A "Whole of Government"
approach to promoting short and
long term well-being in the
European Region
Philip James MD, DSc, ...
Health's contribution to improved prosperity
in the past 50 years: a missed opportunity in
Central Europe and Central Asia...
EU 15
Europe+
Central Asia
South Asia
Latin America+
Caribbean
Middle East +
North Africa
Central Europe and Central Asia ...
-2 0 2 4 6 8 10
Smoking
High blood pressure
Overweight & obesity
High cholesterol
Alcohol use
Physical inactivity
Low frui...
Classic problems of nutritional deficiency
persist: Lancet July 2013
• Anaemia - a neglected issue affecting
Children 11% ...
Crucial nutritional effects do not just affect the
first 1,000 days of life: sensitive organs mature
at different rates
Mu...
Marked changes in societal practices needed :
eliminate smoking, limit markedly alcohol intake &
transform dietary and ina...
Why do we not eat optimally - is it a matter of
education? The current obesity dilemma
Obesity is a normal "passive" biolo...
25 years
65 years
GeneralPop.
Decrease in obesity rates in 25 and 65 year olds + general population
induced by different g...
The cost-effectiveness of policies: individual education for
behavioural change for a whole population is very expensive a...
The keys to success in the food business and in
obesity and chronic disease (NCDs) prevention
• Price
• Availability
• Mar...
Margaret Chan, DG WHO.
WHO 8th Global Health Promotion Conference
June 10th 2013
• "..it is not just Big Tobacco anymore. ...
Margaret Chan, DG WHO.
WHO 8th Global Health Promotion Conference
June 10th 2013
• Tactics also include gifts, grants and
...
PACO III Latin American & Caribbean
Ministerial Conference on childhood obesity 6th
- 8thJune 2013
Ministers of Health's p...
Food tax developments
 Trans fats: Denmark bans in 2003 . Now also Austria&Switzerland.
New 2013 analyses: legislation is...
Early success of major French Parliamentary initiatives in
changing school foods, limiting marketing of foods high in
fats...
Profitable government opportunities for adults and children based on
evidence from Chile, Denmark, France, Finland, Nether...
Conclusions
• The burden of diseases from inappropriate diets and physical inactivity in
the WHO EURO region is exceptiona...
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A "Whole of Government" approach to promoting short and long term well-being in the European Region

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Presented by Philip James of the London School of Hygiene and Tropical Medicine at the WHO European Ministerial Conference on Nutrition and Noncommunicable Diseases in the Context of Health 2020 on 4 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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  • SLIDE 4 OF SEQUENCE
  • A "Whole of Government" approach to promoting short and long term well-being in the European Region

