WHO Euro is conducting one of the most successful childhood obesity surveillance initiatives worldwide…..
On the other hand, in many countries of Europe, we have recorded some of the fastest declines in circulatory mortality in the world. The graph illustrates the rapid fall in age-standardised circulatory mortality seen in many European countries in the last three decades. I highlight one striking example…
This is the first year of the European Action Plan for the Implementation of the Regional Strategy for the Prevention and Control of Noncommunicable Diseases. It is also the year where the World Health Assembly has adopted the historic global goal of a 25% reduction in premature mortality from NCDs by 2025. In this context, it is fitting to note the success of some of the countries in this Region in providing leadership in the achievement of the global target already since a few years. I show here the trends circulatory mortality in three countries: the Russian Federation, Kazakhstan, and the Republic of Moldova, shown here compared to the average trend for the whole of the European Region.In each of these three countries, since 2005, we have seen a large and rapid fall, al most large enough to annihilate the rise seen in the early 1990s in the aftermath of independence an recession. The progress in these countries comes from a combination of increased prosperity, increased investment in health services, and to some extent from a change in risk behaviours as lifestyles shift more towards he European average. The success in these countries calls upon us to document these changes, to note that the global goal is indeed achievable, and to focus even more on country related deliverables in the coming years of the NCD Action Plan.In line with the shift towards integrated work on NCDs and chronic conditions in the WHO Reform, I will deal cover some achievements in a few selected countries under this group of conditions.
Results from a literature review in 2011 on inequalities in physical activity in Europe:Given that disadvantaged groups have lower levels of physical activity, and higher levels of ill health than the general population, the rationale for focusing physical activity promotion efforts on these groups cannot be disputed. By its nature, work with disadvantaged groups has to be local, and focused. Funding for community based projects in Europe is often short-term and piecemeal and it is not surprising that physical activity projects are often not evaluated, and rarely published. Physical activity researchers will need to be proactive in helping overcome the considerable barriers to working with hard-to-reach populations, including difficulties of recruitment, retention, programme tailoring and flexible delivery, as well as partnership working to make a difference in getting people more active.
There is a great opportunity for collaboration between the health sector and the sport sector, as they often share the aim of increasing health-enhancing physical activity levels and promotion of Sport for All. However, it is crucial that development processes ensure intersectoral involvement …
OBESITY, PHYSICAL ACTIVITY& CANCER16 –17th April 2013, London UKJoão BredaWHO Regional Office for Europe
GBD – attributable for 20 RF 2010 as % DALY15 out of 20 RF linked with nutrition and PA Lim & al. 2012“From new estimates to better data” M. Chan, WHO
Quantification of effects of physical inactivity• Risk reductions for:– 20-30% for CHD and CVD morbidity andmortality– Cancer risks:• 30% for colon cancer• 20% - 40% for breast cancer• 20% for lung cancer• 30% for endometrial cancer• 20% for ovarian cancer– 30% for developing functional limitations– 30% for premature all-cause mortalityMagnitude of benefits from reachingminimum recommendations for physicalactivityPhysical Activity Guidelines Advisory Committee.Physical Activity Guidelines Advisory CommitteeReport, 2008. Washington, DC: U.S. Department ofHealth and Human Services, 2008.• 21–25% of breast and coloncancer burden• 27% of diabetes burden• 30% of ischaemic heart diseaseburden
Inactivity status in the European Region• WHO estimates that in adults :– 63% are not reaching the minimumrecommended level of physical activity– 20% of those are rated as “inactive”– 38% are sufficiently/highly active• 40% of EU citizens say that they playsport at least once a week• Citizens of Mediterranean and centralEuropean countries tend to exerciseless• 22% of 11-year old girls and30% of boys report at least one hour ofdaily moderate to vigorous PA (MVPA)Global Health Risk Report, World HealthOrganization, 2009 Eurobarometer 72.3. SpecialEurobarometer 334: Sport and PA Health Behaviour inSchool Aged Children 2005/06 Survey
Age standardized prevalence of overweight (%)among adult males >20 years of age (2008)Source: Global Health Observatory Data Repository. The World Health Statistics 2011.Geneva, World Health Organization (http://apps.who.int/ghodata/, accessed 23 August2011).Overweight includes obesity: BMI >=25.0 kg/m20 10 20 30 40 50 60TajikistanRepublic of MoldovaKyrgyzstanTurkmenistanUzbekistanArmeniaUkraineGeorgiaAzerbaijanRussian FederationBelarusKazakhstanWHO European Region
Childhood Obesity Surveillance –Norway Hovengen R et al. 2011 (COSI)2008 2010Boys 14% 17%Girls 17% 22%Total 16% 19%WHO COSI, round (2010):• 1 in every 3 children aged 6-9 years was overweight or obese• The prevalence of overweight (including obesity) ranged from 24%to 57% among boys and from 21% to 50% among girls.Simultaneously, 931% of boys and 621% of girls were obese.
