Physical activity and health in Chinese children and adolescents: expert consensus statement (2020).

China is experiencing significant public health challenges related to social and demographic transitions and lifestyle transformations following unprecedented economic reforms four decades ago. Of particular public health concern is the fourfold increase in overweight and obesity rates in the nation's youth population, coupled with the low prevalence of adolescents meeting recommended levels of physical activity. Improving the overall health of China's more than 170 million children and adolescents has become a national priority. However, advancing nationwide health initiatives and physical activity promotion in this population has been hampered by the lack of a population-specific and culturally relevant consensus on recommendations for achieving these ends. To address this deficiency and inform policies to achieve Healthy China 2030 goals, a panel of Chinese experts, complemented by international professionals, developed this consensus statement. The consensus was achieved through an iterative process that began with a literature search from electronic databases; in-depth reviews, conducted by a steering committee, of the resulting articles; and panel group evaluations and discussions in the form of email correspondence, conference calls and written communications. Ultimately, the panel agreed on 10 major themes with strong scientific evidence that, in children and adolescents aged 6-17, participating in moderate to vigorous physical activities led to multiple positive health outcomes. Our consensus statement also (1) highlights major challenges in promoting physical activity, (2) identifies future research that addresses current knowledge gaps, and (3) provides recommendations for teachers, education experts, parents and policymakers for promoting physical activity among Chinese school-aged children and adolescents. This consensus statement aligns with international efforts to develop global physical activity guidelines to promote physical activity and health and prevent lifestyle-related diseases in children and adolescents. More importantly, it provides a foundation for developing culturally appropriate and effective physical activity interventions, health promotion strategies and policy initiatives to improve the health of Chinese children and adolescents.

Healthy People for the 21st Century: Understanding Use of Healthy People 2020 as a Web-Based Initiative.

OBJECTIVE: This study assesses how the nation's preeminent health promotion and disease prevention initiative, Healthy People, is utilized by key stakeholders. METHODS: A Web-based survey was administered to assess awareness and use of Healthy People among state, local, tribal health organizations and other key stakeholder groups. Follow-up interviews were conducted with a subset of respondents. RESULTS: Awareness and use of Healthy People have remained high among state, local, and tribal stakeholders. Healthy People 2020 is most frequently used as a data source. The Leading Health Indicators (LHIs) are an important element of the initiative, and nearly 90% of organizations that use the LHIs found them valuable. Awareness and use of other tools and resources are more limited. CONCLUSIONS: Healthy People continues to be a valued resource among public health stakeholders; however, continued outreach is needed to promote the use of tools and resources available on healthypeople.gov for this decade and beyond. Healthy People is a national initiative used most frequently as a data source by state and local health departments, tribal organizations, and other public health practitioners.

A gender-sensitised weight loss and healthy living programme for overweight and obese men delivered by Scottish Premier League football clubs (FFIT): a pragmatic randomised controlled trial.

BACKGROUND: The prevalence of male obesity is increasing but few men take part in weight loss programmes. We assessed the effect of a weight loss and healthy living programme on weight loss in football (soccer) fans. METHODS: We did a two-group, pragmatic, randomised controlled trial of 747 male football fans aged 35-65 years with a body-mass index (BMI) of 28 kg/m(2) or higher from 13 Scottish professional football clubs. Participants were randomly assigned with SAS (version 9·2, block size 2-9) in a 1:1 ratio, stratified by club, to a weight loss programme delivered by community coaching staff in 12 sessions held every week. The intervention group started a weight loss programme within 3 weeks, and the comparison group were put on a 12 month waiting list. All participants received a weight management booklet. Primary outcome was mean difference in weight loss between groups at 12 months, expressed as absolute weight and a percentage of their baseline weight. Primary outcome assessment was masked. Analyses were based on intention to treat. The trial is registered with Current Controlled Trials, number ISRCTN32677491. FINDINGS: 374 men were allocated to the intervention group and 374 to the comparison group. 333 (89%) of the intervention group and 355 (95%) of the comparison group completed 12 month assessments. At 12 months the mean difference in weight loss between groups, adjusted for baseline weight and club, was 4·94 kg (95% CI 3·95-5·94) and percentage weight loss, similarly adjusted, was 4·36% (3·64-5·08), both in favour of the intervention (p<0·0001). Eight serious adverse events were reported, five in the intervention group (lost consciousness due to drugs for pre-existing angina, gallbladder removal, hospital admission with suspected heart attack, ruptured gut, and ruptured Achilles tendon) and three in the comparison group (transient ischaemic attack, and two deaths). Of these, two adverse events were reported as related to participation in the programme (gallbladder removal and ruptured Achilles tendon). INTERPRETATION: The FFIT programme can help a large proportion of men to lose a clinically important amount of weight; it offers one effective strategy to challenge male obesity. FUNDING: Scottish Government and The UK Football Pools funded delivery of the programme through a grant to the Scottish Premier League Trust. The National Institute for Health Research Public Health Research Programme funded the assessment (09/3010/06).

