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School-based diabetes awareness and prevention education in India

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Presentation given by Arogya World CEO, Nalini Saligram, PhD, at the Geneva Health Forum - …

Presentation given by Arogya World CEO, Nalini Saligram, PhD, at the Geneva Health Forum -
PS 07 School based interventions to tackle NCDs

Published in: Health & Medicine

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  • 1. Changing the Course of Chronic Disease, One Community at a TimeSchool-based diabetes awareness andprevention education in India Nalini Saligram, Ph.D. 18 April 2012 Geneva Health Forum PS 07 School based interventions to tackle NCDs Arogya World is a U.S. based non-profit 501 © 3 organization. The name of the organization is simply an articulation of our mission: Arogya in Sanskrit means good health. More literally it means to live a life without disease.
  • 2. Diabetes At Catastrophic Levels in India 50 million. 87 million by 2030 (IDF). India #2. • Urban India prevalence 11 – 12% now vs. 3-4% in the „80‟s Diabetes kills 1MM Indians/yr (2010, IDF). Indians get diabetes 10 years earlier than in the West • >1.1 billion people, 50% < 25 years = alarming public health crisis over the next 20 years Healthcare costs skyrocketing • Low-income family spends 25% of income on diabetes care for 1 adult (IDF). • Diabetic foot ulcers result in 200,000 amputations/year, each costs >$10,000. • India bears heaviest costs of diabetes = 2.1% GDP, $2.8 billion or 11% of total health expenditure in 2010. Increase to $4.8 billion in 2030. 1 person is diagnosed with diabetes every 5 seconds 1 person dies from the complications* of diabetes every 10 seconds 1 limb is amputated because of diabetes every 30 seconds*Complications of diabetes include heart disease, foot ulcers, eye disease, kidney disease etc. © 2010 Arogya World. All Rights Reserved. 2
  • 3. Prevention: The Holy Grail for Tackling NCDs WHO: a healthy diet, exercise and avoiding tobacco can prevent • 80% of premature heart disease • 80% type II diabetes • 40% of cancersCompelling Clinical Proof Exists that Diabetes Can Be Prevented Landmark Trial - Diabetes Prevention Program (DPP) • 3234 high-risk adults in the US. 30 min physical activity/ day + low-fat diet reduced chance of getting diabetes by 58%, (metformin: 31%) NEJM Feb 7, 2002. • The Lancet (2009) …diabetes prevention through lifestyle changes sustained 10 years. Finnish Diabetes Prevention Study  NEJM May 3, 2001. Indian Diabetes Prevention Programme  Diabetologia. 2006 Feb;49(2):289-97. © 2010 Arogya World. All Rights Reserved. 3
  • 4. The Arogya World Approach to the NCD Crisis Two-fold mission Galvanize global action to address Implement Diabetes Prevention non-communicable diseases (NCDs) through Lifestyle Changes in India ► Leverage UN NCD Summit Sep 2011 ► Op-ed, blog and social media campaign ► Multipronged Approach in schools, ► Case studies workplaces and the community ► Women and NCDs ► Leverage technology and partnerships for ► Women for a Healthy Future Petition scalable, cost-effective programs ► 10,000 Women “Perspectives on NCDs” ► Science-based work Global Survey ► Measure effectiveness and impact © 2010 Arogya World. All Rights Reserved. 4
  • 5. Our Whole-of-Society Approach in India:Diabetes Prevention with Lifestyle Changes Community Policy ► mDiabetes: Mobile health outreach – text ► Interact with Policymakers to aid diabetes messages on diabetes and prevention to prevention. 1 million consumers in 12 languages. With Nokia. CGI commitment in 2011. Schools ► Diabetes Awareness & Prevention Workplace ► Healthy Workplace Seal of Approval Education. Teacher/peer-led, 2000 ► Build capacity for Lifestyle Interventionists middle school children Delhi 2011. ► Clinical trial (DPP) based 16 week ► Healthy Schools Seal of Approval diabetes prevention modules Year-long Media and Thought-leader Engagement and Advocacy © 2010 Arogya World. All Rights Reserved. 5
