Com3 monini luisa

Empowered Women Leading Business
Freda Miriklis
BPW International President

28th BPW INTERNATIONAL CONGRESS
JEJU - KOREA
23-27 MAY 2014
Welcome to this workshop organized by the Health Committee titled:
“When women are well, business & economy do better”.
When women are well, business & economy do better
Luisa Monini
BPW International Health Committee Chairperson

L. Monini - When women are well, business & economy do better

OUR
PANELIST

BPW INTERNATIONAL HEALTH COMMITTEE
• Increased levels of savings for investment
• Levels of education and vocational training
• Job possibilities
• Productivity
Women’s Health status may have effects on the economic
system through different modalities but closely connected
one to each other:

THE WELL-BEING
OF THE
POPULATION AND
THE WELFARE OF
THE NATION ARE
BASED ON:
THE CORNERSTONES OF A STRONG ECONOMY
INVESTEMENT
IN HEALTH
ECONOMIC
GROWTH
HEALTHY
POPULATION

In coordination with our President Freda Miriklis I have
been supporting the Women’s Empowerment Principles
outlined by UNIFEM from the Health point of view, and in
particular WEPs 2, 3 and 4:
N.2 Treat all women and men fairly at work –
Respect and support human rights and nondiscrimination
N.3 Ensure the health, safety and wellbeing of all
women and men workers
N.4 Promote education, training and professional
development for women

Primary education is the key to achieve the Millennium Development Goals by 2015. Still
today, however, there are more than 70 million children out of school, half of whom live in
sub-Saharan Africa and are mostly girls. Education for thousands of girls means salvation
from everything that lack of which means lack of awareness of themselves, of their own
rights, of access to cure, of safeguard of their own children, of becoming an integral part of
their own country’s social- economic life and, in the end, of becoming real citizens of the
world.
Csw, United Nations Headquarters, New York, 2007

Freda Mirikilis
BPW International President
Empowered Women Leading Business
Luisa Monini Brunelli
BPW International Health Committee Chairperson
When women do well business and economy do better
TRIENNIUM REPORT
HEALTH COMMITTEE
2011-2014
EMPOWERED WOMEN LEADING BUSINESS

International Health Committee BPW Italy
- Rosamaria LaScola - Fidapa-BPW Italy Sicilia
- Anna Parrini - Fidapa-BPW Italy Toscana
- Paola Sbisà - Fidapa-BPW Italy Friuli Venezia-Giulia
THE RED BELT PROJECT

International
Contributions
The Red Belt
Nicole Alleyne
BPW Barbados
Kathryn Ciccolini
BPW USA
Anastasia Safarian
BPW USA
Sara Louzan
BPW Argentina

Diet and physical activity provide a risk reduction equal to 33% and also
reduce abdominal obesity levels, lipid and blood pressure levels. If you also
stop smoking you can reach a value of 50% of potential global risk reduction.
You also reduce the risk of developing diabetes.
The American Heart Association (AHA) stressed the importance of early
prevention, the earliest the better.
THE RED BELT: FIDAPA-BPW ITALY- BPW INTERNATIONAL PROJECT & NFI:
“The Red Belt“
Today we talk more about cardiovascular diseases as compared to other
fearsome diseases because they are responsible, with bronco-pulmonary
pathologies, for 85% of deaths around the world and for 70% of disability.
Notable figures who have a significant impact on GDP of all countries by
direct medical costs and indirectly in terms of lack of productivity. Direct and
indirect healthcare costs for cardiovascular diseases in 2010 were $ 450 billion
and it is estimated that in 2030 will reach $ 1 trillion. On the other hand the
increasing of 5 years in the life expectancy of the population determines an
increase of 0.3%-0.5% in the growth rate of GDP

CAUSES OF FEMALE CARDIOVASCULAR RISK
The causes of increased female cardiovascular risk include:
It is essential to activate and intensify preventive strategies,
specifically aimed at women
It is therefore mandatory to spread to all women targeted information and
easy-to-use tools that allow them to check in a completely autonomous way
simple but important parameters for prevention and care.
• low academic attention to a disease
the frequency of which is
underestimated in females
• less female attention to major factors
that determine CVR
• low risk awareness in women

That is… Everybody must know their cardiovascular risk
In order to achieve this important goal we must promote in every single person
a conscious prevention. Everyone should know:
• Blood Lipid Levels
• Blood Glucose Levels
• Blood pressure
“The Red Belt“
The Red Belt Project is based on rigorous scientific research; this project
aimed at empowering women with the tools to monitor their Cardiovascular
risk in a simple, quick and cheap manner.

