Promoting health and well-being

1. Promoting health and
well-being in the Eastern
Mediterranean Region
Agenda item 4(c)
65th Session of the Regional Committee for the Eastern
Mediterranean
15‒18 October 2018, Khartoum

2. Outline
• 13th WHO General Programme of Work (GPW 13) 2019-2023 and
Sustainable Development Goals (SDGs)
• Regional situation
• Challenges and opportunities
• Global and regional commitments
• Proposed regional frameworks for action
• Recommendations
2

3. 1 billion more
people enjoying
better health and
well-being
1 billion more
people better
protected from
health
emergencies
1 billion more
people
benefiting from
universal health
coverage
Outcomes
• 3.1 Determinants of health addressed leaving no one
behind
• 3.2 Reduced risk factors through multisectoral
approaches
• 3.3 Health and well-being realized through ‘Health in all
policies’ and ‘Healthy settings’ interventions
Cross-cutting platforms
• Improving human capital across the life-course
• Preventing and controlling communicable and
noncommunicable diseases
• Climate change and environmental health
GPW13 and SDGs
3

4. Underlying drivers
of epidemics Avoidable
death, morbidity
and disability
Physiological risk
factors
Modifiable risk factors
Social, economic, environmental
and commercial determinants
of health 4

5. Regional situation
2nd highest maternal mortality
2nd highest adolescent
mortality
Highest anxiety and depressive
disorders
Steepest diabetes trends
Significant environmental risk factors
Overweight and obesitySteepest tobacco trendsMost conflict
(Refugees
and IDP)
5

6. Regional situation
Most conflict
(Refugees
and IDP)
2nd highest maternal mortality
Steepest diabetes trends Overweight and obesity
Steepest tobacco trends
2nd highest adolescent
mortality
Highest anxiety
and depressive
disorders
Significant environmental risk factors
6

7. Challenges
• Regional contribution to achieving GPW 13 targets and
SDGs
• Inequities and inequalities
• Multisectorality – need for whole-of-society, whole-of-
government approaches
• Complexity of measurement of health and well-being
7

8. Opportunities
• New visionary guidance: WHO GPW 13 and RD’s vision (2019-2023)
• Leadership and patronage (UN high-level meetings)
• Innovation and change = transformation
• Universal health coverage (Global Compact and Salalah Declaration)
• Multisectoral efforts
• Country focus and people-centredness
• Focus on impact and robust metrics
8

9. Global and regional commitments –
frameworks for action
Promoting
health and
well-being in
the Region
UNPD
on NCDs
WHA 2018:
GPW13
2003 2012 2015 2017 2018
WHO FCTC
2011 2013
Global strategy
for women’s,
children’s and
adolescent’s
health
Global
accelerated
action for the
health of
adolescents
2016
UN Decade
on nutrition
2016‒2025
Saving the
lives of
mothers
and children
Regional
framework
for action
on NCDs
Global
Vaccination
Action Plan
Global plan
of action:
VAWG
Regional
Vaccination
Action Plan
Global
strategy
on D&PA
2010
Regional
strategy on
nutrition
2010-2019 SDGs
Decade for
action on
road safety
2011-2020
Regional
strategy on
health and the
environment
Regional
framework
for action
on mental
health
Regional
Director’s
vision
document
Regional
framework
for action
on cancer
Nurturing
care for early
childhood
development
Climate
change and
health: a
framework
for action
RC65 proposed regional
frameworks for action on:
- Obesity prevention
- Tobacco control
- Environmental health
- Preconception care
9

10. Commitments Strategic intervention Progress indicators
Governance Each country is expected to:
Fiscal measures  Carefully use taxes and subsidies to promote healthier diets  Country has introduced taxes and/or
subsidies to promote healthier diets
Public procurement  Ensure procurement and provision of healthy food in public institutions (e.g. schools,
hospitals, military, prison and other government institutions)
 Public procurement of healthy food based
on evidence-based dietary guidelines
Food supply and trade  Use food standards ,legal instruments and other approaches to improve the national
and/or local food supply
 Food standards for healthy diet regulated
on national level
Labelling  Implement or revise standards for nutrition labelling to include front-of-pack labelling
for all pre-packaged foods
 Front-of-pack labelling scheme
implemented
Marketing  Implement appropriate restrictions on marketing (including price promotions) of foods
high in fat, sugar and salt
 Restrictions on marketing of unhealthy
food implemented
Prevention Strategic intervention Progress indicators
Physical activity
interventions
 Implement policies, legislation and interventions to promote and facilitate health-
enhancing physical activity
 Country has policies, legislation and
interventions to promote physical activity
Mass media campaign  Conduct mass media campaigns on healthy diet and physical activity  At least one recent national public
awareness campaign on diet and physical
activity has been conducted
Breastfeeding  Implement a package of policies and interventions to promote, protect and support
breastfeeding
 Marketing of breastmilk substitutes
restrictions
Reformulation  Progressive reformulation of sugar sweetened beverages and HFSS foods  Sugar policies, salt/sodium policies and
fats policies implemented
Obesity management
and treatment
Strategic intervention Progress indicators
Health sector
interventions
 Harness the health sector to enable change and to provide leadership on governance
and accountability
 Implement evidence-based, community-based interventions , addressing both healthy
eating and physical activity, targeting high-risk groups, to promote and facilitate
behaviour change and prevent obesity and diabetes
 Ensure provision of dietary counselling on nutrition, physical activity and healthy weight
gain before and during pregnancy for prospective mothers and fathers
 Integrate screening for overweight and other diabetes risk factors in primary health
care
 Country has a multisectoral plan and
approach to obesity governance,
prevention and management
 Evidence-based dietary counselling and
interventions to facilitate behaviour
change and prevent obesity are present in
Primary health care setting
 Country has national
guidelines/protocols/standards on obesity
screening and management
How do the proposed frameworks add value to health
and well-being?
• Transcribe GPW 13 into regional
action
• Promote evidence-based
interventions
• Help monitoring unhealthy trends
• Fill gaps and missing links in policies
• Encourage consistency and
simplicity
10

