By: Barriguete Melendez J A1, Dvorak J 2, Córdova Villalobos J A3, Juan Lopez M4, Davila Torres Javier5, Compeán Palacios J6, Junge A2 Fuller C W2, Valdés-Olmedo JC7. (See below for affiliations)
Currently, in all regions of the world apart from Africa, more deaths are linked to non-communicable diseases (NCDs) than communicable diseases [WHO, 2010]. Being overweight is a major contributory risk factor for non-communicable diseases such as high blood pressure, coronary heart disease and Type II diabetes. Of the six World Health Organization (WHO) designated regions, the Region of the Americas has the highest prevalence (>60%) of overweight adults (aged 20+ years). Mexico is no exception – the proportion of Mexican adults who are overweight or obese has increased from 61.8% in 2000 to 69.7% in 2006 to 71.2% in 2012.1
The prevalence of overweight and obese adolescents is of even greater concern; for example, the prevalence of overweight and obesity among girls (12 to 19 years old) has grown rapidly in less then 30 years; in this period, the prevalence has more than tripled, rising from 11.1% in 1988 to 28.3% in 1999 to 33.4% in 2006 and now standing at 35.8% in 2012.2 There are 22 million adolescents many of whom are overweight or obese and this imposes a large financial burden on the universal public health system. This situation sent strong alarm bells to the Government and Ministry of Health in Mexico as the prevalence of NCDs represents an important economic impact for families and countries. In 2008, medical expenditure on overweight and obesity in Mexico cost US$4.5 billion (~0.5% of GDP).3
Solutions – a partnership between government and FIFA
Following a detailed evaluation of successful ‘Community-based Interventions’ for adolescents involving sport, the Mexican Ministry of Health found that in 2006 Fédération Internationale de Football Association (FIFA) recognised the unique role that football could play in the promotion of exercise and health behaviours to reduce the burden of NCDs through an initiative entitled `Football for Health´. 4 The role that sport could play in combating NCDs was later reinforced by the International Olympic Committee.5,6 In 2009, FIFA began implementing the ‘FIFA 11 for Health’ programme in Africa.4, 6,7
Implementing the ‘FIFA 11 for Health’ programme as a community-based intervention to tackle obesity and NCDs in Mexico offered many potential benefits. The program provides a positive collaboration with the Mexican Football Federation which provides access to a huge number of active football players and fans all around the country. Football is enormous popularity in Mexico — national teams won the 2011 FIFA U-17 World Cup and the 2012 Olympic Football Tournament. A collaborative group consisting of the Mexico Ministries of Health and Education, Mexico Football Federation and FIFA, decided to implement the ‘FIFA 11 for Health’, Mexico, first as a pilot study, in three cities – Toluca, Puebla and Mexico City. These efforts were supported by three professional football teams and coaches – Toluca, Puebla and Cruz Azul – to evaluate the logistics and resources within the country. This was then followed by a staged nationwide implementation.
A global program with a Mexican focus
The ‘FIFA 11 for Health’ programme was specifically adapted for implementation to boys and girls within Mexican schools over an 11-week period. The programme consisted of 11 ‘Play football’ sessions: Passing, Heading, Dribbling, Shielding, Defending, Trapping, Building fitness, Shooting, Goalkeeping and Teamwork, with 11 complimentary ‘health messages’: Play football, Respect girls and women, Protect yourself from HIV and sexually transmitted diseases, Avoid drugs, alcohol and tobacco, Control your weight, Wash your hands, Drink clean water, Eat a balanced diet, Get vaccinated, Take your prescribed medication and Fair play.
