Obesity - the policy challenges: The report of the National Taskforce on Obesity

Click here to download PDF The prevalence of overweight and obesity has increased with alarming speed over the past twenty years. It has recently been described by the World Health Organisation as a ‘global epidemic’. In the year 2000 more than 300 million people worldwide were obese and it is now projected that by 2025 up to half the population of the United States will be obese if current trends are maintained. The disease is now a major public health problem throughout Europe. In Ireland at the present time 39% of adults are overweight and 18% are obese. Of these, slightly more men than women are obese and there is a higher incidence of the disease in lower socio-economic groups. Most worrying of all is the fact that childhood obesity has reached epidemic proportions in Europe, with body weight now the most prevalent childhood disease. While currently there are no agreed criteria or standards for assessing Irish children for obesity some studies are indicating that the numbers of children who are significantly overweight have trebled over the past decade. Extrapolation from authoritative UK data suggests that these numbers could now amount to more than 300,000 overweight and obese children on the island of Ireland and they are probably rising at a rate of over 10,000 per year. A balance of food intake and physical activity is necessary for a healthy weight. The foods we individually consume and our participation in physical activity are the result of a complex supply and production system. The growing research evidence that energy dense foods promote obesity is impressive and convincing. These are the foods that are high in fat, sugar and starch. Of these potentially the most significant promoter of weight gain is fat and foods from the top shelf of the food pyramid including spreads (butter and margarine), cakes and biscuits, and confectionery, when combined are the greatest contributors to fat intake in the Irish diet. In company with their adult counterparts Irish children are also consuming large amounts of energy dense foods outside the home. A recent survey revealed that slightly over half of these children ate sweets at least once a day and roughly a third of them had fizzy drinks and crisps with the same regularity. Sugar sweetened carbonated drinks are thought to contribute to obesity and for this reason the World Health Organisation has expressed serious concerns at the high and increasing consumption of these drinks by children. Physical activity is an important determinant of body weight. Over recent decades there has been a marked decline in demanding physical work and this has been accompanied by more sedentary lifestyles generally and reduced leisure-time activity. These observable changes, which are supported by data from most European countries and the United States, suggest that physical inactivity has made a significant impact on the increase in overweight and obesity being seen today. It is now widely accepted that adults shoud be involved in 45-60 minutes, and children should be involved in at least 60 minutes per day of moderate physical activity in order to prevent excess weight gain. Being overweight today not only signals increased risk of medical problems but also exposes people to serious psychosocial problems due mainly to widespread prejudice against fat people. Prejudice against obese people seems to border on the socially acceptable in Ireland. It crops up consistently in surveys covering groups such as employers, teachers, medical and healthcare personnel, and the media. It occurs among adolescents and children, even very young children. Because obesity is associated with premature death, excessive morbidity and serious psychosocial problems the damage it causes to the welfare of citizens is extremely serious and for this reason government intervention is necessary and warranted. In economic terms, a figure of approximately â,¬30million has been estimated for in-patient costs alone in 2003 for a number of Irish hospitals. This year about 2,000 premature deaths in Ireland will be attributed to obesity and the numbers are growing relentlessly. Diseases which proportionally more obese people suffer from than the general population include hypertension, type 2 diabetes, angina, heart attack and osteoarthritis. There are indirect costs also such as days lost to the workplace due to illness arising from obesity and output foregone as a result of premature death. Using the accepted EU environmental cost benefit method, these deaths alone may be costing the state as much as â,¬4bn per year. The social determinants of physical activity include factors such as socio-economic status, education level, gender, family and peer group influences as well as individual perceptions of the benefits of physical activity. The environmental determinants include geographic location, time of year, and proximity of facilities such as open spaces, parks and safe recreational areas generally. The environmental factors have not yet been as well studied as the social ones and this research gap needs to be addressed. Clearly there is a public health imperative to ensure that relevant environmental policies maximise opportunities for active transport, recreational physical activity and total physical activity. It is clear that concerted policy initiatives must be put in place if the predominantly negative findings of research regarding the determinants of food consumption and physical activity are to be accepted, and they must surely be accepted by government if the rapid increase in the incidence of obesity with all its negative consequences for citizens is to be reversed. So far actions surrounding nutrition policies have concentrated mostly on actions that are within the remit of the Department of Health and Children such as implementing the dietary guidelines. These are important but government must now look at the totality of policies that influence the type and supply of food that its citizens eat and the range and quality of opportunities that are available to citizens to engage in physical activity. This implies a fundamental examination of existing agricultural, industrial, economic and other policies and a determination to change them if they do not enable people to eat healthily and partake in physical activity. The current crisis in obesity prevalence requires a population health approach for adults and children in addition to effective weight-reduction management for individuals who are severely overweight. This entails addressing the obesogenic environment where people live, creating conditions over time which lead to healthier eating and more active living, and protecting people from the widespread availability of unhealthy food and beverage options in addition to sedentary activities that take up all of their leisure time. People of course have a fundamental right to choose to eat what they want and to be as active as they wish. That is not the issue. What the National Taskforce on Obesity has had to take account of is that many forces are actively impeding change for those well aware of the potential health and well-being consequences to themselves of overweight and obesity. The Taskforce’s social change strategy is to give people meaningful choice. Choice, or the capacity to change (because the strategy is all about change), is facilitated through the development of personal skills and preferences, through supportive and participative environments at work, at school and in the local community, and through a dedicated and clearly communicated public health strategy. High-level cabinet support will be necessary to implement the Taskforce’s recommendations. The approach to implementation must be characterised by joined-up thinking, real practical engagement by the public and private sectors, the avoidance of duplication of effort or crosspurpose approaches, and the harnessing of existing strategies and agencies. The range of government departments with roles to play is considerable. The Taskforce outlines the different contributions that each relevant department can make in driving its strategy forward. It also emphasises its requirement that all phases of the national strategy for healthy eating and physical activity are closely monitored, analysed and evaluated. The vision of the Taskforce is expressed as: An Irish society that enables people through health promotion, prevention and care to achieve and maintain healthy eating and active living throughout their lifespan. Its high-level goals are expressed as follows: Its recommendations, over eighty in all, relate to actions across six broad sectors: high-level government; education; social and community; health; food, commodities, production and supply; and the physical environment. In developing its recommendations the Taskforce has taken account of the complex, multisectoral and multi-faceted determinants of diet and physical activity. This strategy poses challenges for government, within individual departments, inter-departmentally and in developing partnerships with the commercial sector. Equally it challenges the commercial sector to work in partnership with government. The framework required for such initiative has at its core the rights and benefits of the individual. Health promotion is fundamentally about empowerment, whether at the individual, the community or the policy level.

