Tackling Non Communicable Diseases in African Businesses
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Tackling Non‐Communicable Diseases in
African Businesses
A Practical Guide on
Raising Awareness on lifestyle‐related Diseases
among Employees
For Human Resources Managers and Officers, Workplace Programme
Coordinators, Practitioners and Peer EducatorsCommissioned by:
Pan‐African Business Coalition on HIV and Health (PABC)
Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) – Regional Project Support
of the Private Sector in Africa to Fight AIDS (SPAA)
Compilation:
Norbert Roesch (GIZ/PABC, South Africa)
Review:
Dr. Valentine Douala‐Mouteng (PABC, South Africa)
Ute Papkalla (GIZ, Germany)
Judith Fischer (GIZ, Germany)
Martin Weihs (GIZ, AWiSA/AIDC, South Africa)
Josiane Robiarivony (CECM, Madagascar)
December 2011
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Table of Contents
1 Introduction..................................................................................................................................... 4
2 Non‐Communicable Diseases (NCDs) – The Silent Pandemic ......................................................... 5
2.1 What are NCDs? ...................................................................................................................... 5
2.2 Main NCDs ............................................................................................................................... 5
2.3 Main Risk Factors .................................................................................................................... 5
2.4 Economic and Business Impact of NCDs ................................................................................. 6
3 Understanding Non‐Communicable Diseases ................................................................................. 8
3.1 Cardiovascular Diseases .......................................................................................................... 8
3.2 Diabetes................................................................................................................................... 9
3.3 Cancer .................................................................................................................................... 10
3.4 Chronic Respiratory Diseases ................................................................................................ 11
4 Understanding Causes and Risk Factors........................................................................................ 12
4.1 Smoking (Tobacco) ................................................................................................................ 12
4.2 Excessive Alcohol Consumption ............................................................................................ 13
4.3 Unhealthy Diet ...................................................................................................................... 14
4.4 Physical Inactivity .................................................................................................................. 15
4.5 Obesity (Overweight) ............................................................................................................ 16
5 Company Action and Staff Awareness .......................................................................................... 17
5.1 Creating Healthy Workplaces ................................................................................................ 17
5.2 Raising Staff Awareness ........................................................................................................ 17
5.3 The Toolbox and its Application ............................................................................................ 18
6 Toolbox for Workplace Action on NCDs ........................................................................................ 20
6.1 General Information on NCDs ............................................................................................... 20
6.2 Guidance for Company Action and Awareness Creation ...................................................... 23
6.3 Training Manuals ................................................................................................................... 24
6.4 Information and Awareness Material: Fact Sheets, Posters, Leaflets… ............................... 24
6.5 Self‐Assessment Tools (Online and Sheets) .......................................................................... 28
6.6 Reference Institutions ........................................................................................................... 29
6.7 Websites ................................................................................................................................ 29
6.8 World Days ............................................................................................................................ 30
GIZ and PABC do not warrant that the information contained in this guide is complete and correct and shall not be liable
whatsoever for any damages incurred as a result of its use.
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1 Introduction
Non‐Communicable Diseases (NCDs) are the new global threat to health and its impact will
slowly, but steadily rise during the next years and decades to come. The negative effects will also be
increasingly felt in the African private sector in the near future.
The purpose of this document is to raise awareness among African companies on NCDs, to
provide an understanding of their causes and risk factors, and to come up with approaches how
companies can contribute to the fight against NCDs. The focus of this guide is on prevention (i.e. not
on treatment). It is written to Human Resources managers and officers, Workplace Programme
coordinators, practitioners and peer educators who are concerned about the long‐term health of
staff members.
Chapters 2‐4 provide important background information and are aimed at increasing your level
of understanding with regard to the overall context (chapter 2), the medical aspects of NCDs (chapter
3) and their causes (chapter 4). The purpose is to sensitize the reader about the long‐term effects of
NCDs on employees, the businesses and the need for action.
Chapters 5‐6 aim at enabling companies to take action against NCDs. Chapter 5 introduces
into two workplace approaches and provides ideas how businesses can carry out activities in
accordance to their company infrastructure and capacity. Chapter 6 (toolbox) is a compilation of
Internet resources where information, instruments and tools can be viewed and downloaded from.
As NCDs is a relatively new health focus in Africa, much of the information and material
presented in this guide derives from high‐ and middle‐income countries. Nonetheless, the patterns
of NCDs and their risk factors are generally applicable worldwide. In the near future we hope that
there will be more material available from and suitable to the African context.
The focus of this guide and its attached toolbox is on practicality. It is explorative in nature
and provides hands‐on tools rather than scientific literature. The toolbox is not comprehensive, but
serves as a good starting point for workplace action, in particular with regard to information,
education and communication. Other tools and information products might still be ‘out there’,
waiting to be discovered and to be applied.
Most of the tools and information provided in this guide origin from the WHO website, for
various reasons: The multinational organisation is the major global reference institution with regard
to health issues, its website is well‐structured, the information is easy to find, and all health topics
are comprehensively covered and geographically presented in a balanced way. Moreover, most of
the information is also available in French, and to some extent in Portuguese.
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2 NonCommunicable Diseases (NCDs) – The Silent Pandemic
2.1 What are NCDs?
Unlike infectious (= communicable) diseases such as HIV, TB or malaria, non‐communicable diseases
are not contagious and cannot be transmitted from one person to the next. They involve changes in
the body that lead to chronic ailment and are characterized by long duration and slow progression.
NCDs, also referred to as chronic diseases, are most of all lifestyle–related, caused by human
behaviour.
2.2 Main NCDs
Four types of NCDs are very common
and relevant in terms of their
negative impact on health:
• Cardiovascular (heart and
vessels) diseases
• Cancer
• Chronic respiratory diseases
• Diabetes
NCDs are on the rise, both globally
and in Africa. They are by far the
leading cause of death in the world,
representing over 60% of all annual
deaths. Approximately 36 million
people die prematurely from NCDs
every year, and are therefore
regarded largely as preventable
deaths. The majority of NCD deaths
Figure 1: NCDs and their lifestyle‐related risk factors
(80%) occur in developing countries Source: WHO Global Status Report on NCDs, 2010
(WHO).
2.3 Main Risk Factors
There are four main factors that contribute to the development of NCDs. These are:
• Physical inactivity
• Smoking
• Unhealthy diet
• Excessive alcohol consumption
Overweight/obesity and high blood pressure are intermediate risk factors: they are first caused by
one or more of the four risk factors above, and then continue to cause a NCD. For example, a lack of
physical activity and/or an unhealthy diet can lead to overweight and then to heart disease.
