![Sport and health: what is the current
policy situation in EU Member States?
• Analysis of existing sport policy documents
from 15 EU MS concluded, among others:
– […] Local environments have a crucial role in
promoting sport and physical activity, since it is
mainly in the local setting that the opportunities to
be physically active are provided.
– Elite sports facilities should not be prioritized at the
expense of facilities for the general public and
the planning of recreational sports facilities should
be considered as an integral part of urban planning
– Taking a life course approach and offering
physical activity in different settings, including
schools and work places, is essential to the
promotion of sport and physical activity.
– Collaboration should take place not only among
ministries but also across government levels
(national, regional and local), with civil society and
the voluntary and private sectors. […]](https://image.slidesharecdn.com/bredaopac2013-130419051946-phpapp01/85/Breda-opac2013-49-320.jpg)
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Breda opac2013
- 1. OBESITY, PHYSICAL ACTIVITY &CANCER 16 –17th April 2013, London UK João Breda WHO Regional Office for Europe
- 2. We have changeda lot!!!!!
- 3. GBD – attributablefor 20 RF 2010 as % DALY 15 out of 20 RF linked with nutrition and PA Lim & al. 2012 “From new estimates to better data” M. Chan, WHO
- 4. Quantification of effectsof physical inactivity • Risk reductions for: – 20-30% for CHD and CVD morbidity and mortality – 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 mortality Magnitude of benefits from reaching minimum recommendations for physical activity Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Report, 2008. Washington, DC: U.S. Department of Health and Human Services, 2008. • 21–25% of breast and colon cancer burden • 27% of diabetes burden • 30% of ischaemic heart disease burden
- 5. Inactivity status inthe European Region • WHO estimates that in adults : – 63% are not reaching the minimum recommended level of physical activity – 20% of those are rated as “inactive” – 38% are sufficiently/highly active • 40% of EU citizens say that they play sport at least once a week • Citizens of Mediterranean and central European countries tend to exercise less • 22% of 11-year old girls and 30% of boys report at least one hour of daily moderate to vigorous PA (MVPA) Global Health Risk Report, World Health Organization, 2009 Eurobarometer 72.3. Special Eurobarometer 334: Sport and PA Health Behaviour in School Aged Children 2005/06 Survey
- 7. Age standardized prevalenceof 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 August 2011). Overweight includes obesity: BMI >=25.0 kg/m2 0 10 20 30 40 50 60 Tajikistan Republic of Moldova Kyrgyzstan Turkmenistan Uzbekistan Armenia Ukraine Georgia Azerbaijan Russian Federation Belarus Kazakhstan WHO European Region
