School-based diabetes awareness and prevention education in India

Nalini Saligram, Ph.D.18 April 2012

Arogya World is a U.S. based non-profit 501 © 3 organization.  The name of the organization is simply an articulation of our mission: Arogya in Sanskrit means good health.  More literally it means to live a life without disease.

Geneva Health Forum PS 07 School based interventions to tackle NCDs

Changing the Course of Chronic Disease, One Community at a Time

50 million. 87 million by 2030 (IDF). India #2.  • Urban India prevalence 11 – 12% now vs. 3-4% in the ‘80’s

Diabetes kills 1MM Indians/yr (2010, IDF).

Indians get diabetes 10 years earlier than in the West• >1.1 billion people, 50% < 25 years = alarming public health crisis over the next 20 years

Healthcare costs skyrocketing • Low-income family spends 25% of income on diabetes care for 1 adult (IDF).

• Diabetic foot ulcers result in 200,000 amputations/year, each costs >$10,000.

• India bears heaviest costs of diabetes = 2.1% GDP, $2.8 billion or 11% of total health expenditure in 2010. Increase to $4.8 billion in 2030.

*Complications of diabetes include heart disease, foot ulcers, eye disease, kidney disease etc.

Diabetes At Catastrophic Levels in India

2© 2010 Arogya World. All Rights Reserved.

1 person is diagnosed with diabetes every 5 seconds

1 person dies from the complications* of diabetes every 10 seconds

1 limb is amputated because of diabetes every 30 seconds

WHO: a healthy diet, exercise and avoiding tobacco can prevent • 80% of premature heart disease• 80% type II diabetes• 40% of cancers

Compelling Clinical Proof Exists that Diabetes Can Be Prevented

Landmark Trial - Diabetes Prevention Program (DPP) • 3234 high-risk adults in the US. 30 min physical activity/ day + low-fat diet reduced

chance of getting diabetes by 58%, (metformin: 31%) NEJM Feb 7, 2002. • The Lancet (2009) …diabetes prevention through lifestyle changes sustained 10 years.

Finnish Diabetes Prevention Study NEJM May 3, 2001.

Indian Diabetes Prevention Programme Diabetologia. 2006 Feb;49(2):289-97.

Prevention: The Holy Grail for Tackling NCDs

3© 2010 Arogya World. All Rights Reserved.

4© 2010 Arogya World. All Rights Reserved.

The Arogya World Approach to the NCD Crisis

Galvanize global action to address non-communicable diseases (NCDs)

► Leverage UN NCD Summit Sep 2011► Op-ed, blog and social media campaign ► Case studies► Women and NCDs ► Women for a Healthy Future Petition► 10,000 Women “Perspectives on NCDs”

Global Survey

Implement Diabetes Prevention through Lifestyle Changes in India

► Multipronged Approach in schools, workplaces and the community

► Leverage technology and partnerships for scalable, cost-effective programs

► Science-based work ► Measure effectiveness and impact

Two-fold mission

5© 2010 Arogya World. All Rights Reserved.

Our Whole-of-Society Approach in India: Diabetes Prevention with Lifestyle Changes

Community ► mDiabetes: Mobile health outreach – text

messages on diabetes and prevention to 1 million consumers in 12 languages. With Nokia. CGI commitment in 2011.

Policy ► Interact with Policymakers to aid diabetes

prevention.

Schools ► Diabetes Awareness & Prevention

Education. Teacher/peer-led, 2000 middle school children Delhi 2011.

► Healthy Schools Seal of Approval

Workplace ► Healthy Workplace Seal of Approval► Build capacity for Lifestyle

Interventionists► Clinical trial (DPP) based 16 week

diabetes prevention modules

Year-long Media and Thought-leader Engagement and Advocacy

Initiated in 2011 in partnership with Hriday, a youth NGO in India Trained Teachers & peer-leaders. Based on previous MYTRI model. Reached 2,000 children in 6 and 7 grades (11-13 years old). 6 schools in Delhi – 3 government, 3 private. 5 classroom-based interventions. Age appropriate educational modules. Pre- & post intervention surveys. Analysis completed; results are in. Encouraging awareness and behavior change trends. Supported by Merck/MSD India. Second year intervention in the same children will help behavior

changes “stick”.

Non-Communicable Diseases (NCDs) - An Urgent Issue

6© 2010 Arogya World. All Rights Reserved.

