Phase 1: Healthy Public Policies

Phase 1 focuses on primary prevention of diabetes, that is, prevention among healthy people who develop diabetes. Since type 2 diabetes is strongly linked to obesity, we shall focus on encouraging healthy diets and physical activity.

Goal

At the CEAD project, we recognise that individual behaviour is determined, to a great extent, by their setting.  That is why, rather than carrying out educational activities on risk factors for diabetes, recommending individuals to lose weight or do exercise, we will focus on those political actions that modify the setting where people live so that physical activities or healthier diets are encouraged.

This could be done, for instance, by creating safe public spaces that make exercising easier and facilitating access to healthier food in terms of price and availability. This is not a new idea, in fact, it was recognised in the Ottawa Charter issued after the First International Conference on Health Promotion in 1986. However, there is still a long way to go before it becomes a reality, especially in low-resource settings.

Processes

In the first stage of the CEAD Project, we will study a selection of public policies to prevent diabetes, contextualizing them for low-resource settings taking into account social inequality issues such as gender, ethnic group, education and socio-economic level. To this end, we will listen to opinions on the distribution of diabetes and its risk factors in the population and on contextual relevance, and the applicability of a set of political actions that can be operated locally to improve the diet and encourage physical exercise.

Firstly, we will identify a sample of public policies recommended by the main international health agents, such as the World Health Organization. We will focus on those political actions that modify the setting where individuals live so that physical activities or healthier diets are encouraged. We will also focus on actions that can be implemented locally or at municipal level.

To select the most relevant political actions that are applicable to low-income areas, we will conduct a Delphi study (a consensus method) to ask experts their opinion.

We believe it is important to have specific knowledge about the setting where we intend to work. Firstly, in order to understand how diabetes risk factors are distributed and, secondly, to urge action.

That is why we will conduct population surveys in Quito’s urban area and in the rural area of Esmeraldas to analyse the prevalence of diabetes and the risk factors of chronic diseases, taking into account the relevance of social inequality in terms of gender, age, education, and ethnic group in low- and medium-income areas.

We will randomly select 720 residents of the 17D06 health district in Quito and 720 residents of the 08D02 health district in Esmeraldas. If you have taken part in the population survey, please see detailed information about the procedure here.

In the last part of phase 1, we will contextualize the public policies previously selected. We will create 5 focal groups in Quito and 5 focal groups in Esmeraldas to contextualize approximately 10 political actions that can increase physical activity and encourage a healthy diet.

The discussion will focus on analysing the feasibility and applicability of the possible political actions selected in their context. Facilitators will show the results of the survey and participants are expected to talk about the differences observed among the population groups (health inequality), suggest possible reasons for these differences and offer solutions. Finally, participants will analyse the capacity political actions have to approach health inequality in its context.

All the focal groups in the study will consist of participants selected by intentional sampling. There will be 4 types: A. individuals with diabetes and their families; B. members of the community; C. health care professionals; and D. decision makers involved in actions that have an influence on health.

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