Health and Wellness in the Caribbean

HEALTHY HABITS  post the PORT OF SPAIN DECLARATION 2005  - Forum for Discussion
 
I want to share with you from an article that I just read-
Ref Occupational Health Vol. 61 No.9 September 2009 www.ohmagazine.co.uk
 
To quote Professor Kevin Sykes PhD, MSc, Director Postgraduate Centre for Exercise & Nutrition Science, University of Chester, UK
 “ Walking has been proven to have many benefits, including reducing body fat, increasing energy and enhancing mental well being”
He continues in his article to state some interesting facts.
Worldwide studies, he writes,  have confirmed   the benefits of walking-

• Reduction of the risk of coronary heart disease and stroke
• Lowering blood pressure
• Reducing high cholesterol and improving blood lipid profile
• Reducing body fat
• Enhancing mental well being
• Helping to reduce stress
• Fortifying  the immune system, reducing the risk of falling ill or being prone to disease
• Sleeping better
• Increasing bone density, helping to prevent osteoporosis
• Helping osteoarthritis
• Reducing the risk of certain cancers, notably colon cancer
• Reducing the risk of Type2-diabetes
• Improving flexibility and coordination, reducing the risk of falls, especially in older people
• Helping to maintain healthy lung function
• Increasing energy and vitality {Ref. British Heart Foundation [2001] “Walking the Way to Health Newsletter” No. 5}

In developed countries, physical inactivity is now second to smoking as the most important risk factors for ill health.
 
In promoting more activity in these countries,   some interesting initiatives have been started notably:
1)      Health Walks – organized by various groups across the UK
2)      School ‘walking buses’ – getting groups of school children to walk to school quickly and safely under the guidance of trained adult supervisors – an idea developed by the “Living Streets Campaign” – again in the UK. This is dependent on the provision of safe walking routes.
3)      “Walking at work” initiatives being introduced- casual or organized lunchtime walks, walking routes developed around corporate buildings and grounds; workplace “walking buses” or “walking meetings”- where the meeting takes place with the group or committee on the move.
4)      Development  of workstations that include a computer, keyboard and treadmill
5)      The “Paths to Health Project” jointly created by the British Heart Foundation and the “Paths for All Partnership”-UK
6)      “Walking the Way to Health Initiative” –UK developed by the British Heart Foundation and the Countryside Agency linking with the WHO European Network for promoting health-enhancing physical activity (HEPA) in the Netherlands, France, Ireland, Denmark, Belgium, Poland, Austria and Germany
7)      Caring for pets like dogs- to induce people to exercise more, and also to reduce stress and depression by interaction with pets
 
Exercising indoors is known to be beneficial, but research evidence has underscored  the advantages of regular outdoor exercise .
Also, if the exercise intensity is too low, modification of one’s mood is less marked [ Ref J Personality & Social Psychology 60 (4) 555-561 Brown, J (1991)]. It is believed that the best way to positively impact on mood is via moderate intensity exercise and it is emphasized that exercise should be fun and enjoyed rather than undergone as a task or a chore even though exercise can be given as a “prescription”.
 
The Japanese have developed a theory that in walking 10, 000 steps daily, one can keep fit and healthy without the need for additional exercise.
Most persons use  up about 4000 steps a day doing daily tasks; those who are more sedentary walk about 2000 steps a day, while those who are mostly on their feet all day usually walk about 8000 steps a day.
A sedentary person is classified as someone walking less than 5000 steps a day;
a low active person 5000 to 7499 steps daily; moderately active 7500 to 9999 steps a day; very active 10, 000 steps a day and highly active 12, 500 and more steps a day.
Regular exercise  like walking, carried out three (3) times per week for ½ hour or more will result in increased aerobic (cardio-respiratory) fitness, but even a 10-minute brisk walk can increase fitness. Recent research  has shown, for instance that there was no significant difference in fitness levels achieved between women who split their 30 minutes into 3 x10-minute walks  daily and women who walked continuously for 30 minutes daily x 5 days a week . Interestingly, the “short walkers” lost more inches around their waists and more weight overall  than the “long walkers”, provided all walked briskly, without over exerting themselves. [ref. Medicine & Science in Sports & Exercise 30:1:152-7 Murphy .M & Hardman A.E.(1998)]
Walking 10, 000 steps (which is equivalent to walking 5 miles) will burn up about 500 calories. Walking or jogging a mile burns up about 100-120 calories Walking 2 miles daily will burn between 200-240 calories (1400-1800 calories per week or ½ lb fat loss per week or 2 lbs per month) It   must  be remembered however that the heavier the person, the more calories are burned, regardless of the pace, but that there is  a greater risk of injury for the unfit, less fit and overweight .
The intensity of walking- for –fitness- benefits will vary depending on the age and initial fitness of the individual. It is important that the physical demands for the activity eg. A hiking trail or a mountain walk be investigated before each individual embarks on that activity, since if there are underlying medical conditions, this   will  determine the duration and intensity of each exercise activity and this includes walking.
 
