NCD Policy Toolkit

In May 2010, the health officials of the US-affiliated Pacific Islands (USAPIs) joined together in a landmark decision to Declare a Regional State of NCD Emergency: Pacific Island Health Officers Association (PIHOA) Resolution #48-01. It was a critical decision that pulled together the USAPIs in responding to the NCD crisis in ways the region had never experienced, and triggered high-level USAPI responses and commitments across executive and legislative branches of government, and traditional leadership. Following the declaration, an ‘incident command’ response framework (USAPI NCD Strategic Roadmap) was developed to inform the regional response over three key phases: 

1. Sounding the Alert: raising awareness and advocacy amongst key decision-makers in the USAPIs and across the wider Pacific;

2. Crafting the Response: developing NCD-related tools and resources and establishing effective partnerships, and

3. Implementing the Response: adoption of an agreed package of NCD policies and legislation, convening a USAPI NCD law and policy summit, collection and analysis of NCD data and information to track NCD progress and risk factors.

An Introduction to the NCD Policy Toolkit

Dear Pacific Colleagues,

Iakwe kom, kaselehlie maing, len wo, mogethin, hafa adai, ran annim, talofa and alii!

I have the ultimate pleasure to present to you the USAPI NCD Policy Toolkit. It has been a long road to travel in achieving this significant milestone for the Pacific region since an NCD emergency was declared in May 2010. This toolkit has been made possible through the hard work, dedication, passion and commitment of many individuals and organizations over the last couple of years. Most especially, I wish to thank the University of Hawaii John A. Burns School of Medicine, Department of Family Medicine and Community Health team, for their tireless work in researching, developing, refining, editing and putting together in a cohesive and coherent manner, this very important tool and resource which will guide and inform critical work to address NCD risk factors through the adoption of appropriate policies and legislation in the USAPIs. Below is a summary background of when, where and how the USAPI NCD Response began, and the critical next steps in our continued response to reducing the impact of NCDs on our island communities and families.

We hope you will use this toolkit to its maximum potential!

Respectfully,
Emi Chutaro
Executive Director

 

PIHOA Regional NCD Response Timeline (2010-2019)


In June 2012, PIHOA assisted to establish the Health Leadership Council (HLC) as a regional coordination body to bring together a network of existing USAPI professional associations and strengthen partnerships and synergies to address NCDs. The HLC Terms of Reference was developed and endorsed by the USAPI health officials in June 2013, including the USAPI NCD Roadmap which informs and guides NCD work across the HLC members. This was to capitalize on existing NCD interventions and content-area expertise available through the regional professional associations, and to strengthen and enhance collaborative responses to NCDs in support of the USAP NCD emergency response as mandated by the USAPI health officials.

In early 2012, PIHOA also convened two regional technical working groups (TWGs) to discuss and develop a regional NCD surveillance framework and regional NCD policies. In 2013, the USAPI health leadership reviewed and endorsed the USAPI NCD Core Monitoring and Surveillance Framework (and Data Set), as well as the USAPI NCD Commitment Package addressing common NCD risk factors: alcohol and tobacco use, lack of physical activity and poor nutrition.

With wide endorsement and support of the USAPI NCD Commitment Package and a call to convene a USAPI NCD Law and Policy Summit, a USAPI NCD Toolkit needed to be developed to guide and inform NCD policy development appropriate to the USPAI context. In early 2014, PIHOA contracted the University of Hawaii John A. Burns School of Medicine, Department of Family Medicine and Community Health to develop an online NCD toolkit embedded within the PIHOA website. Drafts of the online toolkit were vetted and peer reviewed on several occasions across different regional meetings and forums throughout 2014. CD-ROMs of the toolkit were made and distributed to the USAPIs in 2015.

Next steps will include continued work with the USAPIs to utilize this important resource in advocating, promoting, developing, adopting, implementing and monitoring NCD policies and legislation. By having comprehensive, supportive and enabling NCD policies and legislation in place to address key risk factors, significant strides will be made in reducing the negative impact of NCDs on our islands and communities. 

