NSM-NCD2013 Symposium 2b - Global NCD Challenges - Diet and Physical Inactivity

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By Prof Robert Beaglehole

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NSM-NCD2013 Symposium 2b - Global NCD Challenges - Diet and Physical Inactivity

  1. 1. 4/11/20131GLOBAL NCD CHALLENGES:DIET AND PHYSICAL INACTIVITYRobert Beaglehole, Auckland, NewZealand26 March, 2013Key messages: diet and physicalinactivity NCDs a global and national crisis Plans and strategies – global (WHO), regionaland national –necessary, but not sufficient Policy implementation is critical, includingregulation of unhealthy commodities Accountability, including national goals andtargets – missing link
  2. 2. 4/11/20132Leading risk factors for DALYSMalaysia, GBD 2010UN High-Level Meeting on NCDsSeptember, 2011A major step forward Provide leadership Establish multi-sectoralnational plans by 2013 Integrate NCDs into thedevelopment agenda Set national targets forprevention and treatment Measure results Increase domestic resources
  3. 3. 4/11/20133WHO global voluntary NCD targetsPhysicalinactivity10%Salt/sodium intake30%Tobacco use30%Drug therapy toreduce high CVD risk50% coverageObesity anddiabetesHalt theriseAlcohol10%Genericmedicines andtechnologies80%Bloodpressure25%Premature mortality from NCDs25% reductionTarget (goal) adopted by the World Health Assembly May 2012Priority targets Other targetsMeasuring progress on NCDs: global goal and 5 targetsNCDs and Sustainable DevelopmentBeaglehole et al. Lancet, 2012
  4. 4. 4/11/20134Country actions: a stepwise approach A simple, phased nationalresponse to the politicaldeclaration involves 3steps: planning, implementation, and accountabilityThe Lancet NCD Action GroupBonita et al. Lancet, 2013 at http://www.lancet.com/series/non-communicable-diseasesTobacco control:the key to NCD prevention 40% of men use tobacco in Malaysia Accelerated implementation of the FrameworkConvention on Tobacco Control (especially priceincreases) WHO target of reducing tobacco use by 30% by2025 The longer-trem goal of:A world essentially free (< 5% prevalence)from tobacco by 2040
  5. 5. 4/11/20135Diet and NCDs: the “facts” Diet a major determinant of DALYs in Malaysia Energy imbalance the fundamental cause ofobesity and contributes to diabetes/CVD andsome 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 causeof obesity; guidelines – WHO (10% energy),Malaysia Salt a major cause of elevated blood pressure andthus CVD Alcohol an under-appreciated cause of NCDsDiet and NCDs: a systemsapproach The food environment conditions food choices Transnational corporations are major drivers ofNCD epidemics and profit from unhealthycommodities The answer to diet caused diseases aregovernment policies The politics of food is the most challenging areafor public health
  6. 6. 4/11/20136Profits and pandemics: Key messages Unhealthy commodity industries should have no role in theformation 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 publichealth Public regulation and market intervention are the onlyevidence-based mechanisms that can prevent harm caused byunhealthy commodity industriesMoodie, et al. Lancet 2013Reduction in Malaysian sugarsubsidy“Moderate intake of sugar is acceptable.However, if taken excessively, it may be harmful.In this regard, the Government proposes toreduce the subsidy on sugar by RM0.20 per kg,effective from 29 September 2012.The Government urges the business communitynot to burden the rakyat by increasing the priceof sugar but instead reduce the content of sugarin food and beverage.”
  7. 7. 4/11/20137New threats to growingobesity problem inMalaysiaDiet 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
  8. 8. 4/11/20138Physical activity challenges Key NCD risk factor – GBD 2010 Importance of multisectoral action; cityplanning Transport – public and private Community-based (schools) interventions agood starting point Community-based research; SEACOThe global context: from MDGs toSDGs MDGS established in 2000, for2015 Three health goals – unfinishedagenda NCDs not included although theyundercut MDGs Post 2015: “Sustainable HumanDevelopment Goals” (SDGs),including NCDS
  9. 9. 4/11/20139Next steps: Putting the piecestogether Rapid progress is possible withcheap and effective interventions Use a step-wise approach Use overall risk approach todetermine treatment of riskfactors Regulation necessary to controlprocessed food industries Accountability for UNcommitments essential -monitoring, review and action -focus on equity

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