NCDs are mainly, but not exclusively caused by lifestyle related behaviour: To some, but minor
extent, they are also caused by environmental factors (e.g. indoor smoke in kitchens, exposure to
chemicals in the workplace) or the genetic predisposition of an individual.
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Figure 2: Proportion of NCD mortality under 60 years by income group of countries
Source: WHO Global Status Report on Non‐Communicable Diseases, 2010
The focus of this guide is on lifestyle related factors, as they account for the vast majority of all NCD‐
related deaths.
2.4 Economic and Business Impact of NCDs
The negative impact of NCDs is
increasingly felt in the private
sector, both globally and in Africa.
Although communicable diseases
like HIV, Malaria and TB remain
the major health threats in Sub‐
Saharan Africa for the near future,
the NCD burden will start to
increase significantly in this
ongoing decade, in particular in
urban settings and among
population groups that are
economically better off.
Because NCDs are most of all
lifestyle related, the economic
burden is mostly felt in sectors
where qualified workforce and
higher income groups are
employed: in the formal and
large business sectors, which is Figure 3: Economic Loss from the top 15 Global Causes of Death
the membership base of National Source: The Global Economic Cost of Cancer, American Cancer Society, 2010
Business Coalitions in Africa.
According to a WHO NCD Surveillance Strategy report the burden of disease from NCDs for
developing and newly industrialized countries is expected to rise by 60% by the year 2020. The vast
increase will take place in Africa (World Economic Forum Report 2010 on Global Risks). The WHO
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Global Status Report on NCDs 2010 associates a 10% rise in NCDs with 0.5% lower rates of annual
economic growth. This negative impact of NCDs at the economic level will also be increasingly felt in
the business sector, and needs to be addressed.
During the previous decade Workplace Programme initiatives in Africa were focusing on the three
infectious diseases, HIV/AIDS, TB and Malaria. The fight against non‐communicable diseases will
become a priority of the ongoing decade. Some Occupational Safety and Health (OSH) and Wellness
programmes have already started to include NCDs in their workplace programmes, but a more
comprehensive, systematic and Africa wide approach is needed.
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3 Understanding NonCommunicable Diseases
3.1 Cardiovascular Diseases
Cardiovascular diseases (CVD) are caused
by disorders of the heart and blood
vessels, and include coronary heart
disease leading to heart attacks,
cerebrovascular disease leading to
strokes, raised blood pressure
(hypertension), peripheral artery
disease, rheumatic heart disease,
congenital heart disease and heart
failure.
The most important behavioural risk
factors of heart disease and stroke are
unhealthy diet, physical inactivity,
tobacco use and harmful use of alcohol.
Behavioural risk factors are responsible
for about 80% of coronary heart disease
and cerebrovascular disease (WHO).
Key Facts
• CVDs are the number one cause of
death globally: more people die
annually from CVDs than from any
other cause.
• An estimated 17.1 million people
died from CVDs in 2004,
Figure 4: Types of Cardiovascular Diseases
representing 29% of all global Source: WHO (www.who.int/entity/cardiovascular_diseases/en
deaths. Of these deaths, an /cvd_atlas_01_types.pdf)
estimated 7.2 million were due to
coronary heart disease and 5.7 million were due to stroke.
• Low‐ and middle‐income countries are disproportionally affected: 82% of CVD deaths take
place in low‐ and middle‐income countries and occur almost equally in men and women.
• By 2030, almost 23.6 million people are estimated to die from CVDs, mainly from heart disease
and stroke. These are projected to remain the leading causes of death.
Preventive Action
• Eat a healthy diet, reduce overweight
• Be physically active
• Don’t smoke
• Check the following body parameters regularly: blood pressure and blood lipids
Main source of this chapter: WHO (http://www.who.int/topics/cardiovascular_diseases/en/)
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3.2 Diabetes
Diabetes is a chronic disease, which occurs when either the pancreas does not produce enough
insulin, or when the body cannot effectively use the produced insulin. This leads to an increased
concentration of glucose in the blood (hyperglycaemia). Over time, diabetes can damage the heart,
blood vessels, eyes, kidneys, and nerves.
Type 1 diabetes (previously
known as insulin‐dependent or
childhood‐onset diabetes) is
characterized by a lack of insulin
production.
Type 2 diabetes (formerly called
non‐insulin‐dependent or adult‐
onset diabetes) is caused by the
body’s ineffective use of insulin.
It often results from excess body
weight and physical inactivity.
Gestational diabetes is
hyperglycaemia that is first Figure 5: Diabetes Prevalence and Trends
Source: WHO (www.who.int/entity/cardiovascular_diseases/en/
recognized during pregnancy. cvd_atlas_10_diabetes.pdf)
Key Facts
• More than 220 million people worldwide have diabetes.
• In 2004, an estimated 3.4 million people died from consequences of high blood sugar.
• More than 80% of diabetes deaths occur in low‐ and middle‐income countries.
• WHO projects that diabetes deaths will double between 2005 and 2030.
• Type 2 diabetes accounts for well over 90% of diabetes in Sub‐Saharan Africa, and population
prevalence proportions ranged from 1% in rural Uganda to 12% in urban Kenya.
Preventive Action
To prevent or delay the onset of type 2 diabetes, simple lifestyle measures are effective:
• Achieve and maintain healthy body weight;
• Be physically active
• Eat healthy (fruit, vegetables, reduce sugar and saturated fats intake)
• Don’t smoke
• Check the following body parameters regularly: blood sugar
Main source of this chapter: WHO (http://www.who.int/topics/diabetes_mellitus/en/)
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3.3 Cancer
Cancer is the uncontrolled growth and spread of cells. It can affect almost any part of the body. The
growths often invade surrounding tissue and can metastasize to distant sites. Cancer arises from a
change in one single cell.
The change may be started
by external agents and
inherited genetic factors.
Many cancers can be
prevented by avoiding
exposure to common risk
factors, such as tobacco
smoke, excessive alcohol
use, unhealthy diet and
physical inactivity.
A significant proportion of
cancers can be cured, by
surgery, radiotherapy or
chemotherapy, especially Figure 6: New cases of cancer annually
Source : African Health Monitor Newsletter, January‐June 2008
if they are detected early.
Key Facts
• Cancer accounted for 7.6 million deaths worldwide in 2008 (around 13% of all deaths). The
most frequent types of cancer occur in the organs: lung (1.4 million deaths), stomach (740 000
deaths), liver (700 000 deaths), colorectal system (610 000 deaths), breast (460 000 deaths).
