In 2020, two interconnected pandemics claimed global attention. COVID-19 exposed the fragility of our health care infrastructure. And it brought to the forefront the dire consequences of our inaction to address obesity. Obesity is both a risk factor for severe outcomes of COVID-19, and a consequence of the disease. Now, more than ever, obesity treatment and prevention must be prioritised as a gateway to health; in doing so, the social, economic, environmental, and biological drivers of both obesity and COVID-19 need to inform decision-making processes.

After COVID-19 was declared a public health emergency of international concern, on March 11^th, 2020, it soon became clear that people living with obesity were more susceptible to severe SARS Coronavirus 2 (SARS-CoV-2) outcomes. We now know that the risk for hospitalization for people living with obesity is increased by 113%, whilst the risk of death is 48% higher when compared to individuals of normal weight.[i] Adding to growing concerns are the lockdown restrictions and mental health consequences of the pandemic that threaten weight maintenance and weight-loss efforts, with increased levels of physical inactivity worldwide. Obesity is thus considered an effect of the pandemic and cannot be ignored in both developed and developing countries that bear the highest burden of the disease.

We have nine years to meet the UN global development targets, also known as the Sustainable Development Goals(SDGs). We must act swiftly if we are to do so and fix the catastrophically off-track global obesity targets that are further threatened by the COVID-19 pandemic (SDG3.4, SDG3.8, SDG2). Why so? A lack of progress on obesity jeopardizes achievement of the World Health Organization (WHO) Triple Billion Targets that promises 1 billion people living healthier lives.

As an optimist, I do believe that within a crisis, lie seeds of opportunity. There is hope.

But what is the solution?

From the early days of the COVID-19 outbreak in Wuhan, I followed prevalence trends and response priorities. Having finished my MPH two years ago I never imagined living through a pandemic, at least just yet. Dr. David Nabarro’s Open-Online Briefings provided a platform for interactive discussions and a community to grow with. It exposed me to complex systems thinking – a framework to identify and account for interacting influences on COVID-19 and obesity that will be key to progress.

‘Holding the virus at bay requires following the well-established disciplines of disease outbreak control.  There are no shortcuts and no quick fixes. Different systems need to be woven together at a local level and be well supported by both national authorities and international programmes.  There is a need to do it all and do it well.’ Dr. David Nabarro rightfully says.

What is the missing piece of the puzzle? Youth Voices!

Young people have the innate capacity to see the ‘bigger picture’. They can discover complex interdependencies, including the components of a system that may affect and interact with each other. Their critical tendencies can help us identify barriers in implementing policies, including the incentives and stakeholders that need to be brought to the table. Youth have always been at the forefront of movements for justice and social change, including the Black Lives Matter and Climate Justice movement. They have shown their commitment to activities and improving lives for all.

‘Confronting Obesity: co-creating policy with youth’ (CO-CREATE) a project funded by the European Commission works for youth, with youth. By using a systems approach, the project addresses the unresolved challenges around childhood obesity. Just recently, the perceptions of 257 adolescents  (16-18 year old) on the drivers of childhood obesity across Portugal, Poland, Norway, the Netherlands, and the UK were explored.[ii] Collectively youth identified marketing, access to food (both availability and price), stress, anxiety,  depression, and low body positivity as factors contributing to the obesity epidemic. Not only did they identify such factors, but they also used a process of ‘mapping’ to illustrate how they are causally related to each other and obesity (see figure 1).

Figure 1 – Commercial Drivers of Obesity. Eur J Public Health, ckaa251, https://doi.org/10.1093/eurpub/ckaa251

We must listen to, and work with the important but often most neglected population group in obesity and COVID-19 research. It will build capacity and support decision-making on key issues that are ahead of us:

1. How to re-open schools safely, including the measures that are likely to receive collective support from students.
2. How to address the mental health crisis coming in COVID’s wake.
3. How to roll-out COVID-19 vaccination programmes, particularly amongst populations with low acceptability.
4. How to mitigate and prevent future infectious disease and pandemic outbreaks and the climate change emergency.