11. Regional framework for action on obesity
prevention
To prevent obesity and overweight
• Use evidence-based, cost-effective
interventions
• Apply multisectoral approaches
• Measure desired impact (by 2023)
Commitments Strategic intervention Progress indicators
Governance Each country is expected to:
Fiscal measures  Carefully use taxes and subsidies to promote healthier diets  Country has introduced taxes and/or
subsidies to promote healthier diets
Public procurement  Ensure procurement and provision of healthy food in public institutions (e.g. schools,
hospitals, military, prison and other government institutions)
 Public procurement of healthy food based
on evidence-based dietary guidelines
Food supply and trade  Use food standards ,legal instruments and other approaches to improve the national
and/or local food supply
 Food standards for healthy diet regulated
on national level
Labelling  Implement or revise standards for nutrition labelling to include front-of-pack labelling
for all pre-packaged foods
 Front-of-pack labelling scheme
implemented
Marketing  Implement appropriate restrictions on marketing (including price promotions) of foods
high in fat, sugar and salt
 Restrictions on marketing of unhealthy
food implemented
Prevention Strategic intervention Progress indicators
Physical activity
interventions
 Implement policies, legislation and interventions to promote and facilitate health-
enhancing physical activity
 Country has policies, legislation and
interventions to promote physical activity
Mass media campaign  Conduct mass media campaigns on healthy diet and physical activity  At least one recent national public
awareness campaign on diet and physical
activity has been conducted
Breastfeeding  Implement a package of policies and interventions to promote, protect and support
breastfeeding
 Marketing of breastmilk substitutes
restrictions
Reformulation  Progressive reformulation of sugar sweetened beverages and HFSS foods  Sugar policies, salt/sodium policies and
fats policies implemented
Obesity management
and treatment
Strategic intervention Progress indicators
Health sector
interventions
 Harness the health sector to enable change and to provide leadership on governance
and accountability
 Implement evidence-based, community-based interventions , addressing both healthy
eating and physical activity, targeting high-risk groups, to promote and facilitate
behaviour change and prevent obesity and diabetes
 Ensure provision of dietary counselling on nutrition, physical activity and healthy weight
gain before and during pregnancy for prospective mothers and fathers
 Integrate screening for overweight and other diabetes risk factors in primary health
care
 Country has a multisectoral plan and
approach to obesity governance,
prevention and management
 Evidence-based dietary counselling and
interventions to facilitate behaviour
change and prevent obesity are present in
Primary health care setting
 Country has national
guidelines/protocols/standards on obesity
screening and management
• Halt and reverse the rise of childhood overweight/obesity
• Eliminate industrially produced trans-fats
• Insufficient physical activity ↓7 %
• 20% relative reduction of premature NCD mortality
11

12. To decrease tobacco use
• Fully implement the WHO FCTC and
the MPOWER package
• Apply multisectoral approaches
• Measure desired impact:
• Tobacco use ↓25 %
• 20% relative reduction of premature
NCD mortality
*As called for in RC64 (2017)
Regional framework for action on tobacco
control*
12

13. Regional framework for action on health and the
environment
To reduce the burden of morbidity,
disability and premature mortality
caused by environmental risks
• Apply multisectoral approaches
• Measure desired impact
• Mortality due to air pollution ↓5 %
• Mortality from climate-sensitive disease ↓10 %
• Access to safe drinking water
• Access to safe sanitation
13

14. Regional framework for
action on preconception care
To improve maternal, neonatal and child
health
• Promote effective population level and
clinical interventions
• Measure desired impact :
• Maternal mortality ↓ 30%
• Preventable death of newborn and U5 ↓30%
• Children developmentally on track in health ↑80%
14

15. Recommendations to Member States
• Foster regional and global partnerships in support of national efforts
towards achieving UHC and SDGs
• Endorse proposed regional frameworks of action on obesity prevention,
tobacco control, environmental health and preconception care and
implement and monitor at national settings
• Strengthen linkages to existing national frameworks and strategies
for noncommunicable diseases, mental health, environmental health,
nutrition and reproductive, maternal, neonatal, child and adolescent
health
15

16. Recommendations to Member States
• Create structures for ‘Health-in-all-policies’ to ensure dialogue across
government and with nongovernment stakeholders (‘whole-of-society’)
• Secure patronage for multisectoral interventions and needed human and
financial resources in collaboration with relevant stakeholders
• Maintain/strengthen strong leadership at the highest level of
government to support the implementation of policies for the goals and
platforms of the GPW 13
16

17. Shukran
Merci
Thank you