Mobile health without borders

1. Team: MH LatinAmérica.

2. Members:
Marina Rojo (Leader)
José Rubén Montañez Sánchez
Nicolas Baranek
David Alanís
Rommel Morel
Héctor Pizarro
Paulina Teresa Zanela

3. TOPIC: Use of Mobile to reduce obesity in LatinAmérica.

4. Description of the problem.
Topic selection, concept and vision:
Obesity in latin América
 Over the past three decades the prevalence of overweight and obesity has
increase substancially. Globally, en estimated 170 million children (aged less
18 years) are estimated to be overweight, and in some countries the number
of overweight children has trebled since 1980. The high prevalence of
overweight and obesity has serious health consequences.
 Raised body mass index (BMI) is a major risk factor for diseases such as
cardiovascular disease, type 2 diabetes and many cancers including,
colorectal cancer, kidney cancer and oesophageal cancer.
 These diseases, often referred to as non-communicable diseases (NCDs)
 No only cause premature mortality but also lon-term morbidity.
 In addition, overweight and obesity in children are associated with
reductions in quality of life and a grater risk of teasing, bullying and social
isolation.

5. Due to the rapid increase in obesity prevalence and the serious health
consequences, obesity is commonly considered one of the most health
challenges of the early 21st century.
 In Latin América there are several problems associated to the lack
of access: to services, rights, clean water, food, etc. leading to a dual
epidemiological burden of infectious diseases, infant mortality; but
also chronic disease, cancer, TB, diabetes, etc. There is a lack of
adequate information in order to implement right programatic
decisions.

6. Most of our health systems have had a curative emphasis instead a
preventive one through the last years. Since the Alma-Ata 80´s conference,
WHO invited the country members to revert this and to build an horizontal
system, with the primary focus in health maintenance, health promotion and
healthy life styles, and of course ti treat diseases as well.
Due to the lack of attention of those recommendations, there is an increase of
non transmitted chronic diseases, preventable, most of them promoting
healthy lifestyles and frequent medical visits. In Latin America we don’t have
the culture of routine check ups. We visit the doctors only when we are sick.
We must work in the prevention culture and health education.
For example in Mexico the health problems are serious and multifactorial:
Obesity is related with the consumption of non-nutritional food (being the first
place in this), it is also related to the lack of government control about
advertising and healthy use of nutritional products. The pharmaceutical
industry is huge and promote consumption rather on prevention.

7. All this has been aggravated with the dramatic fall of the national income product
and personal income, getting to a worse health situation.
The health coverage is wide but with lack of quality, lack of investment and medical
training. The services are usually insufficient to cover the demand. Patients can take
months before can have an specialized consultation.
Once in awhile there’s some sort of advertising to promote healthy nutritional habits,
but they aren’t permanent. The programs of safety school and healthy food don't
have an impact due to inadequate school norms or condition being the teachers to
carried out those initiatives.

8. 2. Existing solutions.
The Global Strategy on Diet, Physical Activity and Health (DPAS) was
developed by the World Health Organization (WHO) in 2004 to address
the increasing prevalence and burden of NCDs. More specifically, the
strategy focuses on improving global diet and physical activity patterns,
two of the main risk factors for NCDs.
The four main objectives addressed by DPAS are:
1. To encourage the implementation of public health action and
preventative intervention to reduce the risk factors which result from
unhealthy diet and physical inactivity.
2. To increase recognition of the implications of unhealthy diet and
inadequate physical activity levels and knowledge of preventative
measures.
3. To promote policies and action plans at all levels to address diet and
physical activity behaviors.
4. To encourage monitoring, evaluation and further research.
DPAS calls for priority to be given to the socially, economically and
politically disadvantaged, and for the unhealthy diet and physical activity
behaviours of, in particular, children and adolescents to be addressed.

9. Different campaigns have been carried out but the characteristic of Latin
america is cultural diversity of languages and customs, one solution for one
country may not be feasible for other. People do not adapt to official
messages, at the contrary the messages must be adapted to the
communities. In order to give access primary care it´s essential the use of
voluntary workers, give them access to information, permanent update, tools
to work. Although the use of mobile phones is wider more and more, there
are many educative and cultural app´s for health: still exist wider way to go
with documented experiences with anthropological and sociological focus, in
order to have information on how to go in this direction. We can start a
project in the area of communication and information in the topic of obesity to
people in urban and slum areas, with cellular phones, and register
extensively the experience.

10. 3. Possible innovate solutions.
Educate to lower income population the obesity problem with one app for
mobile phone with a process of gamification which can motivate and modify
behavior, with the support of health workers to support the opportunities of
community health workers through technological tools such cellular phones,
tablets, communication in real time with doctors in case of emergencies,
hospitals networks, etc.
Smartphone applications are now being developed to target changes in
weight-related health behaviors and conditions related to obesity such as
diabetes. A recent review of mobile phone interventions to increase physical
activity and reduce weight found two studies in which smartphone-based
interventions were tested.
Use of mobile technologies, social media, web-based interventions, and other
new technologies for obesity research, prevention and treatment.
Design an application to promote the increase of physical activity and
consumption of fruits and vegetables using a simplified points system for self-
monitoring and team-based social interaction addapted to latin american
population.

11. Nutritional counseling.
Require resources (human/materials) health workers, community leaders,
government, civil society, academy, tablets, cellular phones, monitoring
and measurements system.
Target population: age groups (children, teenagers, young adults, old
adults)
How to evaluate impact: the only way is the registration of measurements
of the group and do this in regular basis.

12. References:
http://www.who.int/dietphysicalactivity/childhood/Childhood_obesity_Tool.pdf
http://mhealth.jmir.org/2013/1/e3/
http://www.saludymedicinas.com.mx/herramientas/infografias/diabetes-en-el-mund
http://www.chicanol.com/mexicanos-obesos-sin-dieta-
latinoamerica-esta-cada-dia-empeorando-su-salud/