Objectives

  The International Health Regulations (2005) bound the member states of the World Health Organization (WHO) to initiate epidemiological investigations of disease outbreaks and to notify WHO within 24 hours of their detection if the event is deemed to constitute public health emergency of international concern. The Japan International Cooperation Agency started the Amhara Regional Infectious Disease Surveillance Project to strengthen the surveillance and response system in the Amhara Region of Ethiopia in 2008. The objectives of the study were to review the project activities and to share the experiences and lessons learned in 22 districts of the North and South Gondar and West Gojjam Zones from mid-2012 through 2014.

Methods

  We conducted training for district surveillance officers and focal point personnel at health centres (HCs), monitoring visits to district health offices and HCs, held review meetings on surveillance, and provided technical assistance in outbreak investigations. We evaluated the project activities in terms of the timeliness of the surveillance reports submitted by the health facilities, provision of technical assistance in outbreak investigations, and the number of training sessions held for the surveillance personnel.

Results

  The timeliness of submission of surveillance reports had improved to almost 100% at end of 2014 compared with before the review period (about 68%). From the third quarter of 2013, we conducted monitoring visits to 59 HCs every semester. We were involved in 11 outbreak investigations of measles, anthrax, pertussis, neonatal tetanus, and typhoid fever. We held a total of 25 training sessions for district surveillance officers and HC focal points.

Conclusion

  The project successfully strengthened the surveillance and response system. We recommend that the Amhara Regional Health Bureau maintain its commitment to the system in terms of human resources and funding. Training for surveillance officers and focal points should be conducted periodically.

Objectives

  To obtain information regarding the current state of obesity and its underlying lifestyle habits and environment in Bangkok.

Methods

  A cross-sectional study was conducted in two study sites, a university and a community health center in Pyatai district in Bangkok. By opportunity sampling, a total of 45 adults (10 males and 35 females, aged 20 to 84 years) participated.

  Anthropometric measurements were taken, and a one to one interview was conducted with a questionnaire to obtain lifestyle behavior data, and 11-item Food Diversity Score Kyoto (FDSK-11) was used to obtain dietary diversity.

Results

  The present study showed a high mean BMI (26.98) among participants in both study sites, and the prevalence of overweight and obesity were higher than the results seen in previous studies. Higher food diversity was significantly related to the frequency of eating out, and that of exercise. Moreover, participants who had higher food diversity tended to have higher BMI.

Conclusion

  The present study indicated that high prevalence of overweight and obesity in both sexes in both study sites. According to the previous study, the more variety of food they took, the less BMI they had. However, the present study showed the opposite. Generally having a variety of food is recommended as healthy dietary habit, however unless we care about the balance and the amount, having too much energy-dense food may contribute to overweight and obesity. Rapid economic growth and urbanization changed people’s lifestyles and eating habits. Current typical diet consists of animal meat and rice rather than the vegetables and rice which Thai people took past. Strategies to give people nutritional education seem to be needed.

  2015年9月の国連総会においてミレニアム開発目標（MDGs）の後継として持続可能な開発目標（SDGs）が採択された。MDGsは先進国から途上国への支援策を念頭に測定可能な課題に焦点を絞って実施された。保健のターゲット占有率は28.6%と高く、保健課題の優先性は顕著であった。一方、SDGsは先進国と途上国すべての国が達成すべき目標を掲げ、17のゴールと169のターゲットから構成されている。SDGsにおける保健の占有率は7.7%でMDGsの4分の1にまで低下したことから、SDGsの中で保健の優先性は後退したかに見える。しかし、SDGsでは保健以外のターゲットに健康に関連する課題が23含まれており、SDGs達成に向け保健は引き続き重要な課題であることに相違ない。また、健康の社会的、環境的、経済的決定要因への広範な介入を目指すHealth in All Policies政策を推進するには有利な環境が整ったとも言える。

  SDGsは持続可能な開発に必要なあらゆる領域を包含しているユニバーサリティ（広範性；universality）を有するゆえ、意思決定者の目には焦点が散漫に映り、理解し難いとの懸念がある。その弱点を補強するために、より包摂的な概念や指標にコンバージェンス（収束；convergence）させる試みが提案されてきた。保健領域においてはその代表的提案がユニバーサルヘルスカバレッジ（UHC）とグランドコンバージェンス（GC）である。

  SDGsは成立までのプロセスに実に多くのステークホルダーが参加し多様な意見が出された結果、非感染性疾患や精神保健、薬物乱用や道路交通事故の対策など近年注視されている問題を数多く取り込むこととなった。その背景に「私の病気はあなたの病気よりも重要である」式に専門分野の重要性を主張する各方面からの要望を排除できなかったことも一因であり、百家争鳴状態に陥ってしまった感は拭えない。UHCとGCはその閉塞を打開する切り札として提案され、その実現が今後の鍵になると思われる。

  日本において1950〜60年代の結核対策というタテのシステムは、1961年に形が整ったヨコのシステムである皆保険制度の発展を助けた。タテとヨコは競合するものではなく、相互に作用しあうものであり、それは現在における結核対策をはじめとする、マラリア、HIV/AIDS対策などタテの介入とユニバーサルヘルスカバレッジ（UHC）というヨコの介入に関しても同様であるべきである。