WHO Global Strategy on Diet Physical Activity and Health

1
WHO Global Strategy on Diet Physical Activity
and Health

• Schools Project
• Dr Colin Tukuitonga
• World Health Organization
• Geneva

2
Outline

• The Challenge
• WHO Global Strategy on Diet Physical Activity and
  Health
• Schools Project

3
Deaths by broad cause group, estimates for 2002
Total deaths 57,027,000
Noncommunicable conditions (58.6) of which
50 are due to CVD
Communicable diseases, maternal and perinatal
conditions and nutritional deficiencies (32.3)
Injuries (9.1)
SourceWHO, WHR, 2003
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Deaths, by broad cause group and WHO Region,
2001
Communicable diseases, maternal and perinatal
conditions and nutritional deficiencies
Noncommunicable conditions
Injuries
75
50
25
AFR
AMR
EMR
EUR
SEAR
WPR
Source WHR 2002
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Prevention Works
6
Dietary change and CHD mortality in Poland
120
14
12
100
10
male CHD mortality
80
Fruit (kg/pers/qtr x 2) Fats (kg/pers/yr)
vegetable fat and oils
8
mortality ratio (1991100)
60
6
40
butter
4
exotic fruit (imported)
20
2
0
0
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
Source Zatonski, McMichael, Powles. Brit Med J
1998
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Estimates and Projections

• Chronic, noncommunicable diseases (NCDs) cause
  60 of global deaths and 47 of burden of disease
  (WHR 2002)
• These estimates expected to rise to 73 and 60
  respectively by 2020
• 66 of NCD deaths occur in developing countries
• Double-burden of disease in many developing
  countries

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Risk factors for chronic diseases

• Physical inactivity
• Low fruit and vegetable intake
• High salt (NaCl) intake
• Saturated fat and trans fatty acid intake
• High blood pressure
• High cholesterol
• Overweight and obesity.

Source WHR 2002
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Foundation of WHO Global Strategy on Diet
Physical Activity and Health

• Prevention of chronic, noncommunicable diseases
  (NCDs)
• addressing risk factors, impacting multiple NCDs
  rather than single diseases
• Multisectoral action
• expanding impact and sustainability by
  coordinating efforts of ministries, private
  sector, experts researchers in health,
  nutrition, education, physical activity, urban
  planning, economics, trade and transport.

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Extensive stakeholder consultations

• 81 countries attended 6 regional consultations,
• 11 UN agencies,
• 22 international nongovernmental organizations
  (NGOs),
• 25 international industry associations,
• Director General-CEO and senior executives
  roundtable with 13 international companies,
• Director General-Civil Society roundtable with 13
  international NGOs,
• Expert Reference Group advised process.

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Key principles

• Strategies, policies should be
• multisectoral,
• address all major chronic NCD risk factors,
• have a long-term perspective
• Implementation needs to address all age, sex and
  socioeconomic groups
• Advocacy must be sustainable and continuing
• Tools for countries should be based on needs
• Macro and micro levels should be addressed in
  combination.

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Policies concerning the environment I

• Multisectoral, multistakeholder policies and
  strategies
• National dietary and physical activity
  guidelines
• Fiscal policies to influence food availability
  and food choices
• Agriculture policies to improve national diets
• Transport and environmental policies to promote
  physical activity.

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Policies concerning the environment II

• School policies that
• improve health literacy,
• promote healthy diet,
• provide physical education and facilities
• Policies regarding marketing practices,
  especially marketing to children
• Policies to encourage development, production and
  marketing of food products that contribute to a
  healthy diets
• Utilization of international tools such as Codex
  Alimentarius, coordination with UN Agencies.

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Policies aimed at individual change

• Governments
• Education and public awareness campaigns and
  adult literacy programmes
• Practical advice by health professionals to
  patients and families to help patients initiate
  and maintain healthy behaviours
• Clear, simplified messages (reduce salt, sugar,
  fat increase fruit vegetables, physical
  activity)
• Private Sector
• Accurate nutrition labelling and monitored
  nutrition and health claims.

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Recommendations that address 'agents'

• Governments
• Encourage environmental planning that allows
  increased walking, cycling and other physical
  activities
• Private Sector
• Modify foods to limit salt, sugar, and fat,
  especially saturated fat and trans fatty acids
• Introduce new products with better nutritional
  value
• Modify marketing practices of foods that
  contribute to unhealthy diet
• Provide usable information for consumers.