A three-pronged approach to social business: a Brazilian multi-case analysis

Social businesses present a new paradigm to capitalism, in which private companies, non-profit organizations and civil society create a new type of business with the main objective of solving social problems with financial sustainability and efficiency through market mechanisms. As any new phenomenon, different authors conceptualize social businesses with distinct views. This article aims to present and characterize three different perspectives of social business definitions: the European, the American and that of the emerging countries. Each one of these views was illustrated by a different Brazilian case. We conclude with the idea that all the cases have similar characteristics, but also relevant differences that are more than merely geographical. The perspectives analyzed in this paper provide an analytical framework for understanding the field of social businesses. Moreover, the cases demonstrate that in the Brazilian context the field of social business is under construction and that as such it draws on different conceptual influences to deal with a complex and challenging reality.

Economic growth with bubbles

We develop a stylized model of economic growth with bubbles. In this model, changes in investorsentiment lead to the appearance and collapse of macroeconomic bubbles or pyramid schemes.We show how these bubbles mitigate the effects of financial frictions. During bubbly episodes,unproductive investors demand bubbles while productive investors supply them. These transfersof resources improve the efficiency at which the economy operates, expanding consumption, thecapital stock and output. When bubbly episodes end, these transfers stop and consumption, thecapital stock and output contract. We characterize the stochastic equilibria of the model and arguethat they provide a natural way of introducing bubble shocks into business cycle models.