 

USAPI NCD Strategic Roadmap

USAPI NCD Surveillance Framework 

 

Acknowledgements

This USAPI NCD Policy toolkit was made possible primarily with funding from PIHOA’s United States Center for Disease Control (CDC) National Public Health Improvement Initiative (NPHII) Grant, as well as additional funding support from PIHOA’s CDC Association of State and Territorial Health Officials (ASTHO) project funds. Technical support for the development and refinement of the toolkit was made possible by the generous support and expertise of the University of Hawaii John A. Burns School of Medicine (JABSOM), Department of Family Medicine and Community Health team and PIHOA Secretariat staff, the Health Leadership Council, Secretariat of the Pacific Community, CDC Chronic Disease, and the USAPI national and state NCD programs. In particular, PIHOA would like to thank:

 

UH JABSOM Team

  • Dr. Lee Buenconsejo-Lum
  • Dr. Neal Palafox
  • Mavis Nitta
  • Dioreme
  • Janos Baksa

PIHOA Secretariat Team

  • Michael Epp
  • Dr. Mark Durand
  • Dr. Gregory Dever
  • Jason Aubuchon
  • Emi Chutaro
  • Billie Hiraishi

CDC Team

  • Roberta Erlwein
  • Suzanne White
  • Loren Cadena

Health Leadership Council

  • Va’a Tofaeono
  • Patrick Luces
  • George Cruz
 
 

NCD Declarations and Executive Orders

Key Pacific NCD Policy Declarations

Key Pacific NCD Policy Executive Orders

 

Health Policies 101

Policy 101 section aims to provide overarching policy-making information that could be taken by each jurisdiction and customized, depending on the needs, resources and customary practices of the jurisdiction. The goal of this section is to provide a concrete and valuable resource for individuals, government agencies and community-based organizations in the United States Affiliated Pacific Islands (USAPI) in activities related to health policy-making in the local and national level. Containing six subparts, each addressing components related to health policy planning and implementation processes, this section aims to be a one-stop resource for all USAPI policy-related needs. Policy 101 is broken down into 6 subparts:

(1) Policy 101

(2) Things to Consider: Intended and Unintended Consequences of Policies

Focusing on the general to specific steps in the policy-making process—from departmental assessments, garnering support from key stakeholders, drafting a bill, and ultimately, to passing and implementation

(3) Capacity Building

(4) Appendices

(5) Supplemental Materials

(5) Additional Resources

 

Policy Engagement and Collaboration

Engagement and Collaboration section aims to provide overarching policy-making information that could be taken by each jurisdiction and customized, depending on the needs, resources and customary practices of the jurisdiction. Engagement and Collaboration section focuses on tools and techniques in effective community engagement between wide groups of people to multisectoral partnerships beyond the health sector. This section encompasses practical templates of community engagement planning as well as best-practices from other communities that could be valuable and adaptable to the USAPI. It also emphasizes sustaining stakeholders’ support and political momentum through collaboration. It incorporates cultural considerations in collaboration activities, as well as guiding principles for public policy and community action. Engagement and Collaboration is broken down into 3 subparts:

(1) Community Engagement and Collaboration

Includes guides that may be useful when working with traditional and cultural leaders, and tools and guides for multisectoral partnerships as well as stories from the Pacific related to collaborative works.

(2) Appendices

(3) Supplemental Materials

NCD Policy Toolkit: Intervention #1–Tobacco Taxation

Continue Increasing Taxes on Tobacco Products

As a single intervention, there is no greater public health impact on tobacco use than taxation. The higher the tax, the fewer people are able to purchase tobacco products, especially youth. Uptake of tobacco use during youth is a key driver of much of the epidemic of non-communicable diseases in all age groups. With increased tax we will quickly see a decrease in tobacco use by youth and a decrease later on in disease and death in adults.

Outreach Materials

For more information and how to get involved, here are links to materials for different target audiences. The fact sheets and presentations includes key facts and resources, along with sample policies, that support the intervention. These documents should be adapted for your community with local data and resources.

 

Here are additional resources to help you get started:

Framework Convention on Tobacco Control

 

NCD Policy Toolkit: Intervention #2–Comprehensive Smoke-Free Air Acts

Pass and Enforce Model Comprehensive Smoke-free Air Acts

Secondhand smoke contains over 7000 chemicals of which 70 are known carcinogens. The evidence shows that secondhand smoke causes premature birth and miscarriages in pregnant women. Exposure to secondhand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer. Smoke free laws protect communities from the dangers of secondhand smoke and help smokers reduce cigarette consumption and quit smoking.

Outreach Materials

For more information and how to get involved, here are links to materials for different target audiences. The fact sheets and presentations include key facts and resources, along with sample policies, that support the intervention. These documents should be adapted for your community with local data and resources.

