The future of monitoring and surveillance for NCD prevention in Europe
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Presented by Prof. Adrian Bauman, Director, Prevention Research Centre, Sydney University, Australia at the WHO European Ministerial Conference on Nutrition and Noncommunicable Diseases in the Context ...

Presented by Prof. Adrian Bauman, Director, Prevention Research Centre, Sydney University, Australia at the WHO European Ministerial Conference on Nutrition and Noncommunicable Diseases in the Context of Health 2020 on 5 July 2013 in Vienna, Austria.

Disclaimer: WHO is not responsible for the content of presentations made by external speakers at its meetings and conferences. This presentation is published here with the speaker's consent, only for information purpose.

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The future of monitoring and surveillance for NCD prevention in Europe Presentation Transcript

  • 1. The future of monitoring and surveillance for NCD prevention in Europe Professor Adrian Bauman MB BS MPH PhD FAFPHM Professor of Public Health and Director, Prevention Research Centre Director, WHO Collaborating Centre in Physical Activity, Nutrition and Obesity Sydney University, Australia
  • 2. Content of this presentation • what is a surveillance system for NCD prevention? • monitoring the preventable risk factors for NCDs and the Burden of Disease • examples of population surveillance for physical activity, obesity and sedentary behaviour • implications for member states and for Europe in the context of the NCD Global Monitoring framework
  • 3. Non Communicable Disease Surveillance: definition and principles 1. ongoing and systematic data collection and analysis “regarding health-related events or behaviour” at the population level 2. keep measures simple – start surveillance of key behaviours – smoking, alcohol, physical activity, diet 3. additional elements of surveillance system – monitor programs, environments, policies 4. Keep measures standardised for trends over time and between-country comparison
  • 4. WHO Global monitoring framework and targets for NCD prevention – ratified at WHA, May 2013 Main Behaviour change targets Health outcome targets Other lifestyle targets
  • 5. The “Global burden of disease” (BOD) approach • Based on epidemiological evidence on the health risks posed by unhealthy diet, obesity, low physical activity [and high levels of sitting] • Identify the health gains [how many deaths or how much disability could be prevented] if the risk factor was reduced or eliminated • Can monitor the BOD and risk factor contributions over time
  • 6. European Health report 2012 Burden of disease by risk factor WHO Euro region, Copenhagen
  • 7. Changes in the risk factors contributing to global deaths [examples, comparing traditional public health risks to NCD risks over time] [Lancet 2012; 380: 2224–60 ] Risk factor 1990 global deaths [millions] 2010 global deaths [milllions] Poor water, sanitation 0.7 0.3  Air pollution [particulates] 2.9 3.2  Under nutrition 3.5 1.4   Vitamin A deficiency 0.35 0.1  Tobacco 5.3 6.2  Alcohol use 3.7 4.9  Overweight and obesity 1.9 3.4  Hypertension 7.2 9.4  Unhealthy diet and physical inactivity 8.5 12.5 
  • 8. Regional Differences in ranking of risk factors contributing to the Burden of Disease {Lancet 2012; 380: 2224–60} Ranking of the leading risk factors for the Burden of disease : W Europe and Central Europe and Eastern Europe W Eur Cent Eur East Eur Tobacco 1 3 3 Hypertension 2 1 2 Obesity 3 4 4 Alcohol 4 2 1 Physical inactivity 5 6 7 Low fruit intake 7 5 5
  • 9. Overweight and obesity surveillance data for Europe • surveillance systems exist - direct measurement of weight, height - representative samples from nations - overweight [slight risk] Body mass index ≥ 25 - obesity [substantial risk] Body mass index ≥ 30
  • 10. 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 CZE MLT GBR SVN ESP IRL HUN LTU LUX DEU SVK PRT CYP POL FIN BGR NOR LVA BEL AUT ITA EST GRC SWE NLD DNK ROU FRA CHE Percentage Country Prevalence of obesity (BMI ≥30.0 kg/m2) among adults in the EU Member States + Norway & Switzerland based on WHO 2008 estimates
