Diet and physical activity strategies for NCD Implementation

Diet and physical activity strategies for NCD Implementation of the WHO Global Strategy on Diet, Physical Activity and Health Dr Timothy Armstrong Coordinator, Surveillance and Population-based Prevention Department of Chronic Diseases and Health Promotion World Health Organization 1 | Prevention of NCD | CHP / SPP; January 2010

Outline l Diet and physical activity as risk factors for NCDs l Global Response to NCDs l WHO's activities to implement DPAS l Prevention of NCDs through diet and physical activity: What Works? l What works for national policies? l Recommended action at national level l Multistakeholder involvement - key to success l Conclusions 2 | Prevention of NCD | CHP / SPP; January 2010

Leading causes of attributable global mortality and burden of disease, 2004 Attributable Mortality 1. High blood pressure 2. Tobacco use 3. High blood glucose 5. 8 4. Physical inactivity 5. 5 5. Overweight and obesity 4. 8 6. High cholesterol 4. 5 7. Unsafe sex 8. Alcohol use 9. Childhood underweight % 12. 8 8. 7 4. 0 3. 8 10. Indoor smoke from solid fuels 3. 3 59 million total global deaths in 2004 3 | Prevention of NCD | CHP / SPP; Attributable DALYs January 2010 % 1. Childhood underweight 7. 8 2. High blood pressure 3. Unsafe sex 4. Unsafe water, sanitation, hygiene 6. 1 5. High blood glucose 6. Indoor smoke from solid fuels 7. Tobacco use 8. Physical inactivity 9. Suboptimal breastfeeding 7. 5 6. 6 4. 9 4. 8 3. 9 10. High cholesterol 3. 8 3. 7 3. 3 1. 5 billion total global DALYs in 2004

Deaths attributed to 19 leading factors, by country income level, 2004 4 | Prevention of NCD | CHP / SPP; January 2010

Obesity: 5 th leading risk factor for death Fact: Being overweight or suffering from obesity is the 5 th leading risk for death. It is responsible for: 8% of deaths in high income countries and 7 % of deaths in middle income countries. Source: WHO, 2009 5 | Prevention of NCD | CHP / SPP; January 2010

Global prevalence and trends of overweight and obesity among preschool children l 43 million children are estimated to be overweight (2010) l In Africa, estimates for childhood overweight and obesity prevalence: – 8. 5% in 2010 – expected to increase to 12. 7% in 2020 l In developed countries, estimated prevalence of overweight in 2010 was double that in developing countries, but in absolute numbers the prevalence is higher in developing countries (35 vs 8 million) Source: WHO data presented at the WHO Forum and Technical Meeting on Population-based Prevention Strategies for Childhood Obesity; Dec. 2009 6 | Prevention of NCD | CHP / SPP; January 2010

From risk factors to diseases Risk factors responsible for more than half of the deaths due to heart disease (the leading cause of death in the world): Low fruit and vegetable intake, Physical inactivity, alcohol and tobacco use, high BMI, high cholesterol, high blood and high blood pressure. 7 |glucose, Prevention of NCD | CHP / SPP; January 2010

What has WHO been doing to mobilize a global response? 2000 Global Strategy for the Prevention and Control of Non-communicable Diseases 2002 2003 2004 2008 A six-year Global Action Plan to address cardiovascular disease, cancer, respiratory disease and diabetes was endorsed by the WHO World Health 8 | Prevention of NCD | CHP / SPP; January 2010 Assembly on 24 May 2008.

What has WHO been doing to mobilize a global response? Endorsed by the World Health Assembly in May 2008 by 193 Member States Six objectives: 1. Raising the priority accorded to NCD in development work at global and national levels 2. Establishing and strengthening national policies and programmes 3. Reducing and preventing risk factors 4. Prioritizing research on prevention and health care 5. Strengthening partnerships 6. Monitoring NCD trends and assessing progress made at country level Under each of the six objectives, there are sets of actions for member states, WHO Secretariat and international partners 9 | Prevention of NCD | CHP / SPP; January 2010

NCD Action Plan Objective 3 Member States are encouraged to implement the recommendations of the Global Strategy on Diet, Physical Activity and Health. Adopted by 192 Member States in 2004 www. who. int/dietphysicalactivity 10 | Prevention of NCD | CHP / SPP; January 2010

NCD Action Plan Objective 3: WHO's activities to implement DPAS l Normative functions l Guidance, tools and technical support – Global Recommendations on Physical Activity for Health (2009/2010) – Recommendations on marketing of foods and non-alcoholic beverages to children (2007/2010) – Population-based Prevention Strategies for Childhood Obesity (2009/2010) – Multistakeholder platforms for reduction of salt intake at the population level (2010) l Capacity building l Interactions with global private sector l Interactions with UN Agencies 11 | Prevention of NCD | CHP / SPP; January 2010

WHO's activities: Guidance, tools and technical support DPAS Implementation Tool Box - DPAS - Interventions on diet and physical activity: What Works - A Framework to Monitor and Evaluate Implementation - Guide for Population-based Approaches to Increasing PA - Global recommendations on physical activity for health (2010) - WHO/FAO Framework to Promote Fruits and Vegetables - Reducing Salt Intake in Populations - Prevention of NCDs at the Workplace - Marketing of Food and Non-alcoholic Beverages to Children (2010) - School Policy Framework - DPAS policy database (Member State experiences) http: //www. who. int/dietphysicalactivity/implementation/toolbox 12 | Prevention of NCD | CHP / SPP; January 2010

