Cyprus: health promotion

Cyprus: health promotion

Introduction

Poor lifestyles have been adopted that predispose the population to the growing incidences of noncommunicable diseases (Bovell-Benjamin et al., 2009).  As Naidoo and Wills (2016) put it, the human body, just like machines, operates at its peak, when the input is a variety of nutrients, minerals, and vitamins. The current generation is having poor and unmonitored ways of feeding themselves with less consideration on what food is essential. Additionally, most of the population is not aware of the factor to do with food rationing, nutrition quantities, and quantities. It might be that people are not aware, or it’s just an act of self-ignorance. Bold decisions to implement the knowledge gained and making healthy choices by individuals or communities should be based on the positive impacts associated with the change (Black et al., 2019).

The island of Cyprus, located in the Mediterranean Sea, has a population of approximately 1,179,678, according to the 2017 Census, with an estimated one-third of its people suffering from noncommunicable disease, potentially shortening their lifespan and possibly resulting in death (Worldometer, 2020). Chronic diseases alias noncommunicable diseases, tend to remain for a long duration or even a lifetime-and arise according to a blend of behavioral, physiological, environmental and genetic factors (Tornaritis et al., 2014).  According to Ozer (2018), these diseases are not transmittable. Such conditions include high blood pressure, obesity, cancer, stroke, heart disease, and diabetes (World Health Organization, 2018).

Red meat and processed foods have been linked to increased incidents of heart disease. This may explain why the Cypriot population has a high incidence of heart health problems, based on their diet is high in red meat, and also the method of cooking is related to cancer, with meat being cooked over charcoal. According to Chiang and Quek (2017), polycyclic aromatic hydrocarbons (PAHs) could result from the direct combustion of the meat at intense heat as well as the exposure to smoking that deposits the PAHs to the meat from incomplete combustion of the heating source (Cyprus, 2019). This necessitates sensitization on matters of health, especially on the choice of food and the preparation of food. Creating awareness of the risks of chronic diseases associated with different foods may help inform the selection of a healthy diet as well as safe food preparation

Needs Assessment

With deaths resulting from non-communicable diseases (NCD) tallying up to over 39 million (71% of 56 million) on a global level, it’s clear that we still have a long way to go (World Health Organization, 2018). NCDs comprise of chronic lung diseases, cardiovascular diseases, diabetes. Cyprus is the sole EU Member State lacking a comprehensive national health program (European Commission, 2017). Total health spending in Cyprus is less than that of most other Member countries of the European Union, at an average of 6.2% of GDP in 2013, with public spending at 2.8% of GDP and private spending at 3.4% (Paraskeva & Bradbury, 2016). Profit spending, on the other hand, consists primarily of direct contributions for health care services in the private industry, some mandatory co-payments, and premiums for private health insurance plans that are generally voluntary. Consequently, the framework is regressive but acknowledged as most Cypriots tend to utilize the private sector.

These statistics spread down to non-communicable diseases such as heart diseases that stem from feeding habits. With the private sector, most of the focus is on, making profits rather than concentrating or focusing on how to mitigate rising health issues in Cyprus. The private sector health services do not create enough awareness on matters to do with dieting and its effects on general health, both locally and regionally. Due to the large percentage of the Cypriot population who appear to be unaware of how their diet is directly responsible for several awareness, but also to offer alternative lifestyle choices (Sahingoz and Sanlier, 2011).

The emergence of multiple chronic diseases included food and lifestyle habits at younger ages. Schools, homes and boarding centers are considered an ideal environment for the alteration of the way of life; nevertheless, there is a shortage of reported dietary evidence in Cypriot old and young population. In the previous decades, Cyprus has undergone major socio-demographic changes, accompanied by an increasing rate of epidemiological transformation and the rise of risk factors for chronic conditions such as for overweight in adults and children, as well as deaths from chronic illnesses such as cardiac disease and cancer (Lazarou et al., 2009).