Theoretical notes on bubbles and the current crisis

We explore a view of the crisis as a shock to investor sentiment that led to the collapse of abubble or pyramid scheme in financial markets. We embed this view in a standard model of thefinancial accelerator and explore its empirical and policy implications. In particular, we show howthe model can account for: (i) a gradual and protracted expansionary phase followed by a suddenand sharp recession; (ii) the connection (or lack of connection!) between financial and real economicactivity and; (iii) a fast and strong transmission of shocks across countries. We also use the modelto explore the role of fiscal policy.

Bubbly collateral and economic activity

This paper develops a model of the bubbly economy and uses it to study the effects of bailoutpolicies. In the bubbly economy, weak enforcement institutions do not allow firms to pledge futurerevenues to their creditors. As a result, "fundamental" collateral is scarce and this impairs the intermediationprocess that transforms savings into capital. To overcome this shortage of "fundamental"collateral, the bubbly economy creates "bubbly" collateral. This additional collateral supports anintricate array of intra- and inter-generational transfers that allow savings to be transformed intocapital and bubbles. Swings in investor sentiment lead to fluctuations in the amount of bubblycollateral, giving rise to bubbly business cycles with very rich and complex dynamics.Bailout policies can affect these dynamics in a variety of ways. Expected bailouts provideadditional collateral and expand investment and the capital stock. Realized bailouts reduce thesupply of funds and contract investment and the capital stock. Thus, bailout policies tend to fosterinvestment and growth in normal times, but to depress investment and growth during crisis periods.We show how to design bailout policies that maximize various policy objectives.

How can we teach EBM in clinical practice? : an analysis of barriers to implementation of on-the-job EBM teaching and learning.

Introduction: Evidence-based medicine (EBM) improves the quality of health care. Courses on how to teach EBM in practice are available, but knowledge does not automatically imply its application in teaching. We aimed to identify and compare barriers and facilitators for teaching EBM in clinical practice in various European countries. Methods: A questionnaire was constructed listing potential barriers and facilitators for EBM teaching in clinical practice. Answers were reported on a 7-point Likert scale ranging from not at all being a barrier to being an insurmountable barrier. Results: The questionnaire was completed by 120 clinical EBM teachers from 11 countries. Lack of time was the strongest barrier for teaching EBM in practice (median 5). Moderate barriers were the lack of requirements for EBM skills and a pyramid hierarchy in health care management structure (median 4). In Germany, Hungary and Poland, reading and understanding articles in English was a higher barrier than in the other countries. Conclusion: Incorporation of teaching EBM in practice faces several barriers to implementation. Teaching EBM in clinical settings is most successful where EBM principles are culturally embedded and form part and parcel of everyday clinical decisions and medical practice.

Un gegant del cel en perill d'extinció : socialització i divulgació de la reintroducció del voltor negre a Catalunya

La interacció de l’home amb les diferents espècies amb les quals cohabita ha creat casos com el del Voltor Negre (Aegypius monachus), l’au necròfaga més gran d’Europa, que actualment es troba en perill d’extinció. La utilització del territori per a ús antropogènic (ramaderia, xarxes elèctriques, zones urbanes,...) ha fet disminuir la població d’aquesta espècie. Així com la incursió, de manera indirecta, en aquestes poblacions degut a l’acció de l’home podem destacar-ne’n dos, el més rellevant és la intoxicació per verí, degut a l’ús il·legal d’aquestes substàncies per al control de depredadors fa que els tòxics vagin pujant per la piràmide tròfica. La segona causa rellevant és la disminució d’aliment degut a la mixomatosis i a la normativa existent d’obligatorietat de retirada dels animals morts a muntanya per sota dels 1400m. Al fer l’anàlisi de problemàtiques, s’observa que la gran majoria són antròpiques, degudes a la desinformació i al desconeixement, per tant; per a realitzar un bon pla de reintroducció és necessari fer un treball previ de socialització de les poblacions de la zona per a que el projecte sigui eficient. El projecte consisteix en fer una conscienciació social als diferents grups implicats (turisme, escoles i població; ramaders i caçadors), mitjançant documents gràfics, material educatiu, material de suport i materials i mètodes de divulgació. Per a que la vall d’Alinyà i Boumort passin a ser destacades per la presencia establerta de les quatre aus necròfagues més rellevants d’Europa; l’Aufrany, el Trencalòs, el voltor comú i el nostre protagonista: el Voltor Negre.