We have all lived with COVID-19 for a year now. The virus is here to stay for the foreseeable future. Equally, not one person has been untouched by confinement, and the hardships that the pandemic has given rise to. If not directly, then indirectly due to the lack of support from neighbouring countries during a local emergency. But this makes us powerful!

We are more united than ever, and It is time to take action as a collective. To engage and support one another for equity and justice for the planet. Every Body needs everybody to address obesity & COVID-19, and this includes youth.

Are you struggling to see systems and appreciate them? Dr. David Nabarro provides excellent guidance here. You can also watch the 4SD narrative on COVID-19 and systemic inequality here.

And remember – ‘Great things are not done by impulse, but by a series of small things brought together’.

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[i] Popkin, BM, Du, S, Green, WD, et al. Individuals with obesity and COVID‐19: A global perspective on the epidemiology and biological relationships. Obesity Reviews. 2020; 1– 17. 

[ii] Savona, N., Macauley, T., Aguiar, A., Banik, A., Boberska, M., Brock, J., Brown, A., Hayward, J., Holbæk, H., Rito, A., Mendes, S., Vaaheim, F., van Houten, M., Veltkamp, G., Allender, S., Rutter, H. and Knai, C., 2021. Identifying the views of adolescents in five European countries on the drivers of obesity using group model building. European Journal of Public Health,.

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About this 4SD Reflection

This article is a reflection by Claudia Batz following the COVID-19 Open Online Briefings of Dr. David Nabarro. Claudia is an emerging public health professional and a youth advocate with 2 years of experience in global and public health, Currently a Policy and Projects Coordinator at the World Obesity Federation and a Core Team Member of Young Leaders for Health.

At WOF, she supports the dissemination, communication, and utilisation of outputs from 2 EU consortium childhood obesity projects (CO-CREATE & STOP), and the development of youth-friendly materials, briefings, and resources to help policymakers and others seeking to implement obesity-related policies in their countries. Her previous role involved supporting the enhancement and delivery of the Strategic Centre for Obesity Professional Education(SCOPE).

Claudia is keen to improve health literacy and strives to elicit and bring the perspectives and skills of young people into the strategic design and delivery of health-related programs and policies through her engagements.

By Miles Bredin.

David is an old friend and colleague of my wife, Jo Nickolls. They worked together on ebola. When I practised for COVID-19 by very nearly dying of H1N1 in 2019, David used systems leadership to harvest a huge honeycomb of knowledge and contacts to help save save my life; Katherine, another member of the 4SD team, once lent us her house for Christmas…

I joined the online briefings in the context that these were good, inspiring, clever people but also wanting to know as much as possible about covid-19. Little did I know that 4SD would guide my thinking on so many broader issues.

Inspired by David, John, Katherine, Thuy, Julien and Florence we have been able to refine our strategy at my company, Well Made Strategy , so that we are now acting with purpose in all that we do. We are a social enterprise and have only ever worked with partners doing great work, turning down jobs with people with whom we disagree. The need for social justice and equity guides all our work. But, ours is a weird case: we provide strategic communications advice in many disparate fields. Indeed we market ourselves on the basis that we are not specialists in anything save communications.

We don’t act for people – like a PR company – we help our clients to act for themselves. As well as private business, we work on learning, health, SGBV, the environment, human rights; the list is endless. Basically, if someone’s doing something good, we help them to do it better. How therefore could we define our purpose?

The blog below tells the story of how our team decided the climate crisis was something we could address with all our partners, setting the example ourselves and helping them to join us. We hope it inspires you to define your purpose and act upon it.

Please have a look and share far and wide.

Taking Action on the Climate Crisis: How WMS plans to work on the Climate Crisis

Free books! Competition!

By TEAM WMS (originally published on LinkedIn)

Well, we made it to February! And if the last year has taught us anything, it is that we must all play our part. The covid-19 response is all about our own personal contributions to the bigger system, our responsibility each to act for the good of others. We must work together to thrive and if we all do our part, things will get better!