• More than 70% of all cancer deaths occurred in low‐ and middle‐income countries
• More than 30% of cancer deaths can be prevented.
• Deaths from cancer worldwide are projected to continue to rise to over 11 million in 2030.
Preventive Action
• Avoid tobacco use
• Be physically active
• Eat healthy (fruit, vegetables, reduce sugar and saturated fats intake)
• Achieve and maintain a healthy body weight;
• Reduce alcohol consumption
Action to detect cancer early to increase the chances for successful treatment
• If locally available, use regular screening offers for certain types of common cancers such as
colorectal cancer, breast cancer and cervix cancer)
• Attend a doctor if you notice unusual body signs and symptoms, since many cancers cannot
be detected by screening methods.
Main source of this chapter: WHO (http://www.who.int/topics/cancer/en/)
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3.4 Chronic Respiratory Diseases
Chronic respiratory diseases, or chronic obstructive pulmonary diseases (COPD), are chronic diseases
of the airways and other structures of the lung. Some of the most common ones are asthma,
respiratory allergies, occupational lung diseases and pulmonary hypertension. The most important
risk factors for preventable chronic respiratory diseases are:
• Tobacco smoking (primary cause)
• Indoor air pollution (smoke, dust…)
• Outdoor pollution
• Allergens
• Occupational hazards (e.g. chemicals)
Figure 7: Causes of chronic respiratory diseases
Source: WHO, Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach (2007)
Key Facts
• Hundreds of millions of people suffer every day from chronic respiratory diseases.
• According to the WHO estimates (2004), 235 million people have asthma, 64 million people
have chronic obstructive pulmonary disease (COPD) while millions have allergic rhinitis and
other often under‐diagnosed chronic respiratory diseases.
• More than 3 million people died of COPD in 2005 (5% of all deaths globally that year).
• Almost 90% of COPD deaths occur in low‐ and middle‐income countries.
Preventive Action
• Reduce tobacco consumption
• Reduce exposure to outdoor and indoor air pollution
• Consult the doctor in case of symptoms of a chronic cough, sputum production, dyspnoea
(difficult or laboured breathing) or/and a history of exposure to risk factors for the disease. A
person at risk of chronic respiratory disease will then be referred to undergo spirometry, a
method that measures how deeply a person can breathe and how fast air can move into and
out of the lungs.
Main source of this chapter: WHO (http://www.who.int/respiratory/en/index.html)
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4 Understanding Causes and Risk Factors
4.1 Smoking (Tobacco)
Tobacco smoking is the leading
preventable cause of death in the
world. Tobacco products are
products made entirely or partly of
leaf tobacco as raw material, which
are smoked, sucked, chewed or
snuffed. All contain the highly
addictive psychoactive ingredient
nicotine. Tobacco use is one of the
main risk factors for a number of
chronic diseases, including cancer,
lung diseases, and cardiovascular
diseases.
Countries in the African region are Figure 8: Risk of smoking over time
experiencing an increasing rate of Source: www.thinkcopdifferently.com/About%20COPD/
Risk%20factors%20for%20COPD/Smoking.aspx
tobacco use. The fast growth of the
population in Sub‐Saharan Africa is leading to larger and more accessible markets and an increasing
of the African consumers’ purchasing power. In addition to that there are the intensive efforts by the
tobacco industry to expand to African markets. Convincing individuals to quit smoking is clearly the
most cost‐effective prevention measure. Quitting smoking leads to body function improvements no
matter how long a person had been smoking. However, the earlier a person quits, the better are the
results (see figure above).
Key Facts
• Tobacco kills up to half of its users.
• Tobacco kills nearly 6 million people per year (one person every six seconds), of whom more
than 5 million are users and ex users and more than 600 000 are non‐smokers (exposed to
second‐hand smoke). More than 5 million are users and ex‐users, and more than 600 000 are
non‐smokers exposed to second‐hand smoke (passive smoking).
• 63 % of all deaths are caused by NCDs, for which tobacco use is the greatest risk factor, after
high blood pressure.
• Nearly 80% of the world's one billion smokers live in low‐ and middle‐income countries.
• Consumption of tobacco products is increasing globally, though it is decreasing in some high‐
income and upper middle‐income countries.
Preventive Action
Company • Ban/ discourage smoking in the workplace
Personally • Quit (best) or reduce smoking (note: lighter cigarettes are not ‘safer’)
• As a non‐smoker: avoid passive smoking
• As a smoker: don’t expose others to your smoking (in particular children)
Main source of this chapter: WHO (http://www.who.int/topics/tobacco/en/)
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4.2 Excessive Alcohol Consumption
The harmful use of alcohol is a global
problem which compromises both
individual and social development. It
results in 2.5 million deaths each
year. It also causes harm far beyond
the physical and psychological health
of the drinker. It also harms the well‐
being of the social network of the
person drinking, in particular his or
her family. An intoxicated person can
harm others or put them at risk of
traffic accidents or violent behaviour,
or negatively affect co‐workers, Figure 9: Model of Alcohol Consumption
Source: WHO, Global Status Report on Alcohol (2004)
relatives, friends or strangers. Thus,
the impact of the harmful use of alcohol reaches deep into society.
Harmful drinking is a major determinant for neuropsychiatric disorders, such as alcohol use
disorders, epilepsy and other non‐communicable diseases such as cardiovascular diseases, cirrhosis
of the liver and various cancers. The harmful use of alcohol is also associated with higher
transmission risks of several infectious diseases like HIV/AIDS, tuberculosis and sexually transmitted
infections (STIs). Furthermore, excessive alcohol consumption weakens the immune system and has
a negative effect on patients’ adherence to antiretroviral treatment.
In addition to the chronic diseases that may develop in those who drink large amounts of alcohol
over a number of years, alcohol use is also associated with an increased risk of acute health
conditions, such as injuries, including from traffic accidents.
Key Facts
• The harmful use of alcohol results in 2.5 million deaths each year.
• 320 000 young people between the age of 15 and 29 die from alcohol‐related causes, resulting
in 9% of all deaths in that age group.
• Alcohol is the world’s third largest risk factor for disease burden,
• Alcohol is associated with many serious social and developmental issues, including violence,
child neglect and abuse, and absenteeism in the workplace.
Preventive Action
• Reduce your alcohol consumption.
• Discourage others from excessive alcohol consumption (in particular when driving).
