With the changes in global environment, various countries encountering problems relate to drop in birth rates, rising in adult death rate, increase in non-communicable disease, and aging society. The key to lay a solid foundation for the country’s sustainable development is the plan to create “Healthy Cities”. Given Taiwan’s diverse environment, experts and scholars from various fields gathered in the “2019 Global Health and Sustainable Development Forum” to share the secrets of development of “Healthy Cities”.
The Rise of Civil Society – Raising Awareness of Non-communicable diseases
Non-communicable diseases (NCDs) sounds strange, but nearly 70% of people worldwide die from non-communicable diseases including cardiovascular disease, lung cancer, stroke, cancer, diabetes, high blood pressure, etc. Possible causes including excess alcohol intake, tobacco use, air pollution, and lack of exercise, unhealthy diet, etc. As pointed by Katie Dain, the Chief Executive Officer of the NCD Alliance, the epidemic of non-communicable diseases lead to devastating effects on individuals, families as well as communities; and further strain the national health system through inadequate prevention with high socio-economic costs.
According to the 2008 WHO report, non-communicable diseases have caused 36 million deaths worldwide, accounting for 63% of all causes of death with 80% from low and middle-income countries. This report has drawn the close attention from various countries’ political leaders, who believe the increasing numbers of unhealthy population can deeply affect the country’s overall development. In 2014, the WHO proposed 17 sustainable development goals (SDGs) to replace the 2000 Millennium Development Goals (MDGs). The MDGs use 15 years of accumulated experience to develop SDGs. From positive perspective, restrictions on tobacco advertising help to improve overall health for children, reduction in sodium and trans fat intake on decreased cardiovascular disease, and increase national investment to $10 million on non-communicable diseases to resolve high medical care costs.
On the negative impacts, the lesser developed countries lack funding and resources to invest in prevention and control of non-communicable diseases, unattainable political commitments, and excessive intervention by international companies. The most unusual thing is that 138 countries within the United Nation demonstrated slow progression with most countries unable to attain SDGs target goals and even some developed countries showed decrease in growth. Among the non-communicable diseases programs and targets from various countries, only 33% were completed in 2015 and only 48% completed in 2017. This shows that non-communicable diseases lack resources including funding, international legal guidelines, federal assistance, and promotion by local society.
Katie Dain stated that civil society has multiple features with using the non-communicable disease alliance as an example. In the control and prevention of non-communicable diseases, the 17 target goals of SDGs were utilized for practical application of research, establishment of dialogue framework to raise public awareness, supervision of government obligations, tracking of tobacco companies, establishment of nutrition score system, and reduction in premature death from non-communicable diseases. We must recognize that health and economic politics are tied together applying the following guidelines: (1) the establishment of observed days, such as World Health Day (2) the promotion by institution and people, such as celebrities, religious organizations, and schools, etc. (3) and service expansions, such as palliative care and community service.
Through social and community participation with leadership from government, the overall resources are centralized and thus able to effectively promote prevention and control of non-communicable diseases. Currently, the non-communicable disease alliance has 58 partners and is still growing. In the future, we need leaders with different perspectives whether it is from social media, citizens, or society, we must work together to build partnerships. With the social media as an example, effective publication is beneficial for communication of political issues. In addition, the establishment of social obligation and responsibility of political figures help to promote prevention and control of disease. Thus, we need to work together as a society and within various industries because non-communicable diseases are seriously affecting our lives and thus we need more understanding and participation from others.
Physician’s Perspective – Food has far reaching effects on our health
According to New Zealand physician Dr. Sudhvir Singh, numerous factors affect health, such as chronic diseases, urban development, environmental sustainability, and food systems etc. The New York Times News discussed recent publication by the Washington research team indicating that one-fifth of the world’s food is considered unhealthy, can lead to high blood pressure, affect health of nearly 150 million children, and cause overweight problem in over 2 billion adults. With over 800 million people worldwide still suffering from hunger, it shows that Earth’s environment continues to deteriorate.
Environmental deterioration stems from issues relating to food processing and food waste; therefore, food production needs systematic planning such as use of agricultural land and minimize use of water resources. As the Earth is very fragile, thus it’s important to see what kind of food planning can achieve the 2025 SDGs goal, which led to the birth of the EAT team. The EAT, comprised of 20 experts from different fields, face enormous challenge from nutrition epidemiology such as how much food do we need? How much food can we eat? We set some goals to avoid over burden the food system and see what response is needed.