That applies to individual people wearing masks to protect their fellows and it applies to governments supporting Covax to protect their fellows.

Somewhere between washing our hands, physical distancing and wearing masks, we were hit by an insight! The exact same thing applies to the climate crisis. Only thirty years late…

As the US once more accepts its climate crisis responsibilities, so must we.

While WMS has a great record of working with organisations on the environment, covid-19 has helped us to rethink our approach and make it more intentional. Last year WMS partnered with many diverse organisations working on their covid-19 response and we saw that while, like the pandemic, the climate crisis affects all aspects of human life, our environmental work at WMS was siloed when it should be infiltrating all that we do. We did great work on climate with Future Earth but how did our work with the Regional Education Learning Initiative tackle the climate crisis?

The world now understands that health care is a security issue. So is the climate crisis. And the climate crisis is a human rights issue, an education issue and an equity issue too.

We know that covid-19 is worse in the rest of the world than it is in Africa – but I’m afraid we are catching up – and yes, we know that the rest of the world is a greater greenhouse gas contributor than we are. Neither fact should stop us from trying to address the crisis for ourselves. And in March last year we were lucky enough to find a guide – Dr. Myriam Sidibe. It has been an eye-opening partnership!

Working with Unilever and UNICEF, Myriam Sidibe has spent decades designing handwashing behaviour change programmes that have reached over a billion people across the globe. And as the world began to plan the covid-19 response all eyes turned to the world’s first doctor of handwashing.

Myriam approached WMS for help with the launch of her book at the start of the pandemic, just as she co-founded the Nairobi Business Compact to address covid-19 in Kenya. She has written a how-to guide that rivals in practicality our own Communications for Social Change Handbook.

Myriam’s book Brands on a Mission encourages organisations in both the public and private sector to go beyond having a purpose to living that purpose and what’s more: it shows us how. Working with Myriam helped us figure out how to use the Sustainable Development Goals to reorient our work on climate.

We feel strongly about positive social change, so we choose our partners as much as they choose us and we have had great success helping all sorts of organisations – business, human rights, child protection, learning – to reach their goals. For years – as many of our partners will remember – we have been teaching how clever the United Nations Environment Programme was at getting the environment into so many of the Sustainable Development Goals. Now we will do it too.

This year at Well Made Strategy we will be expanding our Environmental Social and Governance communications practise and urging all our partners to put the climate crisis at the forefront of their planning. We’ll be reducing our carbon emissions and addressing the climate crisis in all our work.

To embed the climate crisis in all that we do we will be using advice on systems thinking and leadership from the WHO Covid-19 Envoy Dr. David Nabarro and his team at 4SD. As they teach at 4SD, you need to identify all the players in a system, then work out how they relate to each other. To start on that we are launching a competition. In time this will help us to “understand and quantify the impact of those relationships on each other and on those outside the system”.

We commit to going beyond caring about the climate crisis to embedding climate work in all we do.

This will allow us to address equity, justice, nutrition, disability, learning, even female genital mutilation and all of the other issues that drive our work.

Of all the issues that we address daily at WMS, we have found one we are passionate about that can further all our other concerns. And Myriam Sidibe has taught us how to incorporate this into our work.

As we set out, we think you should all know Myriam! So, we’re giving away ten signed copies of her book to people who can best describe what they feel passionately about and what they’re going to do about it.

Dare you tell us?

Follow us @WMSComms and tell us in a tweet what you are passionate about. Tag it #vision21.

And if you’re outside Kenya, we’ll send you an e-book.

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About this 4SD Reflection

This article is a reflection by Miles Bredin following the COVID-19 Open Online Briefings of Dr David Nabarro.

Miles is a bestselling author and former foreign correspondent. He was United Press International’s last East Africa Bureau Chief and private sector strengthening advisor to the Afghan Minister of Finance. He was a Paul Mellon Fellow at Yale’s British Art Center and has written a number of books. Miles set up Well Made Strategy with Rob Burnet, founder of network of social ventures Shujaaz Inc in 2009. Well Made Strategy has devised and implemented communications strategies across Africa and beyond.