Main source of this chapter: WHO (http://www.who.int/topics/alcohol_drinking/en/#main)
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4.3 Unhealthy Diet
An unhealthy diet is one of the
major risk factors for a range of
chronic diseases, including
cardiovascular diseases,
cancer, diabetes and other
conditions linked to overweight
and obesity.
Nutrition is the intake of food,
considered in relation to the
body’s dietary needs. Good
nutrition – an adequate, well
balanced diet combined with
regular physical activity – is a
cornerstone of good health.
Poor nutrition can lead to
Figure 10: The Eatwell Plate
reduced immunity, increased Source: NHS (www.nhs.uk/Livewell/Goodfood/Pages/eatwell‐plate.aspxf)
susceptibility to disease,
impaired physical and mental development, and reduced productivity.
Improving dietary habits is a societal, not just an individual challenge. Therefore it demands a
population‐based, multi‐sectoral, multi‐disciplinary, and culturally relevant approach.
Key Facts
• Unhealthy eating is associated with increased risk for many diseases, including several of the
leading causes of death: heart disease, cancer, stroke, and diabetes.
• A poor or imbalanced diet can increase the risk for lung, esophageal, stomach, colorectal, and
prostate cancers
• Individuals who eat fast food one or more times per week and/or drink sugar‐sweetened
beverages are at increased risk for weight gain, overweight, and obesity
Preventive Action
Company • Provide healthy food at company’s canteen and reduce unhealthy food
• Reduce selling sweets or sugar‐sweetened drinks (‘fizzy drinks’) and/or ban
vending machines
Personally • Eating more fruit, vegetables, nuts and grains
• Cut down on salt, sugar and fats.
• Choose unsaturated (instead of saturated) fats
Main source of this chapter:
WHO (http://www.who.int/topics/diet/en/)
CDC (http://www.cdc.gov/healthyyouth/nutrition/facts.htm)
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4.4 Physical Inactivity
Physical inactivity has been identified as the
fourth leading risk factor for global
mortality causing an estimated 3.2 million
deaths globally. Increasing levels of physical
inactivity are seen worldwide, in high‐
income countries as well as low‐ and
middle‐income countries.
Regular moderate intensity physical activity
– such as walking, cycling, or participating in
sports – has significant benefits for health.
For instance, it can reduce the risk of
cardiovascular diseases, diabetes, colon and
breast cancer, and depression. Moreover Figure 11: Equivalents of Physical Activity
Source: WHO www.who.int/entity/cardiovascular
adequate levels of physical activity will _diseases/en/cvd_atlas_08_physical_inactivity.pdf
decrease the risk of a hip or vertebral
fracture and help control weight.
The term "physical activity" should not be mistaken with "exercise". Exercise is a subcategory of
physical activity that is planned, structured, repetitive, and purposeful in the sense that the
improvement or maintenance of one or more components of physical fitness is the objective.
Physical activity includes exercise as well as other activities which involve bodily movement and are
done as part of playing, working, active transportation, house chores and recreational activities.
Key Facts
• Lack of physical activity is the fourth leading risk factor for global mortality (6% of all deaths
worldwide).
• Physical inactivity is estimated to be the main cause for 21–25% of breast and colon cancers,
27% of diabetes and approximately 30% of ischaemic heart disease burden
• Regular physical activity helps reduce the risk of developing obesity and chronic diseases,
such as diabetes, cardiovascular disease, and colon cancer
• Reduces feelings of depression and anxiety and promotes psychological well‐being
Preventive Action
Company • Provide gym facilities or offer support on gym memberships
• Encourage sports groups
Personally • Do sports
• Be physically active wherever possible in your day‐to‐day routine, e.g.
o Walk or cycle to work or for shopping
o Take stairs instead of using elevator or escalators
o During office work, make short breaks and move
Main source of this chapter:
WHO (http://www.who.int/topics/physical_activity/en/)
CDC (http://www.cdc.gov/healthyyouth/physicalactivity/facts.htm)
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4.5 Obesity (Overweight)
Overweight and obesity are
defined as abnormal or excessive
fat accumulation that presents a
risk to health. They are closely
linked to unhealthy food and lack
of physical activity, considered as
intermediate factors that
contribute to the development of
NCDs.
A crude population measure of
obesity is the body mass index
(BMI), a person’s weight (in
kilograms) divided by the square
of his or her height (in metres). A Figure 12: Trends in global food consumption
Source: WHO (www.who.int/entity/cardiovascular_diseases
person with a BMI of 30 or more is /en/cvd_atlas_09_obesity.pdf)
generally considered obese. A
person with a BMI equal to or more than 25 is considered overweight.
Overweight and obesity are major risk factors for a number of chronic diseases, including diabetes,
cardiovascular diseases and cancer. Once considered a problem only in high income countries,
overweight and obesity are now dramatically on the rise in low‐ and middle‐income countries,
particularly in urban settings.
Obesity has reached epidemic proportions globally, with at least 2.6 million people dying each year
as a result of being overweight or obese. Once associated with high‐income countries, obesity is now
also prevalent in low‐ and middle‐income countries.
Key Facts
• Worldwide obesity has more than doubled since 1980.
• In 2008, 1.5 billion adults, 20 and older, were overweight. Of these over 200 million men and
nearly 300 million women were obese.
• 65% of the world's population live in countries where overweight and obesity kills more
people than underweight.
• Obesity is preventable.
Preventive Action
• Do physical exercises
• Eat healthy (see chapter 4.3)
• Participate in weight reduction programmes
• Join local sports or weight reduction groups (e.g. weight watchers)
Source of this chapter: WHO (http://www.who.int/topics/obesity/en/)
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5 Company Action and Staff Awareness
Companies can play a vital role in disease prevention, as the workplace is a conducive environment
to reach a substantial proportion of a population with targeted interventions. This applies
particularly to NCDs, because of their slow and silent progression and the fact that their negative
long‐term effects only become visible when it is often too late to reverse the condition.