- 8. 34.3 31.1 34.5 35.5 29.2 36.0 33.9 32.4 31.0 29.2 29.5 27.9 29.9 30.6 29.5 33.9 26.4 27.5 25.4 30.2 26.3 27.6 30.3 26.9 24.1 29.5 23.3 26.0 28.0 26.0 29.6 27.0 26.9 26.4 26.8 27.0 22.0 20.8 18.5 17.4 19.3 21.0 18.2 17.2 19.7 18.1 20.1 15.0 18.3 16.0 12.4 12.4 15.1 13.0 14.4 12.0 11.8 11.0 9.9 8.0 9.0 7.8 42.5 36.0 46.7 40.7 36.3 49.7 39.3 41.0 42.8 45.5 40.4 41.1 44.4 38.3 44.9 44.5 45.8 31.1 44.5 38.8 40.4 41.3 41.3 38.5 43.0 40.6 44.8 41.0 41.0 40.9 43.8 43.0 39.0 37.68.7 13.0 11.0 10.4 11.8 12.9 13.0 8.5 13.3 16.0 13.9 11.2 18.3 15.4 17.5 15.5 11.8 14.5 16.9 14.6 4.9 18.3 26.0 21.2 20.5 23.9 21.0 14.2 22.2 19.5 25.2 21.6 26.7 26.0 17.9 13.3 19.6 27.7 22.7 23.9 30.0 27.5 22.3 21.1 22.4 15.5 18.0 18.2 9.7 7.1 80 60 4020 0 20 40 60 80 United Kingdom: Scotland, 2008, 16+ Hungary, 2009, 18+ Turkey, 2008, 15–49 Croatia, 2003, 18+ United Kingdom: England, 2007–2008, 16+ Serbia, 2006, 20+ Malta, 2006–2007, 18+ Bulgaria, 2004, 20+ United Kingdom: Wales, 2009, 16+ Czech Republic, 2008, 20+ Germany, 2005–2007, 18–80 Poland, 2003–2005, 20–74 Greece, 2003, 20–70 Luxembourg, 2008, 16+ Azerbaijan, 2006, 15–49 Portugal, 2003–2005, 20–74 Lithuania, 2008, 20–64 Latvia, 2006, 15–64 Russian Federation, 2005, 20–49 Spain, 2006, 18+ Estonia, 2008, 16–64 Finland, 2008, 15–64 Slovenia, 2007–2008, 18–65 Armenia, 2005, 15–49 Georgia, 2009, 15–49 Netherlands, 2009, 20+ Republic of Moldova, 2005, 15–49 France, 2009, 15+ Ireland, 2007, 18+ Belgium, 2008, 18+ Albania, 2008–2009, 15–49 Sweden, 2009, 16–84 Cyprus, 2003, 15+ Denmark, 2005, 16+ Italy, 2006, 18+ Norway, 2008–2009, 16+ Austria, 2007–2008, 18–65 Switzerland, 2007, 15+ Tajikistan, 2003, 25–49 Surveycharacteristics:country,year,agerange(years) Percentage (%) WomenMen Pre-obese, measured data Obese, measured data Pre-obese, self-reported data Obese, self-reported data © WHO, 2010.
- 10. Childhood Obesity Surveillance– Norway Hovengen R et al. 2011 (COSI) 2008 2010 Boys 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.
- 11. 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Percentagedistribution Projected obesity distributionto 2030 (adult males) 2010 2030
- 12. Prevalence gains avoidedper 100,000 of the EU population in 2030 by scenarios 0 200 400 600 800 1000 1200 Cancer CHD+stroke Diabetes Hypertension 1% decrease 5% decrease Scenario 1 – 3 Mo avoided Scenario 2 – 9 Mo avoided
- 13. Austria Belgium Bulgaria Cyprus CzechRepublic Denmark Estonia Finland France Germany Greece Hungary Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Poland Portugal Romania Slovakia Slovenia Spain Sweden UKofGBandN-Ireland 0 200 400 600 800 1000 1200 Eu 27 countries Fruitand vegetables availability 2009 (grams per capita per day)
- 14. Proportion (%) ofchildren exclusively breastfed at 3 and 6 months, 2005-2010 0 10 20 30 40 50 60 70 80 90 100 Albania Armenia Azerbaijan Belarus Belgium BosniaandHerzegovina Bulgaria Croatia Cyprus CzechRepublic Finland Germany Greece Hungary Iceland Ireland Italy Kazakhstan Kyrgyzstan Luxembourg Montegegro Netherland Norway Poland Portugal Maldova Russia Slovakia Slovania Spain Sweden Switzerland Tajikstan Macedonia Ukraine UnitedKingdom 3 Months 6months Sources: National Surveys
- 17. Nutrition, PA andObesity International highlights from the HBSC 2009/2010 International Report
- 18. Key findings: agechanges Health behaviors: all worsen Overweight and obesity: all increase Breakfast: decreases in both boys and girls Fruit: decreases in both boys and girls Physical activity: decreases in both boys and girls
- 19. Austria Belgium Bulgaria Cyprus CzechRepublic Denmark Estonia Finland France Germany Hungary Ireland Italy Latvia Lithuania Netherlands Poland Portugal Romania Slovakia Slovenia Spain Sweden UKofGBandN-Ireland 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0 11.0 12.0 13.0 14.0 15.0 16.0 17.0 18.0 Salt intake formen or total (g per capita/day) TURKEY = 18 g/d
- 20.
