This document outlines Dr. Susie Perera's presentation on non-communicable diseases (NCDs) in Sri Lanka. It discusses the high burden of NCDs in the country, which account for 70% of deaths. The main risk factors driving the NCD epidemic are an aging population and changes in lifestyle, including unhealthy diets high in salt, sugar, and trans fats but low in fruits and vegetables, physical inactivity, smoking, and alcohol use. The Super Eight program is introduced as a social marketing tool to promote lifestyle changes through eight simple health targets related to body mass index, salt, sugar, trans fats, physical activity, tobacco, fruits/vegetables, and blood pressure. The

1. Dr Susie Perera
Director Organization Development
And Policy Analysis, Ministry of Health
Bishops College
31st
October 2013

2. Outline of presentation
 NCD problem in the country
 Common risk factors and lifestyle
change
 Social marketing tool- Super Eight
 lifestyle change within the School

3. This is for...
YOU
and
Your
Organization

4. Why?
 Hypertension
 Ischemic Heart Diseases
 Diabetes
 Stroke
 Chronic Respiratory Diseases
 Cancer
70% of
deaths in Sri
Lanka due to
NCDs!

5. In Sri Lanka
There are
350
Deaths per day
250
Deaths due to NCD per day
100
Deaths per day due to Heart Disease
40
Deaths due to Stroke

6. Prevalence of chronic NCD
• Prevalence of hypertension 20-25%
(wijewardana et al 2005 , risk factor study 2006)
One in FIVE
• Prevalence of diabetes –( age over 20 ) around 10%
(katulanda et al 2006)
One in TEN

7. Determinants of Non Communicable
Diseases

8. Aging population

9. Lifestyle change
• Occupation
• Transportation
• Day to day work at home
• Housing and limitation in
space
• Dietary pattern
• Smoking / alcohol
• Leisure time activities

10. Prevalence of NCD risk factors among adult population
(18-65 Years)
22.80% 26.00%
81.40%
18% 20%
0.30% 1.20%
83.30%
31.90% 30.40%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
Current smokers Alcohol users Unhealthy diet Physical inactivity Over weight and
Obese
Percentage
Present situation on major risk factors
Male
Female

11. In Sri Lanka - rise in NCD burden is due to
 Aging population
AND
 Increase prevalence of NCD risk factors
(Changes in lifestyle )

12. Main 4 risk factors – for NCDs
 Smoking
 Alcohol
 Physical inactivity
 Unhealthy diet

14. Every street corner

18. Smoking

19. Alcohol!

20. Ideal weight for height
Waist circumference !

21. How figure conscious are you?
Your BMI is a good predictor of Health risk!
It is a net result of your lifestyle
What you eat!
Drink – including alcohol!
How much physical activity you engage in!

22. Fruit and vegetables

23. Typical Sri Lankan diet
 A mountain of rice with some vegetables

24. SALT!

25. Adding Salt to the rice pot?
An average Sri Lankan consumes more
than twice the daily recommended amount
of salt.

26. 1. Spreads on bread
2. Sauces with rice
3. Several rice pullers [lunudehi,
chillipaste,karawala jadi]
4. Added salt at the table
Are you in the habit of using...

27. ADDED SUGAR!

28.  Milo pack – 3 tsp
 Sprite (buddy bottle) – 4.2tsp
 EGB (buddy) – 5 tsp
 Smack mix fruit pkt – 5.2 tsp
 Pepsi (buddy) – 5.2 tsp
 Fanta (buddy) – 5.4 tsp
 Elephant House Cream Soda (buddy) – 6.0tsp
 Elephant House Necto (buddy) – 6.3 tsp
 Mirinda (buddy) – 6.8 tsp
 Coca-cola (buddy) – 9.5 tsp
(see poster for further information)
Do you know that popular beverages
contain high sugar levels?

29. Are you in the habit of having:
Cool drinks (high sugar) for
thirst?

30. Common myths about sugar intake
• I am not a diabetic, you can add some more sugar to
my tea.
• We do not have diabetics in our family, so I can enjoy
more sugar.
• Drinking any amount of “no-added sugar drinks” is
okay!

32. Trans fat

33. Fatty food

34. Trans fats are formed…….
• High heat for stir frying
• Repeated use of the same oil for frying
Even if sunflower oil, corn oil and olive oil are
used.
Trans fats are also found in…….
• Cakes, Biscuits, Pastries (worse is flaky and
puff pastry!)
• Some Salad dressings (eg. mayonnaise)
• READ FOOD Labels!

35. Physical Activity- do you look for
opportunity or take the easy way
out ?

36. Prevention is better than cure

37. Impact of prevention

38. Health Planners point of view : The
Need for a Population wide strategy –
WHY ?Increasing NCDs in rapidly aging population
Increasing NCDs even at a younger age
Significant level of unhealthy practices
Same cardiovascular risk factors are
determinants of several common chronic NCDs in
Sri Lanka
Low level of awareness on modifiable risk factors
Lesser Emphasis on synergy of several
modifiable risk factors – often awareness
programs mention one at a time
A strategy is needed to address DEMAND and
SUPPLY towards healthier lifestyles

39. The Need for Majority to adopt
good practices
 Lifestyle change is needed across
board for all
 START early! – changes
take place over a long
time
 All risk factors need to be addressed in a collective
manner

The message for collectiveness is
important

40. Super eight formulated
Scientific evidence based approach to
identify Eight health targets
Social marketing principles were used to
identify the eight health targets in a
branded form
 – Super eight: A simple way for a better
life

41. Determinants of Non Communicable Diseases

42. Common Risk Factor
Approach

43. SALT

44. 1 level tea spoon of salt per person per
day
A 400 g pack of salt should be sufficient for a family of
4 for 20 days
Target

45. SUGAR

46. Target
Avoid excess added sugar
not more than 6 teaspoons of sugar per
non-diabetic person per day

47. Trans fat

48. Target
Limit food with Trans Fats
found in some commercially baked and fried
food such as short eats, pastries, cakes and
re-heated oil

49. Fruit &
Vegetables

50. Target
Consume 5 servings of Fruit & Vegetables per
day (the recommended amount is 400 gms of Fruit and
Vegetables per person per day). Remember variety is good.