Holding a country countdown to 2015 conference on Millennium Development Goals (MDGs) - the Zambian experience.

Initiatives such as the Country Countdown to 2015 Conference on Millennium Development Goals (MDGs) have provided countries with high maternal and child deaths like Zambia a platform to assess progress, discuss challenges and share lessons learnt as a conduit for national commitment to reaching and attaining the MDGs four and five. This paper discusses and highlights the process of holding a successful country countdown conference and shares Zambia's experience with other countries planning to organise country countdown to 2015 Conferences on MDGs.

Why the MDGs need good governance in pharmaceutical systems to promote global health.

BACKGROUND: Corruption in the health sector can hurt health outcomes. Improving good governance can in turn help prevent health-related corruption. We understand good governance as having the following characteristics: it is consensus-oriented, accountable, transparent, responsive, equitable and inclusive, effective and efficient, follows the rule of law, is participatory and should in theory be less vulnerable to corruption. By focusing on the pharmaceutical system, we explore some of the key lessons learned from existing initiatives in good governance. As the development community begins to identify post-2015 Millennium Development Goals targets, it is essential to evaluate programs in good governance in order to build on these results and establish sustainable strategies. This discussion on the pharmaceutical system illuminates why. DISCUSSION: Considering pharmaceutical governance initiatives such as those launched by the World Bank, World Health Organization, and the Global Fund, we argue that country ownership of good governance initiatives is essential but also any initiative must include the participation of impartial stakeholders. Understanding the political context of any initiative is also vital so that potential obstacles are identified and the design of any initiative is flexible enough to make adjustments in programming as needed. Finally, the inherent challenge which all initiatives face is adequately measuring outcomes from any effort. However in fairness, determining the precise relationship between good governance and health outcomes is rarely straightforward. SUMMARY: Challenges identified in pharmaceutical governance initiatives manifest in different forms depending on the nature and structure of the initiative, but their regular occurrence and impact on population-based health demonstrates growing importance of addressing pharmaceutical governance as a key component of the post-2015 Millennium Development Goals. Specifically, these challenges need to be acknowledged and responded to with global cooperation and innovation to establish localized and evidence-based metrics for good governance to promote global pharmaceutical safety.

Health impact assessment in a network of European cities.

The methodology of health impact assessment (HIA) was introduced as one of four core themes for Phase IV (2003-2008) of the World Health Organization European Healthy Cities Network (WHO-EHCN). Four objectives for HIA were set at the beginning of the phase. We report on the results of the evaluation of introducing and implementing this methodology in cities from countries across Europe with widely differing economies and sociopolitical contexts. Two main sources of data were used: a general questionnaire designed for the Phase IV evaluation and the annual reporting template for 2007-2008. Sources of bias included the proportion of non-responders and the requirement to communicate in English. Main barriers to the introduction and implementation of HIA were a lack of skill, knowledge and experience of HIA, the newness of the concept, the lack of a legal basis for implementation and a lack of political support. Main facilitating factors were political support, training in HIA, collaboration with an academic/public health institution or local health agency, a pre-existing culture of intersectoral working, a supportive national policy context, access to WHO materials about or expertise in HIA and membership of the WHO-EHCN, HIA Sub-Network or a National Network. The majority of respondents did not feel that they had had the resources, knowledge or experience to achieve all of the objectives set for HIA in Phase IV. The cities that appear to have been most successful at introducing and implementing HIA had pre-existing experience of HIA, came from a country with a history of applying HIA, were HIA Sub-Network members or had made a commitment to implementing HIA during successive years of Phase IV. Although HIA was recognised as an important component of Healthy Cities' work, the experience in the WHO-EHCN underscores the need for political buy-in, capacity building and adequate resourcing for the introduction and implementation of HIA to be successful.