  • 6. Our Schools Work in India Initiated in 2011 in partnership with Hriday, a youth NGO in India Trained Teachers & peer-leaders. Based on previous MYTRI model. Reached 2,000 children in 6 and 7 grades (11-13 years old). 6 schools in Delhi – 3 government, 3 private. 5 classroom-based interventions. Age appropriate educational modules. Pre- & post intervention surveys. Analysis completed; results are in. Encouraging awareness and behavior change trends. Supported by Merck/MSD India. Second year intervention in the same children will help behavior changes “stick”. © 2010 Arogya World. All Rights Reserved. 6
  • 7. First Results
  • 8. Awareness and Knowledge Improved Unhealthy Eating Increases Physical Inactivity Increases100 Risk for Diabetes Risk for Diabetes 90 100 80 90 70 80 60 77.2 70 50 65.4 60 40 50 61.3 50.1 40 Baseline Year 1 Baseline Year 1 Diabetes Complications Diabetes is Preventable Knowledge 100100 90 90 80 80 70 70 60 60 73.2 50 50 67.3 40 50.7 42.1 40 30 Baseline Year 1 Baseline Year 1
  • 9. First Signs of Behavior ChangeUnhealthy Food Consumption Reduced Carbonated Fried Snacks40 Drinks35 4030 3525 3020 2515 2010 15 15.6 10 5 8.9 0 5 9.8 7.8 0 Baseline Year 1 Baseline Year 1 Sweets Chips40 4035 3530 3025 2520 2015 1510 10 21.4 18.8 15.3 5 10.3 5 0 0 Baseline Year 1 Baseline Year 1
  • 10. More Exciting Evidence of Behavior ChangeChildren Consistently Chose Healthier Foods Lemonade over Soda Fruit chaat over Aloo Tikki 100 100 80 80 60 60 40 75.1 62.6 40 20 60.3 68.9 20 0 0 Baseline Year 1 Baseline Year 1 Rajma Rice over Chole Poha over Samosa Bhatura 100 80 100 80 60 60 40 63 40 50.8 57 64.3 20 20 0 0 Baseline Year 1 Baseline Year 1
  • 11. Back-Up
  • 12. Arogya World Network of InfluencersBoard* Dr. Nalini Saligram – Arogya World; Dr. Pamela Yih, Treasurer – Pamela Y-F Yih Inc.; Kathryn Graves – Emory Univ Rollins School of Public Health; Dr. MeryleMelnicoff– formerly at WISTAR InstituteIndo-US Scientific Steering Committee* Based in India - Dr K. Srinath Reddy – President, Public Health Foundation of India, Dr V. Mohan – Madras Diabetes Research Foundation, Dr Ashok K. Das – Additional Director General Health Services, Dr Prabhakaran – Centre for Chronic Disease Control, and PHFI, Dr Nikhil Tandon – All India Institute of Medical Sciences, Dr. Prasanna Kumar – Bangalore Diabetes Hospital Based in the US - Dr K.M. VenkatNarayan – Emory University, Dr Sreekumar Nair – Mayo Clinic, Dr Francine Kaufman – Medtronic, Dr KarmeenKulkarni – Abbott Diabetes Care, Dr Sethu Reddy – Merck, Dr. Om Ganda -JoslinAdvisors*Dr A Ramachandran - India Diabetes Research Foundation, Chennai; Dr SubhankarChowdhury-IPGME&R and SSKM Hospital, Kolkata; Monika AroraHriday-Shan; C.V. MadhukarPRS Legislative Research; Deanna M. HoelscherMichael and Susan Dell Center for Advancement of Healthy Living; Dr Sudeep Singh Gadok, International Health and Development Expert; Raj Dave ARE Consulting, Dr. ArunChockalingamWorld Hypertension League, Dr. David C U’PrichardDruid ConsultingBehavior Change Task Force* Based in the US - Dr. Fran Kaufman, Medtronic, Dr. LinelleBlais, Emory University, Andrea Falls, Edelman Based in the UK – Zoe Hellman, Weight Watchers Based in India – Dr. Ranjani Harish, Dr. Mohan‟s Diabetes Specialities Centre, Dr. Monika Arora, Hriday-Shan, SukantiGhosh, APCO Worldwide, Dr. KanavKahol– PHFI*all working pro-bono+ConsultantsTheaJoselow (Washington DC – digital media expert), Dr. S Kumar (Bangalore - senior consultant India), Dr. SandhyaRamalingam (Bangalore – market research expert), Beau Young (Philadelphia- accountant)
  • 13. Our Track Record • Feb 2009 – Workshop with 66 stakeholders in Delhi to gather input on priorities. • World Diabetes Day 2009; 40 community walks in Delhi; 6,000 children asked MrsGursharanKaur, wife of Prime Minister of India, for help in making policy changes •Formalized as US-based non-profit organization March 2010. •New Diabetes Friendly Recipe Created for Arogya World by celebrated Manhattan chef from Devi Nov 2010 •Initiated Schools diabetes education program in India 2011; completed year 1 program, encouraging results •Clinton Global Initiative Commitment 2011 – 1 million consumers diabetes mHealth campaign in India; 30,000 consumers received messages through March 2012. • Healthy Workplace Stakeholder Input Session in India Bangalore, Feb 24, 2012 •Women for a Healthy Future – 2011 petition;