Basically, there are two preventive workplace approaches how companies can contribute to the
reduction of lifestyle related risks that cause NCDs:
1. Creating healthy workplaces (supply‐side measures) to facilitate the consumption of healthy
products and services (and vice versa: impede the access to ‘unhealthy’ goods), and
2. Raise employees’ awareness on NCDs (demand‐side measures) to increase their knowledge
on NCDs, to achieve a change in attitude and increase their demand for healthier goods (and
vice versa: to lower their demand for unhealthy goods and activities)
5.1 Creating Healthy Workplaces
The company can reduce unhealthy life‐style of its employees by actively taking action in its own
realms:
• Assessing NCD‐related risks and hazards in the company and of employees’ lifestyle, and
developing a plan of action
• Formulating a policy that promotes employee health and regular medical check‐ups to
respond to the often silent progressing of NCDs
• Discouraging unhealthy behaviour e.g. through a ban on smoking at the workplace or
reducing the number of vending machines that sugar‐sweetened food products or
beverages (‘fizzy drinks’)
• Encouraging healthy behaviour i.e. by supporting a company sports group or membership
in a gym
• Providing or subsidizing health oriented services such as healthy food in the canteen
• Checking employees‘ individual workplace conditions and provide advice to reduce adverse
long‐term effects on fitness and health, e.g. by an external health expert during health
campaigns or events.
5.2 Raising Staff Awareness
The company can use its influence and the workplace as a setting to contribute to an increased
awareness regarding healthy and harmful behaviour of the individual. This can be done in different
ways:
• Informing thoroughly about the company’s health policy
• Disseminating information through posters, leaflets, etc.
• Communicating health messages and facts on NCDs via emails and other communication
channels (payment slips, etc.) to employees
• Conducting awareness days or aligning NCD campaigns to other company events
• Inviting external health specialists to give talks on specific topics
• Supporting health education during work time possibly by special health champions or peer
educators
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5.3 Applying this Guide and the Toolbox
Both approaches as described in chapter 5 complement each other and should be pursued
concurrently. The toolbox in chapter 5 provides links to a wide range of material, instruments and
tools that can be used to pursue these strategies and to implement activities in the workplace. From
a more practical oriented perspective, the information and instruments from the toolbox can be
applied in following ways.
Dissemination of Information
Noticeboards: Print information sheets, posters, etc. and hang them at notice boards and other
public places like canteens, change rooms, etc.
Leaflets and flyers: Print and copy information sheets (if appropriate/necessary, adapt them to your
country‐specific situation) and distribute among staff. institutions like the World Heart Federation
also offer to send information material to organisations on request.
Health Communication and Reminders
Staff emails: Send regular health messages to staff, copying pictures and short text (keep short and
concise, 50‐100 words)
Messages on payment slips, etc.: Copy and paste short messages, facts etc. on payment slips (max.
10 words, e.g. smoking causes cancer).
Promotion Material: Distribute T‐Shirts, pens etc. with NCD‐related messages.
Health Campaigns and Events
Awareness days: conduct special days in your companies on certain health issues, ideally in line with
respective World Days (e.g. World Cancer Day on 4th February, World Heart Day on 29th September,
World Diabetes Day on 14th November, etc., see also Chapter 6.7).
Sports events: conduct, support or promote local sports events (5, 10, 20 km walks, etc.) and
encourage staff to join them, individually or as a company team, also useful for team‐building
purposes. In large companies: provide gym facilities in the workplace.
Healthy canteen days: Set aside one day on which all of the food served in the company canteen will
be nutritionally balanced. Organize an external dietician for this day. Provide recipes on home‐made
healthy lunches, you can promote these on a company intranet. And/or conduct a team building
competition with different groups trying to cook the healthiest food.
Educational Sessions
Internal expert: include NCD topics into your educational workplace programme (if any).
Alternatively or additionally, develop an NCD‐focused agenda with peer educators, focal persons or
medical staff (from your company’s in‐house clinic) and conduct educational staff meetings (sessions
in workplace ergonomics are very popular, in particular in office settings).
External experts: Invite external (medical) experts or health service providers, for examples from
local clinics, health NGOs, health insurances, etc., in particular in combination with other activities
like awareness days.
There are still more activities and ideas that can be applied than the ones suggested above. Thinking
out‐of‐the‐box and developing innovative ideas (competitions, raffles…) is important in order to bring
the message to the people more effectively and to achieve a change in behaviour. The toolbox in 5
provides more ideas in this regard.
Page 18Tackling Non‐Communicable Diseases
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Case Study: Automotive Industry Development Centre tackling NCDs in the Workplace
The Automotive Industry Development Centre (AIDC), Eastern Cape, supports South African automotive supplier
companies in the areas of skills development, training and supply chain development to help in increasing the global
competitiveness of the South African automotive industry.
AIDC with support of the GIZ AWiSA programme offers health‐oriented workplace programme solutions and has
assisted 12 companies in setting up and/or improving their HIV/AIDS and wellness workplace programmes. Since 2009
they reached out to over 3000 employees. Their comprehensive wellness approach includes health topics like high blood
pressure, diabetes, cancer, overweight and alcohol abuse.
Wellness workplace coordinators and peer educators, trained in the AIDC workplace programme, conduct health
campaigns and address health issues and risk factors like high blood pressure, diabetes, unhealthy diet, smoking, physical
inactivity and excessive alcohol consumption in their awareness sessions, ideally in line with the official Health Calendar.
When wellness days are conducted in supplier companies usually blood pressure and glucose is measured, BMI tests
are conducted and HIV Counselling and Testing is also included (see Health Passport below). Two companies also carry
out PAP smears to diagnose cervical cancer during their wellness days. In 2010 and 2011 more than 90% of staff
participated in the comprehensive testing package.
The AIDC/AWiSA case shows that comprehensive workplace programmes that follow a holistic health approach are
more likely to be successful than stand‐alone HIV&AIDS Workplace Programmes.
Box 1: AIDC Health Passport for employees in the automotive supply chain industry
Source: AIDC 2011
Page 19Tackling Non‐Communicable Diseases
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6 Toolbox for Workplace Action on NCDs
The lists below are sorted by category; therefore multiple mentioning of tools is possible. All
information is available in English. It is highlighted where it is also available in French ( ), which
applies to most WHO material (simply click on the language link on top of the WHO website).