- 21. Austria Belgium Bulgaria Cyprus CzechRepublic Denmark Estonia Finland France Germany Hungary Ireland Italy Latvia Lithuania Netherlands Poland Portugal Romania Slovakia Slovenia Spain Sweden UKofGBandN-Ireland 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 Eu 27 countries Saltintake for men or total (g per capita/day)*
- 24. Reduction of CirculatoryMortality European average European average European average
- 25. Primary prevention ofCVD with a Mediterranean Diet end point Estruch et al. 2013
- 26. WHO Core functions •Promoting development • Fostering health security • Strengthening health systems • Harnessing research, information and evidence • Enhancing partnerships • Improving performance • Translating evidence into policy
- 27. WHO Europe’s policyframework and tools for action
- 28. WHO/EUROPE: mandate foraction
- 29.
- 30. Capacity to measureNational Health Reporting All EUR-A EUR B+C NCD mortality 100% 100% 100% NCD morbidity 98% 96% 100% NCD risk factors 73% 78% 68% Capacity to Disaggregate: Medium to Low
- 31. WHO/Europe: mandate foraction
- 32. WHO Europe’s: Toolsfor Action
- 33.
- 34. Inequalities in physicalactivity and sport • Existence of disparities in physical activity and sport across different social class and ethnic groups within countries in Europe. • Lower income groups, and those from ethnic minority backgrounds are most at risk for leisure time physical inactivity (-> double burden) • The environment is an important contributor • Significant gap in the evidence base on interventions targeting physical activity in disadvantaged groups enormous potential for health promotion!
- 35. National level: PApromotion policies • Total identified policy documents, currently: around 170 (from around 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 sector and is often integrated in other sectors such as environment, education, and transport
- 36. Physical Activity Policy Physical activity should be promoted as part of daily life and across all settings (home, workplace, schools, transport, leisure) Formulating a policy on Health Enhancing Physical Activity gives: Support, coherence and visibility at political level Common objectives and strategies for the involved sectors/settings/institutions Clear roles and responsibilities Greater accountability and greater allocation of resources
- 37. Important elements ofsuccessful 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
- 38. How much physicalactivity do we need? WHO Global Recommendations • Main aim: providing guidance on dose response relation between frequency, duration, type and total amount of PA needed for prevention of NCD • Three age-groups; 5-17 year olds; 18-64; and 65+ • Main target audience; national and local policy makers
- 39. Global recommendations onphysical activity for health • Why? – Evidence based starting point to promote physical activity + advocacy – Limited existence of national guidelines in low and middle income countries; different guidelines • PA independent risk factor for: 1. Cardio-respiratory health (coronary heart disease, cardiovascular disease, stroke and 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 falls 6. Anxiety, depression, cognitive functions
- 40. Austria Belgium Denmark Estonia Finland France Hungary Iceland Ireland Lithuania Luxembourg Malta Netherlands Norway Romania Russian Federation Slovenia Sweden Switzerland Turkey United Kingdom PArecommendations in WHO European Region 21 Member States
- 41. The Main SearchPage 41
- 42. No Action Partly Implemented FullyImplemented Overview Policy Actions Implementation - some Member States Food Based Dietary Guidelines Guidelines Physical Activity Subsidized School Fruit Scheme School Vending Machines Promote Active Travel Initiatives to reduce Salt Increase healthier processed foods Measures to affect food prices Legislation labelling energy Signposting Food Products Regulation Marketing Baby Friendly Hospital Promotion Breastfeeding
- 44. Salt policies andinequalities Inequality-adjusted Human Development Index (IHDI) compared to the current status of the national salt initiative within Member 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 countries with no current salt reduction initiative.
- 45. Marketing food tochildren in the NIS & Georgia No Partly Fully ARM √ AZE √ BLR √ GEO √ KAZ √ KGZ √ MDA √ RUS √ TJK √ TKM √ UKR √ UZB √
- 47. Matrix for price/fiscalpolicy Evidence Current Practice Social Impact Tobacco Alcohol Foods • Effect on consumption • Elasticity • Pass through effects • Effects on revenue • Mechanisms: minimum price, excise… • Response to financial crisis • What products are targeted? • Cross-border sales • Smuggling • Illegal production • Earmarking • Monitoring • Strategy • Regressivity • Effects on different SEG • What is the health impact? • Competitiveness
- 48. Overview of theavailable international and national surveys on physical (in)activity levels and patterns in the 27 EU Member States; Data collection methods applied and the items measured; Challenges experienced in collecting and integrating physical activity data in the EU.
