MAIN ACTIVITIES ON HEALTH PROMOTION

THROUGH NUTRITION AND PHYSICAL ACTIVITY

“HEPA MACEDONIA”, 2001 - 2007

President: SIMOVSKA VERA, MD., PhD.

spec. of sports medicine, subspec. of hygiene nutrition
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www.cindi.makedonija.com
 HEPA MACEDON IA

HEPA Macedonia National Organization for the Promotion of Health through Nutrition
and Physical Activity is established on 11 October 2005.

The aim was to develop the steps to implement national policy, startegy and
programme on the key health determinant, physical activity and nutrition in accordance to
the new EU Health Strategy (2007-2016).

In February 2006 HEPA Macedonia was accepted as “temporary” member by the

Steering Committee of the WHO HEPA EUROPE until confirmation by the network at 2nd
Annual meeting on 14 June in Tampere, Finland. Also it,s is a member of the World “Move
for Health” network.

There is a need for quick action to implement this strategy associated with the
implementation of the WHO Resolution WHA 57.16 on ”Health Promotion and Healthy
Lifestyle” and WHA 57.17 on “Global Srategy on Diet, Physical Activity and Health” as well
as with the A/RES/58/5 on “Sport as a means to promote Education, Health, Development
and Peace”.

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 IN TRANSITION 1991-2003

■ There is a strong evidence for the Macedonian nutrition and

physical activity initiative/strategy and programme.

■
During last decade, statistic showed very bad public
health situation.

■
The major cause of death and disability are CVD, cancer,
diabetes, obesity and respiratory diseases.

■
CVD with predominant CHD mortality is continuosly increasing up
to 57% of all deaths in 2002.

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Figure 1. Mortality rate from noncommunicable diseases in
Macedonia for the period 1991-2001 up to 100.000 population

500
450
464.9 464.9 458.7 468.6
400
350 385.9
359.5
300
250
200
150
100 140.5 142.6 150.3
129.5
108.3 111.4
50 KVB
Cancer
0
1991 1993 1995 1997 1999 2001

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Map 1. Deaths by causes in Macedonia, 2000

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 PUBLIC HEALTH APPROACH
RISK FACTOR IDENTIFICATION IN MACEDONIA

■ High important public health problem are high prevalence of biological

(morphfunctional), behavioural (lifestyle) and envoronmental risk factors
responsible for development of the leading NCD in Macedonia.
■ 41.2% of Macedonian adult population was increasingly overweight and obese
in 1988 and the percentage was increased up to 58.3% in 2000 (fig. 3)
■ High prevalence of other major biological risk factors such as high total serum
cholesterol, high blood presure and hyperglicaemia (fig. 5).
■ The health of 64.5% of adult population was at risk from physical inactivity in
2002.
■ PA are declined in 50% of school-age girls from 7-12 years old.
■ Application of a standard questionnaire for PA such as IPAQ, periodically used
was never undertaken.
 Assessment and comparison of socio-economic differences in PA levels and
food habits included level of education were never done.

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 Figure 3. BMI Distribution in adult population in Skopje
during the last 10 years (1990-2000)

80 75.8
% BMI<25
65.5
70 58.8 BMI>25-29.9
60 BMI>30
50 41.6 41.5 3-D Column
4
40

30 15.9 18.6
23
14.9 18.6 16.8
20
9.3
10

0
1990 1995 1998 2000

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Figure 5. Prevalence of risk factors for CVD and other NCD in adult
population from central region in Skopje (1990-1998)

80
75
%

60

40 35,9 35,2
28,8 28,2
23,8 23,4
18,2
20 14,2 18,2 15,8
12,5
3,7
2,5
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 WHO/FIMS PHYSICAL ACTIVITY RELATED ACTIVITIES, 1996-2006

■ Sedentary lifestyle with reduced level of physical activity (PALs) and

cardiorespiratory fitness under the recommended minimum is clearly kay risk
factors for major NCD.
■ 1986 - WHO CINDI Programme: Protocol for Integrated preventive interventions
are aimed to those risk factors that can be modified and are common for several
NCD such as lifestyle risk factors: physical inactivity, unhealthy diet, smoking
and stress.
■ 1996 - The FIMS and WHO had increased efforts toward PA.
■ 2000 - WHO estimates that physical inactivity leads to more than 2 million
deaths/years. Worldwide, it is estimated that at least 60% of the population is not
active enough to benefit their health.
■ 7 April 2002 - World Health Day ”Move for Health - Reduce the Risk”;
■ 10 May 2003 - WHO “Move for Health” Initiatives Around the World
■ 2004 - “Move for health - Active Youth”,
■ 2005 - ”Move for health - Supportive Environments”,
■ 2005 - Starting the WHO HEPA European network
■ 2005 - WHO strategy on PA recommendations: implementation of an integrated,
comprehensive and coordinated approach with stable intersectoral partnership.
■ 2006 ”Move for Health - Active Communities" 9
 The vision and main goal of HEPA Macedonia

People in Macedonia should enjoy to achieve better health

through increasing physical activity and healthy nutrition.