The feature image is a COVID-19 campaign in Kimaa (Maasai language) by Well Made Strategy and friends at Shujaaz and the Africa Educational Trust which were distributed in Tanzania and Kenya.

Participants of the COVID-19 Open Online Briefings are invited to share their reflections on how they are navigating complexities from their own perspectives. The views and opinions expressed in these reflections are intended to inspire greater systems leadership during the COVID-19 pandemic. They do not necessarily reflect the official policy or position of 4SD as an organisation or it’s associated personnel. Any content provided by authors are of their opinion and are not intended to malign any religion, ethnic group, club, organization, company, individual or anyone or anything.

By Dr Carlos Madrigal- Iberri

During this Open Online Briefing with Dr. Nabarro, I realized that local efforts are crucial in order to stop and overcome this pandemic. My opinions of this session will address one main topic: What can we learn from governments that are successfully controlling the virus and how to implement those learnings in developing countries?

According to WHO statistics, COVID-19 is affecting 213 countries and territories around the world, and the number of new cases are rising at an astonishing rate. So far, we have learned many lessons but probably, one of the most important is that we are just at the beginning of this sanitary crisis.

Different strategies had been taken from some countries where they really took on board many communities’ members, such as heads of states and business, civil societies, universities, local entrepreneurs, etcetera and this is how they could put themselves ahead of the virus.

New Zealand for example, has declared itself as a COVID-19 free country. Aware that they cannot close the borders and live forever in the lock down, they teach every citizen in the country about the threat that this virus represents to their lives.  The Public Health Department focused on preparing the entire population to know what to do in case someone gets sick and explained the importance of how these measures can get them ahead of the virus.

Germany and Ireland are other good examples of how the adequate organization and straightforward communication between government and society truly works. The measures taken by these countries are focused on assure to their citizens that if there is a new outbreak they are prepared to stop it as soon as possible and they can offer protection to the most vulnerable people, the older and the factory workers.

So far, we have learned that strong leaderships and deep commitment to face this crisis is the more solid strategy to overcome the pandemic that is going to live with us from now on. Unfortunately some other countries, are not dealing with the situation by these learnings. USA, Mexico and Brazil are three particular cases where their leaders had diminished the danger of this virus to their population and by not setting a clear direction, the amount of cases continues peaking every week. Because of not having a nationwide effort to make citizens conscious of what this threat means to their lives, these three countries are some of the most deadly places where you can get sick of Coronavirus. It still does not seems like they can stop the transmission soon.

Despite the beliefs and non-logical declarations that had been made for these three leaders of state, the COVID crisis will not disappear from one day to another a huge effort is needed between governments, academia, healthcare systems and citizenship in order to reduce the risk of infection. The message must be sent loud and clear: The virus will not magically evaporate; we need to increase the physical distancing and adequate hygiene measures. Continuous education and disease awareness are imperative to isolate contagious persons, particularly in very dense populated areas if we want to stop deaths due to coronavirus.

The virus is becoming almost endemic in many places and also the economic crisis is arising, by being certain that the population really understands the nature of the disease, we are closer to reduce the transmission and adapting ourselves to a new reality. We must recognize that this condition affects specially people living in poverty and we need to keep a constant and intensive effort to clear away the barriers that endangers these minorities.

Against presidential obstruction, local communities can and empowering themselves to defeat this condition, we do not need government permission to change our behavior, to getting organized, to keep physical distance and frequently wash our hands. Being part of the change is a personal decision and spreading the adequate information should be our responsibility. If we want to make a sustainable change, we must start by ourselves and to involve our communities.

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Follow Salvando Latidos on Social Media @salvandolatidos

Follow One Young World on Social Media @OneYoungWorld

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About this 4SD Reflection

This article is a reflection by Dr. Carlos Madrigal- Iberri following the COVID-19 Open Online Briefing of Dr David Nabarro on 9 June 2020. It forms part of a collaboration between 4SD and One Young World to inspire greater systems leadership amongst youth during the COVID-19 pandemic.