6.1 General Information on NCDs
Target Group: Workplace Programme Coordinators
Item Organisation Internet Source Comment
General information on NCDs
Introduction WHO http://www.who.int/nmh/en/index.html Good overview and
http://www.who.int/topics/chronic_diseases/en/ introduction into the topic
Preventing NCDs in the WHO & World https://members.weforum.org/pdf/Wellness/WHOWEF_ Provides research data and
Workplace through Diet and Economic Forum report.pdf rationale for why tackling
Physical Activity http://www.who.int/dietphysicalactivity/workplace/en/i NCDs in companies
ndex.html
Introduction Public Health http://www.phac‐aspc.gc.ca/cd‐mc/index‐eng.php (EN)
Agency of http://www.phac‐aspc.gc.ca/cd‐mc/index‐fra.php (FR)
Canada
Article on NCDs News from http://www.newsfromafrica.org/newsfromafrica/
Africa, April 2011 articles/art_12523.html
NCDs: An overview of Africa’s African Health indexmedicus.afro.who.int/iah/fulltext/Ahm/an‐
new silent killers Monitor, Jan.‐ overview.pdf
June 2008
Global status report on NCDs WHO http://www.who.int/nmh/publications/
2010 ncd_report2010/en/index.html
http://whqlibdoc.who.int/publications/
2011/9789240686458_eng.pdf
NCD country profiles WHO http://www.who.int/entity/nmh/publications/ncd_profil
es_report.pdf
http://www.who.int/nmh/countries/en/index.html (by
countries)
Global InfoBase on NCDs WHO https://apps.who.int/infobase/ NCD Data per country and
risk factor *
Cardiovascular Diseases (CVDs)
General Information WHO http://www.who.int/topics/cardiovascular_diseases/en/ Good overview and
introduction into the topic
The Atlas of Heart Disease WHO http://www.who.int/cardiovascular_diseases/resources/ Very good resource with
and Stroke atlas/en/ informative (1‐page) sheets
on CVDs and its causes
Types of Cardiovascular WHO http://www.who.int/entity/cardiovascular_diseases/en/ Very informative and
Diseases cvd_atlas_01_types.pdf illustrative 1‐page sheet !!
Employer's resource guide World Heart http://www.world‐heart‐federation.org/what‐we‐ Extremely useful guide on
and Workplace Wellness Federation do/awareness/world‐heart‐day/engaging‐ what can be done in the
Engagement Ideas employers/employers‐resource‐guide/ workplace
Q&A: What can I do to avoid WHO http://www.who.int/features/qa/27/en/index.html
a heart attack or a stroke?
Resources for health Blood Pressure http://www.bpassoc.org.uk/HealthProfessionals/Resour Broad range of resources on
professionals Association (UK) ces (EN) high blood pressure (UK‐
http://www.bpassoc.org.uk/HealthProfessionals/Otherla oriented, but technically
nguages#liVc (FR) good material)
Information leaflets for High Blood http://www.hbpf.org.uk/downloads.php UK‐oriented, but technically
downloading Pressure good material, detailed
Foundation (UK)
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Item Organisation Internet Source Comment
Diabetes
General Information WHO http://www.who.int/topics/diabetes_mellitus/en/ Good overview and
introduction into the topic
General Information CDC http://www.cdc.gov/diabetes/ Vast collection of material,
although focus on USA
Risk Factor: Diabetes WHO http://www.who.int/entity/cardiovascular_diseases/en/ Very informative and
cvd_atlas_10_diabetes.pdf illustrative 1‐page sheet !!
Q&A: What are the risks of WHO http://www.who.int/features/qa/65/en/index.html
diabetes in children?
Advocacy and Information International http://www.idf.org/worlddiabetesday/2009‐ Very useful material,
Material: Posters, Diabetes 2013/materials available in many languages
Campaignbook, Booklets and Foundation
Web‐banners
Country Data on Diabetes WHO http://www.who.int/diabetes/facts/world_figures/en/ Note that it is average
national data. The data
need to be
contextualised: NCD
rates correlate positively
with income level.
Strategies to raise employees’ Diabetes at Work http://diabetesatwork.org/NextSteps/
awareness and encourage AwarenessAndParticipation.cfm
participation
Chronic Obstructive Pulmonary Disease (COPD
General Information WHO http://www.who.int/respiratory/en/index.html
General Information CDC http://www.cdc.gov/copd/
General information British Lung http://www.lunguk.org/you‐and‐your‐lungs/conditions‐
Foundation and‐diseases/copd.htm
Chronic obstructive WHO http://www.who.int/respiratory/copd/en/
pulmonary disease (COPD)
General Information on WHO http://www.who.int/topics/asthma/en/index.html
Asthma
Website of Global Initiative Global Initiative http://www.goldcopd.org/ General information on
for COPD with Guidelines, for COPD COPD
resources…
World COPD Day Materials International http://www.internationalcopd.org/wcdmaterials/WCD_ Useful tool how to conduct
COPD Coalition Materials.aspx COPD Day (Media) and
information material
Cancer
General Information WHO http://www.who.int/topics/cancer/en/ Good overview and
introduction into the topic
Smoking
General Information WHO http://www.who.int/topics/tobacco/en/
http://www.afro.who.int/en/clusters‐a‐
programmes/hpr/health‐risk‐factors/tobacco.html
Alcohol
General Information WHO http://www.who.int/topics/alcohol_drinking/en/#main
Global Status Report on WHO http://www.who.int/substance_abuse/publications/
Alcohol and Health 2011 global_alcohol_report/en/index.html
Global data http://www.who.int/entity/substance_abuse/publicatio
ns/
global_alcohol_report/msbgsruprofiles.pdf (global data)
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Item Organisation Internet Source Comment
Global Status Report on WHO http://www.who.int/entity/substance_abuse/publicatio Quite interesting,
Alcohol and Health 2011 ns/
(Africa country sheets) global_alcohol_report/msbgsrafr.pdf (Africa data)
http://www.who.int/substance_abuse/publications/
global_alcohol_report/profiles/en/index.html
Global maps on alcohol WHO http://gamapserver.who.int/mapLibrary/app/searchRes
consumption ults.aspx
Unhealthy Diet Æ see also at obesity
General Information WHO http://www.who.int/topics/diet/en/
http://www.who.int/gho/ncd/risk_factors/unhealthy_di
et_text/en/index.html
The Eatwell Plate NHS http://www.nhs.uk/Livewell/Goodfood/Pages/eatwell‐ Illustrative information on
plate.aspx how to eat healthier, with
many additional useful links
for more in‐depth
information
Physical Inactivity
General Information WHO http://www.who.int/topics/physical_activity/en/
Risk factor: physical inactivity WHO http://www.who.int/entity/cardiovascular_diseases/en/ Very informative and
cvd_atlas_08_physical_inactivity.pdf illustrative 1‐page sheet !!