 

Here are additional resources to help you get started:

Framework Convention on Tobacco Control

 

NCD Policy Toolkit: Intervention #3–Tobacco Product Advertising

Ban Forms of Tobacco Product Advertising

Tobacco is the only legal product that when used as directed kills the user. Advertising tobacco products encourages their use, especially among youth. Thus, no tobacco advertising should be acceptable. The World Health Organization noted that bans on advertising, promotion and sponsorship are one of the most effective ways to reduce tobacco consumption. Preventing individuals from beginning to smoke, and supporting those who wish to quit, should be a primary goal.

Outreach Materials

For more information and how to get involved, here are links to materials for different target audiences. The fact sheets and presentations include key facts and resources, along with sample policies, that support the intervention. These documents should be adapted for your community with local data and resources.

 

Here are additional resources to help you get started:

Framework Convention on Tobacco Control

 

NCD Policy Toolkit: Intervention #4–Tobacco Cessation Programs

Establish and Sustain Tobacco Cessation Programs

Cessation is beneficial for all ages, especially long-term health benefits for people who stop at an earlier age. Tobacco dependence is a chronic disease that often requires repeated intervention and multiple attempts to quit. Treatment for tobacco addiction is much less effective and more expensive than other prevention measures. However, treatment can be very effective and is part of a comprehensive approach.

Outreach Materials

For more information and how to get involved, here are links to materials for different target audiences. The fact sheets and presentations include key facts and resources, along with sample policies, that support the intervention. These documents should be adapted for your community with local data and resources.

 

Here are additional resources to help you get started:

Framework Convention on Tobacco Control

 

What you should know about tobacco?

Tobacco is the only product sold in the USAPI that when used as instructed kills people. It is the only legal way to kill someone. It is a major risk factor for all major NCDs, including cardiovascular disease, diabetes, cancer and chronic respiratory disease.

Why is it important?

    • Tobacco kills up to half of its users.
    • Nearly 80% of the world’s one billion smokers live in low- and middle-income countries.
    • The US-Affiliated Pacific Islands have very high rates of tobacco use:
Tobacco Use in the USAPI Youth Adults
Marshall Islands 25.9%1 (any tobacco use) 19.8%7 (current daily smokers)
Palau 50.3%2 (any tobacco use) n/a
FSM 37.0%3 (other tobacco use) 31.6%8 (current smokers)
Guam 23.1%4 (current smokers) 27.4%9 (current smokers)
American Samoa 24.2%5 (current smokers) 29.9%10 (current smokers)
CNMI 23.9%6 (current smokers) 21.8%11 (current smokers)
1 GYTS 2009; 2 PYTS 2009; 3 2007 FSM Epi Profile-(28.3% current smokers); 4 2007 Epi Profile Guam – YRBS 2007; 5 Epi Profile, A.S. (high school). 33% for college students; 6 2011 YRBS (high school students) as reported in CNMI; 7NCD STEPS survey 2002 as reported in the RMI Epi profile, 2010; 8 2002 STEPS Report, Pohnpei State; 9 DPHSS, BRFSS, 2008 as reported in Guam Epi Profile Update, 2008; 10 2004 STEPS survey; 11 who smoke every day during the past 30 days 2011 CNMI Epi Profile.
  • It is estimated that two people die each minute from tobacco-related disease in the Western Pacific Region.
  • Secondhand smoke causes premature birth and miscarriages in pregnant women.
  • Secondhand smoke has immediate negative effects on the cardiovascular system, which can cause lung cancer and heart disease.

NCD Policy Toolkit: Intervention #5–Alcohol Advertising

Ban Forms of Alcohol Advertising

Advertisements for alcohol are everywhere–on radio and television, at sporting and other social events, and on billboards and stores. Alcohol advertising directly impacts drinking rates in communities, especially drinking among youth. Youth initiated into drinking are more likely to become adult problem drinkers. Therefore, restrictions are needed on the advertising of alcohol, especially to children.

Outreach Materials

For more information and how to get involved, here are links to materials for different target audiences. The fact sheets and presentations includes key facts and resources, along with sample policies, that support the intervention. These documents should be adapted for your community with local data and resources.

 

Here are additional resources to help you get started:

Framework Convention on Tobacco Control

 

NCD Policy Toolkit: Intervention #6–Alcohol Access Restrictions

Restrict Access to Alcohol

Restricting access to alcohol availability can be done in a number of ways and it can have positive effects on improving community safety and minimizing problems such as underage drinking, crime and violence. Examples include creating policies or laws on strengthening minimum age laws, restricting hours of alcohol sales, limit density of alcohol outlets and ban use of alcohol during events (i.e. cultural, religious and social events).