City leadership for health and well-being: back to the future.

The new European Health Policy Framework and Strategy: Health 2020 of the World Health Organization, draws upon the experience and insights of five phases, spanning 25 years, of the WHO European Healthy Cities Network (WHO-EHCN). Applying the 2020 health lens to Healthy Cities, equity in health and human-centered sustainable development are core values and cities have a profound influence on the wider determinants of health in the European population. "Making it Happen" relies on four action elements applied and tested by municipalities and their formal and informal partners: political commitment, vision and strategy, institutional change, and networking. In turn, the renewed commitment by member states of the WHO Regional Committee to work with all spheres and tiers of government is a new dawn for city governance, encouraging cities to redouble their investment in health and health equity in all policies, even in a period of austerity. For phase VI, the WHO-EHCN is being positioned as a strategic vehicle for implementing Health 2020 at the local level. Healthy Cities' leadership is more relevant than ever.

Evaluating WHO Healthy Cities in Europe: issues and perspectives.

In this introductory article, we situate the findings of the Phase IV evaluation effort of the WHO European Healthy Cities Network in its historic evolutionary development. We review each of the contributions to this supplement in terms of the theoretical and methodological frameworks applied. Although the findings of each are both relevant and generated with a scholarly rigor that is appropriate to the context in which the evaluation took place, we find that particularly these contextual factors have not contributed to optimum quality of research. Any drawbacks in individual contributions cannot be attributed to their analysts and authors but relate to the complicated and evolving nature of the project. These factors are also reviewed.

Equity and the social determinants of health in European cities.

Equity in health has been the underlying value of the World Health Organization's (WHO) Health for All policy for 30 years. This article examines how cities have translated this principle into action. Using information designed to help evaluate phase IV (2003-2008) of the WHO European Healthy Cities Network (WHO-EHCN) plus documentation from city programs and websites, an attempt is made to assess how far the concept of equity in health is understood, the political will to tackle the issue, and types of action taken. Results show that although cities continue to focus considerable support on vulnerable groups, rather than the full social gradient, most are now making the necessary shift towards more upstream policies to tackle determinants of health such as poverty, unemployment, education, housing, and the environment, without neglecting access to care. Although local level data reflecting inequalities in health is improving, there is still a long way to go in some cities. The Healthy Cities Project is becoming an integral part of structures for long-term planning and intersectoral action for health in cities, and Health Impact Assessment is gradually being developed. Participation in the WHO-EHCN appears to allow new members to leap-frog ahead established cities. However, this evaluation also exposes barriers to effective local policies and processes to reduce health inequalities. Armed with locally generated evidence of critical success factors, the WHO-EHCN has embarked on a more rigorous and determined effort to achieve the prerequisites for equity in health. More attention will be given to evaluating the effectiveness of action taken and to dealing not only with the most vulnerable but a greater part of the gradient in socioeconomic health inequalities.

Age-friendly cities of Europe.

This article summarizes how members of the European Healthy Cities Network have applied the 'healthy ageing' approach developed by the World Health Organization in their influential report on Active Ageing. Network Cities can be regarded as social laboratories testing how municipal strategies and interventions can help maintain the health and independence which characterise older people of the third age. Evidence of the orientation and scope of city interventions is derived from a series of Healthy Ageing Sub-Network symposia but principally from responses by 59 member cities to a General Evaluation Questionnaire covering Phase IV (2003-2008) of the Network. Cities elaborated four aspects of healthy ageing (a) raising awareness of older people as a resource to society (b) personal and community empowerment (c) access to the full range of services, and (d) supportive physical and social environments. In conclusion, the key message is that by applying healthy ageing strategies to programmes and plans in many sectors, city governments can potentially compress the fourth age of 'decrepitude and dependence' and expand the third age of 'achievement and independence' with more older people contributing to the social and economic life of a city.

Evaluation of partnership working in cities in phase IV of the WHO Healthy Cities Network.