Fig 1.0 % causes of death by Non-communicable diseases from 2000-2016 (Worldometer)

From the data, the origin of Death by Non-Communicable Diseases was conveyed at 91.1 % in December 2016. This accounts for a reduction from the erstwhile sum of 91.2 % in December 2015. The statistics are branded under the Global Database’s Cyprus. The origin of death talks about the portion of all deaths for all ages by fundamental causes. Non-communicable diseases include cancer, diabetes, cardiovascular diseases, digestive illnesses, musculoskeletal diseases, and congenital anomalies (World Health Organization Estimates).

Fig 1.1 Cyprus’ vulnerable population age bracket to dietary illness (World Health Organization)

Looking at the vulnerable age in the above figure, the adolescent population and the pre-adults are the populations that are more are more prone to dietary illnesses id their BMI is not monitored. However, this does not mean the other population is not vulnerable. Every individual who does not maintain a balanced feeding habit can fall prey to illnesses relating unbalanced diet (Harvard University, 2019). Accordingly, adherence to the Mediterranean model is critical for maintaining overall health, whereas early adulthood can be an effective period to engage and develop long-term wellness patterns. Given that a significant percentage of young people are enrolling in colleges, university campuses are a perfect place for data-driven health education activities. Because the transformation from puberty to young adulthood is a crucial time of youth embracing and developing lifelong norms of health behavior, it is important to investigate the dietary behaviors of this particular age demographic.

Intervention

Aims and Objectives

Transform the diet and health results of vulnerable segments of Cypriot communities (children, women and the elderly) by supplying foods that will raise vegetable and fruit intake, decrease calorie intake and raise micro-nutrient intake. Implement the universal food protection and quality requirements for a balanced, market-oriented product supply chain in Cyprus. Also, the implementation of effective nutritional interventions that may effectively reduce no-communicable diseases linked with bad eating habits. In particular, the goal is to extend and develop human and organizational capacity to solve issues of lack of knowledge on nutritional contributions to the state of health of the Cypriot population.

Some of the projected outcomes include; a shift in consumer behavior towards a greater intake of a diverse vegetable and fruit diet, with ramifications for the illnesses correlated with obesity, heart diseases, and weight management. Adopting local and national strategies to change the conduct of food intake by enhanced communications mechanisms and with the assistance of the private sector. Also, individual and systemic capacity development for solving food and nutrition-based diseases in Cyprus.

Health Approaches Promotion and Model

Two health approaches and promotion models will be used in the intervention; Behavioral change model and collective action model. The model of behavioral modification is a therapeutic strategy, focused on health-impact lifestyle habits (New Zealand Government, n.d). This aims to encourage people to incorporate healthier habits of the environment, using preventive health care and take full responsibility for their health. The model of behavioral modification is focused around the idea that presenting the knowledge to individuals can alter their values, perceptions, and behaviors (New Zealand Government, n.d). Throughout certain instances, this approach has proved to be inadequate as it lacks variables that influence health in the general context, including physical, fiscal, cultural, and political influences. A collective action model is a socio-ecological approach that takes into consideration the person’s interconnections with the environment. It is founded on the premise that health is primarily determined by factors that function beyond individual control. This concept requires group mobilization concepts, which allow individuals and society to develop the awareness, comprehension, expertise, and determination to strengthen social mechanisms that have such a strong impact on the health status of individuals. It involves people in analytical thought to enhance their perception of the factors influencing the well-being of individuals and the environment.

Intervention through behavioral changes entails primary intervention, which seeks to deter a person from experiencing a first heart attack or stroke, requiring surgery or experiencing any other type of cardiac failure at risk of heart disease. The main treatment typically addresses Cypriots who have already acquired risk factors such as elevated blood pressure or high cholesterol. Like with secondary prevention, primary treatment relies on managing such risk factors by implementing improvements in the healthier lifestyle, behavior and taking a balanced when appropriate. Having said that, the presence of alarming cardiovascular disease in Cyprus indicates that inflammation, atherosclerosis, and/or endothelial and other diet-related disease are still a place, and are not reversible through clinical intervention but a change of feeding behavior. And this primary intervention cuts across all population ages in Cyprus. Children are more vulnerable to diet-related diseases just like the elderly.