Prevalence and risk factors for therapy escalation in ulcerative colitis in the Swiss IBD Cohort Study

BACKGROUND: Physicians traditionally treat ulcerative colitis (UC) using a step-up approach. Given the paucity of data, we aimed to assess the cumulative probability of UC-related need for step-up therapy and to identify escalation-associated risk factors. METHODS: Patients with UC enrolled into the Swiss IBD Cohort Study were analyzed. The following steps from the bottom to the top of the therapeutic pyramid were examined: (1) 5-aminosalicylic acid and/or rectal corticosteroids, (2) systemic corticosteroids, (3) immunomodulators (IM) (azathioprine, 6-mercaptopurine, methotrexate), (4) TNF antagonists, (5) calcineurin inhibitors, and (6) colectomy. RESULTS: Data on 996 patients with UC with a median disease duration of 9 years were examined. The point estimates of cumulative use of different treatments at years 1, 5, 10, and 20 after UC diagnosis were 91%, 96%, 96%, and 97%, respectively, for 5-ASA and/or rectal corticosteroids, 63%, 69%, 72%, and 79%, respectively, for systemic corticosteroids, 43%, 57%, 59%, and 64%, respectively, for IM, 15%, 28%, and 35% (up to year 10 only), respectively, for TNF antagonists, 5%, 9%, 11%, and 12%, respectively, for calcineurin inhibitors, 1%, 5%, 9%, and 18%, respectively, for colectomy. The presence of extraintestinal manifestations and extended disease location (at least left-sided colitis) were identified as risk factors for step-up in therapy with systemic corticosteroids, IM, TNF antagonists, calcineurin inhibitors, and surgery. Cigarette smoking at diagnosis was protective against surgery. CONCLUSIONS: The presence of extraintestinal manifestations, left-sided colitis, and extensive colitis/pancolitis at the time of diagnosis were associated with use of systemic corticosteroids, IM, TNF antagonists, calcineurin inhibitors, and colectomy during the disease course.

Suorituskyvyn analysointi ja mittaaminen julkisella sektorilla

Suorituskyvyn mittaamiselle ja seurannalle on nykyisin laajaa tarvetta myös julkisella sektorilla. Tutkimuksen tarkoituksena oli kehittää soveltuvia suorituskykyä kuvaavia mittareita ja rakentaa niistä käyttökelpoinen suorituskyvyn analysointijärjestelmä julkisen sektorin käyttöön. Ensisijaisena lähtökohtana olivat fyysiset mittarit, koska ne soveltuvat paremmin julkisen sektorin toimintaympäristöön.Tutkimuksen teoriaosassa esitetään joitakin suorituskyvyn analysointijärjestelmiä. Julkiselle sektorille soveliaina viitekehyksinä esitellään yleisellä tasolla balanced scorecard, suorituskykypyramidi, benchmarking, dynaaminen suorituskyvyn mittausjärjestelmä, laatupalkintokriteeristö, SAKE-sovellus ja suorituskykymatriisi.Työssä paneudutaan melko laajalti tekijöihin, joilla on voimakas vaikutus suorituskykyyn. Tällaisia tekijöitä ovat laatuasiat, tuottavuus ja organisaation kilpailukyvykkyys.Tutkimuksen käytännön osassa rakennettiin suorituskyvyn analysointi- ja mittausjärjestelmä. Ensin määriteltiin mittausjärjestelmään soveliaat suorituskyvyn osa-alueet ja seuraavaksi mittarit. Taloudellisia mittareita kehitettiin vain muutama, sillä pääpaino mittarien kehittelyssä olivat ei-taloudelliset mittarit. Mittaristo auttaa organisaatiota mittaamaan sen tilannetta matkalla jatkuvan parantamisen tiellä.