    1. 1. A "Whole of Government" approach to promoting short and long term well-being in the European Region Philip James MD, DSc, FRCP London School of Hygiene and Tropical Medicine, International Association for the Study of Obesity
    2. 2. Health's contribution to improved prosperity in the past 50 years: a missed opportunity in Central Europe and Central Asia Health's contribution to full income growth % 50 40 30 20 10 Europe+ C. Asia SEARO WPRO EMRO AFRO Lat Am+ Caribb. Smith et al World Bank June 2013.
    3. 3. EU 15 Europe+ Central Asia South Asia Latin America+ Caribbean Middle East + North Africa Central Europe and Central Asia (WHO EURO) is the region with the slowest improvement in life expectancy since 1960 of all the WHO regions in the world. Smith et al. Improving health service outcomes in Europe and Central Asia. World Bank June 2013. 80 70 60 50 40 1960 1970 1980 1990 2000 2010
    4. 4. -2 0 2 4 6 8 10 Smoking High blood pressure Overweight & obesity High cholesterol Alcohol use Physical inactivity Low fruit & veg. intake Illicit drug use Unsafe sex Iron deficiency anemia Attributable disease burden (% regional DALYs; total 149 million) The top risk factors underlying the disease burden of high income countries (all preventable) WHO / World Bank. Global Burden of Disease. Lopez et al., 2006. Primary dietary cause
    5. 5. Classic problems of nutritional deficiency persist: Lancet July 2013 • Anaemia - a neglected issue affecting Children 11% affluent; 26% Central/Eastern Europe Women 16% affluent; 22% Central/Eastern Europe • Exclusive breast feeding limited and needs ignored:major public health issue in Western & Central Europe: need to replicate Scandinavia and transform societal approach • Childhood stunting still affects 20-30% in some rural areas of EURO • Pregnancy - the forgotten public health issue: 15% small for dates babies in Caucasus/Central Asia+ Asian immigrants: babies programmed for abdominal obesity + diabetes Overweight girls/women: gestational diabetes+ big babies: programmed obesity and diabetes. Optimum birth weight range!
    6. 6. Crucial nutritional effects do not just affect the first 1,000 days of life: sensitive organs mature at different rates Muscle, bo ne &gut Reproductive organs Lymphatic immune system Liver, kidney, hear t, lung. Brain: follows internal organ changes in size but major structural and functional changes before full maturation at age 20+. Adolescent brain highly susceptible to emotional cues Prentice et al. Critical windows for nutritional interventions against stunting Am J Clin. Nut. 2013;97: 911-918 For brain changes see:: Dosenbach et al . Prediction of individual brain maturity using fMRI. Science 2010;329: 1358-1361
    7. 7. Marked changes in societal practices needed : eliminate smoking, limit markedly alcohol intake & transform dietary and inactivity patterns FIBRE-RICH Vegetables & Fruit Increase fatty acids from fish &n-3 vegetable sources Exclusive Breast Feeding for 6 months Modest animal protein intake Saturated Fats TOTAL FAT Trans fat Sugars & Refined starches Salt Iodine+
    8. 8. Why do we not eat optimally - is it a matter of education? The current obesity dilemma Obesity is a normal "passive" biological response to our changed physical and food environment Some children/adults are more susceptible for genetic, social and economic reasons Overwhelming environmental impact reflects outcome of normal industrial development "Obesity reflects failure of the free market" UK Government report Oct. 2007 Provided on a non - political basis by the Chief Scientist
    9. 9. 25 years 65 years GeneralPop. Decrease in obesity rates in 25 and 65 year olds + general population induced by different government policies. OECD 2010. Note insignificance of approaches using media on its own Media Work-site Schools Drs + Dietetic Fiscal Food Labelling Food Advertising Regulated Voluntary
    10. 10. The cost-effectiveness of policies: individual education for behavioural change for a whole population is very expensive and often ineffective. Legislative/regulatory measures usually much more effective and less costly.
    11. 11. The keys to success in the food business and in obesity and chronic disease (NCDs) prevention • Price • Availability • Marketing
    12. 12. Margaret Chan, DG WHO. WHO 8th Global Health Promotion Conference June 10th 2013 • "..it is not just Big Tobacco anymore. Public health must also contend with Big Food, Big Soda and Big Alcohol. All of these industries fear regulation, and protect themselves by using the same tactics. • Research has documented these tactics well. They include front groups, lobbies, promises of self-regulation, lawsuits, and industry funded research that confuses the evidence and keeps the public in doubt.
    13. 13. Margaret Chan, DG WHO. WHO 8th Global Health Promotion Conference June 10th 2013 • Tactics also include gifts, grants and contributions to worthy causes that cast these industries as respectable corporate citizens in the eyes of politicians and the public. They include arguments that place the responsibility for harm to health on individuals, and portray government actions as interference in personal liberties and free choice.
    14. 14. PACO III Latin American & Caribbean Ministerial Conference on childhood obesity 6th - 8thJune 2013 Ministers of Health's primary role is to act as leaders and ambassadors for change in other government departments e.g. a) Education - changing curriculum and total food + drink sources in all educational facilities b) Transport: structural changes promoting walking/cycling + public transport & minimizing car use c) Finance: Taxation of unsuitable foods/drinks; financial incentives for behavioural change allowing for regressive effects on disadvantaged; Planning for progressive help to local farming/food provision + activity industries d) Business : promote good food and activity: import /export health criteria + supermarket changes e) Agriculture &Food: Link local industries to government supported catering.
    15. 15. Food tax developments  Trans fats: Denmark bans in 2003 . Now also Austria&Switzerland. New 2013 analyses: legislation is the most cost effective intervention not voluntary measures.  Sugar : Finland introduced taxes on sugared products such as soft drinks , ice cream and confectionary by EUR 0.75 per kilo product. Also Denmark. France introduces a 7 cent/litre tax on all soft drinks  HFSS: Sept. 1, 2011. Hungary: a 10 forint (€ 0.37) tax on foods with high fat, sugar and salt content; also increased taxes on soft drinks and alcohol  Saturated fat. Denmarkintroduces small selective tax for 15 months: clear reduction in intake - see separate presentation
    16. 16. Early success of major French Parliamentary initiatives in changing school foods, limiting marketing of foods high in fats, sugar and salt and new taxes on soft drinks; now a new National Nutrition and Health Programme 2011 - 2015 2005 1. Vending machines banned in schools; quality of all foods served improved 2. All national advertising of foods and drinks must carry a health message, with the penalty of being subject to an earmarked tax December 2011 3. Tax of 7 cents/ litre on all soft drinks 4. Food quality in schools controlled by law Repeated national surveys: Overweight &obesity rates in 7-9 year old children (IOTF criteria) Fall of ≈ 15% from 1998-2007 Government initiatives Results 1 Actual price increase =7cents/l 2. Sales fall by 4% 3. Population accepts especially if some tax transferred for health care 4.Tax income 280 M€ in 2012
    17. 17. Profitable government opportunities for adults and children based on evidence from Chile, Denmark, France, Finland, Netherlands & Sweden relating to cardiovascular disease, diabetes and obesity prevention. 1. Control foods+ drinks available in schools, hospitals, all government supported institutions - thisinduces major driver in the free market food chain 2. Develop local farming consortia to provide school meals etc. as educational + financially rewarding strategy (a major opportunity for Europe) 3. Promote inclusion of vegetables/salad bar in main mealat no extra cost 4. Ban trans fat productionin country 5. Define progressively lower food salt content ; no salt on tables as a default measure 6. Regulate lower cost for half and skimmed milk, butter and margarine sales 7. Tax price sensitive items: sugar, - fat (especially saturated fats) on a commodity not a retail basis 8. Ban all marketing of food and drink to all children including adolescents 9. Control fast food outlet density as well as alcohol and tobacco sales in city centres
    18. 18. Conclusions • The burden of diseases from inappropriate diets and physical inactivity in the WHO EURO region is exceptionally high • Slow progress in reducing the premature mortality and disease burden in many countries in the region. • Anaemia and poor pre-pregnancy and maternal nutrition are neglected issues; low birth weight and stunting persists: EURO is also the region with the lowest natural dietary iodine supply. • High priorities in nutrition: Reduce substantially intakes of total fat, trans fat, saturated fat, sugar, salt. Iodize salt and ensure folate + iron for anaemia. All are explicit, newly reinforced, WHO recommendations. • Legislation, regulatory, fiscal policies are far more effective than media campaigns; establishing a healthy foods exclusive policy in all government supported institutions transforms the food chain and health.

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