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Global Strategy on Diet, PhysicalActivity and Health

Ursula TruebswasserNutrition and Food Security

WHO Regional Office for Europe

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Overview of the presentation

Global disease burdenRisk factorsPhysical activity/Diet HealthProcess of the Global Strategy on Diet,Physical Activity and Health (DPAS)Content of DPASImplementation of DPAS and activities atthe European level

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Epidemiological: NCD overriding CD, & double burden of diseases inmany developing countries

Diet and physical Diets are rapidly changingactivity: and physical activity

reduced

Demographic: Population ageing

Globalisation: Increasing global influences

The World Health is in Transition

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Injuries (9.1%) Noncommunicableconditions (59.0%)

Communicable diseases,maternal and perinatal

conditions and nutritionaldeficiencies (31.9%)

Total deaths: 55,694,000

Source: WHO, World Health Report 2001

Death by broad cause group 2000

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Deaths, by broad cause group and WHO Region,2000

InjuriesNoncommunicableconditions

Communicable diseases, maternaland perinatal conditions andnutritional deficiencies

AFR EMR EURSEAR WPR AMR

25

50

75

%

Source: WHO, World Health Report 2001

-

0

50,000

100,000

150,000

200,000

2000 2020 2000 2020 India SEA

Double burden of disease in middle/low income countries

DALYs

Communicable, maternal/perinatal cond.,nutr. deficienciesNoncommunicable Conditions

Source: WHO/EIP Global Burden of Disease

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Deaths due to CVD by WHO Region,2000

Strokes Heart attacks

AFR EMR EURSEAR WPR AMR

10

20

30% Deaths

Source: WHO, World Health Report 2000

-

0102030405060708090

Afr Eur SEA W Pa Amer E Med

199520002025

World Health Report, 1997

The prevalence of diabetes in adults(millions of people)

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Prevalence of overweight and obesitya among adults in countries in the WHO European Region based on surveys with an ending year of 1999 or later

42.236.233.733.135.533.532.539.830.931.329.031.028.732.532.429.931.129.323.928.827.428.925.728.026.728.226.928.624.425.122.426.023.725.824.919.921.321.818.420.719.6

18.220.418.0

15.918.216.3

16.919.5

13.5

12.314.912.313.511.4

11.89.5

13.4

15.011.0

11.38.79.1

9.17.5

25.826.0

25.235.6

5.9

22.723.5

23.012.5

20.1

19.915.9

14.1

12.4

12.7

10.37.1

44.341.037.442.139.8

54.337.5

26.531.4

44.644.840.541.038.138.7

32.044.1

38.830.138.343.041.141.846.341.042.041.641.843.044.843.2

46.745.843.048.656.522.8

16.522.419.9

21.6

13.922.2

14.317.1

26.617.0

15.720.1

13.426.0

13.714.2

11.911.3

13.613.7

12.414.9

9.912.9

7.711.9

13.512.0

11.49.3

9.8

9.17.9

5.46.4

100 80 60 40 20 0 20 40 60 80 100

Albania: Tirana city , 2001, 25+Bosnia and Herzegov ina, 2002, 25-64

United Kingdom: Scotland, 2003-2004, 16+Israel, 1999-2001, 25-64

Croatia, 2003, 18+Turkey , 2003, 15-49

United Kingdom: England, 2003, 16+Georgia: Chugureti district, 2004, 25-64

Serbia and Montenegro, 2000, 20+Hungary , 2003-2004, 18+

Malta, 2002, 20-64United Kingdom: Wales, 2003-2004, 16+

Poland, 2000, 19+Ireland, 1997-1999, 18-64

Portugal, 1999, 15+Greece, 2003, 20-70

Czech Republic, 2002, 16+Lithuania, 2004, 20-64

Latv ia, 2004, 15-64Bulgaria, 2001, 15+

Armenia, 2000-2001, 15-49Germany , 2003, 18+Estonia, 2004, 16-64Iceland, 2002, 15-80Finland, 2005, 15-64

Netherlands, 2005, 20+Cy prus, 2003, 15+

Romania, 2000, 15+Belgium, 2004, 18+

Azerbaijan, 2001, 15-44Slov akia, 2002, 15+

Sw eden, 2005, 16-84France, 2003, 15+

Italy , 2003, 18+Denmark, 2000, 16+

Kazakhstan, 1999, 15-49Austria, 1999, 20+

Sw itzerland, 2002, 15+Turkmenistan, 2000, 15-49

Uzbekistan, 2002, F:15-49;M:15-59Norw ay , 2002, 16+

Surv

ey c

hara

cter

istic

sb : cou

ntry

, yea

r, a

ge r

ange

(yea

rs)