In order to walk in one’s  “heart rate training zone” one must try to walk so that the target  heart rate is greater than 50% of this figure which is calculated by subtracting one’s  age from 220.
Devices such as pedometers and pulse monitors can  give feedback about  performance, assist  in setting goals and motivate us and our patients to become more active and physical.
Remember also that walking is an ideal way to exercise, requiring no special equipment, expense or expertise and in addition exposure to the outdoors in a healthy and safe environment can only add to one’s overall well being.
 
Some online resources in the UK on walking for health are:
www.whi.org.uk British Heart Foundation’s Walking the Way to Health Initiative
www.ehnheart.org European Heart Network (EHN)
www.thewalkingbus.co.uk The Walking Bus concept
www.pathsforall.org.uk
www.ramblers.org.uk/
 
Most  of the above was information that was not new to me, but what intrigued me was the response of the UK and other first-world policy makers  to the challenge of sedentariness and the risks attached to health.
 
 DISCUSSION
In September 2005, the heads of governments of the Caribbean  Region and their technical advisors met in Port of Spain, informed  by research material shared with them by a Commission chaired by Sir George Alleyne, Chancellor of the University of the West Indies and former PAHO Director.
With great fanfare, the Port of Spain Declaration was  released with several commitments made by the heads of governments of CARICOM – “Uniting to stop the epidemic of Chronic Non- communicable diseases of Obesity, Heart Disease, Diabetes and Arthritis”-   since the pattern in our 3rd world nations is the same as in the 1st world . http://www.caricom.org/jsp/communications/meetings_statements/declaration_port_of_spain_chronic_ncds.jsp
The Heads of States  "recalled, affirmed, declared, encouraged, committed themselves to the promotion of policies and actions; promised  to endorse, support initiatives; to provide incentives for public education and promotion of wellness and healthy lifestyles; as a matter of urgency   to provide research programmes for surveillance of risk factors   for NCDs with the support of regional Universities and CAREC; to mandate the re-introduction of physical education in schools and encourage physical fitness in the adult population, eg at work sites, through sport and mass activities; to  increase public facilities such as parks and recreational spaces in order to encourage physical activity by the widest cross- section of the citizenry "
They declared “ That  our Ministries of Health, in collaboration with other sectors, will establish by mid-2008 comprehensive plans for the screening and management of chronic diseases and risk factors so that by 2012, 80% of people with NCDs would receive quality care and have access to preventive education based on regional guidelines”
 
At our recently concluded 4th Pan Caribbean Family Medicine Conference held in Barbados,in 2009,  we were told of initiatives that have started in various territories in CARICOM and of events that coincided with Caribbean Wellness Day- the 2nd Saturday in September that was instituted at the Port of Spain Conference in 2005.
 
But my  experience of the follow up to this Declaration  is somewhat different since I live close to one of the sites showed in the presentation and the percentage and intensity of involvement of the citizenry does not compute with the visuals that were shown. Possibly these were taken on the day that the initiative was inaugurated.
In the UK article, “working walks “ and “walking meetings” are mentioned but in the Caribbean, meetings at work are noted for the catering, the calories, the desserts  and the drinks.
In some  territories, persons who used to be able to walk are now afraid for their safety and have either stopped walking or gone indoors. Increasingly, the commute to and from work in bumper to- bumper traffic has  meant that physical activity has been severely curtailed for both adults and children, and  the health of our citizenry  deteriorates due to the ingestion of petrol fumes and carbon monoxide, from lack of sleep because of having to leave home earlier to “beat the traffic” as well as being locked up in air conditioned, temperate -climate buildings all day   where more and more concrete and glass continue to supplant green and healthy spaces.
Our children  are sent to schools that have no play areas or sports fields and are destined to stay longer and longer hours glued to their whiteboards or computers because of impossible agendas defined by unrealistic curricula too heavily weighted academically  and not  geared to critical thinking or  awakening multiple intelligencies.
Our Heads of Governments promise big things, prate big words and then forget, going about their business as usual and our technocrats and programme coordinators get so bogged down with the many issues of the day that it seems to me that nothing really happens unless there are zealous “Joans of Arcs” disguised as NGO’s or some perceived “leader” deciding to follow the fashion of the developed nations and copy their initiatives under the watchful guidance of the   foreign Consultant who will be hired at great expense to teach us what we all already know.
 
My questions for  members of the College are these:
1)      What is your experience locally following  this Declaration?
2)    What initiatives have you  seen in your community  that have stemmed from these promises? How are they being managed?
3)      What do you think we as a College can  do to make some of these promises a reality?
4)      How can members of the College make a difference in getting other disciplines or groups  eg. The Architects and Planners; the Supermarkets and Food outlets; members of our profession; the ordinary citizen   excited about   being part of  the revolution of returning to health and wellness in our Caribbean?
 
I welcome your ideas and responses.