Very high-resolution digital elevation models: are multi-scale-derived variables ecologically relevant?

1. Digital elevation models (DEMs) are often used in landscape ecology to retrieve elevation or first derivative terrain attributes such as slope or aspect in the context of species distribution modelling. However, DEM-derived variables are scale-dependent and, given the increasing availability of very high-resolution (VHR) DEMs, their ecological relevancemust be assessed for different spatial resolutions. 2. In a study area located in the Swiss Western Alps, we computed VHR DEMs-derived variables related to morphometry, hydrology and solar radiation. Based on an original spatial resolution of 0.5 m, we generated DEM-derived variables at 1, 2 and 4 mspatial resolutions, applying a Gaussian Pyramid. Their associations with local climatic factors, measured by sensors (direct and ambient air temperature, air humidity and soil moisture) as well as ecological indicators derived fromspecies composition, were assessed with multivariate generalized linearmodels (GLM) andmixed models (GLMM). 3. Specific VHR DEM-derived variables showed significant associations with climatic factors. In addition to slope, aspect and curvature, the underused wetness and ruggedness indices modelledmeasured ambient humidity and soilmoisture, respectively. Remarkably, spatial resolution of VHR DEM-derived variables had a significant influence on models' strength, with coefficients of determination decreasing with coarser resolutions or showing a local optimumwith a 2 mresolution, depending on the variable considered. 4. These results support the relevance of using multi-scale DEM variables to provide surrogates for important climatic variables such as humidity, moisture and temperature, offering suitable alternatives to direct measurements for evolutionary ecology studies at a local scale.

Shout and Act: an Algorithm for Digital Objects Preservation Inspired from Rescue Robots

We adapt the Shout and Act algorithm to Digital Objects Preservation where agents explore file systems looking for digital objects to be preserved (victims). When they find something they “shout” so that agent mates can hear it. The louder the shout, the urgent or most important the finding is. Louder shouts can also refer to closeness. We perform several experiments to show that this system works very scalably, showing that heterogeneous teams of agents outperform homogeneous ones over a wide range of tasks complexity. The target at-risk documents are MS Office documents (including an RTF file) with Excel content or in Excel format. Thus, an interesting conclusion from the experiments is that fewer heterogeneous (varying skills) agents can equal the performance of many homogeneous (combined super-skilled) agents, implying significant performance increases with lower overall cost growth. Our results impact the design of Digital Objects Preservation teams: a properly designed combination of heterogeneous teams is cheaper and more scalable when confronted with uncertain maps of digital objects that need to be preserved. A cost pyramid is proposed for engineers to use for modeling the most effective agent combinations

Suuri ikäluokka jää eläkkeelle - Ratkaisukeinot ongelmiin

Tutkimuksen päätavoitteena on keskittyä tarkastelemaan ratkaisukeinoja mitä suuren ikäluokan eläkkeelle jääminen mahdollisesti kansantalouksissa aiheuttaa. Ikäpyramidi muuttuu seuraavien 40 vuoden aikana vähitellen käänteiseksi, mikä tarkoittaa sitä, että kansantalouksissa on enemmän eläkeikäisiä ihmisiä kuin lapsia. Ihmisen elinikä on nousussa jatkuvasti edistyneen terveydenhuollon ansiosta, mikä myös osaltaan aiheuttaa ongelmia. Päätavoitteena on keskittyä selvittämään sitä, mikä tai mitkä olisivat parhaat ongelmien ratkaisuvaihtoehdot. Tutkimuksessa pohditaan tulevien sukupolvien kohtaamia ongelmia työvoiman pienentyessä ja kansantalouksia koskettavia muutoksia ja haasteita, joita suuren ikäluokan eläkkeelle siirtyminen aiheuttaa. Ongelma koskettaa suuresti Eurooppaa, jossa ikääntyminen on jo alkanut. On ennustettu, että tulevaisuuden Euroopassa jopa 60 prosentille työikäisestä väestöstä tulisi maksaa eläkettä.