Converting Western diets based on localized diet needs and using highly developed Western countries as an example, there is excessive red meat intake and inadequate intake of certain food that calls for change in diet pattern. But people living in impoverished areas needs more nutrients from animal protein and some areas needs nutrient from plants such as nuts. This policy is not aimed at the elderly or chronic disease patients. Improving public health can first start with water pollution, clean water supply, loss of biodiversity, and carbon emissions (agriculture cannot increase carbon emissions). Earth needs more trees and lands to abnormal carbon monoxide emission, thus should not deforest trees to increase agriculture productions.
Agricultural production also needs change; for example, although the EU has agriculture policy, it does not take health into consideration. We need a food policy and not just a simple agricultural policy. Fortunately, the EAT team is working with more than 40 cities, such as Paris, to gradually improve food procurement, farm location, and reduction of waste, which will greatly improve health of urban population and environmental maintenance.
According to Sudhvir Singh, from the perspective of environmental protection, animal husbandry occupies large area of land and dense breeding is prone to spread of avian flu. In addition, current animal breeding uses excessive antibiotics leading to many problems including food wastes. From the perspective of land sustainability, Asians have advantages compared to Westerners in terms of plant cultivation and meat selections. Furthermore, healthy food selections reduce mortality rate by 30%, decrease red meat production, reduce agriculture land expansion, and reduce use of fertilizers; all which can be beneficial for health and environmental sustainability.
In addition, a strict monitoring mechanism is favorable for increasing healthy food production as well as beneficial for growth of urban economy and overall development. Therefore, the EAT team is committed to develop a new monitoring mechanism. In the land index, the sudden drop in the number of bees and insects is deemed a crisis since reduction in bees leads to decreased production in fruits and vegetables. The systematic planning of food involves various levels of operation and requires tremendous expertise and professional support. Therefore, we must use multidisciplinary collaborations and allow involvement from different professions to further facilitate health maintenance of various cities to achieve 2025 SDG goals.
The Establishment of Healthy Cities rely on Local Economic Support
The establishment of a healthy city depends on various factors, such as the rise of civil society, economic and political support, and adequate healthy food supply, etc. Former leader of Executive Yuan Mr. Mao Zhiguo expressed that promotion of public health is well supported in various parts of Taiwan with assistance from different professions across geographical locations, political views as everyone contribute their own support. With local government leaders as example, they are willing to contribute personal experiences and expertise to share their own successful experiences with people in different positions and countries.
The mayor of Chiayi city in Taiwan, Ms. Huang Minhui, indicated that Chiayi is a holy place for Taiwan’s democracy. In addition, Chiayi has two advantages including the training of numerous health professionals and local government leveraging geographical competitive advantages and resources. In addition, Ms. Huang MinHui used her individual “Brave Motherly” like characteristics , which is similar to frugal nature of mothers in Taiwan, to transform Chiayi from a healthy city to elderly friendly city, provide food education for schools in Chiayi, develop local comprehensive care, and reduce air pollution related agendas. Especially the city’s subsidized school lunch program employs 11 nutritionists to monitor student health; the delicious taste of school lunch prompted the British girl Martha to express her envy of Taiwan’s school lunch compared to her own school lunch in her own blog.
Have you heard of Taiwan International Surfing Open, the Taiwan International Hot Air Balloon Carnival, and the Taiwan International Triathlon? No doubt these are well-known events in Taitung. Former County Mayor of Taitung, Mr. Huang Xianting asked if everyone presents know that Taitung was a place of beautiful scenery with short life expectancy prior to 2009 as local residents suffered from poverty due to illness and further decline in health due to poverty. Therefore based on his prior finance experiences, he concluded that government findings should not be spent directly on local healthcare, but to create wealth for locals and thus help to maintain their health. Local governments initiated planning for international tourism activities to create employment opportunities, assist in abstinence programs for over 2000 alcoholics with surplus, and plan ICT (information and communication technology) to connect local health services which all constitute the “Silent Revolution of Taitung”. According Mr. Huang Jianting, Taiwan has unique local resources. Since he was born in Taitung and familiar with the advantages of Taitung’s environment, he established the “Hot Air Ballon Economics” that attracted over 6 million tourists to Taitung every year and won international recognition from the world’s top 10 emerging tourist cities as well as ICF Smart 21 smart cities.
Mr. Liu Zeng, the county magistrate of Lianjiang County, proudly expressed that “the Lianjiang County has an impressive achievement with its local scientific research program, which effectively reduced rate of gastric cancer and was recognized by WHO and internationally renowned medical journals. (Lancet). According to Mr. Liu Zengying, who is a physician, he returned to Lianjiang County Hospital after completing medical education and training. He devote his knowledge and training to give back to local society and investment tremendous amount of time to improve health of local residents in Mazu. In the future, they will leverage experiences gained from information exchanges to prioritize local economic development and cost improvements.