• EDUCATIONAL LEAFLETS FOR PARTICIPANTS
“The Red Belt“
GOLDEN GOAL
WOMEN'S HEALTH MUST BE PROTECTED AND PROMOTED GLOBALLY
• INVESTING IN HEALTH LEADS TO REDUCED
DISABILITY AND LOWERING LOSS OF PRODUCTIVITY
• CAUSES OF FEMALE CARDIOVASCULAR RISK NEED
TO BE BETTER KNOWN
• BETTER INDICATORS FOR ASSESSMENT OF
CARDIOVASCULAR RISK ARE NEEDED
• INFORMATION ON PREVENTING FEMALE
CARDIOVASCULAR RISK
• CALCULATION AND EPIDEMIOLOGY OF WSR
(WAIST/STATURE RATIO) A NEW PARAMETER TO
MEASURE THE CARDIOVASCULAR RISK
STRATEGIES
TOOLS: INNOVATIVE
FORCE OF THE PROJECT

INDICATORS FOR ASSESSMENT OF
CARDIOVASCULAR RISK
Several epidemiological studies have confirmed the importance
of abdominal circumference (waistline), and of its relationship
with the height (WSR, or waist/stature ratio) as an indicator of
abdominal fat and cardiovascular risk, more effective and trusted
than body mass index ( BMI ), which describes the relationship
between weight and height without considering the distribution of
body fat.
Practically speaking:
If height is shorter than double our abdominal circumference
The cardiovascular risk is increased
The relationship between waist circumference and height, proposed by American
authors, plays a better role, from a predictive standpoint, than BMI; this parameter
should be below 0.50.
To obtain the value simply divide the waist by the height, and if it is above 0.5 (i.e., the
waist is more than half the height) the abdominal fat is in excess and therefore the
person is at risk of developing cardiovascular disease.

Intra-abdominal adiposity is closely correlated with
abdominal obesity
Waist circumference (cm)
300
200
100
0
r = 0.80
60 80 100 120
IAA(cm2)
IAA: intra-abdominal adiposity;
CT : computed tomography;
MRI: magnetic resonance imaging
To assess IAA, the simplest measure of abdominal
obesity is waist circumference, which is strongly
correlated with direct measurement of IAA by CT
scan or MRI, considered to be the gold standard
Visceral adipose tissue
Subcutaneous adipose
tissue

SO, GENERALLY SPEAKING, THE LESS VISCERAL FAT YOU HAVE, THE BETTER IT IS.

INFORMATION ON PREVENTING FEMALE
CARDIOVASCULAR RISK
To promote a better and wider knowledge of cardio-metabolic risk and thus
contributing to the prevention of heart failure and stroke.
The BPW International Commission for Health,in partenership with NFI (Nutrition
Foundation of Italy)
PROMOTED
The project launched in Sorrento during the 14th BPW European Congress, has
been expanded to the BPW International countries across five Regions.
Measuring a new CV risk factor
Spreading information
Data gatherig. Statistical analysis
BPW-Women’s Health Day, for:

Doctors, Nurses or BPW International affiliates collected information about age,
job, weight, waist, height, blood pressure, medical history, lifestyle of women
(smoke – alcool) of all ages in city squares and assessed the presence of
cardiovascular risk factors.
What distinguishes this initiative is the assesment of two parameters that make it
possible to tell women, in any context and instantly, what is their metabolic and
cardiovascular risk.
HeightWaistline

Women participants have been given ad hoc information (gadgets,
leaflets) and have been provided with guidance on cardiovascular
prevention and on the importance of controlling abdominal fat to
reduce cardio-metabolic risk.
The leaflets highlighted the benefits of adopting a proper diet and an active
lifestyle to keep waist height ratio under 0.5
Two types of leaflets, according to waist-height ratio, have been
distributed:
• Leaflets for women with
optimal ratio (≤ 0.5 )
• Leaflets for women with
high ratio (> 0.5 )

THE RED BELT TOOLKIT
1)The advertising video you saw and a longer one, in Italian and in English where
Dr.Andrea Poli explains the scientific reasoning behind The Red Belt Project
2)The Power Point Presentation, with explanatory notes
3)The Abstract
4)The two Information pamphlets in various languages for at-risk and not-at-risk women
5)Data gathering forms
The Red Belt Project provided any BPW member interested in contributing with
a complete downloadable toolkit, which I developed personally and
distributed free of copyright and free of charge, to make it as accessible as
possible. It consists of a fully annotated presentation with all the scientific
explanations BY MEANS

WE ONLY NEED A RIBBON METER!
BUT HOW CAN WE KNOW IF WE ARE AT RISK?

