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Breda opac2013


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Breda opac2013

  1. 1. OBESITY, PHYSICAL ACTIVITY& CANCER16 –17th April 2013, London UKJoão BredaWHO Regional Office for Europe
  2. 2. We have changed a lot!!!!!
  3. 3. 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
  4. 4. 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
  5. 5. 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
  6. 6. 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 (, accessed 23 August2011).Overweight includes obesity: BMI >=25.0 kg/m20 10 20 30 40 50 60TajikistanRepublic of MoldovaKyrgyzstanTurkmenistanUzbekistanArmeniaUkraineGeorgiaAzerbaijanRussian FederationBelarusKazakhstanWHO European Region
  7. 7. 34.331.134.535.529.236.033.932.431.029.229.527.929.930.629.533.926.427.525.430.226.327.630.326.924.129.523.326. 60 40 20 0 20 40 60 80United Kingdom: Scotland, 2008, 16+Hungary, 2009, 18+Turkey, 2008, 15–49Croatia, 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, 18–80Poland, 2003–2005, 20–74Greece, 2003, 20–70Luxembourg, 2008, 16+Azerbaijan, 2006, 15–49Portugal, 2003–2005, 20–74Lithuania, 2008, 20–64Latvia, 2006, 15–64Russian Federation, 2005, 20–49Spain, 2006, 18+Estonia, 2008, 16–64Finland, 2008, 15–64Slovenia, 2007–2008, 18–65Armenia, 2005, 15–49Georgia, 2009, 15–49Netherlands, 2009, 20+Republic of Moldova, 2005, 15–49France, 2009, 15+Ireland, 2007, 18+Belgium, 2008, 18+Albania, 2008–2009, 15–49Sweden, 2009, 16–84Cyprus, 2003, 15+Denmark, 2005, 16+Italy, 2006, 18+Norway, 2008–2009, 16+Austria, 2007–2008, 18–65Switzerland, 2007, 15+Tajikistan, 2003, 25–49Surveycharacteristics:country,year,agerange(years)Percentage (%)WomenMenPre-obese, measured dataObese, measured dataPre-obese, self-reported dataObese, self-reported data© WHO, 2010.
  8. 8. 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, 931% of boys and 621% of girls were obese.
  9. 9. 0%5%10%15%20%25%30%35%40%45%50%PercentagedistributionProjected obesity distribution to 2030 (adult males)20102030
  10. 10. 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
  11. 11. AustriaBelgiumBulgariaCyprusCzechRepublicDenmarkEstoniaFinlandFranceGermanyGreeceHungaryIrelandItalyLatviaLithuaniaLuxembourgMaltaNetherlandsPolandPortugalRomaniaSlovakiaSloveniaSpainSwedenUKofGBandN-Ireland020040060080010001200Eu 27 countriesFruit and vegetables availability 2009 (grams per capitaper day)
  12. 12. Proportion (%) of children exclusively breastfed at3 and 6 months, 2005-20100102030405060708090100AlbaniaArmeniaAzerbaijanBelarusBelgiumBosniaandHerzegovinaBulgariaCroatiaCyprusCzechRepublicFinlandGermanyGreeceHungaryIcelandIrelandItalyKazakhstanKyrgyzstanLuxembourgMontegegroNetherlandNorwayPolandPortugalMaldovaRussiaSlovakiaSlovaniaSpainSwedenSwitzerlandTajikstanMacedoniaUkraineUnitedKingdom3 Months6monthsSources: National Surveys
  13. 13. Nutrition, PA and ObesityInternational highlights from the HBSC 2009/2010International Report
  14. 14. 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
  15. 15. AustriaBelgiumBulgariaCyprusCzechRepublicDenmarkEstoniaFinlandFranceGermanyHungaryIrelandItalyLatviaLithuaniaNetherlandsPolandPortugalRomaniaSlovakiaSloveniaSpainSwedenUKofGBandN-Ireland0. intake for men or total (g per capita/day)TURKEY = 18 g/d
  16. 16. AustriaBelgiumBulgariaDenmarkEstoniaFinlandFranceGermanyGreeceHungaryIrelandItalyLatviaLithuaniaLuxembourgMaltaNetherlandsPolandPortugalRomaniaSloveniaSpainSwedenUKofFBandN-Ireland02468101214Eu 27 countriesSaturated fat intake 2007 (% of calories in total diet)
  17. 17. AustriaBelgiumBulgariaCyprusCzechRepublicDenmarkEstoniaFinlandFranceGermanyHungaryIrelandItalyLatviaLithuaniaNetherlandsPolandPortugalRomaniaSlovakiaSloveniaSpainSwedenUKofGBandN-Ireland0. 27 countriesSalt intake for men or total (g percapita/day)*
  18. 18. Reduction of Circulatory MortalityEuropeanaverageEuropeanaverageEuropeanaverage
  19. 19. Primary prevention of CVD with aMediterranean Diet end pointEstruch et al. 2013
  20. 20. WHO Core functions• Promoting development• Fostering health security• Strengthening health systems• Harnessing research, information andevidence• Enhancing partnerships• Improving performance• Translating evidence into policy
  21. 21. WHO Europe’s policy framework andtools for action
  22. 22. WHO/EUROPE: mandate for action
  23. 23. To properlyevaluatepolices
  24. 24. Capacity to measure National HealthReportingAll EUR-A EUR B+CNCD mortality 100% 100% 100%NCD morbidity 98% 96% 100%NCD risk factors 73% 78% 68%Capacity to Disaggregate: Medium to Low
  25. 25. WHO/Europe: mandate for action
  26. 26. WHO Europe’s: Tools for Action
  27. 27. Global Action Tools
  28. 28. 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!
  29. 29. 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
  30. 30. 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
  31. 31. 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
  32. 32. 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
  33. 33. 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
  34. 34. AustriaBelgiumDenmarkEstoniaFinlandFranceHungaryIcelandIrelandLithuaniaLuxembourgMaltaNetherlandsNorwayRomaniaRussian FederationSloveniaSwedenSwitzerlandTurkeyUnited KingdomPA recommendationsin WHO EuropeanRegion21 Member States
  35. 35. The Main Search Page41
  36. 36. 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
  37. 37. 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.
  38. 38. Marketing food to children in the NIS & GeorgiaNo Partly FullyARM √AZE √BLR √GEO √KAZ √KGZ √MDA √RUS √TJK √TKM √UKR √UZB √
  39. 39. 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
  40. 40. 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.
  41. 41. 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. […]
  42. 42. Outcomes of the2011 UN General AssemblyHigh-level Meeting on NCDs
  43. 43. 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
  44. 44. 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)
  45. 45. 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
  46. 46. Raised bloodpressure25% reductionSalt/sodium intake30% reductionTobacco use30% reductionPhysicalinactivity10% reductionHarmful use ofalcohol10% reductionDrug therapyand counseling50%Prematuremortality fromNCDs25% reductionDiabetes/obesity0% changeEssential NCDmedicines andtechnologies80%
  47. 47. 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
  48. 48. 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
  49. 49. Health 2020: aEuropean policyframeworksupporting actionacross governmentand society forhealth and well-being
  50. 50. Paving the way for a new WHOEuropean Region NutritionPolicy Framework
  51. 51. To guarantee universal access to food, equityand gender equality for the nutrition of all citizensof the WHO European Region throughintersectoral nutrition policies.Mission
  52. 52. 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
  53. 53. WHO European Ministerial Conference onNutrition and NCD in the Context of Health 2020
  54. 54. Thank