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Recommendations to Private Sector

• "Workplaces are important settings for health
  promotion and disease prevention. People need to
  be given the opportunity to make healthy choices
  in the workplace in order to reduce their
  exposure to risk. Further, the cost to employers
  of morbidity attributed to noncommunicable
  disease is increasing rapidly. Workplaces should
  make possible healthy food choices and support
  and encourage physical activity".

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Recommendations to Private Sector

• Promote healthy diets and physical activity
• Limit levels of saturated fats, trans-fatty
  acids, free sugars, salt in existing products
• Develop and provide affordable, healthy and
  nutritious choices to consumers
• Introduce new products with better nutritional
  value
• Provide consumers with adequate and
  understandable product and nutrition information.

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Recommendations to Private Sector

• Practice responsible marketing that supports the
  strategy,
• especially foods high in saturated fats,
  trans-fatty acids, free sugars, or salt and
  especially to children
• Issue simple, clear and consistent food labels
  and evidence-based health claims,
• help consumers to make informed and healthy
  choices with respect to the nutritional value of
  foods
• Provide information on food composition to
  national authorities
• Assist in developing and implementing physical
  activity programmes.

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Recommendations to Civil Society

• Lead grass-roots mobilization and advocacy,
• Disseminate information on chronic disease burden
  and prevention,
• Form networks for action and support,
• Organize campaigns, events to stimulate action,
• Monitor governments and industry.

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Responsibilities WHO HQ and Regional Offices

• Provide leadership, recommendations, advocacy at
  international level,
• Continue dialogue with private sector/industry,
• Support Member States in
• Regional, national policy and standards,
• National dietary and physical activity
  guidelines,
• Standardized surveillance,
• Interventions to promote healthy diet, physical
  activity,

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Responsibilities WHO HQ and Regional Offices

• Lead collaboration with UN agencies and
  international partners,
• Promote, support research in priority areas,
• Work with WHO collaborating centres,
• Establish, support networks to build research and
  training capacity,
• Mobilize input and interaction with civil
  society,
• Promote integration of chronic NCD prevention
  policies with development policy.
• Integration of diet and physical activity
  interventions into healthcare and training,
• Interaction with industry.

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WHO HQ Priorities 2004 - 2005

• Provide global leadership, advocacy,
  communication, resource mobilisation
• Support regional offices and countries
• Develop effective partnerships and relationships
  private sector, civil society/NGOs
• Collate and disseminate evidence for policy
• focus physical activity guidelines.

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"49. School policies and programmes should
support the adoption of healthy diets and
physical activity. Schools influence the lives of
most children in all countries. They should
protect their health by providing health
information, improving health literacy, and
promoting healthy diets, physical activity, and
other healthy behaviours. Schools are encouraged
to provide students with daily physical education
and should be equipped with appropriate
facilities and equipment. Governments are
encouraged to adopt policies that support healthy
diets at school and limit the availability of
products high in salt, sugar and fats. Schools
should consider, together with parents and
responsible authorities, issuing contracts for
school lunches to local food growers in order to
ensure a local market for healthy foods."1
1 WHA 57.17, p.15, available under
http//www.who.int/gb/ebwha/pdf_files/WHA57/A57_R1
7-en.pdf .
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DPAS School Project
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Why Schools?

• Utilise existing strengths and networks
• WHO settings approach
• Risks develop early
• Long term benefits
• High enrolment in most countries
• China 93,
• Brazil 97,
• Indonesia 92

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DPAS Schools Project

• Builds on existing experience and networks
  "Health Promoting Schools"
• Joint Nutrition and Chronic Diseases and Health
  Promotion Departments
• (Nutrition Friendly Schools Initiative)
• WHO Collaborating Centres
• UN Agencies

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DPAS School Project

• Goal
• Develop a policy framework for the prevention
  and control of chronic diseases in schools,
  focusing on the promotion of a healthy diet and
  physical activity/education
• The framework will assist Member States to
  develop national / sub-national policies or
  guidelines on school food provision and promotion
  of a healthy diet and physical activity/education.

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Activities

• Map of current activities UN Agencies, WHO
  Regional Offices, NGOs, private sector
• Literature Review
• Draft policy framework for consultation
• ? Expert meeting
• Finalise and disseminate framework

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Conclusions

• Chronic diseases is the major public health
  problem of our time
• A concern for all countries
• Society-wide solutions are needed
• DPAS is a vision and a tool
• Schools provide a golden opportunity