Advocacy to extend our reach against non-communicable diseases (NCD): from the most complex to the simplest interventions for behavioral changes

Abstract

The UN 2011 political declaration highlighted 4 major NCD risk factors: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol. The most complex and successful advocacy, the WHO Framework Convention on Tobacco Control (FCTC), covers more than 90% of the world population. Our advocacy in Hong Kong is for a total ban of e-cigarettes and new tobacco products in 2019, and a total tobacco ban in 2030. Following FCTC, advocacy for a Framework Convention on Alcohol Control shows a little progress. In a Lancet commentary (April 2019), we advocate to drop the term “harmful use” from alcohol as there is no safe use of alcohol, and to unite for an FCAC. The obesity epidemic, expanding globally, is at an early stage. We advocate for a Framework Convention on Obesity Control. We advocate for the simplest interventions for small behavioral changes as a ‘foot-in-the-door” strategy. In our community intervention programmes, we promote the simplest exercise, Zero Time Exercise (ZTEx). ZTEx is the integration of simple strength- and stamina-enhancing physical activity into daily life, and can be done anytime, anywhere and by anyone. We focus on reducing sugar intake especially from sugar sweetened beverages. For smoking cessation, we test brief AWARD (Ask, Warn, Advice, Refer, Do-it-again) interventions in different settings, and completed a trial on physician’s very brief advice (about 30 seconds, 13671 smokers). Our trials have consistently shown good evidence of effectiveness (small to moderate effect size). Advocacy for simplest interventions should have great potentials to extend our reach.