51. Physical activity

52. Target
At least 30 minutes of moderate physical
activity per day for at least 5 days a week
brisk walk, aerobic exercises, cycling

53. Tobacco &
Alcohol

54. Target
Give up smoking and Alcohol

55. Body Mass Index
(BMI)

56. Target
Maintain your Body Mass Index (BMI)
between 18.5- 24.9 (the ideal is 23)

57. Blood Pressure

58. Target
Maintain your Blood Pressure below
140 /90.
Check your blood pressure annually

59. Totality !
Those who are exercise fanatics also get heart
attacks!!
Those who never smoke also get heart attacks!!!
Those who are pure vegetarians ……
Those who claim that they never had a sweet
tooth…….
The Combination of Risk
factors need to be addressed

60. Common risks that address the range of NCDs
• BMI ( over weight or obese)
• Unhealthy diet( salt, sugar, tans fat,
low intake of fruit and vegetables)
• Physical inactivity
• Smoking & alcohol

62. From Health Sector –
The Way forward to empower people and
institutionalize Super Eight
• Training all MOOHs in the country
• creating greater Community awareness through MOOHs
• Institutionalizing Super Eight through government and private
sector
• Taking Super eight to pre schools , schools and youth groups
• Creating super eight conducive market - catering to new demands
of people who want to change lifestyle
• Promoting home gardens to increase fruit and vegetable
consumption

63. Super Eight Reach
 Government institutions (166)
 Universities (11)
 Hospitals (43)
 Nurse training schools ( government ) (17)
 Authorities and Commissions (27)
 Ministries (60)
 Other 08)
- Central Bank
- Foreign Employment bureau
- Bandaranayaka International Airport
- National Chamber of Commerce
- NIHS

64. Non governmental organizations (09)
Private sector (71)
Provincial Governors (09)
Provincial Health Departments (09)
Regional Health departments(24)
Hotels (35)
Restaurants (11)
Schools (14)
Tea Factories/ business enterprises (20)
CONT...

65. List of tools that are developed on
SUPER 8
Posters/ leaflets :
1. Super 8 health targets [8 posters in a set]
2. Sugar Analysis
3. Jigsaw Poster
4. Myths
5. Super 8 health targets [in Sinhala, English and Tamil]
Guidelines:
A. Guideline for Institutionalizing Super Eight- to be used by lead agencies attempting to introduce Super
eight to institutions
B. Check list to be used by Head of Institution to mainstream 'Super eight' health targets within the
organization
C. Guidelines for provincial/ district health managers for institutionalizing Super eight and empowering
Communities with Super eight
D. Guidelines for institutionalizing Super Eight in School settings
E. Guide for a Healthy cafeteria setting
F. Quick guide for healthier menu planning- business meetings
Presentations:
1. Slideshow
2. PPT for Healthcare Workers
3. PPT for Government officials/ other institutions
4. PPT for Armed forces
5. PPT for youth/ schools

68. Institutionalizing
Super Eight –
making it a way of
life through the
school

69. How can the school setting
promote healthier lifestyle?
 YOU
 Be aware – understand what this means
to you
 Get to know the Super 8 health targets
 Assess where you are with your family
 Discuss how you and your family need
to change

70. How can the school setting
promote healthier lifestyle?
Your School
 Key decision makers must want to take
this change
 Prefects body, old girls associations,
School development societies, School
health clubs, Interactors can get
together to discuss how you want to
change to create healthier options

71. How can healthier practices be
fostered through school setting?
 1. Peer lead activity– Super 8, read food labels, to
make your choice known
 2. BMI checks
 3. exercise - happy face days
 4. healthier options in school canteen
 display of health targets at school canteen,
 5. extending knowledge from school to parents,
families and well wishers – days to check BMI and
BP, healthier food festivals,
 6. opportunity to demonstrate about their
experiences in adopting super eight at school
assembly, essay competitions, poster and drama
competitions

72. How can healthier practices be
fostered through school setting?
 Super eight messages in school
newsletters or as foot notes in common
letters that are widely circulated
 School functions serving healthier
options – give a choice
 Talk about good practices and
commend such practices

73. Super 8 logo

74. 1.Maintain your Body Mass Index (BMI)
Between 18.5 to 24.9 (ideal is 23)

75. 2. Avoid excess Salt
Limit salt consumption to one teaspoon of salt per person per day.
A 400g pack of salt should be sufficient for a family of four, for 20
days.

76. 3. Avoid food with trans fats.
Found in some commercially prepared fried food,
short eats, pastries, cakes and re-heated oil.

77. 4. At least 30 minutes of Moderate
Physical Activity
Do brisk walking, aerobic exercises, cycling, swimming
for at least 30 minutes per day for 5 days a week.

78. 5.Avoid excess added sugar.
Not more than 6 teaspoons of sugar per non-diabetic
person per day.

79. 6.Consume 5 servings of fruits and vegetables
per day.
Recommended amount is 400 gms of fruits and vegetables per person per
day.
Remember variety is good.

80. 7.Avoid smoking and alcohol.

81. 8.Maintain your Blood Pressure below 140/90
Check your blood pressure at least once a year.

82. Thank