Audacious actions are being taken in Aruba, an island paradise in the Caribbean, to improve the health of its residents, said Richard Visser, the Minister of Health, Welfare, and Sport of Aruba at a recent meeting I attended. Of late the residents of this paradise have taken a turn for the worse healthwise as more than 81% of the population is overweight and 51% are obese. The challenge is tremendous especially for childhood obesity. However, in the five years since programmes to combat this have been implemented, the number of people doing moderate to intense physical activity increased from 9% to 39%. With a special focus on children, Visser created an island appropriate nutritional guide, and fruit and other healthy choices are now within reach.
Visser also plans to bring about something known as “H-Tourism”—in which the resorts and hotels make clear the nutritional value (calories/fat/sodium) of menu items and include healthy choices as well as add physical activities to the list of available activities—so that holiday makers can travel to Aruba and leave without that bloated, horrible post holiday feeling that makes it so hard to get back to the gym or back on the scale.
Visser was discussing this at a policy forum on 21 September convened by the World Bank in partnership with the Pan American Health Organization (PAHO) and the American College of Sports Medicine, in Washington DC. The forum sought to highlight Active Cities: Transforming Communities for Smart Growth and Health.
Other innovations were discussed by Miguel Malo, Vice Minister of Health in Ecuador, and Jorge Munoz Wells, the Mayor of Miraflores, Peru. Both men talked about the importance of urban design and activities to unify communities. This can be done through the creation of green spaces that can serve the dual purpose of space to exercise and play sport as well as absorb climate change issues such as river flooding. These seasoned politicians know that once a city grows there is no political will to make major changes so that urban growth must be clean and efficient with an eye on wellness.
Some concrete examples of action being taken include the introduction of elevated bike lanes (ciclovias in Spanish); closing major roads on one weekend morning per week to allow more space for jogging and cycling; sponsoring sporting events and games; and a concerted effort to make fruit and vegetables more widely available and decrease the availability of carbonated beverages—especially in and around schools.
The forum also reminded me of the social cost of NCDs that cannot be overlooked such as the disability sequela of illness which are disabling to the individual and expensive for the individual, their family, and the entire community. These conditions can be difficult to manage and sadly although most are preventable we have somehow managed to engineer healthy living out of our lives—at least in North America and Europe. These examples show us that retrofitting is possible, but will it catch on? Made aware, we must set new goals that recognise that unhealthy living is not a necessary part of development—active, healthy lifestyles can be planned in urban areas as they grow.
We often forget that public health springs forth from beliefs in social justice. However as public health has evolved access to clean water, access to preventative health services, monitoring the spread of disease, access to safe foods, and the concept of helping ourselves and our communities has become lost as bits and pieces of public health have been separated into silos—of agriculture, trade, sanitation, education, and medicine. It is time to break through these silos and bring all of these groups together.
Tracey Koehlmoos is adjunct professor at George Mason University and adjunct scientist at ICDDR,B.