0%5%10%15%20%25%30%35%40%45%50%PercentagedistributionProjected obesity distribution to 2030 (adult males)20102030
Prevalence gains avoided per 100,000 ofthe EU population in 2030 by scenarios020040060080010001200Cancer CHD+stroke Diabetes Hypertension1% decrease5% decreaseScenario 1 – 3 Mo avoidedScenario 2 – 9 Mo avoided
AustriaBelgiumBulgariaCyprusCzechRepublicDenmarkEstoniaFinlandFranceGermanyGreeceHungaryIrelandItalyLatviaLithuaniaLuxembourgMaltaNetherlandsPolandPortugalRomaniaSlovakiaSloveniaSpainSwedenUKofGBandN-Ireland020040060080010001200Eu 27 countriesFruit and vegetables availability 2009 (grams per capitaper day)
Proportion (%) of children exclusively breastfed at3 and 6 months, 2005-20100102030405060708090100AlbaniaArmeniaAzerbaijanBelarusBelgiumBosniaandHerzegovinaBulgariaCroatiaCyprusCzechRepublicFinlandGermanyGreeceHungaryIcelandIrelandItalyKazakhstanKyrgyzstanLuxembourgMontegegroNetherlandNorwayPolandPortugalMaldovaRussiaSlovakiaSlovaniaSpainSwedenSwitzerlandTajikstanMacedoniaUkraineUnitedKingdom3 Months6monthsSources: National Surveys
Nutrition, PA and ObesityInternational highlights from the HBSC 2009/2010International Report
Key findings: age changesHealth behaviors: all worsenOverweight and obesity: all increaseBreakfast: decreases in both boys and girlsFruit: decreases in both boys and girlsPhysical activity: decreases in both boys and girls
AustriaBelgiumBulgariaCyprusCzechRepublicDenmarkEstoniaFinlandFranceGermanyHungaryIrelandItalyLatviaLithuaniaNetherlandsPolandPortugalRomaniaSlovakiaSloveniaSpainSwedenUKofGBandN-Ireland0.01.02.03.04.05.06.07.08.09.010.011.012.013.014.015.016.017.018.0Salt intake for men or total (g per capita/day)TURKEY = 18 g/d
AustriaBelgiumBulgariaDenmarkEstoniaFinlandFranceGermanyGreeceHungaryIrelandItalyLatviaLithuaniaLuxembourgMaltaNetherlandsPolandPortugalRomaniaSloveniaSpainSwedenUKofFBandN-Ireland02468101214Eu 27 countriesSaturated fat intake 2007 (% of calories in total diet)
AustriaBelgiumBulgariaCyprusCzechRepublicDenmarkEstoniaFinlandFranceGermanyHungaryIrelandItalyLatviaLithuaniaNetherlandsPolandPortugalRomaniaSlovakiaSloveniaSpainSwedenUKofGBandN-Ireland0.02.04.06.08.010.012.014.016.018.0Eu 27 countriesSalt intake for men or total (g percapita/day)*
Reduction of Circulatory MortalityEuropeanaverageEuropeanaverageEuropeanaverage
Primary prevention of CVD with aMediterranean Diet end pointEstruch et al. 2013
WHO Core functions• Promoting development• Fostering health security• Strengthening health systems• Harnessing research, information andevidence• Enhancing partnerships• Improving performance• Translating evidence into policy
WHO Europe’s policy framework andtools for action
Inequalities in physical activity and sport• Existence of disparities in physical activity and sport across differentsocial class and ethnic groups within countries in Europe.• Lower income groups, and those from ethnic minority backgroundsare most at risk for leisure time physical inactivity (-> double burden)• The environment is an important contributor• Significant gap in the evidence base on interventions targetingphysical activity in disadvantaged groupsenormous potential for health promotion!