Outreach Materials

For more information and how to get involved, here are links to materials for different target audiences. The fact sheets and presentations include key facts and resources, along with sample policies, that support the intervention. These documents should be adapted for your community with local data and resources.

 

Here are additional resources to help you get started:

Framework Convention on Tobacco Control

 

NCD Policy Toolkit: Intervention #7–Alcohol Taxation

Increasing Taxes on Alcohol

Alcohol taxes have been shown to reduce excessive drinking rates. Increasing the price of alcohol and limiting access to alcohol reduces the amount of drinking in communities. Studies have shown that by increasing alcohol taxes, alcohol use by youth will decrease, and disease and death in adults will decrease later on.

Outreach Materials

For more information and how to get involved, here are links to materials for different target audiences. The fact sheets and presentations include key facts and resources, along with sample policies, that support the intervention. These documents should be adapted for your community with local data and resources.

 

Here are additional resources to help you get started:

Framework Convention on Tobacco Control

 

What you should know about alcohol?

The misuse and abuse of alcoholic beverages is a public health threat. It can lead to injuries, liver cirrhosis, cancers, cardiovascular diseases, and premature deaths. Socially, alcohol misuse and abuse can lead to poverty, family and partner violence, and poor social acceptance. Effective alcohol policy will help to reduce the prevalence of alcohol-related injuries, cardiovascular disease, cancers of the mouth and throat, esophagus, stomach, and liver, premature deaths, and disabilities. It will also improve the quality of life for individuals and communities, and potentially improve the socio-economic status of those otherwise affected by excessive alcohol use.

Why is this important?

  • Alcohol is the leading risk factor for disease in the Western Pacific.
  • In some Pacific Islands, the coconut toddy, or also known as tuba, can be distilled into an alcoholic drink. It is a source of cheap unregulated alcohol and has a high content of alcohol.
  • Alcohol use causes harm to the individual and the people around them. Alcohol use is linked to violence, crime, sexual abuse, road traffic accidents, and loss of work, putting others at risk or danger.
  • Alcohol drinking by mothers is harmful to the health of the developing fetus.
  • Almost 10% of all deaths for young adults ages 19-29 are due to alcohol-related causes.

NCD Policy Toolkit: Intervention #8–Salt Consumption Reduction

Implement Policies that Reduce Salt Consumption

Excess salt consumption leads to impairments in health. Although the recommended amount of sodium consumed is two grams to be healthy, most people eat five times this amount. As a result, many people develop health problems and leads to early death. Ingesting too much salt can cause high blood pressure which is one of the main contributors to heart attacks and stroke. It can also cause stomach cancer, kidney disease, and osteoporosis. Reducing salt levels in food through the policy adoption of model hospitals and school nutrition standards, the region can reduce the prevalence of hypertension and the burden of non-communicable diseases.

Outreach Materials

For more information and how to get involved, here are links to materials for different target audiences. The fact sheets and presentations includes key facts and resources, along with sample policies, that support the intervention. These documents should be adapted for your community with local data and resources.

 

Here are additional resources to help you get started:

Framework Convention on Tobacco Control

 

NCD Policy Toolkit: Intervention #9–Sugar Consumption Reduction

Implement Policies that Reduce Sugar Consumption

The United States Department of Agriculture recommends eating no more than ten teaspoons of sugar per day, yet a single can of soda contains nine teaspoons of sugar, and a sixteen ounce chocolate milk carton contains eleven teaspoons of sugar, making it easy to exceed the daily recommendation with a single product. Sugar is found in everything from salad dressings to canned soups so people commonly eat too much sugar without realizing it. The US-Affiliated Pacific Islands have among the highest obesity rates in the world however through implementing sugar-sweetened beverage taxes, and other policies of model hospital, school, and government offices meals and nutrition, the region can reduce overweight and obesity prevalence in high school students and adults.

Outreach Materials

For more information and how to get involved, here are links to materials for different target audiences. The fact sheets and presentations include key facts and resources, along with sample policies, that support the intervention. These documents should be adapted for your community with local data and resources.