An intersectoral partnership for health improvement is a requirement of the WHO European Healthy Cities Network of municipalities. A review was undertaken in 59 cities based on responses to a structured questionnaire covering phase IV of the network (2003-2008). Cities usually combined formal and informal working partnerships in a pattern seen in previous phases. However, these encompassed more sectors than previously and achieved greater degrees of collaborative planning and implementation. Additional WHO technical support and networking in phase IV significantly enhanced collaboration with the urban planning sector. Critical success factors were high-level political commitment and a well-organized Healthy City office. Partnerships remain a successful component of Healthy City working. The core principles, purpose and intellectual rationale for intersectoral partnerships remain valid and fit for purpose. This applied to long-established phase III cities as well as newcomers to phase IV. The network, and in particular the WHO brand, is well regarded and encourages political and organizational engagement and is a source of support and technical expertise. A key challenge is to apply a more rigorous analytical framework and theory-informed approach to reviewing partnership and collaboration parameters.

Developing a model to estimate the potential impact of municipal investment on city health.

This article summarizes a process which exemplifies the potential impact of municipal investment on the burden of cardiovascular disease (CVD) in city populations. We report on Developing an evidence-based approach to city public health planning and investment in Europe (DECiPHEr), a project part funded by the European Union. It had twin objectives: first, to develop and validate a vocational educational training package for policy makers and political decision takers; second, to use this opportunity to iterate a robust and user-friendly investment tool for maximizing the public health impact of 'mainstream' municipal policies, programs and investments. There were seven stages in the development process shared by an academic team from Sheffield Hallam University and partners from four cities drawn from the WHO European Healthy Cities Network. There were five iterations of the model resulting from this process. The initial focus was CVD as the biggest cause of death and disability in Europe. Our original prototype 'cost offset' model was confined to proximal determinants of CVD, utilizing modified 'Framingham' equations to estimate the impact of population level cardiovascular risk factor reduction on future demand for acute hospital admissions. The DECiPHEr iterations first extended the scope of the model to distal determinants and then focused progressively on practical interventions. Six key domains of local influence on population health were introduced into the model by the development process: education, housing, environment, public health, economy and security. Deploying a realist synthesis methodology, the model then connected distal with proximal determinants of CVD. Existing scientific evidence and cities' experiential knowledge were 'plugged-in' or 'triangulated' to elaborate the causal pathways from domain interventions to public health impacts. A key product is an enhanced version of the cost offset model, named Sheffield Health Effectiveness Framework Tool, incorporating both proximal and distal determinants in estimating the cost benefits of domain interventions. A key message is that the insights of the policy community are essential in developing and then utilising such a predictive tool.

'You need a support. When you don't have that . . . chocolate looks real good'. Barriers to and facilitators of behavioural changes among participants of a Healthy Living Program.

BACKGROUND: Health behavioural change is complex, especially for underserved patients who have higher rates of obesity and physical inactivity. Behavioural change interventions that show high efficacy in clinical trials may be difficult to disseminate and may not be effective in the office. OBJECTIVE: We sought to identify factors that facilitate or hinder behavioural change among past participants of a healthy lifestyle intervention in an urban underserved health centre. METHODS: Between March and October 2011, we conducted five focus group sessions with a total of 23 past participants. The focus group transcripts were analysed with a framework approach using the Social Ecological Model as a coding structure. RESULTS: We found four interconnected levels of social contexts: individual, interpersonal, programmatic and community levels. Themes of social support and the importance of relationships for making and maintaining behavioural changes were found at all levels. CONCLUSION: Social support and relatedness were key facilitators of healthy lifestyle changes and influenced individual motivation and perseverance. Harnessing the power of social support and motivation may be a way for future behavioural change interventions to bridge the gap between efficacy and effectiveness.

Primary care providers' perceptions of physical activity counselling in a clinical setting: a systematic review.