- 49. Sport and health:what is the current policy situation in EU Member States? • Analysis of existing sport policy documents from 15 EU MS concluded, among others: – […] Local environments have a crucial role in promoting sport and physical activity, since it is mainly in the local setting that the opportunities to be physically active are provided. – Elite sports facilities should not be prioritized at the expense of facilities for the general public and the planning of recreational sports facilities should be considered as an integral part of urban planning – Taking a life course approach and offering physical activity in different settings, including schools and work places, is essential to the promotion of sport and physical activity. – Collaboration should take place not only among ministries but also across government levels (national, regional and local), with civil society and the voluntary and private sectors. […]
- 50. Outcomes of the 2011UN General Assembly High-level Meeting on NCDs
- 51. 2000 2003 2004 2008 Global Strategy forthe Prevention and Control of Noncommunicable Diseases Global Strategy on Diet, Physical Activity and Health Action Plan 2008-2013 on the Global Strategy for the Prevention and Control of NCDs 2010 2009 2011 Global Strategy to Reduce the Harmful Use of Alcohol WHO Global Status Report on NCDs Political Declaration on NCDs 2013 2020 WHO Action Plan for the Prevention and Control of NCDs for 2013-2020 WHO’s global road map on NCDs
- 52. Formal Meeting ofMember States to conclude the work on the comprehensive global monitoring framework including indicators and a set of voluntary targets for the prevention and control of NCDs On 7th November the meeting agreed on a global monitoring framework and a set of voluntary global targets for the prevention and control of noncommunicable diseases This will be integrated into the work under way to develop a draft WHO Action Plan (2013-2020)
- 53. Comprehensive Global MonitoringFramework Mortality & Morbidity Cancer incidence by type of cancer per 100 000 population Unconditional probability of dying between ages 30 and 70 years from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases Salt Fruits and Vegetables Saturated Fat Overweight and Obesity Physical Inactivity Blood glucose/diabetes Blood Pressure Total Cholesterol Harmful use of Alcohol Risk Factors Tobacco use Access to palliative care National Systems Response Policies to limit SFA and virtual elimination of PHVO Essential NCD Medicines HPV Vaccine Marketing to children Drug therapy and counseling Cervical cancer Screening Hepatitis B Vaccine
- 54. Raised blood pressure 25% reduction Salt/ sodiumintake 30% reduction Tobacco use 30% reduction Physical inactivity 10% reduction Harmful use of alcohol 10% reduction Drug therapy and counseling 50% Premature mortality from NCDs 25% reduction Diabetes/ obesity 0% change Essential NCD medicines and technologies 80%
- 55. Human rights NCDsare a challenge to social and economic development Universal access and equity Life-course approach Evidence-based action Empowerment of people and comunities Vision: A world in which all countries and partners sustain their political and financial commitments to reduce the avoidable global burden and impact of NCDs, so that populations reach the highest attainable standards of health and productivity at every age and NCDs are no longer a barrier to socio-economic development Overarching principles: Main elements of the Draft Action Plan Goal: To reduce the burden of preventable morbidity and disability and avoidable mortality due to NCDs
- 56. Action Plan forthe Implementation of the European Strategy Prevention Control NCDs Health Promotion Planning & oversight National plan Health info sys with social determinants disaggregation Health in all policies Fiscal policies Marketing Salt Trans-Fat Healthy Settings Workplaces & Schools Active Mobility Secondary prevention Cardio- metabolic risk assessment & management Early detection of cancer
- 57. Health 2020: a Europeanpolicy framework supporting action across government and society for health and well- being
- 58. Paving the wayfor a new WHO European Region Nutrition Policy Framework
- 59. To guarantee universalaccess to food, equity and gender equality for the nutrition of all citizens of the WHO European Region through intersectoral nutrition policies. Mission
- 60. Ministerial Conference willachieve high level political commitment in three dimensions: • Governance, intersectoral action and food and nutrition systems • Life-course, nutrition and noncommunicable diseases • Inequalities in nutrition, obesity and noncommunicable diseases
- 61. WHO European MinisterialConference on Nutrition and NCD in the Context of Health 2020
- 62.
Editor's Notes
- #10 WHO Euro is conducting one of the most successful childhood obesity surveillance initiatives worldwide…..
- #24 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…
- #25 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.
- #35 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.
- #50 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 …