Cardiometabolic Risk
How to measure Waist Circumference
Locate upper hip
bone and top of
right iliac crest
Place measuring
tape in horizontal
plane around
abdomen at iliac
crest
Ensure tape is snug;
but does not
compress the skin
Tape should be
parallel to floor
Record
measurement at the
end of a normal
expiration

ENGLISH
1) measure (standing) the circunference of your waist at the navel
2) measure your height
3) divide your waist circunference by your height
4) check the result :
5) if it is less or equal to 0,5 that means you are right. If it is more than 0,5 you are at
cardiovascular risk.
FRANCAIS
1) mesure en te tenant droit la circonference de ta taille au nombril
2) mesure ton hauteur
3) divise la circunference de la taille par l'hauteur
4) controle le resultat
5) si il est moin de 0,5 tu es bien, s'il est plus que 0,5 tu es a risque cardiovasculair
ESPANOL
1) mesura la circunferencia de la talle a l'ombligo
2) mesura tu altura
3) divide la circunferencia por l'altura
4) controla el resultado
5) si esta menos que 0,5 , todo va bien. Si esta mas que 0,5 tu es a risgo
cardiovascular

DEUTSCH
1) messen daine Taillenweite
2) messen daine Grosse
3) viertein das Taillenweite durch das Grosse
4) kontrollieren das Resultat
5) wenn weniger als 0.5,in Ordnuung, wenn mehr als 0,5 Sie Gefahr laufen
(Herzkranker)
ITALIANO
1) Da stazione eretta, misura la tua circonferenza vita, all'altezza dell'ombelico.
2) Misura la tua altezza
3) Dividi la misura della circonferenza vita con la misura della tua altezza
4) Controlla il risultato
Se minore uguale a 0.5 vuol dire che stai bene
Se maggiore di 0.5 vuol dire che sei a rischio cardiovascolare

The data, collected by NFI, have been used to evaluate the distribution
of two cardio-metabolic risk factors: waist circumference and waist-
height ratio.
As of March 2013, NFI had received data from three of the five BPW
Regions: Europe, South America and North America.
This sample is still too small for doing a complete and detailed statistical
analysis.
Nevertheless it’s still possible to observe some interesting results

Italy North America Argentina
City/club Trieste San Vincenzo Canicattì
(n) (n=39) (n=28) (N=14) (n=51) (n=93)
Age (y) 46.7 54.6 60.1 45-54 70.8
Age range
(y, min-max)
23-79 46-69 35-86 >18, 75+ 50-89
Children (yes) 20 23 9 29
Schooling
Middle school 4 12 1 0
High school 24 10 5 5
University 11 6 8 46
Smokers 8 6 0 2
Alchol (yes) 0 6 2 38
Weight (kg) 66.28 62.82 63.48 69.85 70.79
Height (m) 1.63 1.65 1.60 1.65 1.60
Waist (cm) 81.15 86.57 85.36 82.09 87.59
BMI 24.84 23.07 25.01 25.59 27.82
Waist/Height 0.50 0.53 0.54 0.50 0.55
SBP (mm Hg) 126 124 129 115
DBP (mm Hg) 75 79 78 71

South America had the highest average W/H ratio (0.55) and also the highest BMIs and
highest average BMI.
North America had an average W/H ratio that fell exactly at 0.5, our threshold between
risk and non-risk, yet it had an average BMI in the “overweight” scale. Note that blood
pressure, both systolic and diastolic, was on average lower in North America than
elsewhere. This suggests that the Northamerican women risk is actually overestimated by
BMI, and that using the W/H ratio some overweight person would be more properly
classified at normal risk.
In Centre Europe we found an average W/H ratio that is 0.5, the ratio was slightly higher
in Southern Europe. Compared to North America, which gave similar W/H ratios, BMI are
lower. Yet blood pressure is higher.
Characteristics of the five population groups

10%
7%
5%
11%
20%
14%
33%
Coronary heart desease
Stroke
Other CVD
Cancer
Neuropsychiatric Disorders
Injuries
All other causes
CORONARY HEART DESEASE 10%
STROKE 7%
OTHER CVD 5%
CANCER 11%
NEUROPSYCHIATRIC DISORDERS 20%
INJURIES 14%
ALL OTHER CAUSES 33%
Heart failure is, statistically, the first cause of death in women. Half of all
unnecessary early deaths in the Western countries are due to
cardiovascular diseases. And those who don’t die, risk serious
impairment.