  • 11. Increasing: from 1/4 in 2008 to 1/3 in 2010 High overweight/obesity rates in children and adolescents all countries 15 MS of the EU already part of the project. Others to join and sustainability increase due to EU support Childhood obesity surveillance WHO COSI, round (2010): Prevalence of (overweight and obesity) from 24% to 57% for boys and from 21% to 50% for girls The subset that were obese: 931% of boys & 621% of girls
  • 12. 25 30 35 40 45 50 55 60 65 70 1994 1997 2000 2003 2006 2009 2012 Belgium, 18+ Estonia, 16–64 Finland, 15–64 France, 15+ Germany, 18+ Ireland, 18+ Italy, 18+ Latvia, 15–64 Lithuania, 20–64 Luxembourg, 16+ Netherlands, 20+ Portugal, 18–64 Spain, 18+ Sweden, 16–84 United Kingdom, Wales, 16+ United Kingdom, England, 16+ United Kingdom, Scotland, 16–64 Comparing the prevalence of overweight (%) among adult men (BMI ≥25.0 kg/m2) in EU From: within -country surveillance systems for overweight and obesity [men shown here]
  • 13. Comparing overweight (%) among adult women (BMI ≥25.0 kg/m2) in the European Union 25 30 35 40 45 50 55 60 65 70 1994 1997 2000 2003 2006 2009 2012 Belgium, 18+ Estonia, 16–64 Finland, 15–64 France, 15+ Germany, 18+ Ireland, 18+ Italy, 18+ Latvia, 15–64 Lithuania, 20–64 Luxembourg, 16+ Netherlands, 20+ Portugal, 18–64 Spain, 18+ Sweden, 16–84 United Kingdom, Wales, 16+ United Kingdom, England, 16+ United Kingdom, Scotland, 16–64
  • 14. 0 10 20 30 40 50 Prevalenceofoverweight(including obesity)(%) 6-year-olds 7-year-olds 8-year-olds 9-year-olds Childhood obesity prevalence in 11 EU countries + Norway – COSI 2010
  • 15. What is „physical activity‟ • „Exercise‟ • Sport • Physical activity 16
  • 16. Inactivity Smoking Obesity How much of chronic disease preventable 9% 9% a 5% a Deaths attributed to risk factor (per y) 5M 5M a b 3M a Potential gain in LE with removal of factor 0·68 y from birth 1·1–2·2 y c from age 50 (9 high-income countries) 0.7–1.1 y d from birth (USA) Physical activity compared to other risk factors {Lee, Lancet PA series, July 2012} a 2009 WHO Global Health Risks; b Ezzati 2003; c Crimmins 2011; d Olshansky 2005
  • 17. Physical activity surveillance in the EU DG SANCO report 2010 Examples of PA surveillance - Finbalt Health Monitor since 1978 - Health Behaviour in School children (HBSC) since 1983 [initially 6, now >30 EU nations] - EU survey 1997 - EUPASS 1999 - Eurobarometer surveys, 2003 2005/6, 2009/10 - European Health interview survey 2007-2009 - country specific health surveys, some once only, some repeated regularly [annual, or every few years]
  • 18. BRFSS surveys This line represents the “net sum” of preventive efforts to change this risk factor USA – good population surveillance of physical activity ... but not much public health impact
  • 19. • Eurobarometer survey from adults in 16 EU countries 2002 • Physical activity focus „meeting recommended physical activity guidelines‟ [five times/week and 150 mins total PA/week] 20
  • 20. Eurobarometer 2002/3 Low levels of PA, below guidelines,16 EU countries
  • 21. 22 EUROBAROMETER 2010 „Sport participation‟ asked [not Physical Activity]
  • 22. 23 Example of long term standardised physical activity monitoring in Finland • Shows leisure time physical activity ↑ • But occupational physical activity ↓ • Commuting [active travel] ↓ .... So total PA may not be increasing ! Borodulin K, et al European J Public Health 2007:18:339-344
  • 23. 24 DAILY PHYSICAL ACTIVITY LEVELS Health Behaviour in school children [national surveys every 4 years] A WHO Europe supported project since 1983
  • 24. Sitting during transport sitting at work sitting at home
  • 25. 26 Currie C et al HBSC report WHO Europe 2012
  • 26. 27 Sitting 6+ hours / day Eurobarometer 2002/3 16 countries Sjostrom, Smith, Bauman 2006
  • 27. link to WHO current work in global monitoring 28
  • 28. 9 voluntary NCD targets 29
  • 29. Conclusions & relevance of NCD surveillance for prevention actions • Need to consider one standardised surveillance system for NCD risk factors within-country over time and between countries • Need identical measures and survey methods • Use existing surveillance systems more for policy • A surveillance system provides key indicators for NCD monitoring and evidence of progress – Important measures, obesity, physical activity, alcohol, tobacco, nutrition – Consider new measures, such as “sitting time” 30