Percentage (%)

Men Women

Pre-obese, measured data

Pre-obese, self-reported data

Obese, measured data

Obese, self-reported data

WHO Regional Office for Europe, 2006

Adults

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ChildrenPrevalence of overweight and obesitya among children 11 years or younger in countries in the WHO European Region based on surveys with an ending year of 1999 or later

21.421.9

21.719.518.014.816.617.0

15.514.814.716.012.69.84.911.711.39.9

12.310.5

7.56.98.3

6.34.4

4.0

3.6

4.26.7

11.4

4.45.7

20.0

15.2

22.5 7.0

2.0

4.5

3.0

4.0

18.9

7.410.310.56.99.18.7

15.014.014.312.9

16.011.515.813.313.716.7

19.919.1

5.9

5.43.9

2.411.2

7.64.9

4.03.93.04.1

3.05.5

7.06.6

4.65.8

10.310.3

10.1

17.0

40 30 20 10 0 10 20 30 40

Portugal, 2002-2003, 7-9Spain, 1998-2000, 2-9

Italy : fiv e v illages in Milan prov ince, 2000-2002, 6-11Ireland, 2001-2002, 4-9

United Kingdom: three South Wales localities, 2001-2002, 5Cy prus, 1999-2000, 6-9

Poland, 2000, 1-9Germany : Zerbst, Hettstedt and Bitterfeld counties, 1998-

Sw eden, 2003, 8Iceland, 2004, 9

Sw itzerland, 2002-2003, 6-9Norw ay , 2000, 8-9France, 2000, 7-9Sw eden, 2003, 4

Slov akia, 2001, 7-9Italy : Perugia, Terni and Rieti prov inces, 1993-2001, 3-9

Greece, 2003, 2-6Netherlands, 2005, 2-9

Serbia and Montenegro: North Backa region, 1995-2002, 6-10Cy prus, 2004, 2-6

Germany : Aachen city , 2001-2002, 5-6

Surv

ey c

hara

cter

istic

sb : cou

ntry

, yea

r, a

gera

nge

(yea

rs)

Percentage (%)

GirlsBoys

Pre-obese, measured data

Obese, measured data

Pre-obese, self-reported or parent-reported dataObese, self-reported or parent-reported dataOverweight, measured data

WHO Regional Office for Europe, 2006

Children

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0 1000 2000 3000 4000 5000 6000 7000 800

Unsafe water, sanitation, and hygiene

Alcohol

Physical inactivity

High Body Mass Index

Fruit and vegetable intake

Unsafe sex

Underweight

Cholesterol

Tobacco

Blood pressure

Deaths worldwide in 2000 attributableto selected leading risk factors

Number of deaths (000s) Source: WHR 2002

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The impact of risk factors on diseasesand deaths I

High salt (NaCl) intake:– sodium intake is directly associated with

High blood pressure

Saturated fats and trans fatty acids:– raise total and LDL cholesterol– usually animal fat based or hardened

vegetable oil– replacement by unsaturated vegetable

oils effectively lowers blood cholesteroland coronary heart disease risk

Source: WHR 2002

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The impact of risk factors on diseasesand deaths II

Obesity:– 58% of DM, 21% of ischaemic heart

diseases and 8-42% of certain cancersare attributable globally to a BMI > 21kg/m2

Low fruit and vegetable intake:– causes 19% of gastro-intestinal cancers

and 31% of ischaemic heart diseases– causes 2.7 million deaths / year (5%)

Source: WHR 2002

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Diet, physical activity and risk ofNCD

Up to 80 % of cases of coronary heartdisease and up to 90 % of type 2diabetes could be avoided throughchanging lifestyle factors

About one third of cancers could beprevented by eating healthily,maintaining normal weight and beingphysically active throughout the lifespan.

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Physical activity and health

Physical inactivity is estimated to cause1.9 million deaths worldwide annually10-16% of cases each of breastcancer, colon cancers and diabetes22% of ischemic heart diseases

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Physical activity and health

Improves glucose metabolism,reduces body fat, lowers bloodpressure, effects on hormonalmetabolism and improvesmuscoloskeletal conditionsHeart diseases, stroke, breast andcolon cancers, osteoporosis

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Healthy diet and physical activity are

For the individual:

an effective way toprevent disease andpromote health

For society:

a cost effective andsustainable way toimprove publichealth

The Global Strategy on Diet, PhysicalActivity

and Health is of great importancefor global public health.

