1. COMMUNITY INTERVENTIONS FOR HEALTH SUCCESSES AND CHALLENGES IN MEXICO Jorge A. Ramírez, Teresa Fernández, Gabriela Capó, Vianey Cortés, Samanta De Larrosa, Diana López, Marlene Medina, Beatriz Champagne

3. Baselines Data Sectors% current smoked tobacco user % current smokeless tobacco user % PA<30 minutes per day, 7 days every week * % PA<1 hour per day for children % >=5 servings of fruit and vegetables per day MFMFMFMF Youth 18.5114.968.445.1183.7790.2318.5522.14 Community 28.5913.221.060.8523.1224.7414.3515.30 Workplace 27.4018.441.000.4736.1748.765.529.91 Clinicians 17.609.1200.2940.8042.9423.2031.34

4. Baseline Data Summary Points School aged children Low levels of physical activity among school children Girls are less physical active than boys Girls are eating more fruits and vegetable than boys Smokeless tobacco uses is higher in school-aged children compared to adult population 7.1% of students in lower grade reported smokeless tobacco use as compared with 5.8% of students in upper grades

5. Baseline Data Summary Points Cont… Adults in different settings Adults in the community report higher level of physical activity than adults in workplaces and clinicians Adults are not physical active daily 10.0% males and 14.9% females are doing less than 30 minutes of PA per day on average Adults are not eating sufficient amounts of fruits and vegetables especially in workplaces Among adult population clinicians had highest reported level of meeting the recommended fruit and vegetable consumption

6. RATIONALE OF THE INTERVENTIONS 1. Define microregions to pull together, in a geographical area, cultural & socio economic characteristics Pueblos, ( rural traditional) Barrios(urban traditional) Barrios ( Colonias (urban) Blocks of flats

8. RATIONALE OF THE INTERVENTIONS Schools and health care centres as the driving forces of intervention. Up to 20-25% of the community is contacting through the students. 20,000 medical consultations are delivered in the primary health care system of Tlalpan monthy.

11. Rationale of the Interventions Main stakeholders

12. Intervention: schools Nutrition education and promoting the establishment of canteens Working with different stakeholders to improve the types of food offered in schools

13. School: Interventions Promoting and implementing physical activity 3 times a week

15. Posters created by school children on healthy eating School Interventions

16. Intervention: health centres Educating patients on nutrition and physical activity

17. Promoting physical activity within health care facilities Intervention: health centres

18. Health promoters 100 paid health promoters funded by National Sports Commission and Delegación Tlalpan (local authority). Community oriented 400 trained volunteered promoters Doctors and health care personnel in contact with patients, teachers and different people in the community. Target population 200,000 people

20. Intervention: community Community fiestas Health promoters activate community members Education on nutrition Creating open air gyms Creating health murals

24. Community murals

25. Materials prepared by the community

26. Material prepared with the community

28. Challenges Mexico is the most obese country world wide Time required to cultivate partnership with key stakeholders Important policies can be passed by decision makers but there are inconsistencies in how policies are implemented Food environment is not supportive for healthy eating Lots of high fat food/salt foods, soft drinks are widely consumed and available A very large informal market in food retail with unhealthy food.

29. Successes CIH has brought national programmes to Tlalpan Develop culture of healthy living and physical activity in young people and in the community Better coordinated efforts to tackling obesity epidemic in Mexico City Energizing different stakeholders toward action in prevention NCD CIH being recognized and consulted as experts in NCD prevention

30. Sustainability Ministry of Health in the City of Mexico is considering scaling CIH activities city wide CIH trained health professionals will continue to prescribe patients on physcal activity, nutrition and tobacco counselling Advising on operation of new hospital in Tlalpan Funding for health promoters will continue afterwards

31. Thank you