Employer's resource guide World Heart http://www.world‐heart‐ Very useful ideas how to
and Workplace Wellness Federation federation.org/fileadmin/user_upload/images/world‐ carry out activities in the
Engagement Ideas heart‐ workplace
day/2010/WHD_Employers_resource_guide/Employers%
20Engagement%20Ideas%20FINAL.pdf
Obesity
General Information WHO http://www.who.int/nmh/en/index.html Good overview and
introduction into the topic
Risk Factor: Obesity WHO http://www.who.int/entity/cardiovascular_diseases/en/ Very informative and
cvd_atlas_09_obesity.pdf illustrative 1‐page sheet !!
Map on worldwide obesity International http://www.iaso.org/iotf/obesity/ Click on a country for
prevalence Obesity national prevalence data *
Taskforce
High Blood Pressure
Risk Factor: High Blood WHO http://www.who.int/entity/cardiovascular_diseases/en/ Very informative and
Pressure cvd_atlas_05_HBP.pdf illustrative 1‐page sheet !!
Material is also available in French
Page 22Tackling Non‐Communicable Diseases
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6.2 Guidance for Company Action and Awareness Creation
Target Group: Workplace Programme Coordinators
Item Organisation Internet Source Comment
Cardiovascular Diseases (CVDs)
Employer's resource guide World Heart http://www.world‐heart‐federation.org/what‐we‐ Extremely useful guide on
and Workplace Wellness Federation do/awareness/world‐heart‐day/engaging‐ what can be done in the
Engagement Ideas employers/employers‐resource‐guide/ workplace
Diabetes
Advocacy and Information International http://www.idf.org/worlddiabetesday/2009‐ Very useful material,
Material: Posters, Diabetes 2013/materials available in many languages
Campaignbook, Booklets and Foundation
Web‐banners
Strategies to raise employees’ Diabetes at Work http://diabetesatwork.org/NextSteps/
awareness and encourage AwarenessAndParticipation.cfm
participation
Chronic Obstructive Pulmonary Disease (COPD)
Website of Global Initiative Global Initiative http://www.goldcopd.org/ General information on
for OPCD with Guidelines, for COPD COPD
resources…
Unhealthy Diet and Physical Inactivity
Employer's resource guide World Heart http://www.world‐heart‐ Very useful ideas how to
and Workplace Wellness Federation federation.org/fileadmin/user_upload/images/world‐ carry out activities in the
Engagement Ideas heart‐ workplace
day/2010/WHD_Employers_resource_guide/Employers%
20Engagement%20Ideas%20FINAL.pdf
Preventing NCDs in the WHO & World https://members.weforum.org/pdf/Wellness/WHOWEF_ Provides research data and
Workplace through Diet and Economic Forum report.pdf rationale for why tackling
Physical Activity http://www.who.int/dietphysicalactivity/workplace/en/i NCDs in companies
ndex.html
Employer's resource guide World Heart http://www.world‐heart‐ Very useful ideas how to
and Workplace Wellness Federation federation.org/fileadmin/user_upload/images/world‐ carry out activities in the
Engagement Ideas heart‐ workplace
day/2010/WHD_Employers_resource_guide/Employers%
20Engagement%20Ideas%20FINAL.pdf
A guide for employer: Public Health http://www.healthpromotionagency.org.uk/Resources/ Useful booklet on how
Promoting healthy eating at Agency HSC workwell/workwellhealthyeating08.html employers can take simple
work (2008) (UK/Northern http://www.healthpromotionagency.org.uk/Resources/ action on promoting or
Ireland) workwell/pdfs/promoting%20healthy%20eating%20at% providing healthier food,
20work08.pdf (PDF, A5, 8p.) with or without company
canteens.
Page 23Tackling Non‐Communicable Diseases
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6.3 Training Manuals
Item Organisation Internet Source Comment
Training manual for health WHO www.emro.who.int/cbi/pdf/trainers_guide_module4_en Developed for Eastern
volunteers (here part 4 on .pdf Mediterranean region
NCDs, draft)
Employee Wellness GIZ http://german‐practice‐collection.org/en/links/other‐ Tackles Hypertension
Programme ‐ Peer Educator’s gdc‐related‐publications/employee‐wellness‐programme
Manual (1.2 MB)
Training Manual for Peer IUHPE http://www.iuhpe.org/uploaded/Activities/Scientific_Aff Developed in Zambia
Educators on Cervical cancer airs/CDC/TrainingManual_PeerEducators_WEB.pdf
Diabetes Education Training World Diabetes http://www.worlddiabetesfoundation.org/media(3813,1 234 pages (!), very in‐depth
Manual for sub‐Saharan Foundation 033)/IDF_Diabetes_Education_Training_Manual.pdf
Africa (2007)
Blood Pressure Training www.welchallyn.com/documents/.../7171WAWorkbook For health professionals and
Guide _AUG5.pdf nurses
6.4 Information and Awareness Material: Fact Sheets, Posters, Leaflets…
Target Group: Workplace Programme Coordinators, but in particular staff. Check also for more
material at World Day websites (see category further down).
Item Organisation Internet Source Comment
General Information on NCDs
Fact Sheet on NCDs and WHO http://www.who.int/features/factfiles/
Chronic Diseases noncommunicable_diseases/en/index.html
10 Facts Sheet on NCDs WHO http://www.who.int/features/factfiles/ Useful information for staff
noncommunicable_diseases/en/index.html awareness
http://www.who.int/features/factfiles/
noncommunicable_diseases/facts/en/index.html
Cardiovascular Diseases (CVDs)
Fact Sheet on CVDs WHO http://www.who.int/mediacentre/ Copy and paste key
factsheets/fs317/en/index.html information for staff
awareness
Types of Cardiovascular WHO http://www.who.int/entity/cardiovascular_diseases/en/ Very informative and
Diseases cvd_atlas_01_types.pdf illustrative 1‐page sheet !!
Case study on stroke: WHO http://www.who.int/features/galleries/ Slides; short, illustrative,
Roberto survives on family chronic_diseases/roberto/01_en.html very useful and touching;
support http://www.who.int/features/2005/ (not African story)
chronic_diseases/en/index.html
Q&A: What can I do to avoid WHO http://www.who.int/features/qa/27/en/index.html
a heart attack or a stroke?