 

Here are additional resources to help you get started:

Framework Convention on Tobacco Control

 

NCD Policy Toolkit: Intervention #10–Fat Consumption Reduction

Implement Policies that Reduce Fat Consumption

Animal fats and trans fats in excess can cause heart attacks, strokes, obesity, and diabetes. Most of the fats in the USAPI diet comes from imported and processed foods. The objective of these resources is to enact and enforce model laws and regulations for tax on high fat items and trans fat import restrictions. Policy implementation can lead to reduced obesity prevalence among high school youth and adults and results in reduced prevalence of high cholesterol in adults.

Outreach Materials

For more information and how to get involved, here are links to materials for different target audiences. The fact sheets and presentations include key facts and resources, along with sample policies, that support the intervention. These documents should be adapted for your community with local data and resources.

 

Here are additional resources to help you get started:

Framework Convention on Tobacco Control

 

NCD Policy Toolkit: Intervention #11–Breastfeeding

Implement Policies that Promote Breastfeeding

UNICEF, the World Health Organization and many government health agencies recommend that babies breastfeed for the first six months of life. Breastfed babies are less likely to become overweight and adults who were breastfed as babies are less likely to develop heart disease, obesity, and high blood pressure. Women who breastfeed also have a lower risk of developing obesity, breast cancer, and ovarian cancer later in life. If all six jurisdictions become officially certified as Baby Friendly Hospitals, the prevalence of overweight and obesity will likely decrease.

Outreach Materials

For more information and how to get involved, here are links to materials for different target audiences. The fact sheets and presentations include key facts and resources, along with sample policies, that support the intervention. These documents should be adapted for your community with local data and resources.

 

Here are additional resources to help you get started:

Framework Convention on Tobacco Control

 

NCD Policy Toolkit: Intervention #12–Grow and Eat Local Food

Implement Policies that Promote the Production and Consumption of Local Foods

The WHO STEPS report indicate that Pacific Islanders are eating more imported foods and less locally grown fresh foods that are rich in micronutrients and low in fats, sugars, and salt. Islands need to strengthen local food production and consumption through the adoption and enforcement of model school nutrition and feeding policies that include provisions for promoting local foods. Reducing processed foods decrease non-communicable diseases and obesity.

Outreach Materials

For more information and how to get involved, here are links to materials for different target audiences. The fact sheets and presentations include key facts and resources, along with sample policies, that support the intervention. These documents should be adapted for your community with local data and resources.

 

Here are additional resources to help you get started:

Framework Convention on Tobacco Control

 

What you should know about nutrition?

Traditional foods typically have a high nutrient content and provide energy needed for active lifestyles. Unfortunately, the Western influence has brought the islands canned meat, soda, white rice, and junk food, all of which are high in calories and low in nutrients. Pacific communities that once were self-sustaining are now dependent upon unhealthy imports for food. Eating habits are established in childhood, and the availability of cheap processed foods (versus local foods) determines what youth eat. Unhealthy food habits lead to obesity, disease and death. With effective food policies we will see a decrease in obesity among children – within 1-2 years – and decrease in disease and death in adulthood.

Currently, much of the food that is easily available, accessible, and affordable in the USAPI, is unhealthy. There are few options for people to choose healthy foods and beverages with the competing demands of work, culture, religion, and social obligations. High rates of non-communicable diseases in the USAPI region suggest that food consumption patterns need to change. To facilitate this movement, policies can be implemented.

Why is it important?

    • In the Western Pacific Region obesity prevalence is highest in the Pacific countries, where some of the highest rates of overweight and diabetes are found.
  Obesity Rates (BMI > 30 kg/m2)* Diabetes Rates*
American Samoa 75% 47%
Federated States of Micronesia 43% 32%
Republic of the Marshall Islands 45% 28%
U.S. Aggregate 33% 8%
*WHO STEPS 2008
  • Poor nutrition can contribute to stress, tiredness and reduced capacity to work.
  • Poor dietary choices can lead to conditions related to malnutrition, which include a weakened immune system and long-term chronic diseases, such as high blood pressure, high cholesterol, heart disease, diabetes, cancer and gout.

NCD Policy Toolkit: Intervention #13–Encourage Built Environments

Develop a Built Environment to Promote Physical Activity

The environment in most island communities no longer promote physical activity. Roads and unleashed dogs discourage walking and make exercising outdoors dangerous. Unfortunately, most schools and workplaces do little to encourage or value movement. The built environment (i.e. parks, walking trails) is one of many variables that can increase physical activity.