Non-Communicable Diseases (NCDs) - An Urgent Issue

Non-Communicable Diseases (NCDs) - An Urgent Issue

Our Schools Work in India

First Results

Baseline Year 140

50

60

70

80

90

100

65.477.2

Baseline Year 1405060708090

100

50.161.3

Physical Inactivity Increases Risk for Diabetes

Baseline Year 1405060708090

100

67.3 73.2

Diabetes Complications Knowledge

Baseline Year 130405060708090

100

42.150.7

Diabetes is Preventable

Unhealthy Eating Increases Risk for Diabetes

Awareness and Knowledge Improved

Baseline Year 105

10152025303540

15.68.9

Baseline Year 105

10152025303540

9.8 7.8

Fried Snacks

Baseline Year 105

10152025303540

15.310.3

Sweets

Baseline Year 105

10152025303540

21.4 18.8

Chips

Carbonated Drinks

First Signs of Behavior Change Unhealthy Food Consumption Reduced

Baseline Year 10

20

40

60

80

100

62.675.1

Baseline Year 10

20

40

60

80

100

60.3 68.9

Fruit chaat over Aloo Tikki

Baseline Year 10

20

40

60

80

100

50.8 63

Poha over Samosa

Baseline Year 10

20

40

60

80

100

57 64.3

Rajma Rice over Chole Bhatura

Lemonade over Soda

More Exciting Evidence of Behavior Change Children Consistently Chose Healthier Foods

Back-Up

Board* Dr. Nalini Saligram – Arogya World; Dr. Pamela Yih, Treasurer – Pamela Y-F Yih Inc.; Kathryn Graves – Emory Univ Rollins School of Public Health; Dr. Meryle Melnicoff – formerly at WISTAR Institute

Indo-US Scientific Steering Committee* Based in India - Dr K. Srinath Reddy – President, Public Health Foundation of India, Dr V. Mohan – Madras Diabetes

Research Foundation, Dr Ashok K. Das – Additional Director General Health Services, Dr Prabhakaran – Centre for Chronic Disease Control, and PHFI, Dr Nikhil Tandon – All India Institute of Medical Sciences, Dr. Prasanna Kumar – Bangalore Diabetes Hospital

Based in the US - Dr K.M. Venkat Narayan – Emory University, Dr Sreekumar Nair – Mayo Clinic, Dr Francine Kaufman – Medtronic, Dr Karmeen Kulkarni – Abbott Diabetes Care, Dr Sethu Reddy – Merck, Dr. Om Ganda -Joslin

Advisors*Dr A Ramachandran - India Diabetes Research Foundation, Chennai; Dr Subhankar Chowdhury-IPGME&R and SSKM Hospital, Kolkata; Monika Arora Hriday-Shan; C.V. Madhukar PRS Legislative Research; Deanna M. Hoelscher Michael and Susan Dell Center for Advancement of Healthy Living; Dr Sudeep Singh Gadok, International Health and Development Expert; Raj Dave ARE Consulting, Dr. Arun Chockalingam World Hypertension League, Dr. David C U’Prichard Druid Consulting

Behavior Change Task Force* Based in the US - Dr. Fran Kaufman, Medtronic, Dr. Linelle Blais, Emory University, Andrea Falls, Edelman Based in the UK – Zoe Hellman, Weight Watchers Based in India – Dr. Ranjani Harish, Dr. Mohan’s Diabetes Specialities Centre, Dr. Monika Arora, Hriday-Shan,

Sukanti Ghosh, APCO Worldwide, Dr. Kanav Kahol – PHFI

*all working pro-bono

+

Consultants

Thea Joselow (Washington DC – digital media expert), Dr. S Kumar (Bangalore - senior consultant India), Dr. Sandhya Ramalingam (Bangalore – market research expert), Beau Young (Philadelphia- accountant)

Arogya World Network of Influencers

Our Track Record

• Feb 2009 – Workshop with 66 stakeholders in Delhi to gather input on priorities.• World Diabetes Day 2009; 40 community walks in Delhi; 6,000 children asked Mrs Gursharan Kaur, wife of Prime

Minister of India, for help in making policy changes• Formalized as US-based non-profit organization March 2010. • New Diabetes Friendly Recipe Created for Arogya World by celebrated Manhattan chef from Devi Nov 2010• Initiated Schools diabetes education program in India 2011; completed year 1 program, encouraging results• Clinton Global Initiative Commitment 2011 – 1 million consumers diabetes mHealth campaign in India; 30,000

consumers received messages through March 2012. • Healthy Workplace Stakeholder Input Session in India Bangalore, Feb 24, 2012 • Women for a Healthy Future – 2011 petition;