To strengthen and support efforts and actions that

increase participation and improve the conditions
favourable to a healthy lifestyle, in particular with
respect to health - enhancing physical activity (HEPA).

To initiate national approache and network for physical activity

promotion, inter-ministerial and -sectoral approache and
a general framework for physical activity promotion policy.

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 HEALTH SECTOR 1. SPORT

2. EDUCATION

3. TRANSPORT

4. URBAN PLANNING

Framework for Physical Activity Promotion

within a Multi-Dimensional Health Policy

Programmes &
Policy Process
Framework for Physical Activity Promotion
Programmes &
Policy Process Activities
Activities
within a Multi-Dimensional Health Policy Programmes &
Policy Process
Knowledge Activities
Base Knowledge Programmes &
Policy Process
Base Activities
Health Knowledge
Physical Activity Physical Activity
Base
Determinants
Behaviour Knowledge
Physical Activity Base
Behaviour Determinants
Physical Activity
Physical Activity
Leisure Behaviour
Physical Activity Diet
Determinants
Transport Behaviour Determinants
Work / School Smoking
Domestic
www.hepa.ch ……
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 The a i m s

1. To promote health through nutrition and PA using population-based

approach.

2. To formulate National strategy and programme for the promotion of

healthy diet and PA - ”HEPA Programme”:
- the main objective is to reduce major chronic disease morbidity/mortality
- the intermediate objectives are to reduce the population levels of biological
risk factors for chronic disease by introduction changes in the lifestyle:
increased PA, balanced nutrition and smoking cessation.

3. In addition to provide the background for the identification and development

of an overview of relevant HEPA Action Plan for implementation of HEPA
startegy/programme in Macedonia (2005-2010).

4. To strengthen cooperation, partnership and collaboration with other relevant

programmes, sectors, NGOs e.t.c in promotion of HEPA.

5. To formulate organizational structure and establishement a national network.

6. To prepare annual work programme for the main planned activities and
events

7. To establish specific outcomes, monitoring and evaluation, and deliverables

for HEPA Europe.
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 START OF HEPA PROMOTION WITHIN THE NATIONAL
CINDI PROGRAMME IN MACEDONIA (2001 - 2004)

■ In September 2001- National PA startegy is initiated as part of CINDI conceptual model:

“The health promotion and NCD prevention dimensions of the PA strategy”.

■
In 2001/02 - Formulation of the Action Plan for development, implementation
and monitoring the PA programme within the contex of the first Draft-Plan
of Action for CINDI Programme in Macedonia, 2002-2007.

■ Action Plan is based on:

- the best scientific evidence on health, social and economic benefit of PA

- intersectoral and multidisciplinary

■ 2001 - Planning CINDI coordinative centre in Skopje with an information base and
organization structure for implementation of the CINDI programme.

■ 2001 - Realised “pylot“ study “CINDI Health Monitor” survey on demonstration level;
- Planning a national register for NCD risk factors focused on PA

■ 2001 - Planning seminar/lecture in Skopje

Modern aspects of NCD primary prevention: programmed PA and dietary interventions
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 START OF THE PROMOTION OF HEPA WITHIN THE NATIONAL
CINDI PROGRAMME IN MACEDONIA (2001-2003)
II part

■ 2002 - Initiation of preventive interventions and national quidelines for

reduction of lifestyle risk factors: PA and diet.
■ 2003 - “Move for Health 2003 Initiative Around the World”
The first step was made in collaboration with the WHO Department
for NCD prevention and health promotion (Puska P, WHO/HQ, Geneva).

■ 10 May 2003 - Establishing a national coordination with Executiv Counsil

Move for Health within Macedonian CINDI Programme.
■ 2003 - The website was developed “Macedonia on the Move”
http://www.cindi.makedonija.com

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 NATIONAL “MOVE FOR HEALTH DAY“
PROGRAMME IN MACEDONIA, 2003

Annual Move for Health Day was organized on 10 May as part of a larger
and sustained Move for Health initiative, policy and programme to promote
physical activity and related healthy lifestyle within the Macedonian population
throughtout 2003.

Used as vehicles to get the message of the importance of PA for health and
well-being to political leaders. It was a polivalent programme and part of a
larger campaign in Macedonia to develop a national programme on PA and
health with goals and specific targets in partnership with main concerned
sectors.

www.who.int/entity/moveforhealth/countries/en/mfh03_macedonia.pdf

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 Ongoing activities on national level, 2004 - 2007:

10 May 2004 - Mass media campaign “Move for Health - Active Youth”.
The Macedonian “Move for Health” Declaration was adopted.