OBJECTIVE: The evidence regarding the effectiveness of promoting physical activity (PA) in primary care is varied. The present study systematically reviews the literature pertaining to primary care providers' perceptions about PA counselling to identify the barriers and enablers to PA counselling in clinical practice. DESIGN: A systematic literature review (through 2011) of quantitative and qualitative studies was conducted. Articles were included in the review if the study population consisted of primary care providers and the study evaluated providers' attitudes and perceptions pertaining to PA counselling. RESULTS: Nineteen articles met the inclusion criteria. Most primary care providers believe PA counselling is important and that they have a role in promoting PA among their patients. However, providers are uncertain about the effectiveness of counselling, feel uncomfortable providing detailed advice about PA, and cite lack of time, training and reimbursement as barriers. Providers are more likely to counsel their patients about PA if they are active themselves, or if they feel their patients' medical condition would benefit from a lifestyle change. CONCLUSION: Primary care providers are receptive to the notion of PA promotion in the clinical setting, yet numerous individual and organisational barriers need to be addressed to integrate PA counselling into primary care effectively.

The Healthy Children, Strong Families intervention: design and community participation.

Healthy Children, Strong Families (HCSF) is a 2-year, community-driven, family-based randomized controlled trial of a healthy lifestyles intervention conducted in partnership with four Wisconsin American Indian tribes. HCSF is composed of 1 year of targeted home visits to deliver nutritional and physical activity curricula. During Year 1, trained community mentors work with 2-5-year-old American Indian children and their primary caregivers to promote goal-based behavior change. During Year 2, intervention families receive monthly newsletters and attend monthly group meetings to participate in activities designed to reinforce and sustain changes made in Year 1. Control families receive only curricula materials during Year 1 and monthly newsletters during Year 2. Each of the two arms of the study comprises 60 families. Primary outcomes are decreased child body mass index (BMI) z-score and decreased primary caregiver BMI. Secondary outcomes include: increased fruit/vegetable consumption, decreased TV viewing, increased physical activity, decreased soda/sweetened drink consumption, improved primary caregiver biochemical indices, and increased primary caregiver self-efficacy to adopt healthy behaviors. Using community-based participatory research and our history of university-tribal partnerships, the community and academic researchers jointly designed this randomized trial. This article describes the study design and data collection strategies, including outcome measures, with emphasis on the communities' input in all aspects of the research.

Promoting active transportation as a partnership between urban planning and public health: the columbus healthy places program.

Active transportation has been considered as one method to address the American obesity epidemic. To address obesity prevention through built-environment change, the local public health department in Columbus, Ohio, established the Columbus Healthy Places (CHP) program to formally promote active transportation in numerous aspects of community design for the city. In this article, we present a case study of the CHP program and discuss the review of city development rezoning applications as a successful strategy to link public health to urban planning. Prior to the CHP review, 7% of development applications in Columbus included active transportation components; in 2009, 64% of development applications adopted active transportation components specifically recommended by the CHP review. Active transportation recommendations generally included adding bike racks, widening or adding sidewalks, and providing sidewalk connectivity. Recommendations and lessons learned from CHP are provided.

Oklahoma Healthy Homes initiative.

Compelling scientific evidence suggests that a strong association exists between housing-related hazards and the health and safety of their residents. Health, safety, and environmental hazards (such as asthma and allergy triggers), unintentional injury hazards, lead-based paint hazards, and poor indoor air quality are interrelated with substandard housing conditions. This article describes a Healthy Homes initiative to address these hazards in a coordinated fashion in the home, rather than taking a categorical approach, even in the presence of multiple hazards. It also provides an overview of Oklahoma's Healthy Homes initiative and its pilot project, the Tulsa Safe and Healthy Housing Project, which is currently administered in Tulsa in collaboration with Children First, Oklahoma's Nurse-Family Partnership program. This pilot project seeks to open new areas of research that can lead to a greater understanding of environmental health issues related to substandard housing in the United States, which will eventually make homes safer and healthier.

[Sex education as a cornerstone for a healthy teenage sexuality]. / Educación sexual: un pilar fundamental en la sexualidad de la adolescencia.

Sexuality is more than reproduction, it is an intrinsic part of each of us, is how we develop and relate with others and with the environment of the society to which we belong. Adolescence is a period with special vulnerability for the development of risky behaviors. In Chile, a progressive decrease in the age of sexual activity onset is observed, particularly in lower socioeconomic strata. The main consequences in sexual health are teenage pregnancies and the risk of acquiring sexually transmitted infections such as HIV. The main strategy for the prevention of this risks is a thorough sexual education, that has to be timely, objective, based on scientific evidence, friendly and confidential.