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Development of the strategy

53rd WHA resolution for prevention and controlof NCDs (2000)

55th WHA resolution on diet, physical activityand health in 2002: calls for preparation ofGlobal Strategy

The guiding principles of the strategy developmentprocess were:stronger evidence for policyadvocacy for policy changestakeholder involvementa strategic framework for action

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Consultation Process Consultation Process

Memberstates

Memberstates

Civil SocietyCivil

SocietyPrivate sectorPrivate sector

UN agencies

UN agenciesPh

ase

IIWHO Strategy on Diet, Physical Activity and HealthWHO Strategy on Diet, Physical Activity and Health

WHA 2004WHA 2004

EB Jan 2004EB Jan 2004 SecretariatSecretariatReference group

Reference group

Phas

e III

Assemble and compile evidence,complete expert report

Assemble and compile evidence,complete expert report

Phas

e I

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WHO/FAO Expert Report on Diet,Nutrition and the Prevention of

Chronic Diseases

Report of the joint WHO/FAO expertconsultation in Geneva, Switzerland

28 January - 1 February 2002

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WHO/FAO Expert ConsultationTRS 916, 2003

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Process with StakeholdersPrivate Sector Consultation

Dialogues with representatives of food, non-alcoholicbeverage, sport and insurance companies, individually andthrough coordination of International Business LeadersForum

Civil Society ConsultationDialogues with representatives of international civil societyand nongovernmental organisations whose focus includeschronic diseases, nutrition, physical activity; individually andthrough networksConsultation with UN and IntergovernmentalAgenciesDialogues with representatives of UN and other agencies, with representatives from FAO, IFPRI, UNESCO, UNDP,World Bank, WFP among others

Regional Consultations

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Adoption of the Global Strategyon Diet, Physical Activity andHealth

March 2004,57th World HealthAssembly

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Main objectives of the DPAS

to reduce the risk factors for NCDsto increase the overall awareness andunderstanding of the influence of diet andphysical activity on healthto encourage the development, strengtheningand implementation of global, regional, nationaland community policies and action plansto monitor scientific data and key influences ondiet and physical activity; to support research ina broad spectrum of relevant areas

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Recommendations of the DPAS

Achieve energy balance and healthy weightLimit energy intake from total fats and shift fatconsumption away from saturated tounsaturated fats and towards the elimination oftransfatty acidsIncrease consumption of fruits and vegetables,legumes, whole grains and nutsLimit the intake of free sugarsLimit salt (sodium) consumption from all sourcesand ensure that salt is iodizedPhysical activity: at least 30 minutes of regular,moderate-intensity physical activity

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Principles for action

comprehensivelife-course perspectiveHelps poor populationsand is gender sensitivesupports Member Statesaddresses globalresponses

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Key topics the strategy addresses -1

National strategies on diet and physicalactivityNational dietary guidelinesNational physical activity guidelinesInformation environment: – Marketing– Labelling– health claims

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Key topics the strategy addresses -2

National food and agriculture policies:pricing, food programmesBuilding prevention into health servicesSurveillance, research and evaluationInstitutional capacitySpecific reference to internationalstandards like CODEX

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Framework to monitorand evaluate the

implementation of theGlobal Strategy on Diet,

Physical Activity andHealth

Sep 2006

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Framework for DPAS implementation

National strategic

leadership on diet and

physical activity

SUPPORTIVEENVIRONMENTS

SupportivePolicies

SupportiveProgrammes

Behaviourchange

Social

HEALTH

Economic

Monitoring, evaluation and surveillance

Process Output Outcome

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Framework for DPAS implementationThe WHA Resolution WHA57.17, endorsing DPAS,urges Member States "to strengthen existing, orestablish new, structures for implementing thestrategy through the health and other concernedsectors, for monitoring and evaluating itseffectiveness and for guiding resource investmentand management to reduce the prevalence ofnoncommunicable diseases and the risks related tounhealthy diet and physical inactivity"; […] and "todefine for this purpose, consistent with nationalcircumstances: […] (d) measurable process andoutput indicators that will permit accurate monitoringand evaluation of action taken and a rapid responseto identified needs" […]. “

Furthermore, WHO is asked in the DPAS to "set up amonitoring system and to design indicators fordietary habits and patterns of physical activity."