11October 2005 - Establishing a National Public Health Organization

“HEPA MACEDONIA”.

2006 - Member of the” WHO HEPA Europe” and “ World Move for Health”
network.

2006 - Collaborative Partner of the EU network and research project for PA

and Aging - “EUNAAPA” . www.eunaapa.org

May 2006 - WHO “Quit & Win” Programme for smoking cessation in
Macedonia with title “Tobacco - Free Sport”;
www.nosmoking.cjb.net

22 September 2007 - “European day without cars” - Ohrid.

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 MAIN ACTIVITIES OF HEPA MACEDONIA
NATIONAL PUBLIC HEALTH ORGANIZATION FOR
THE PROMOTION OF HEALTHY NUTRITION AND
PHYSICAL ACTIVITY

RESEARCH:
• Effects of applied programmed PA at children, youth and adult population
• Efficacy of PA on reduction on diet-related risk factors for chronic
diseases
• Researches in area of public health
- health promotion through PA and healthier nutrition
- monitoring and evaluation of outcomes

HEALTH PROMOTION IN GENERAL:

• Healthy lifestyle
• Skills for health

PROMOTION OF PHYSICAL/SPORT ACTIVITY:

• On population and individual levels
• On national, regional and local level in Macedonia

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 TEACHING / ADVOCACY ON NUTRITION and PHYSICAL ACTIVITY,
2006 - 2007:

- Continuing doctoral education - CME, accrediated by Macedonian Medical

Association, Faculty of Medicine and Doctor Chamber of Macedonia.

- Traening seminars, workshops and teaching courses.

- Mass-media campaigns: “Move for Health” and “Quit & Win”

- Policy and strategy documents: Health strategy of Macedonia

including PA Strategy / Programme.

- Statute for transformation of Sports medicine institutions countrywide.

- Strategy for Sport-decentralization of sport in Macedonia.

- Legislation (Low for Sport).

- Recommendations and guidelines.

- Preparing proposal basic preventive medical services in area of

Sports Medicine and Dietology. Project Unit at Ministry of Health and
Health Insurance Company. 18
 CONTINUING MEDICAL EDUCATION, (CME) 2006

Workshop: New way of presenting of the reccommendations for physical activity

and application in the preventive-therapeutic programmes focused on obesity.
Simovska V., MD., PhD. Institute of Sports Medicine, Skopje, 31 May 2006 -
www.lkm.org.mk.
Professional - scientific meeting: Non-pharmacological combined therapeutic
threatment at obese population. Simovska V., MD., PhD.
Faculty of Medicine, Clinic for pediatric disorders, Skopje, 21 April, 2006.

The First Annual HEPA Macedonian Conference.

Public Health Institute of Sports Medicine, Skopje, 26 December 2006 - mld.org.mk.
Topics:
1. Vision and goals of HEPA Macedonia - National Public Health Organization for
the Promotion of Health-Enhancing Physical Activity.
Simovska V. MD., PhD, President of HEPA Macedonia.
2. Anthropometric,s characterisitics in patients with M. Cushing.
Doc. dr Stratovska - Subevska S, Faculty of Medicine. Clinic of Endocrinology.
3. Startegies in treatment of obesity: dietotherapy in individuals with
overweight and obesity. Simovska V.MD., PhD.
4. Annual Report of HEPA Macedonia 2006.
5. Annual HEPA Macedonian Work Programme 2007.

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 CONTINUING DOCTORAL EDUCATION, 2007

Annual Conference of the National Public Health Organization HEPA

Macedonia (NGO not for profit)

Plenary lecture: Simovska V., HEPA Macedonia.

“National startegy for the promotion of HEPA integrated in multidimanzional
health policy - fats and perspectives”.
Skopje, 29 November 2007.

Worshop: Influence of physical inactivity, obesity and psycho-social stress on

process of atherosclerosis and/or diabetes mellitus-type 2: Patophysiology and
treatment of Syndrom X.
Skopje, 10 January, 2008.

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 Physical Activity Promotion Policy Framework

Outcomes of Policy
Policy Develop and Implement Policy
Determinants of Policy
Identify Policy

a l g ion al ate i o n al
L oc R e St Nat
Health
Parks/Public Spaces Scale
Transportation Sector
Worksite
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 Developing a HEPA PROGRAMME in Macedonia

Key point 1.

Explore and resolve the potential relationship, role and function

between HEPA promotion and two key groups:
- Health professionals and HEPA, especially in PHC
- Sport and HEPA

Key point 2.

Cultivate and recruit other potential HEPA organization and

professionals groups at the national, regional and local levels
- Medical personals in public health
- Health promotion staff
- Exercise and fitness professionals
- Sports pedaqouges and coaches

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