Framework for implementation at the national level Reduction in the Reduction in of: the prevalence of: - Raised BP - Raised Cholesterol -Raised cholesterol - Physical Inactivity -Physical inactivity -Obesity -Diabetes - Diabetes 13 | Prevention of NCD | CHP / SPP; January 2010

Prevention of NCD: What works? l Multi-component interventions l Adapted to the local context l Culturally and environmentally appropriate interventions l Using existing social structures of a community (e. g. schools, weekly meetings of older adults) l Multistakeholder involvement throughout the process l Listening, learning and targeting populations needs. 14 | Prevention of NCD | CHP / SPP; January 2010

What works for national policies? l Multi-targeted approaches to encourage walking and cycling to school, healthier commuting and leisure activities l Interventions targeting the built environment l Government regulatory policies to support a healthier composition of staple foods l Fiscal policies and point-of-purchase prompts to support healthier choices. 15 | Prevention of NCD | CHP / SPP; January 2010

NCD Action Plan Objective 3 Example of government regulatory policies: In Denmark, as of 1 January 2004: – the level of industrially produced TFA in oil and fats intended for the consumer, either alone or as an ingredient in foods, must not exceed 2%. The rules do not apply to TFA naturally occurring in animal fats. l Surveys on target products 2002 -03 and 2004 -05 showed: – – – – Significant decrease in products >2 % TFA Low level of transgression (2 -6 %) Replacement of removed TFA: Both monounsaturated and saturated fats IP-TFA reduced to negligible level in all product groups No signs of increase in intake of saturated fats New methods of production developed No increase in prices No reduction of product variability Source: Paolo M. Drostby Dept. Head of Division for Nutrition Danish Ministry of Food, Agriculture and Fisheries 16 | Prevention of NCD | CHP / SPP; January 2010

NCD Action Plan Objective 3 Example of government regulatory policies: l In 1987, the Mo. H of Mauritius introduced a regulatory policy to change the composition of general cooking oil: – limiting the content of palm oil and replacing it with soya bean oil. l 5 years after the intervention: – total cholesterol concentrations had fallen significantly in men and women. – Consumption of saturated fatty acids had decreased by an estimated 3. 5% of energy intake. – This activity was part of the national NCD intervention programme and a demonstration project within WHO's “Interhealth” initiative Source: WHO, what works, 2009 17 | Prevention of NCD | CHP / SPP; January 2010

NCD Action Plan Objective 3 Recommended action at national level l develop and implement national guidelines on physical activity for health; Brazil Liberia Chile Uganda 18 | Prevention of NCD | CHP / SPP; January 2010 Laos

NCD Action Plan Objective 3 Recommended action at national level l Introducing transport policies that promote active and safe methods of travelling to and from schools and workplaces, such as walking or cycling; Ciclovia, Bogota, Colombia http: //www. streetfilms. org/archives/ciclovia/ 19 | Prevention of NCD | CHP / SPP; January 2010

NCD Action Plan Objective 3 Recommended action at national level l Implement school-based programmes in line with WHO’s health-promoting schools initiative; Spotlight: The cook Islands health and physical wellbeing curriculum Spotlight: Inexpensive playground facilities in the UK Spotlight: Physical examination of all students in Iran http: //www. who. int/dietphysicalactivity/schools 20 | Prevention of NCD | CHP / SPP; January 2010

Example of effective intervention in schools: Know Your Body – Crete, Greece Intervention: l Know Your Body: 6 -year programme (grades 1 to 6) Characteristics: l Comprehensive, multi-component, focus on diet and PA. l Constructs from social learning theory l Curricula offered by trained teachers l Strong parental focus. Outcomes: l 4 - to 5 -fold increases in self-reported leisure-time activity. l improvements in knowledge and food choices. l reductions in intake of dietary fat. Source: WHO, What Works, 2009 21 | Prevention of NCD | CHP / SPP; January 2010

Policies & interventions must be multisectoral Involve all relevant sectors and stakeholders Income & Social Status Employment & working conditions Personal health practices & coping skills 22 | Prevention of NCD | CHP / SPP; Social Support Networks Physical environments Healthy child development January 2010 Education Health services Agriculture, food production and distribution

Multistakeholder involvement is key to success WHO's activities NGOs: l International Olympic Committee: l l l l – Beijing (2008); London (2012); Brazil (2016) International Society for Physical Activity and Health Consumers International IFAVA World Heart Federation International Diabetes Federation International Association for the Study of Obesity International Union Against Cancer 23 | Prevention of NCD | CHP / SPP; January 2010

Multistakeholder involvement is key to success WHO's activities International partners: – FAO, e. g. : fruit and vegetable initiative – UNICEF, World Bank, ILO, UNESCO, WTO, SCN, UN University, IMF, ECOSOC Private Sector: – Informal dialogues with globally represented food and nonalcoholic beverage producers – Interaction with World Economic Forum: Workplace wellness 24 | Prevention of NCD | CHP / SPP; January 2010

Multistakeholder involvement is key to success WHO & WEF Joint Events WHO: participants from academia, Government agencies, ministries of health, NGOs 2 Joint events (China 2007 & India 2008), Joint decision on: goals, objectives, programme, agenda, background papers 2 Joint reports Joint stakeholder mobilization WEF: Participants from business/ private sector http: //www. who. int/dietphysicalactivity/workplace 25 | Prevention of NCD | CHP / SPP; January 2010

Conclusions l Interventions to improve the dietary habits and PA levels of populations exist and have been successfully implement. l Up to 80% of type 2 diabetes and premature heart disease cases & 40% of cancers could be prevented l Many NCD prevention interventions are simple, cheap and cost effective. 26 | Prevention of NCD | CHP / SPP; January 2010