National level: PA promotion policies• Total identified policy documents, currently: around 170 (fromaround 41 MS)• Most identified policy documents national• Institutional involvement: mainly Ministry of Health• Main focus in most cases not only HEPA, also nutrition,obesity, cardiovascular disease prevention, public health,sustainable development or environmental health• PA promotion goes beyond just the health and sport sectorand is often integrated in other sectors such as environment,education, and transport
Physical Activity Policy Physical activity should be promoted as part of daily lifeand across all settings (home, workplace, schools,transport, leisure) Formulating a policy on Health Enhancing Physical Activitygives: Support, coherence and visibility at political level Common objectives and strategies for the involvedsectors/settings/institutions Clear roles and responsibilities Greater accountability and greater allocation of resources
Important elements of successful policies• High level political commitment• Surveillance, monitoring and evaluation• Multi-stakeholder support• Leadership and workforce development• Integration into national strategies & policies• Multiple intervention strategies• Stepwise approach to implementation• Culturally appropriate• Implementation at different levels within "local reality"• Dissemination• National Physical Activity Guidelines
How much physical activity do we need?WHO Global Recommendations• Main aim: providing guidance ondose response relation betweenfrequency, duration, type and totalamount of PA needed for preventionof NCD• Three age-groups; 5-17 year olds;18-64; and 65+• Main target audience; national andlocal policy makers
Global recommendations on physicalactivity for health• Why?– Evidence based starting point to promote physical activity + advocacy– Limited existence of national guidelines in low and middle incomecountries; different guidelines• PA independent risk factor for:1. Cardio-respiratory health (coronary heart disease, cardiovascular disease, strokeand hypertension)2. Metabolic Health (diabetes and obesity)3. Musculo-skeletal health (bone health, osteoporosis)4. Cancer (breast and colon cancer)5. Functional Health and prevention of falls6. Anxiety, depression, cognitive functions
AustriaBelgiumDenmarkEstoniaFinlandFranceHungaryIcelandIrelandLithuaniaLuxembourgMaltaNetherlandsNorwayRomaniaRussian FederationSloveniaSwedenSwitzerlandTurkeyUnited KingdomPA recommendationsin WHO EuropeanRegion21 Member States
No ActionPartly ImplementedFully ImplementedOverview Policy ActionsImplementation - some Member StatesFood Based Dietary GuidelinesGuidelines Physical ActivitySubsidized School Fruit SchemeSchool Vending MachinesPromote Active TravelInitiatives to reduce SaltIncrease healthier processed foodsMeasures to affect food pricesLegislation labelling energySignposting Food ProductsRegulation MarketingBaby Friendly HospitalPromotion Breastfeeding
Salt policies and inequalitiesInequality-adjusted Human Development Index (IHDI) compared to the current status of the national salt initiative withinMember States if the World Health Organization region for Europe. Category 1: No current salt initiative, Category 2:Partially implemented/planned Category 3 : Fully Implemented. A lower IHDI appears to be more common in countrieswith no current salt reduction initiative.
Marketing food to children in the NIS & GeorgiaNo Partly FullyARM √AZE √BLR √GEO √KAZ √KGZ √MDA √RUS √TJK √TKM √UKR √UZB √
Matrix for price/fiscal policyEvidence CurrentPracticeSocialImpactTobaccoAlcoholFoods• Effect onconsumption• Elasticity• Pass througheffects• Effects onrevenue• Mechanisms:minimumprice, excise…• Response tofinancial crisis• What productsare targeted?• Cross-bordersales• Smuggling• Illegalproduction• Earmarking• Monitoring• Strategy• Regressivity• Effects ondifferent SEG• What is thehealth impact?• Competitiveness
Overview of the availableinternational and nationalsurveys on physical(in)activity levels and patternsin the 27 EU Member States;Data collection methods appliedand the items measured;Challenges experienced incollecting and integratingphysical activity data in theEU.