Carlos is a Medical Doctor & One Young World ambassador who is deeply committed to Global Health. He serves on the Board of Salvando Latidos a non-profit organization, which provides free medical care to low income populations; during this pandemic, they are fundraising to provide protective personnel equipment for hospitals facing COVID-19 in Mexico. He has also been actively working for Novartis Mexico to bring to public agenda Chagas Disease, which is one of the 17 Neglected Tropical Diseases determined by World Health Organization and the second cause of heart failure in Latin America.

Carlos states, “In order to make a difference in public health, the world needs people that are willing to join forces to make this problem a part of our past, and not a new threat to our future”.

COVID-19 Open Online Briefing #23
Tuesday, 9 June 2020
17:00 – 18:00 CEST

The views and opinions expressed in these reflections form part of the collaboration between 4SD and One Young World to inspire greater systems leadership amongst youth during the COVID-19 pandemic. They do not necessarily reflect the official policy or position of 4SD as an organisation or it’s associated personnel. Any content provided by authors are of their opinion and are not intended to malign any religion, ethnic group, club, organization, company, individual or anyone or anything.

One Young World (OYW) is the global forum for young leaders. OYW identifies, promotes and connects the world’s most impactful young leaders to create a better world, with more responsible, more effective leadership. The annual OYW Summit convenes the brightest young talent from every country and sector, working to accelerate social impact. Learn more about OYW at https://www.oneyoungworld.com/

I attended Dr David Nabarro’s debrief session of 18 June from Bangalore, India. As an admirer of strong leaders in public health through my work at GE Healthcare, trying to conceal my ‘fan-boy’ face was quite a challenge.

Dr Nabarro opened with discussing different facets of the pandemic and the manner in which the world should navigate a gradual opening of its social and economic systems. He mentioned of the cases steadily declining in Europe, on the contrary cases are increasing towards the East and in the USA. This strengthens the correlation between higher population and higher population densities to the number of infections. This correlation also poses a question, what would be the extent of damage caused to human life before countries with a higher population can flatten the curve, since there is never a shortage of people who could be infected.

Behaviour change is needed

While governments over the world over are doing their best (lockdowns, contact tracing, etc.) to manage the pandemic, there are a set of behavioural changes every individual has to exercise to manage the pandemic. These behavioural changes could be summarized as physical distancing of at least one meter and face protection when in public. These behavioural changes not only reduce the likelihood of exposure to the virus, they also reduce the amount of virus (viral load) one could be exposed to.

Emerging epidemiological and clinical aspects

There is also research towards patients suffering from lingering COVID and their identifying features. This research would help improve treatment protocols and improve patient outcomes. Amidst the various research efforts towards improving chances of recovery, dexamethasone’s efficacy towards helping patients recover from extreme inflammatory immune response due to COVID is being looked at as a wonder drug. The drug’s efficacy in reducing mortality was especially noted in patients in the late stages of disease progression. Another plus point of dexamethasone is its affordability.

Clinicians mention, an important feature worth tracking in COVID patients is blood oxygen saturation via SpO2 meters. Monitoring SpO2 early on can help clinicians undertake remedial actions timely (ex: Oxygen therapy), thus improving patient outcomes. To facilitate this effort, WHO has taken up in provisioning oxygen to several hospitals, particularly in developing countries. Such findings are important not only in reducing COVID mortalities, but also to uplift the general public sentiment.

It has been found that the virus spread is not uniform across regions. The avenues of high transmissibility often lie at the intersection of ability to physically distance in a region, ventilation of the region, and most importantly, prosperity of the region. Inequity of various forms, such as prosperity, gender, ethnicity, or age determine access to quality healthcare and consequently recovery. Governments must focus localized efforts towards identifying such areas of high incidence of patients and address the root cause for the virus spread.