Outreach Materials

For more information and how to get involved, here are links to materials for different target audiences. The fact sheets and presentations includes key facts and resources, along with sample policies, that support the intervention. These documents should be adapted for your community with local data and resources.

 

Here are additional resources to help you get started:

Framework Convention on Tobacco Control

NCD Policy Toolkit: Intervention #14–Exercise at Work

Promote Physical Activities at the Workplace

Regular physical activity is an effective disease prevention behavior. The workplace offers opportunities to reach a large number of the working population and different levels to influence behavior can be targeted. Getting people active at work will likely result in a healthier workforce. Thus, they can be more productive and healthier. Increased workplace health related policies and incentivized programs can improve the overall health of employees.

Outreach Materials

For more information and how to get involved, here are links to materials for different target audiences. The fact sheets and presentations include key facts and resources, along with sample policies, that support the intervention. These documents should be adapted for your community with local data and resources.

Here are additional resources to help you get started:

Framework Convention on Tobacco Control

NCD Policy Toolkit: Intervention #15–Exercise at School

Promote Physical Activities in the Schools

A large number of school-aged children are physically inactive or insufficiently active. The current generation of island children is the most obese in island history and many have worse health outcomes and shorter lives than their parents. This is due in part to the lack of physical activity. Implementation and enforcement of physical activity programs in schools will help to establish good exercise habits and decrease the prevalence of overweight and obesity in the USAPI youth.

Outreach Materials

For more information and how to get involved, here are links to materials for different target audiences. The fact sheets and presentations include key facts and resources, along with sample policies, that support the intervention. These documents should be adapted for your community with local data and resources.

Here are additional resources to help you get started:

Framework Convention on Tobacco Control

What you should know about physical activity?

In the past, Pacific Islander communities were active farming, fishing, building, dancing, walking, and swimming. Today, communities move less and consume more calories than they burn. Cars reduce the need to walk. Many people are employed in jobs where they sit all day long. The result is an inactive population with high rates of obesity and non-communicable diseases, such as cancer, diabetes and heart disease. Establishing policies that support active lifestyles is critical for healthy communities.

Why is it important?

  • Physical inactivity is considered one of the main risk factors contributing to obesity and related diseases in both developed and undeveloped countries.
  • Globally, approximately 3.2 million deaths each year are attributable to insufficient physical activity.
  • Since 1980, obesity prevalence among children and adolescents has almost tripled in the U.S.
  • Exercising just 30 minutes of day can reduce your risk of heart disease, diabetes, and cancer. For older adults, physical activity can improve mental function.

What Should you Know About Health in All Policies?

Health in All Policies (HiAP) is an approach to policy development and implementation that considers the social and environmental implications of its decisions. It recognizes that other factors beyond healthcare can have a significant impact on health and the community’s well being. HiAP encourages other sectors to get involved and inform decisions in policies. Through partnership, connections can be thoroughly examined allowing a broader perspective in the process of policy making and a more effective approach to improving the health outcomes and health equity of communities.

HiAP was first coined in the early 1990s, however, it was more thoroughly defined in 2006 during the Finnish presidency of the EU. It’s tougher approach through strengthening existing legislation and implementing policies through cooperation across sectors, influenced others to adopt a HiAP approach. HiAP strategies can now be seen in countries worldwide, such as Australia, Iran, Cuba, Norway and Thailand. Its implementation and incorporation across varying degrees of political organization and socioeconomic status illustrate its feasibility regardless of a country’s development.

Plans for environmentally sustainable communities in California, tighter tobacco regulations in Brazil and tougher child protection policies in Chile, are just a few examples of the way HiAP models are making significant achievements in health and challenging their country’s biggest health problems. Its feasibility lies in its collaborative and cohesive approach and its promotion in “doing the best possible within the context of political will and resources” (WHO).

 

NCD Policy Toolkit: Intervention #13–Encourage Built Environments

Develop a Built Environment to Promote Physical Activity

The environment in most island communities no longer promote physical activity. Roads and unleashed dogs discourage walking and make exercising outdoors dangerous. Unfortunately, most schools and workplaces do little to encourage or value movement. The built environment (i.e. parks, walking trails) is one of many variables that can increase physical activity.

Outreach Materials

For more information and how to get involved, here are links to materials for different target audiences. The fact sheets and presentations includes key facts and resources, along with sample policies, that support the intervention. These documents should be adapted for your community with local data and resources.

 

 

 

 

 

Here are additional resources to help you get started:

Framework Convention on Tobacco Control