Sport and health: what is the currentpolicy situation in EU Member States?• Analysis of existing sport policy documentsfrom 15 EU MS concluded, among others:– […] Local environments have a crucial role inpromoting sport and physical activity, since it ismainly in the local setting that the opportunities tobe physically active are provided.– Elite sports facilities should not be prioritized at theexpense of facilities for the general public andthe planning of recreational sports facilities shouldbe considered as an integral part of urban planning– Taking a life course approach and offeringphysical activity in different settings, includingschools and work places, is essential to thepromotion of sport and physical activity.– Collaboration should take place not only amongministries but also across government levels(national, regional and local), with civil society andthe voluntary and private sectors. […]
Outcomes of the2011 UN General AssemblyHigh-level Meeting on NCDs
2000200320042008Global Strategy for the Prevention andControl of Noncommunicable DiseasesGlobal Strategy on Diet,Physical Activity and HealthAction Plan 2008-2013 on the Global Strategy for thePrevention and Control of NCDs201020092011Global Strategy toReduce the Harmful Useof AlcoholWHO Global StatusReport on NCDsPolitical Declaration on NCDs20132020WHO Action Plan for the Prevention and Control of NCDs for 2013-2020WHO’s global road map on NCDs
Formal Meeting of Member States to conclude thework on the comprehensive global monitoring frameworkincluding indicators and a set of voluntary targets for theprevention and control of NCDsOn 7th November the meeting agreedon a global monitoring framework anda set of voluntary global targets forthe prevention and control ofnoncommunicable diseasesThis will be integrated into the workunder way to develop a draft WHOAction Plan (2013-2020)
Comprehensive Global Monitoring FrameworkMortality &MorbidityCancer incidence by typeof cancer per 100 000populationUnconditional probabilityof dying between ages30 and 70 years fromcardiovascular diseases,cancer, diabetes orchronic respiratorydiseasesSaltFruits and VegetablesSaturated FatOverweight and ObesityPhysical InactivityBlood glucose/diabetesBlood PressureTotal CholesterolHarmful use of AlcoholRisk FactorsTobacco useAccess to palliative careNational SystemsResponsePolicies to limit SFA andvirtual elimination ofPHVOEssential NCD MedicinesHPV VaccineMarketing to childrenDrug therapy andcounselingCervical cancer ScreeningHepatitis B Vaccine
Human rights NCDs are achallenge tosocial andeconomicdevelopmentUniversal accessand equityLife-courseapproachEvidence-basedactionEmpowermentof people andcomunitiesVision:A world in which all countries and partners sustain their politicaland financial commitments to reduce the avoidable global burdenand impact of NCDs, so that populations reach the highestattainable standards of health and productivity at every age andNCDs are no longer a barrier to socio-economic developmentOverarching principles:Main elements of the Draft Action PlanGoal:To reduce the burden of preventable morbidity and disability andavoidable mortality due to NCDs
Action Plan for the Implementation of theEuropean Strategy Prevention Control NCDsHealth PromotionPlanning &oversightNational planHealth info syswith socialdeterminantsdisaggregationHealth inall policiesFiscal policiesMarketingSaltTrans-FatHealthySettingsWorkplaces &SchoolsActive MobilitySecondarypreventionCardio-metabolic riskassessment &managementEarly detectionof cancer
Health 2020: aEuropean policyframeworksupporting actionacross governmentand society forhealth and well-being
Paving the way for a new WHOEuropean Region NutritionPolicy Framework
To guarantee universal access to food, equityand gender equality for the nutrition of all citizensof the WHO European Region throughintersectoral nutrition policies.Mission
Ministerial Conference will achievehigh level political commitment inthree dimensions:• Governance, intersectoral action and food andnutrition systems• Life-course, nutrition and noncommunicablediseases• Inequalities in nutrition, obesity andnoncommunicable diseases
WHO European Ministerial Conference onNutrition and NCD in the Context of Health 2020