Preventive Health: Beyond Our Borders

What We Can Learn From Our Friends Around the World

Man and woman jogging in Paris
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The True Health Initiative is a global effort, involving experts from some 33 countries. That offers a unique view from altitude of policies, practices, behaviors, and customs around the world, and their effects on health for good or for ill.

This roundtable benefits from that wide view and explores some of the salient factors affecting health in different countries. We might all imagine a healthcare system informed by the lessons of a global community.

The power to do anything like that begins with knowledge of what works best and what can be improved upon. This discussion is a window to that “world” of opportunity.

Australia: Health-Supporting Surroundings

Kara Landau, APD, AN
“Travelling Dietitian”—Australian Accredited Practicing Dietitian living in New York City

Many of Australia’s major cities line the ocean, making for a very supportive environment to get out and be active. With fitness boot camps run early in the morning on the beach, many seaside dwellers are motivated to rise early and start their day with a workout.

The bounty of fresh produce offered at many of the inner city weekend farmers markets; cafes offering an abundance of healthy, all-day breakfasts and freshly squeezed vegetable and fruit juices; and a very prominent component of the mainstream media discussing nutrition and diet—Australian awareness of the importance of healthy living, as well as supportive environments being set up for wellbeing, is at an all-time high.

Brazil: Wellness as Part of a Societal Agenda

Rodrigo Bornhausen Demarch, MD
Chair, Worksite Health Promotion Committee – Brazilian National Association of Occupational Medicine; Global Faculty Trainee – Byers Center for Biodesign, Stanford University


Alberto Ogata, MD
Coordinator, Healthcare Innovation Lab – PAHO and Brazilian Health Insurance Agency

During the last half century, due to a drop in communicable diseases, life expectancy in Brazil increased from 45 to 75.5 years. This can be attributed to urbanization; improved living conditions; greater access to sanitation and other social conveniences; medical advances, such as vaccines, antibiotics and antivirals; and increased access to health services, particularly primary care.

However, as in many countries around the world, Brazil’s transition came with a significant increase in non-communicable disease incidence. We’re observing a skyrocketing epidemic of obesity, with rates rising from 11.8 percent to 18.9 percent in the decade leading up to 2015. Overweight increased from 42.6 percent to 53.9 percent, and diabetes rose from 5.5 percent to 7.5 percent in roughly the same time period. A national population study involving more than 73,000 adolescents showed that 15 percent of them were overweight and almost 10 percent were obese. In other words, the next generations are also at risk.

The good news is that health promotion and wellbeing are increasingly being included in Brazilian society's agenda with several initiatives that include active transportation, healthy food, and use of technology to stimulate healthy behaviors. Still, despite the progress that has been made, a lot of effort is still necessary, particularly in reduction of social inequalities, higher levels of education, pollution control, and a stronger connection between different stakeholders in the country.

France: Taste Cultivated from a Young Age

Dina Rose, PhD
Sociologist, Parent Educator, Feeding Expert

The French have a secret for teaching children healthy eating habits. It’s called taste development. French parents expose their infants to a wide variety of tastes and textures from their very first bites. An important element of this is making several changes in what is offered; one study found that French parents make an average of 18 changes in what they feed their babies in the first thirty days of weaning.

Compare that to the American approach: The American Academy of Pediatrics recommends parents give infants one new food at a time. This translates into parents giving babies the same food for two to three days, and then another food for the same duration. This approach is designed to identify (though it is important to note, not prevent) allergies. The unintended consequence is that American children are exposed to a restricted number of foods and learn that repeatedly eating the same food is normal.

The result of the French using the opposite strategy? Babies learn to eat lots of different foods, including plenty of fruits and vegetables, which—for many—has the long-lasting effect of a palette that craves a variety of healthy foods for a lifetime.

Italy: Joint Forces for Wellness Education

Daniele Del Rio, PhD
Associate Professor of Human Nutrition at the University of Parma, Italy

The city of Parma is well-known for some of the best food available in Italy, but its nutrition education and physical activity is also noteworthy. Through the University of Parma and a project named GIOCAMPUS, we presently target more than 7,000 children per year with innovative and inspiring nutrition and lifestyle education programs.

Since the project’s introduction in 2002, Parma has seen impressive changes in those involved with it: The prevalence of overweight decreased from 15.5 percent to 11.7 percent; the number of children having fruits and vegetables for breakfast increased a stunning 120 percent, as did the number of children walking to school. In addition, almost all the measures of physical activity and performance (strength, mobility, balance, and coordination) have improved significantly. The project now involves almost 9,000 children per year and touches all of the primary schools in the city.

This would not be feasible without the fruitful collaboration of the public and private entities behind this project.

Spain: A Departure From the Traditional

When you think of Spain, you probably think of its sun, wonderful monuments, and beaches. You may also think of foods associated with the Mediterranean diet, a regionally traditional way of eating that is associated with greater longevity, and reduced mortality and morbidity from certain cancers and some diet-related chronic diseases. This diet may have been typical of Spain in the 1960s, but the country has changed a lot since then. One only has to see the alarming rates of some chronic diseases to realize the result.

For example, in Spain, type 2 diabetes affects 10.4 percent of the adult population, and that’s expected to rise to 14.39 percent in 2035. Obesity and overweight affect 21.6 percent and 39.3 percent of Spanish adults, respectively; nearly 40 percent of children and teenagers are obese or overweight, which is of special concern to healthcare professionals.

A change of the Spanish food patterns in the last decades is partly to blame, as are other factors, such us physical inactivity. When it comes to the current Spanish dietary pattern, we are far from the essence of what a Mediterranean diet is, and we are in need of urgent interventions.

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