Each ‘health message’ is supported by an international football star: Chicharito (Mexico), Diego Forlan (Uruguay), Neymar (Brazil), Cristiano Ronaldo (Portugal), Samuel Eto’o (Cameroon), Carles Puyol (Spain), Marta (Brazil), Lionel Messi (Argentina), Didier Drogba (Ivory Coast), Gianluigi Buffon (Italy), Vicente del Bosque (Spain). The implementation methodology for the ‘FIFA 11 for Health’ programme was taught to 21 physical activity school teachers and 9 football team coaches during a 5-day training course. These teachers and football coaches subsequently presented the programme to 842 high school 1st grade children. The programme not only increased the children’s knowledge on health issues and football skills, but was also popular among children who recommended the programme to other children because it was fun and easy to participate in.
National role out – scale up
After the successful pilot study in 2012, it was decided at Ministerial level to go ‘nationwide’ with the project, in four phases involving public, and social institutions: Foundations (Fundación Mexicana para la Salud [FUNSALUD], Fundacion Rio Arronte, Fomento Banamex), Football Federation. The aim is to expand the implementation, from the 21 schools involved in the 2012 pilot study to a nationwide implementation of 32,135 public schools in 2015; from 21 physical activity teachers in 2012 to 22,141 teachers in 2015; from 840 children in 2012 to 2’173, 406 children in 2015. The ‘FIFA 11 for Health’, Mexico project is an ambitious project that aims to reach the whole country, to share successful preventive interventions, to promote health and to tackle the problem of obesity and NCDs in Mexico.
This success story in Mexico provides an important model for other nations considering how to address the major problem of NCDs. Mexico is among the 19 countries that have adopted FIFA’s ’11 for Health’ – a program that fits very well within the World Health Organizations ‘7 Investments’9 for NCD prevention. The BJSM welcomes success stories from all nations and diverse community settings (e.g., sport, schools) as part of its commitment to implementation.
Acknowledgement. Salomón Chertorivski, Decio de María, Javier Salinas, Miguel Limón, Gloria Cervantes and Cecilia López. Edomex Gabriel O`Shea y Raymundo Martínez. Puebla Jorge Aguilar y Luis Maldonado. Mexico City. Armando Ahued y Luis Eduardo Sánchez.
1. Encuesta Nacional de Salud y Nutrición (ENSANUT 2012). Instituto Nacional de Salud Pública. Secretaría de Salud. Mexico. P 28.
2. Encuesta Nacional de Salud y Nutrición (ENSANUT 2012). Instituto Nacional de Salud Pública. Secretaría de Salud. Mexico. P 30.
3. Economic Department 2011 MoH Mexico.
4. Fuller CW, Junge A, DeCelles J, et al. ‘Football for Health’–a football-basedhealth-promotion programme for children in South Africa: a parallel cohort study. Br J Sports Med 2010; 44:546–54.
5. The Olympic Movement in Society. Proceedings from the XIII Olympic Congress. Recommendations of Theme ‘Olympism and Youth’. Olympic Congress 2009. Copenhagen, Demark, 2009.
6. Mountjoy M, Andersen L B, Armstrong N, et al. International Olympic Committee consensus statement on the health and fitness of young people through physical activity and sport. Br J Sports Med 2011; 45:839–848.
7. Fuller CW, Junge A, Dorasami R, et al. ‘11 for Health’, a football-based health education programme for children: a two-cohort study in Mauritius and Zimbabwe. Br J Sport Med 2011; 45: 612-618.
8. Dvorak J, Fuller CW, Junge A. Planning and implementing a nationwide football-based health-education programme. Br J Sports Med 2012; 46: 6-10.
9. Global Advocacy for Physical Activity (GAPA) the Advocacy Council of the International Society for Physical Activity and Health (ISPAH). NCD Prevention: Investments that Work for Physical Activity. Br J Sports Med 2012;46:709–712. Br J Sports Med 2012;46(10):709-12.
Authors’ affiliations: 1Instituto Nacional de Ciencias Médicas y Nutrición. Mexico; 2 FIFA Medical Assessment and Research Centre, Zurich, Switzerland; 3 Medicine National Academy, Mexico; 4 Ministery of Health, Mexico. 5 IMSS, Mexico; 6 Mexican Football Federation. Mexico; 7 Mexican Health Foundation (FUNSALUD).