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Tobacco use is among the leading behavioural risk factors for morbidity and mortality. These high rates result in a high cost to society. Therefore, the aim of the current study was to provide a contemporary overview of the direct medical and indirect costs attributable to smoking tobacco in Belgium. Data from the Belgian Health Interview Survey (BHIS) was combined with health insurance claims data. Healthcare costs were calculated on individuals' cigarette smoking patterns (daily, former, and never smokers). Lost productivity costs were calculated by multiplying the number of absence days by the national average wage cost per day. Univariate and multivariable regression analyses with negative binomial distribution and log link were performed to evaluate the average healthcare costs and indirect costs in relation to tobacco use, socio-demographic characteristics, and (behavioural) risk factors. A total of 10 829 individuals were included in the analyses, of which 47.7% were men, with 15% being smokers. Men were more likely to be smokers than women (56.8% vs. 43.2%; P  < 0.001). Compared to never smokers, significantly higher direct medical costs were found for daily (20%; P  = 0.03) and former smokers (27%; P  < 0.001). No significant differences were observed for the indirect costs for the smoking population compared to never smokers. Taking into account that 15% of the Belgian population were daily smokers in 2018, the national cost for daily smokers equates to €533.861.010. Results of our study show that cigarette smoking has higher direct medical costs compared with never smokers. [ABSTRACT FROM AUTHOR]

Introduction Physical inactivity is a major driver of poor health globally and a risk factor for noncommunicable diseases. (1) About a third of adults in the Caribbean are estimated to [...], The World Health Organization (WHO) Global Action Plan on Physical Activity recommends adopting a systems approach to implementing and tailoring actions according to local contexts. We held group model-building workshops with key stakeholders in the Caribbean region to develop a causal loop diagram to describe the system driving the increasing physical inactivity in the region and envision the most effective ways of intervening in that system to encourage and promote physical activity. We used the causal loop diagram to inform how the WHO Global Action Plan on Physical Activity might be adapted to a local context. Although the WHO recommendations aligned well with our causal loop diagram, the diagram also illustrates the importance of local context in determining how interventions should be coordinated and implemented. Some interventions included creating safe physical activity spaces for both sexes, tackling negative attitudes to physical activity in certain contexts, including in schools and workplaces, and improving infrastructure for active transport. The causal loop diagram may also help understand how policies may be undermined or supported by key actors or where policies should be coordinated. We demonstrate how, in a region with a high level of physical inactivity and low resources, applying systems thinking with relevant stakeholders can help the targeted adaptation of global recommendations to local contexts. Le Plan d'action mondial pour l'activite physique elabore par l'Organisation mondiale de la Sante (OMS) recommande d'adopter une approche systemique pour la creation et le deploiement d'actions adaptees aux contextes locaux. Nous avons organise des ateliers de construction de modeles regroupant divers acteurs cles de la region Caraibes. Objectif: developper un diagramme de boucles causales afin d'identifier le systeme a l'origine de la sedentarite croissante dans cette region, mais aussi de concevoir les moyens les plus efficaces pour s'immiscer dans ce systeme en vue d'encourager et de promouvoir l'exercice physique. Nous avons employe le diagramme de boucles causales pour definir comment le Plan d'action mondial pour l'activite physique de l'OMS peut etre adapte au contexte local. Bien que les recommandations de l'OMS se rapprochent considerablement de notre diagramme, ce dernier illustre aussi l'importance du contexte local dans la maniere dont les interventions sont censees etre coordonnees et mises en oeuvre. Certaines de ces interventions prevoyaient d'ouvrir des espaces securises dedies a la pratique sportive pour les deux sexes, de lutter contre les attitudes negatives vis-a-vis de l'activite physique dans des situations specifiques, notamment a l'ecole et au travail, et de rendre les infrastructures compatibles avec les modes de transport actifs. Le diagramme de boucles causales permet en outre de mieux comprendre comment les acteurs cles peuvent soutenir ou au contraire discrediter les politiques en la matiere, et de voir oU ces politiques ont besoin de coordination. Nous demontrons comment, dans une region marquee par un taux de sedentarite eleve et de faibles ressources, l'adoption d'une approche systemique impliquant les principaux intervenants peut contribuer a ajuster avec precision des recommandations mondiales a des contextes locaux. El Plan de accion mundial sobre actividad fisica de la Organizacion Mundial de la Salud (OMS) recomienda adoptar un enfoque sistemico para implementar y adaptar las acciones segun los contextos locales. Celebramos talleres de construccion de modelos de grupo con las principales partes interesadas en la region del Caribe para desarrollar un diagrama de circuito causal para describir el sistema que impulsa la creciente inactividad fisica en la region y prever las formas mas eficaces de intervenir en ese sistema para fomentar y promover la actividad fisica. Utilizamos el diagrama de circuito causal para informar sobre como se podria adaptar el Plan de accion mundial sobre actividad fisica de la OMS a un contexto local. Aunque las recomendaciones de la OMS se ajustaban bien a nuestro diagrama, este tambien ilustra la importancia del contexto local a la hora de determinar como deben coordinarse y aplicarse las intervenciones. Algunas intervenciones incluyen la creacion de espacios seguros para la actividad fisica para ambos sexos, la lucha contra las actitudes negativas hacia la actividad fisica en determinados contextos, incluidos los colegios y los lugares de trabajo, y la mejora de las infraestructuras para el transporte activo. El diagrama de circuito causal tambien puede ayudar a entender como las politicas pueden ser socavadas o apoyadas por actores clave o donde deben coordinarse las politicas. Demostramos como, en una region con un alto nivel de inactividad fisica y pocos recursos, la aplicacion del pensamiento sistemico con las partes interesadas pertinentes puede ayudar a la adaptacion especifica de las recomendaciones globales a los contextos locales. [phrase omitted]

Abstract Background As countries in sub-Saharan Africa develop their economies, it is important to understand the health of employees and its impact on productivity and absenteeism. While previous studies have assessed the impact of single conditions on absenteeism, the current study evaluates multiple health factors associated with absenteeism in a large worker population across several sectors in Namibia. Methods From March 2009 to June 2010, PharmAccess Namibia conducted a series of cross-sectional surveys of 7,666 employees in 7 sectors of industry in Namibia. These included a self-reported health questionnaire and biomedical screenings for certain infectious diseases and non-communicable disease (NCD) risk factors. Data were collected on demographics, absenteeism over a 90-day period, smoking behavior, alcohol use, hemoglobin, blood pressure, blood glucose, cholesterol, waist circumference, body mass index (BMI), HIV status, and presence of hepatitis B antigens and syphilis antibodies. The associations of these factors to absenteeism were ascertained using negative binomial regression. Results Controlling for demographic and job-related factors, high blood glucose and diabetes had the largest effect on absenteeism (IRR: 3.67, 95%CI: 2.06-6.55). This was followed by anemia (IRR: 1.59, 95%CI: 1.17-2.18) and being HIV positive (IRR: 1.47; 95%CI: 1.12-1.95). In addition, working in the fishing or services sectors was associated with an increased incidence of sick days (IRR: 1.53, 95%CI: 1.23-1.90; and IRR: 1.70, 95%CI: 1.32-2.20 respectively). The highest prevalence of diabetes was in the services sector (3.6%, 95%CI:-2.5-4.7). The highest prevalence of HIV was found in the fishing sector (14.3%, 95%CI: 10.1-18.5). Conclusion Both NCD risk factors and infectious diseases are associated with increased rates of short-term absenteeism of formal sector employees in Namibia. Programs to manage these conditions could help employers avoid costs associated with absenteeism. These programs could include basic health care insurance including regular wellness screenings.