The Red Belt Project will not finish here in Jejù. I hope that it will be
used to continue monitoring BPW Women’s Health and that of our children by
presenting it in schools as a scientific monitoring system against childhood
obesity and all it entails.
Dear Ladies in Red

FAT EXCESS
Fat excess is measured by B.M.I. (body mass index ) that is equal to
weight divided by squared height.
(bmi 25-30 )=Overweight
(bmi 30-35 )=Mild Obesity
(bmi 35-40)=Medium Obesity
(bmi>40 )=Serious Obesity
Height 1,70 m Weight 62 kg:

“The Red Belt“
SCIENCE BANISH BMI TO THE LOFT

Subcutaneous adipose tissue
INTRA-ABDOMINAL (VISCERAL) OBESITY

Cardiometabolic Risk
How to measure Waist Circumference
Locate upper hip bone and top of
right iliac crest
Placemeasuring tape in horizontal
plane around abdomen at iliac
crest
Ensure tape is snug; but does not
compress the skin
Tape should be parallel to floor
Record measurement at the end of
a normal expiration

I.A.A. is a major contributor to increased
cardiometabolic risk
Kershaw EE et al, 2004; Lee YH et al, 2005;
Boden G et al, 2002
Associated with
inflammatory markers
(C-reactive protein)

Free fatty
acids
Inflammation
Insulin
resistance
Dyslipidaemia
Increased
cardiometabolic
risk
IAA = high risk fat
Secretion of
adipokines
(↓ adiponectin)

IAA: intra-abdominal adiposity

Life-Style Modification: Is it Important?
Exercise
Weight loss
Goals
Improves CV fitness, weight control,
sensitivity to insulin, reduces incidence of
diabetes
Improves lipids, insulin sensitivity, BP
levels, reduces incidence of diabetes
Brisk walking - 30 min./day
10% reduction in body wt.

“The Red Belt“
All of this has enormous direct and indirect costs on governments. Think
of how much money is spent treating the diseases and caring for the
invalids, and think of how much money is lost when these women and
men die prematurely. All of this is preventable. Identifiable risk factors
account for 90% of global risk. Diet and physical activity alone account
for 33%. Add smoking and you reach 50%. And there can be no
economic growth without a healthy population.

• More fatty acids to the liver
• More triglycerides in blood
• Less “good” HDL cholesterol
• More inflammation
• More Insulin resistance
MORE CARDIOVASCULAR DISEASES
Subcutaneous adipose tissue
INTRA-ABDOMINAL (VISCERAL) OBESITY

Screening/Public Health Approach
Public Education
• Blood Sugar
• Lipids
• Blood pressure
• Tobacco use
• Body type
• Family history
Screening for at risk individuals:

The Red Belt Project provided any BPW member interested in contributing with a
complete downloadable toolkit; which I developed personally and distributed free of
copyright and free of charge, to make it as accessible as possible. It consists of a fully
annotated presentation with all the scientific explanations, the advertising video yousaw
and longer one, in Italian and in English, with a clear, concise scientific analysis of the
research; pamphlets in various languages for at-risk and not-at-risk women; and data
gathering forms.

THE RED BELT TOOLKIT

NFI agreed to cooperate, as scientific partners with BPW-International in defining the
aims of the project, in presenting the project to the Congress in Sorrento and in
preparing informative material, which has been set up on the basis of international
guidelines in terms of prevention and control of cardiovascular risk factors.
THE NFI EFFORTS CONSISTED IN:
• preparation of questionnaires to be administered during the International Day
BPW-NFI CO-OPERATION
• processing of data posted no later than May 2013
• preparation of information materials on women's cardiovascular prevention (leaflet and
poster)
• gadget definition

Com3 monini luisa

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