chronic respiratory disease, cancer and diabetes These diseases are preventable. Approximately 80% could be prevented by addressing the main risk factors The three main risk factors are tobacco use, unhealthy diet and physical inactivity Action Plan, WHO 2010

The Oxford Health Alliance Individual or Community Interventions? Traditionally, medical research investigating risk of NCD targets the at-risk individual Randomised controlled trail are conducted, comparing an intervention group with a control group Effective interventions at the individual level are identified These individual-level behaviour change interventions are often unsuccessful at community or population level The challenge is to find a way to change the environment to promote health and reduce risk of disease

The Oxford Health Alliance Community Interventions for Health (CIH) CIH is the largest and most comprehensive multinational collaborative study for community interventions ever undertaken The long-term goal of the CIH study is to create sustainable interventions that prevent and control the leading chronic diseases by addressing the three main risk factors CIH aims to develop, evaluate and showcase sustainable interventions in addressing tobacco use, unhealthy diet and physical inactivity in communities

The Oxford Health Alliance CIH sites and target population Leicester, UK 150,00 Kerala, India Hangzhou, China 300,000 Mexico City 150,00

The Oxford Health Alliance Study design In each study area, an intervention and control site has been selected for comparison Baseline data have been collected from all sites and comprise: -Questionnaires from a sample of the population -Biometrics from a sub-sample -Environmental scans Interventions have been implemented Final data collection for comparison with baseline will be collected at the end of 2011

Knowledge, attitudes and behaviors for healthy eating, physical activity and tobacco use Process system for CIH Inputs for change Locus of change Assessment of change Health education Social marketing Community mobilization Structural change Strategies for change IndividualFamilyCommunitySociety Questionnaires Environmental scan Policy reviews

CIH management board International National Local China IndiaMexicoUK NeighborhoodsHealth Centers Workplaces Schools NeighborhoodsHealth Centers Workplaces Schools NeighborhoodsHealth Centers Workplaces Schools NeighborhoodsHealth Centers Workplaces Schools Organisation of CIH

The Oxford Health Alliance Evaluation: Research Study Sample Survey sample per country site NeighbourhoodSchool children Workplaces (including industry, health centres, and schools) Health care providers (doctors and nurses) TOTAL Intervention site1,0002,0002,700 (1,000, 1000, 700) 4006,100 Control site1,0002,0002,700 (1,000, 1000, 700) 4006,100 SAMPLE AGGREGATE 2,0004,0005, ,200

400m (0.25m) Information Streets Stores and kiosks Cigarette vending Street vending Restaurants and food services Parks and gardens Recreationa l facilities School Evaluation: Environmental scanning for CIH

The Oxford Health Alliance Examples of baseline data Tobacco use in China Overweight and obesity among schoolchildren in Mexico Physical activity among schoolchildren in India BMI of study population in all sites

The Oxford Health Alliance The Oxford Health Alliance Tobacco Use - China Current smoking tobacco Men: 42.9% Women: 1.4%

The Oxford Health Alliance Childhood obesity - Mexico BMI – adjusted for age and gender % (N = 4,082) < – >308.4

The Oxford Health Alliance Frequency of Physical Activity in Indian Schoolchildren

The Oxford Health Alliance Rates of overweight and obesity (BMI>25) Site Adult BMI >25 (%) Child BMI >25 (%) Hangzhou, China Kerala, India Mexico City Leicester, UK46.1no data

The Oxford Health Alliance Interventions – tobacco control in China Extensive health education programme Smoking banned in worksites and public places

The Oxford Health Alliance Interventions – improving diets to reduce obesity in Mexican school children School meals are not routinely provided in Mexican schools Many children eat snacks and fast food from vendors Parents in some schools have begun to cook and provide healthy meals

The Oxford Health Alliance Interventions – increasing physical activity in girls in India Culturally, girls in India are not encouraged to take exercise CIH provides bicycles for school girls and organises cycling lessons

The Oxford Health Alliance Summary – achievements to date Community Interventions for Health has: Been operating since 2008 Involved 750,000 people in 4 countries Been established as the largest global trial of community intervention so far Generated much world-wide interest Published a methodology paper 1 Agreed publication of a manual with Oxford University Press 1.O’Connor Duffany et al. Community Interventions for Health (CIH): a novel approach to tackling the worldwide epidemic of chronic diseases. CVD Prevention and Control (2011) 6: 47-56

The Oxford Health Alliance Challenges ahead Data collection is due to be completed by the end of 2011 Analysis of the data will involve: –organisation and collation –support for the statistical team – one year’s duration (2012) to allow reports from each country individually and then to combine data to give overview results and messages –papers to be prepared for publication

The Oxford Health Alliance Thanks from the team