Non-communicable diseases – In the final article in our series on NCDs, Wendy Holmes looks at a successful strategy for mitigating the impact of these diseases in Sri Lanka.
The grey-haired women in their saris race down the field, grab the coconuts set out for them and grate them energetically, eager to finish first.
Old men watch from their seats on the sidelines and chuckle, while the young people cheer on their grandmothers.
The women are taking part in one of the competitive events at a sports day for tea estate Elders’ Clubs organised by local elders.
The organisers have invited young people, estate managers and local politicians to attend.
Elders’ Clubs
Establishing Elders’ Clubs was one of several strategies in a project that started in 2004, to improve the health and well-being of the elders and foster traditional values of respect in the tea estates of Nuwara Eliya in Sri Lanka.
The project is a collaboration between a local community development organisation, PALM Foundation, and the Burnet Institute for Medical Research and Public Health.
And the Elders’ Club strategy has had broader benefits than expected.
Sri Lanka is a good example of an Asian country that is responding to rapid population ageing while still poor.
As a result of early decreases in mortality and fertility rates, the proportion of the population over 60 years of age is doubling in less than 25 years – a transition that took 100 years in Western countries.
This is happening at the same time as social changes stemming from globalisation, with many migrating to cities and overseas, and women working outside the home.
Not a burden
Increasing numbers of older people bring benefits to society as well as challenges. Older people care for small children enabling parents to work; they shop, cook and clean; they grow vegetables and look after domestic animals.
Their economic contribution is often considerable – but doesn’t appear in national accounts. They provide emotional security; a sense of continuity with traditions; a listening ear and sense of belonging for young people; and provide accumulated wisdom and experience for young mothers.
But these contributions are often limited by preventable illness and disability, putting a burden of care on family members, who are usually women.
This loss of independence may occur gradually, such as vision loss from cataracts or increasing stiffness from arthritis, or suddenly, with a catastrophic event such as a stroke.
NCDs and the developing world
The epidemic of chronic non-communicable conditions in low- and lower middle-income countries is at last on the international health agenda.
The World Health Organisation’s (WHO) strategy for dealing with them focuses on four important risk factors that contribute to heart attacks, stroke, diabetes, and cancers.
These are smoking, high-fat and high-salt diets, lack of physical activity and excessive alcohol use.
A rigorous summary analysis of a large number of prospective studies published last year found social isolation to be as significant a risk factor for premature mortality as these so-called “lifestyle” risk factors.
Social participation protects against a wide range of health problems, including heart disease, diabetes, depression and dementia, in varied settings.
We have evolved as a social species so it’s not surprising that stress interacts with feelings of loneliness to increase risk of disease.
Much recent work has clarified the neural and hormonal mechanisms through which our experiences influence the autonomic, cardiovascular and immune systems resulting in adverse physical changes.
Friendships, helping others and other forms of social participation increase self-esteem and confidence, making it more likely that older people will adopt and maintain healthier behaviours, seek health care, and better manage their own chronic conditions.
Local autonomy
PALM Foundation staff are familiar with their local communities and found it feasible and inexpensive to catalyse the formation of Elders’ Clubs.
Activities included music, singing and dance competitions; taping of oral history discussions; sports events; visiting the sick and bereaved; and cooking demonstrations.
Club meetings made it possible to assist elders obtain welfare entitlements; organize eye, dental and general health screening and referrals; and to provide interactive health promotion sessions, including peer education and “preparation for healthy ageing” workshops with younger groups.
The tea estates are isolated and most retired tea workers rarely leave the estate. The most popular and transforming activity was day trips in a hired bus, mostly to the religious sites requested by the elders.
Elders who’d been sitting apathetic and ignored at home since retirement came to life, dressed in their best, bought presents for their grandchildren and had something to talk about.
They valued sharing the practice of their rituals with each other.
And they soon took on running their own Clubs. With small grants, they started revolving loan and income generating schemes.
They now have greater visibility and a collective voice which they are using to improve their conditions and those of their communities.
This year the Sri Lankan government developed a National Action Plan on Ageing which includes the promotion of Elders’ Committees across the country.
HelpAge International has also supported successful Older People’s Associations in several poor Asian countries.
It’s vital to recognise the significance of social participation in preventing and managing the huge and increasing burden of non-communicable diseases in low-income settings. Laughter is not just the best medicine, it can help make old age a happy, healthy and productive stage of life.
This is the final part of our non-communicable diseases series. To read the other instalments, follow the links here:
Part One: Sir George Alleyne discusses why we need a new paradigm to tackle NCDs
Part Two: Regulating alcohol to control NCDs
Part Three: Stopping the obesity epidemic will require action on the population-level
Part Four: The results of the UN High-Level Meeting on Non-Communicable Diseases on New York September 19-20
Part Five: How plain packaging works to reduce smoking – one of the biggest causes of non-communicable diseases
Part Six: Blueprint for making medicines more affordable for everyone
Part Seven: Action on salt will mean longer, healthier lives -
Part Eight: Death by suburban sprawl: better urban planning will combat sedentary lifestyles
Part Nine: Where we come from determines how we fare – the fetal origins of adult disease