Improving diet and physical activity: 12 lessons from controlling tobacco smoking

In their article, Yach, McKee and Lopez, (BMJ 2005; 330: 898-900) draw our attention to important lessons learned through the years from the history of tobacco control. From a developing country perspective I find that lessons 3, 4 and 7 are a key in addressing the risk factors of unhealthy diets and lack of physical activity.

Public Health decisions at policy level usually take longer in our context compared to developed countries. Waiting for detailed evidence of the effectiveness of interventions to start discussing the possibility of taking decisions at policy level will certainly deprive our population from easier–healthier choices.

There are specific interventions known to be effective. Lobby is needed at regional and national level to provide a favorable context for the implementation of these interventions. In some cases is more effective to move from regional level to national level than expecting a national action to start acting.

I personally believe that “broad based, well networked, vertical and horizontal coalitions” might be one of the most significant lessons for our developing countries. Funds allocated for prevention are usually not prioritized. Policy will provide a favorable context, but hands at work are needed. From personal experience in Argentina and the Philippines (DEMOBAL Project, Program for Prevention of Infarction in Argentina, Preventive Medicine, 2001, 33: S14) this kind of network will provide the human resources and sometimes part of the material-financial resources needed for planning, implementation and evaluation of interventions. Motivated health professionals and community members often motivate policy makers. Financial support from government or external funds are much needed to increase the probabilities of success, but decision for allocating these funds usually do not take place without a story of sacrifice and dedication from a committed group of community members and health professionals.

Quoting Dr. Peka Puska (International Journal of Epidemiology, 2001; 30: 1493-1494) “The global problem is huge: Much firm evidence exists for prevention. It is time to act –with sound theoretical base and sufficient preventive dose- from demonstration to national policy actions –not exporting, but working in global partnership- and also putting one’s heart into the action!”

Competing interests: None declared