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NSM-NCD2013 Symposium 2b - Global NCD Challenges - Diet and Physical Inactivity
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GLOBAL NCD CHALLENGES:
DIET AND PHYSICAL INACTIVITY
Robert Beaglehole, Auckland, New
Zealand
26 March, 2013
Key messages: diet and physical
inactivity
NCDs a global and national crisis
Plans and strategies – global (WHO), regional
and national –necessary, but not sufficient
Policy implementation is critical, including
regulation of unhealthy commodities
Accountability, including national goals and
targets – missing link
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Leading risk factors for DALYS
Malaysia, GBD 2010
UN High-Level Meeting on NCDs
September, 2011
A major step forward
Provide leadership
Establish multi-sectoral
national plans by 2013
Integrate NCDs into the
development agenda
Set national targets for
prevention and treatment
Measure results
Increase domestic resources
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WHO global voluntary NCD targets
Physical
inactivity
10%
Salt/
sodium intake
30%
Tobacco use
30%
Drug therapy to
reduce high CVD risk
50% coverage
Obesity and
diabetes
Halt the
rise
Alcohol
10%
Generic
medicines and
technologies
80%
Blood
pressure
25%
Premature mortality from NCDs
25% reduction
Target (goal) adopted by the World Health Assembly May 2012
Priority targets Other targets
Measuring progress on NCDs: global goal and 5 targets
NCDs and Sustainable DevelopmentBeaglehole et al. Lancet, 2012
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Country actions: a stepwise approach
A simple, phased national
response to the political
declaration involves 3
steps:
planning,
implementation, and
accountability
The Lancet NCD Action GroupBonita et al. Lancet, 2013 at http://www.lancet.com/series/non-communicable-diseases
Tobacco control:
the key to NCD prevention
40% of men use tobacco in Malaysia
Accelerated implementation of the Framework
Convention on Tobacco Control (especially price
increases)
WHO target of reducing tobacco use by 30% by
2025
The longer-trem goal of:
A world essentially free (< 5% prevalence)
from tobacco by 2040
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Diet and NCDs: the “facts”
Diet a major determinant of DALYs in Malaysia
Energy imbalance the fundamental cause of
obesity and contributes to diabetes/CVD and
some cancers
Fat (total intake) an important cause of obesity
Type of fats influence CVD risk (eg replacing sat.
fat with polyunsaturated fat improves lipid profile)
Sugar a major cause of dental caries and a cause
of obesity; guidelines – WHO (10% energy),
Malaysia
Salt a major cause of elevated blood pressure and
thus CVD
Alcohol an under-appreciated cause of NCDs
Diet and NCDs: a systems
approach
The food environment conditions food choices
Transnational corporations are major drivers of
NCD epidemics and profit from unhealthy
commodities
The answer to diet caused diseases are
government policies
The politics of food is the most challenging area
for public health
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Profits and pandemics: Key messages
Unhealthy commodity industries should have no role in the
formation of national or international policy for NCD policy
There is no evidence to support the effectiveness of self-
regulation and public–private partnerships to improve public
health
Public regulation and market intervention are the only
evidence-based mechanisms that can prevent harm caused by
unhealthy commodity industries
Moodie, et al. Lancet 2013
Reduction in Malaysian sugar
subsidy
“Moderate intake of sugar is acceptable.
However, if taken excessively, it may be harmful.
In this regard, the Government proposes to
reduce the subsidy on sugar by RM0.20 per kg,
effective from 29 September 2012.
The Government urges the business community
not to burden the rakyat by increasing the price
of sugar but instead reduce the content of sugar
in food and beverage.”
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New threats to growing
obesity problem in
Malaysia
Diet and NCD: other challenges
Restrict marketing of unhealthy products
Increase quality of food in schools
Food labelling; front of pack (traffic lights)
Increased funding for prevention
Multisectoral leadership and action
Accountability: review, monitoring, action
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Physical activity challenges
Key NCD risk factor – GBD 2010
Importance of multisectoral action; city
planning
Transport – public and private
Community-based (schools) interventions a
good starting point
Community-based research; SEACO
The global context: from MDGs to
SDGs
MDGS established in 2000, for
2015
Three health goals – unfinished
agenda
NCDs not included although they
undercut MDGs
Post 2015: “Sustainable Human
Development Goals” (SDGs),
including NCDS
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Next steps: Putting the pieces
together
Rapid progress is possible with
cheap and effective interventions
Use a step-wise approach
Use overall risk approach to
determine treatment of risk
factors
Regulation necessary to control
processed food industries
Accountability for UN
commitments essential -
monitoring, review and action -
focus on equity