According to a study done by Tornaritis et al (2014), Cypriot children eat a low-value diet with a large percentage of children consuming less than the lowest of 45% energy (en) of carbohydrate (18.4%-66.5% in various age groups) and surpassing the commended consumptions of entire fat (42.4%-83.8%), saturated fatty acids (90.1%) and protein (75%), while almost all (94.7%-100%) did not meet the indorsed fiber intake. With the facts on the smaller section of Cypriot’s population being on the needed diet, the chance of development of diet-related diseases is high. This may include obesity, heart failure, and cancer-related illnesses. With such a situation, the behavioral change model can apply. At their tender change, children can be exposed to change of behavior. Parents have a big role to play, for those children who are getting their daily meals from parents.

In learning situations, the environment provided by the administration should enable students to get a diet that is balanced and not concentrated on one major diet. Currently, the world is appreciating fast foods, which in many scenarios is characterized by junk food. With the help of institution policy authorities, the administration can create a proper diet enabling environment where students and pupils can absorb the character of consuming a balanced diet. And this is where an intervention through the collective action model comes in.

As an initiative to promote dietary disease intervention through behavioral change, Cypriots can practice the use of ‘The Mediterranean Diet.’ The Mediterranean diet is a diet developed in the 1980s in the Western hemisphere and influenced by Greece and Italy’s dietary patterns in the 1960s. The Mediterranean diet is focused on the diets of Cretan, Greek and Southern Italian people. The Mediterranean diet has become common globally because people exhibit low heart disease, cardiovascular disease, and obesity levels. The Mediterranean diet pattern emphasizes whole grains, healthy fats (beans, olive oil, almonds, etc.), vegetables, fruits, pork, and some non-food meat being eaten relatively rarely. The Mediterranean diet, coupled with nutrition, stresses the need to spend time together with friends and carry out physical exercise. Cyprus young and population is characterized by poor eating habits across years, with statistics mentioning that dietary elated diseases accounting for a large percentage of mortality rate.

Essentially, adopting a Mediterranean diet implies eating in the way those people historically ate in the Mediterranean region. A typical Mediterranean diet contains a large contribution of fresh fruit, whole grain, legumes and some balanced fats and fish (Hadjimbei et al., 2018). The basic diet recommendations suggest feeding people; a large range of plants, beans, and whole grains; good fats, such as almonds, peas, and olive oil; small levels of dairy and fish; and hardly any white meat and red meat. The Mediterranean diet concentrates more on plant products than many of the other diets (Hadjimbei et al., 2018). For fruits, whole grains, and legumes, producing dinner isn’t unusual. But that’s the only way Cyprus can come out of dietary illnesses.

Intervention Process

Because the main population of focus is Cypriot’s young population, the process is going to touch on children, teenagers, and youths in learning institutions and social centers. In schools, to foster behavioral change, the first process will involve engaging with the learning institutions authorities to create in learning timetables, a period where students can be taught on nutrition and healthy living. With daily learning of issues to do with diet, food consumption and issues relating to dietary illnesses, the students can start practicing how to avoid unnecessary foods such as the junks. Additionally, with the power of mass awareness and social media, the administration can create both soft and hard posters that can be shared in various students’ platforms mentioning the importance of being healthy concerning having a proper diet.

Now that the intervention is aimed at reducing illnesses relating to heart disease and other dietary illnesses, the intervention will also aim at reducing the effects of non-monitored consumption of low-quality meals. This will involve the inclusion of physical activities. Daily physical activity, nutrition, and wellness are increasingly essential to people of all ages for their safety and well-being. Research has shown that nearly all people will profit from daily physical activity, whether they partake in intense exercise or a form of mild physical activity that enhances wellbeing (Kelishadi & Poursafa, 2014). Mobility and coordination can be enhanced particularly in vulnerable and very elderly adults by physical exercise. Physical health can also be a focus for Cypriots of all ages.

This health campaign will be launched strategically and will have national coverage.  The advertising will be such that culture and tradition are incorporated into its promotional material.  Celebrities will be brought on board to promote healthier food choices and to demonstrate the simple to prepare meals.  Sporting heroes will encourage walking and daily exercise regimes.  It will encompass these strategies that will lead to the success of the Cypriot population having a reduction in the likelihood of experiencing a noncommunicable disease within their lifetime.