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Examples for process and outputindicators

Expanded indicatorsPhysical activityDiet% of schools with physical

activity school policy% of schools offering a

minimum of one hour ofphysical activity daily

% of schools with food policy% of schools offering schools

meals consistent to dietaryguidelines

Existence of national schoolphysical activity policy

Existence of national schoolfood policyNutritional standards for

school meals consistent withnational dietary guidelines

Physical activityDietCore indicators

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Examples for outcome indicators

Reduction in the percentage of overweight and obesityin a targeted population% of adults with raised blood pressure (e.g. SBP >140

and/or DBP >90mmHg% of adults with raised total cholesterol (e.g.

>5.2mmol/l)

Core indicators – intermediate term

% of the population aware of the health benefits of theadequate consumption of fruit and vegetables% of population aware of the health benefits of physical

activity

Core indicators – short term

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Fruit and Vegetable promotion Initiative1st Expert Meeting, Geneva 2003

Ways to involve industry at global and nationallevels, guidance to countries wishing to initiatefruit and vegetables promotion programmes.

WHO/FAO workshop, Kobe/Japan, 2004:Framework to promote fruit and vegetables atnational level

Workshops to support implementation:Portuguese speaking countries, Lisbon, 2005Spanish speaking countries Argentina, 2006Francophone countries, Cameroon, Jan 2007

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Actions in the WHO EuropeanRegion

European Strategy for the Preventionand Control of NoncommunicableDiseases, 2006European Ministerial Conference onCounteracting Obesity: European Charteron Counteracting Obesity (Draft), 2006Promoting Physical Activity for Health – aFramework for Action in the WHOEuropean RegionSecond Action Plan for Food andNutrition Policy, 2007

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European Strategy for the Preventionand Control of Noncommunicable

DiseasesGOAL

To avoid premature death and significantlyreduce disease burden from NCDs throughintegrated action, improving quality of life andmaking healthy life expectancy more equitablewithin and between Member States

OBJECTIVESTo take integrated action on risk factors andtheir underlying determinants across sectorsTo strengthen health systems for improvedprevention and control of noncommunicablediseases

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• Istanbul on 15-17 November 2006,hosted by the Ministry of Health ofTurkey

• Participants: Health Ministers andrepresentatives from the agriculture,trade, transport, environment, educationsectors

• International partners: EuropeanCommission, Council of Europe, FAO,OECD, The World Bank, UNICEF

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The Conference agenda

• Statement of the public health challengeposed by obesity

• Socio-economic determinants• Evidence for effective policies – what

works and what else is emerging fromrecent experiences?

• The role of partnerships: governmentsectors, civil society, the private sector,international organizations

• Adopting the European Charter on obesity• The way forward in countries and Region-

wide

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Promoting Physical Activity for Health –a Framework for Action in the WHO

European Region1. Background

– Our sedentary lifestyle and why?2. Guidelines for action

– The healthy choice must be the easychoice

3. From principles to action– National, local and intersectoral action

4. Setting goals and measuring success– Continued work and surveillance

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Framework for action

Raise overall awareness to physicalactivity as a health determinantDeveloped with leading internationalexpertsContribute to give more focus on thephysical activity component relatedto the Ministerial Conference onCounteracting Obesity in Nov. 2006Serve as a guide for Member Statesin implementing physical activity

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Rational for the second European ActionPlan for Food and Nutrition Policy

Policies on food and nutrition appear to havedeveloped successfully in the European Regionand now almost all Member States havegovernment-approved documents dealing withnutrition and food safetyHowever, in the majority of the countries in theEuropean region, nutrition related andfoodborne disease still represent a considerablepublic health burdenThe First European Action Plan needs to bestrategically adapted and renewed in order toprovide a coherent set of actions spanningsectors and ensuring commitment at theinternational level

Monitoring and evaluation

POLICY SECTORsHEALTH CHALLENGES

– Obesity and nutrition related non communicable diseases– Micronutrient deficiencies– Food insecurity– Food borne diseases

Existing international commitments:First European Action Plan for Food and Nutrition Policy 2000-2005

Global Strategy on Food Safety, 2002Global Strategy on Diet, Physical activity and health, 2004

European Strategy for Child and Adolescent health and development, 2005European Strategy for the Prevention and Control of Noncommunicable Diseases, 2006

European Charter on Counteracting Obesity (Draft), 2006

Second European Action Plan on Food and Nutrition Policy

Implementation mechanisms

Core sectors:-Health-Agriculture-Food industry anddistribution-Consumer policy,information andcommunication

Supporting sectors:-Education-Transport, urbanplanning and housing-Environment-Labour-Social policy-Research

More information

www.euro.who.int/nutritionwww.euro.who.int/obesity

obesity@euro.who.int