Microbusiness: A new social business model to alleviate poverty in developing countries?

Poverty alleviation views have shifted from seeing the poor as victims or as potential consumers, to seeing them as gainers. Social businesses include microfinancing and microfranchising, which engage people at the bottom of the pyramid using business instead of charity. There are, however, social business firms that do not fit to the existing social business model theory. These firms provide markets to poor producers and mix traditional, local craftsmanship with western design. Social business models evolve faster than the academic literature can study them. This study contributes to filling this gap. The purpose of this Master’s thesis is to develop the concept of social business as poverty alleviation method in developing countries. It also aims; 1) to describe the means for poverty alleviation in developing countries; 2) to introduce microbusiness as a social business model; and 3) to examine the challenges of microbusinesses. Qualitative case study is used as a research strategy and theme interviews as a data collecting method. The empirical data is gathered from four interviews of Finnish or Finnish-owned firms that employ microbusiness – Mifuko, Tensira, Mangomaa and Tikau – and this is supported with secondary data including articles on case companies. The results show that microbusiness is a valid new social business model that aims at poverty alleviation by engaging the poor at the bottom of the pyramid. It is possible to map the value proposition, value constellation, and economic and social profit equations of the case firms. Two major types of firms emerge from the results; the first consists of design-oriented firms that emphasize the quality and design of the products, and the second consists of bazaar-like firms whose product portfolio is less sophisticated and who promote more the stories of the products – not the design. All microbusiness firms provide markets, promote traditional handicrafts, form close relationships to their producers, and aim at enhancing lives through their businesses. The attitudes towards social businesses are sometimes negative, but this is changing for the better. In conclusion, microbusiness answers to two different needs at the same time – consumers’ needs for ethical products and the social needs of the producers – but the social need is the ultimate reason why the entrepreneurs started business. Microbusiness continues as a poverty alleviation tool that sees the poor as gainers; by providing them steady employment, microbusiness increases the poor’s self-esteem and enables them for a better living. Academic literature has not been able to offer enough alternative business models to cover all social businesses; the current study contributes to this by concluding that microbusiness is another social business model.

Fundraising and investor relations in social enterprise: Marketing your way out of the pioneer gap in African off-grid renewable energy

Social enterprises apply the best of business for the pursuit of social or environmental mission while also generating revenues. Globally, nearly 1,3 billion people lack access to electricity, as well as another billion having access to only low quality and infrequent electricity. Off-grid renewable energy, like solar, will increasingly have a key role in the solution of the energy access issue. The pioneer gap in off-grid renewable energy consists of financing (or funding) gaps and capacity gaps, to do with both the early stage of the enterprises in question, as well as the early stage of the whole industry. The gaps are emphasised by specific characteristics of off-grid renewable energy business models and the requirements of operating in bottom-of-the-pyramid markets. The marketing perspective to fundraising is chosen to uncover the possible role enterprises themselves have in bridging the pioneer gap. The purpose of this thesis is to study how social enterprises operating in off-grid renewable energy in Africa utilise marketing activities in their investor relations in bridging the pioneer gap. This main research question is divided into the following sub-questions:  How does the pioneer gap affect fundraising for these enterprises?  How are the funding needs for these enterprises characterised?  How do these enterprises build trust in their investor relations? The theoretic framework is built on relationship marketing and investor relations, with an emphasis on creation of trust. The research is conducted as a thematical case study. Primary data is gathered via semi-structured interviews with six solar energy companies and two accelerators. According to the findings, the main components affecting trust-creation are diminished information asymmetry and perceived risk, mission alignment as well as a personal fit or relationship with the investor. Therefore, an enterprise can utilise e.g. the following marketing activities in their investor relations to bridge the pioneer gap: ensuring investor material, the enterprise story and presenting of them is clear, concise and complete to “package” the enterprise as an investment; taking investor needs and motivations into account as well as utilising existing investors as ambassadors.