Additionally, most learning institutions in Cyprus have students eating from the school meal system (Durrell, 2012). Therefore, the meals timetable that is composed of a low diet (poor diet), can be modified to help curb dietary illnesses as early as possible. With the help of the local government and local social services, change of the school meal system can be modified to suit to meet health guidelines and reduce the causes of non-communicable diseases resulting from poor feeding habits.

In social gathering centers such as hospitals, companies, sports ground, the firms should ensure each consumer they are handling in their meals section is accorded a proper diet ion every order made. For instance, in the company canteen, the food provided should or can entail a meal order with all nutrients, given in the right quantity. Food orders in such social firms are of different levels. It might not be easy to come up with a proper meal order than is having a balanced diet, but efforts to attain the ‘Mediterranean Diet’ can happen. Moreover, public social firms should be encouraging the reduction of dietary-related illnesses by making sure the meals they provide to their consumers are up to health standards.

According to the World Health Organization, Cyprus is having food guidelines relating to diet and its intended audience. (World Health Organization, n.d). Under these guidelines, Cyprus practices a food pyramid separated into nine stages: cereals, fruits, and vegetables shelter the first and second stages, correspondingly. These are followed by olive oil, fish, dairy products and seafood, and lean meats (Not part of red meat). On the latter, three levels are pulses and olives, foodstuffs high in sugar and fat, and red meat (World Health Organization, 2018). With these guidelines, enforcing the interventions on behavioral change and changing the social environment setting will be easy and accommodated by the current national system.

Funding

Most of the funding these interventions will be assisted by health agencies and the Federal Government concerning the guidelines and legislation protecting social healthy standards. For instance, because these interventions are related to the health goals of most health institutions in Cyprus, the institutions can allocate funds that can be used in producing flyers, banners, and pamphlets to create awareness in learning institutions and social firms. Cyprus agencies such as ‘Funds for NGOs’ helps in connecting funding agencies with policy creators to enable grant and financial services to any initiative that brings sustainability to the country. According to the agency, no intervention can be fruitful unless the effecting group has viable resources to work over an extensive period. By offering funding prospects from around the globe and allocating tools backing organizational development, the agency hopes to play its part in generating an enhanced world.

In the hope of reducing the funds’ burden, the intervention process will also include students in learning institutions engaging in health and nutrition learning and research. With their, help, they can help to campaign on the importance of proper diet to the well-being of every student. With their help, they can receive guidelines on how to run daily or weekly campaigns on dieting and healthy living, with the permission and further coaching from the institution’s administration. Student parents and school tutors can also be role models in making sure their children and students adapt to the best lifestyle behavior that promotes healthy living.

Evaluation of the intervention

Because the population of interest in this intervention s centered on teenagers and young adults, the assessment will be carried out on majorly on learning institutions. To asses the efficacy of the intervention, behavioral data will be taken from students who are in their first year of study in the institutions. The selection is because, comparison and analysis will only be feasible after a period of one year where health measures such as weight, BMI, blood pressure, and disease incidence can be compared from the previous year to the current year. With the help of Cyprus agencies such as The Cyprus Agency of Quality Assurance and Accreditation in Higher Education (CYQAA), (assist policymakers in learning institutions) questionnaires and surveys will be carried prior, during and after the interventions, which will aid in the evaluation after one year of intervention (CYQAA, n.d).

Conclusion

Conclusively, there is a gap in knowledge of chronic disease association to diet in Cyprus. Cypriots need to be provided with information, facts, figures and regular health update on matters to do with dietary illnesses.  They don’t only need to be told what not to eat, how not to cook, but also alternatives and secure options. With the rate of mortality rate due to non-communicable diseases, Cyprus’ population needs to know how to achieve optimum health and offer positive change and easy to follow lifestyle choices. Based on the findings of (Noble and Barrett, 2018), information regarding health and healthier eating and exercise should be concise, educational, emphasized as being highly important, easy to remember and understand and to have a long-lasting effect on their consciousness.

Additionally, with the proposed interventions, the Cyprus population will see a change in the health status of not only of their young population but also the aged. Matters to do with the change of lifestyle is a requirement for all population ages, even if the vulnerable population are a target.

References

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