World Heart Day (WHD) World Heart http://www.world‐heart‐federation.org/what‐we‐do/ You can order (electronic)
29th September Federation awareness/world‐heart‐day/ leaflets and posters for WHD
http://www.world‐heart‐federation.org/what‐we‐ activities
do/awareness/world‐heart‐day/2011‐campaign‐
material/
Resources for health Blood Pressure http://www.bpassoc.org.uk/HealthProfessionals/Resour Broad range of resources on
professionals Association (UK) ces (EN) high blood pressure (UK‐
http://www.bpassoc.org.uk/HealthProfessionals/Otherla oriented, but technically
nguages#liVc (FR) good material)
Information leaflets for High Blood http://www.hbpf.org.uk/downloads.php UK‐oriented, but technically
downloading Pressure good material, detailed
Foundation (UK)
Page 24Tackling Non‐Communicable Diseases
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Item Organisation Internet Source Comment
World Stroke Day World Stroke http://www.worldstrokecampaign.org/media/Pages/ Check for resources on the
29th October Organization AboutWorldStrokeDay2010.aspx webpage
High Blood Pressure Fact www.aahealth.org/ltl_pdf/highbloodpressure.pdf Useful
Sheet
Diabetes
Fact Sheet on Diabetes WHO http://www.who.int/mediacentre/factsheets/fs312/en/i Useful information for staff
ndex.html awareness
Risk Factor: Diabetes WHO http://www.who.int/entity/cardiovascular_diseases/en/ Very informative and
cvd_atlas_10_diabetes.pdf illustrative 1‐page sheet !!
Case study on diabetes: WHO http://www.who.int/features/galleries/ Slides; short, illustrative,
Zahida's story, living with chronic_diseases/zahida/01_en.html useful and touching (not
diabetes http://www.who.int/features/2005/ African story)
chronic_diseases/en/index.html
Q&A: What are the risks of WHO http://www.who.int/features/qa/65/en/index.html
diabetes in children?
Facts & Figures on Diabetes WHO http://www.who.int/diabetes/facts/en/index.html
Advocacy and Information International http://www.idf.org/worlddiabetesday/2009‐ Very useful material,
Material: Posters, Diabetes 2013/materials available in many languages
Campaignbook, Booklets and Foundation
Web‐banners
Fact Sheets (>20), e.g. Diabetes at Work http://diabetesatwork.org/NextSteps/FactSheets.cfm Useful fact sheets, according
• Myths to everybody’s needs
• What is it, etc.
Chronic Obstructive Pulmonary Disease (COPD)
Fact Sheet: Chronic WHO http://www.who.int/mediacentre/factsheets/fs315/en/i
obstructive pulmonary ndex.html
disease (COPD)
Asthma Fact Sheet WHO http://www.who.int/mediacentre/factsheets/fs307/en/i
ndex.html
World COPD Day Materials International http://www.internationalcopd.org/wcdmaterials/WCD_ Useful tool how to conduct
COPD Coalition Materials.aspx COPD Day (Media) and
information material
Cancer
Fact Sheet on cancer WHO http://www.who.int/mediacentre/factsheets/fs297/en/i Useful information for staff
ndex.html awareness
10 Facts about Cancer WHO http://www.who.int/features/factfiles/cancer/01_en.ht 10 slides; short, illustrative,
ml very useful
http://www.who.int/features/factfiles/cancer/en/index.
htm
Two case studies on cancer WHO http://www.who.int/features/cancer/en/index.html Slides; short, illustrative,
http://www.who.int/features/galleries/chronic_diseases useful and touching
1. Maria’s story (Tanzania) /
2. Miriame’s story (Uganda) maria/01_en.html
http://www.who.int/features/2006/cancer/
miriame/en/index.html
Fact sheets on Cancer National Cancer http://www.cancer.gov/cancertopics/factsheet/ 200 frequently updated fact
(USA) Institute sheets on a wide array of
cancer topics
Smoking (Tobacco)
Fact Sheet on Tobacco Use WHO http://www.who.int/mediacentre/factsheets/fs339/en/i
ndex.html
Page 25Tackling Non‐Communicable Diseases
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Item Organisation Internet Source Comment
10 Facts WHO http://www.who.int/features/tobacco/en/index.html
a.) on the tobacco epidemic http://www.who.int/features/factfiles/tobacco_epidemi
and its control c/
en/index.html
http://www.who.int/features/factfiles/tobacco_epidemi
c/
tobacco_epidemic_facts/en/index.html
10 Facts WHO http://www.who.int/features/factfiles/gender_tobacco/
b.) on gender and tobacco en/index.html
http://www.who.int/features/factfiles/gender_tobacco/
facts/en/index.html
10 Facts WHO http://www.who.int/features/factfiles/tobacco/en/index
c.) on second‐hand (passive) .html
smoke http://www.who.int/features/factfiles/tobacco/
tobacco_facts/en/index.html
Campaign Materials WHO http://www.who.int/tobacco/wntd/2011/en/index.html
1.) Poster http://www.who.int/entity/tobacco/wntd/ EN and FR
2011/poster/en/index.html
2.) Flyer
http://www.who.int/entity/tobacco/wntd/2011/flyer/en Smoker’s body quite
3.) Sticker
/index.html shocking (also genitals
4.) The smoker’s body (4 MB)
http://www.who.int/entity/tobacco/wntd/2011/sticker/ exposed)
en/index.html
http://www.who.int/entity/tobacco/resources/publicati
ons/smokersbody_en_fr.pdf
Fact Sheet on Tuberculosis WHO http://www.who.int/tobacco/resources/publications/ Only to be used in areas /
and Tobacco fact_sheet_set09/en/index.html sectors with relatively high
TB rates
Alcohol
Fact Sheet on Alcohol WHO http://www.who.int/mediacentre/factsheets/fs349/en/i
ndex.html
Unhealthy Diet Æ see also obesity
Enjoy healthy eating (2008) Public Health http://www.healthpromotionagency.org.uk/Resources/n Useful booklet (suitable for
Agency HSC (UK) utrition/Enjoy_healthy_eating.html middle and higher income
http://www.healthpromotionagency.org.uk/Resources/n groups).
utrition/pdfs/Healthy%20eating%20leaflet%20FINAL.pdf
(PDF, A5, 16 p.)
The Eatwell Plate NHS http://www.nhs.uk/Livewell/Goodfood/Documents/Eat Poster of the Eatwell Plate
wellplate.pdf (rather for middle and high‐
income groups)
Physical Inactivity
Facts about Physical Activity CDC http://www.cdc.gov/healthyyouth/physicalactivity/facts.
htm
Risk factor: physical inactivity WHO http://www.who.int/entity/cardiovascular_diseases/en/ Very informative and
cvd_atlas_08_physical_inactivity.pdf illustrative 1‐page sheet !!
10 Facts about Physical WHO http://www.who.int/features/factfiles/physical_activity/
Activity en/
http://www.who.int/features/factfiles/physical_activity/
facts/en/index.html
Page 26You can also read