A community-led public health response

The most recent demand in reaction to the pandemic is to increase public health spending. This is where I found Dr Nabarro’s suggestion very interesting. He suggests that models of public healthcare must be formulated that go outside the hospitals and to the communities. In my personal opinion, the advantage of such a system is that it would be agnostic to socio-economic inequalities and meet its intended purpose. I believe governments and corporations would be willing to implement such out-of-hospital public healthcare models for several reasons such as:

• Reduced inventory cost (beds, equipment, etc.) in hospitals.
• Improved employment prospects (nurses, facilitators, etc.) that aren’t always centred around big cities.
• Improved outreach.
• Improvement of technical infrastructure to meet the out-of-hospital public healthcare model, which in turn would create more employment and revenue.

Question and answers from participants

One of the attendees, Katherine, raised a question on the accessibility of the drug dexamethasone. It sparked an interesting discussion. While the drug is certainly very cheap, it should only be administered in qualified healthcare settings, which may not be available to socio-economic disadvantaged groups. This comment underscored the importance of equal healthcare access.

Another attendee, Anthony Zwi raised an interesting point of view that individuals are only as empowered as the local community organizations that lend to them that power. Horizontal empowerment and facilitation by the local organizations to the citizen is very important to ensure success of community initiatives.

Karin Wiedenmayer brought an interesting situation to notice. She mentions the ignorance of some governments towards remedying the pandemic situation and feeding misinformation to their people. WHO intends find any measure possible to rectify the situation, even if it means bypassing those governments.

I had my fan-boy moment soon after where I asked Dr Nabarro’s take on the following situation. Currently, some cities (ex: New Delhi) are admitting only symptomatic cases and not pre-symptomatic and asymptomatic COVID cases. I asked, “Is the WHO looking at issuing homecare guidelines to pre-symptomatic and asymptomatic patients so that their disease progression is slowed and it gives hospitals the required bandwidth to cater to critical cases?”. The good news was that issuing such guidelines is in active discussion within the WHO. Given my line of work (healthcare technology, software development, and AI), Dr Nabarro discussed with me the role of AI in COVID, which is promising, especially towards screening COVID patients.

Annie and Jonathan raised an interesting point where the correct use of language and managing mental health by the leadership helps to handle the public during the pandemic.  A simple example of this would be using the phrase ‘physical distancing’ over ‘social-distancing’. Nendirmwa’s story brought us back to ground reality. She lost her job amidst this pandemic since her employer couldn’t empathize with her challenges of working from home. Sadly, this is an issue faced by many.

Such a discussion brought to light the fact that while the pandemic is a grave situation, we must use this as an opportunity to identify and improve our areas of socio-economic inequalities as we remedy the pandemic.

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Follow One Young World on Social Media @OneYoungWorld

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About this 4SD Reflection

This article is a reflection by Sehaj Sharma following the COVID-19 Open Online Briefing of Dr David Nabarro on 18 June 2020. It forms part of a collaboration between 4SD and One Young World to inspire greater systems leadership amongst youth during the COVID-19 pandemic.

Sehaj is a One Young World Ambassador active in the space of healthcare technology and Artificial Intelligence. He is passionate about the Sustainable Development Goals of Quality Education, Good Health and Wellbeing, and Reduced Inequality. He represented these causes at the One Young World Summit 2019 in London.

 

 

COVID-19 Open Online Briefing #25
Thursday, 18 June 2020
08:30 – 09:30 CEST

The views and opinions expressed in these reflections form part of the collaboration between 4SD and One Young World to inspire greater systems leadership amongst youth during the COVID-19 pandemic. They do not necessarily reflect the official policy or position of 4SD as an organisation or it’s associated personnel. Any content provided by authors are of their opinion and are not intended to malign any religion, ethnic group, club, organization, company, individual or anyone or anything.

One Young World (OYW) is the global forum for young leaders. OYW identifies, promotes and connects the world’s most impactful young leaders to create a better world, with more responsible, more effective leadership. The annual OYW Summit convenes the brightest young talent from every country and sector, working to accelerate social impact. Learn more about OYW at https://www.oneyoungworld.com/