A-whole-of-society-approach-to-addressing-noncommunicable-diseases-ncds
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Presentation delivered by Zsuzsanna Jakab, WHO Regional Director for Europe, on 15 December 2014 in Valletta, Malta
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- 1. A whole-of-society approach to addressing noncommunicable diseases (NCDs) Zsuzsanna Jakab WHO Regional Director for Europe 15 December 2014, Valletta, Malta
- 3. Building on the 2010 vision Source: European Health for All database (HFA-DB). Copenhagen: WHO Regional Office for Europe; 2014. Highest rate in WHO European Region Regional average Lowest rate in Region 82 years 75 years 68 years Life expectancy increased by 5 years but inequities persist
- 4. Facing the future Health higher on the political agenda Croatia: World Health Day
- 5. Responding to the challenges: renewed policy environment
- 7. Public health at the heart of Health 2020 implementation
- 8. Investing in public health interventions • Clear policy frameworks and supporting strategies • Strong public health infrastructure • Cohesion in health sector, and better coordination across sectors
- 9. Health 2020: counting on strong leadership Montenegro: Zsuzsanna Jakab with Milo Đukanović, Prime Minister of Montenegro San Marino: Zsuzsanna Jakab with the Captains Regent of San Marino Kyrgyzstan: Health 2020 launch with the Prime Minister of Kyrgyzstan and ministers
- 11. Tangible results from European action plan on NCDs
- 12. Decreasing premature mortality from NCDs 0 50 100 150 200 250 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Standardized death rate, 0–64 years, per 100 000 population Declining premature mortality from circulatory diseases, 2000–2011 European Region Eur‐A Eur‐B+C Eur‐A: 27 countries with very low child and adult mortality Eur‐B: 17 countries with low child and adult mortality Eur‐C: 9 countries with low child but high adult mortality Source: European Health for All database (HFA-DB). Copenhagen: WHO Regional Office for Europe; 2014.
- 13. Investing in health promotion and disease prevention Investments bring returns in short and medium terms Turkey: health promotion event in Ankara with Dr Mehmet Müezzinoglu, Minister of Health
- 19. Whole-of-government and -society approaches needed
- 20. What can this look like? Intersectoral action for health National level Local level Many sectors or just 2 About health or just one issue Working with commun‐ ities Working with private sector 4
- 21. National-level action 5 Ministerial or interdepartmental committees • Hungary’s intersectoral public health committee Regulation • Tobacco taxation • Minimum unit price for alcohol • Trans-fat ban Health impact assessment as a tool • Slovenia’s food and nutrition plan
- 22. Working with communities 7 Citizen health conferences • Germany’s state health conferences • Resolutions must be considered by government Building community resilience • Belgium “community diagnosis” leading to subsidized housing improvements and skills training for poor and ethnic minorities
- 23. Education All children in school, better learning Healthy diets, active children, less family spending on tobacco/alcohol Agriculture Improved production, environmental and financial sustainability Increased consumption of fruits and vegetables (more available and affordable) Industries Improved productivity, fewer staff absent Healthier people (reducing premature disability and death from NCDs) Urban planning Beautiful city, happier residents, more tourists, more money Safe spaces for physical activity and social interaction, smoke-free environments Finance More money for government budget Higher taxes on tobacco and alcohol Private sector Profit, brand reputation Reformulating products to be “healthier”, marketing healthy lifestyles Gender equity Less violence and poverty for women, more access to health care and education for women Reduced alcohol consumption, less household spending on tobacco and alcohol Police Less violence, crime and traffic accidents Alcohol control What do other sectors care about? How can actions to promote health help?
- 24. Burden of Disease – Malta
- 25. Overweight and Obesity in WHO European Region
- 26. 49 45 45 34 34 32 30 29 28 26 25 25 24 24 24 23 0 10 20 30 40 50 60 GRC ITA** ESP MLT* MKD PRT SVN NOR** BGR IRL HUN LVA LTU CZE SWE BEL * 6-year-olds ** 8-year-olds Prevalence of overweight among boys aged 7 years in Europe, data from Childhood Obesity Surveillance Initiative (COSI), 2010, by country % MKD: the former Yugoslav Republic of Macedonia.
- 27. Source: Health Behaviour in School-aged Children (HBSC) study 15%≤ BMI-for-age <20% 10%≤ BMI-for-age <15% BMI-for-age >10% BMI-for-age ≥20% No information Prevalence of overweight among European 11-, 13- and 15-year-old boys and girls 2002 BMI: body mass index.
- 28. Source: Health Behaviour in School-aged Children (HBSC) study 15%≤ BMI-for-age <20% 10%≤ BMI-for-age <15% BMI-for-age >10% BMI-for-age ≥20% No information Prevalence of overweight among European 11-, 13- and 15-year-old boys and girls 2006
- 29. Source: Health Behaviour in School-aged Children (HBSC) study 15%≤ BMI-for-age <20% 10%≤ BMI-for-age <15% BMI-for-age >10% BMI-for-age ≥20% No information Prevalence of overweight among European 11-, 13- and 15-year-old boys and girls 2010
- 30. Physical inactivity – WHO estimates 2008 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 MLT GBR CYP ITA IRL PRT ESP LUX SWE BEL FIN ROU DNK AUT LVA FRA SVN DEU CZE HUN POL BGR HRV LTU SVK NLD EST GRC Percentage Country
- 31. In Europe: high exposure, high burden of mortality and disease Deaths caused by alcohol in people aged 15–64 (clearly premature deaths, given the life expectancy in Europe): • 1 in 7 for men • 1 in 13 for women
- 32. Total average alcohol consumption per capita, recorded and unrecorded, 2008–2010, men and women 0 2 4 6 8 10 12 14 16 18 20 Turkey Azerbaijan Tajikistan Israel Turkmenistan Kyrgyzstan Uzbekistan Armenia FYRMacedonia Italy Albania Malta Bosnia&Herzegovina Iceland Norway Georgia Montenegro Sweden Cyprus Netherlands Estonia Kazakhstan Greece Austria Switzerland Belgium Spain Denmark Bulgaria Slovenia UK Germany Luxembourg Ireland France Croatia Latvia Finland Poland Serbia Portugal Slovakia CzechRepublic Hungary Andorra Ukraine Romania Russia Lithuania Moldova Belarus Litresofpurealcohol
- 33. Country examples – changes in total alcohol consumption from 2005 to 2010 • Italy: decrease from 10.5 to 6.7 L (36%) • Moldova: decrease from 18.2 to 16.9 L (8%) • Serbia: increase from 9.2 to 12.6 L (37%) • Georgia: increase 5.6 to 7.7 L (38%)
- 34. Current mortality attributable to tobacco in Europe No room for complacency WHO region Deaths attributed to tobacco (%) Europe 16 Americas 16 Western Pacific 13 South East Asia 10 Eastern Mediterranean 7 Africa 3 Global 12
- 35. Current mortality attributable to tobacco in Europe No room for complacency WHO region Male prevalence (%) Female prevalence (%) Both sexes (%) Europe 38 19 28 Western Pacific 47 3 25 Eastern Mediterranean 38 4 22 Americas 26 16 20 South East Asia 34 4 19 Africa 22 7 15 Global 36 8 22
- 36. Overview policy actions implementation in the 53 WHO European Member States, 2012–2013 Policy Actions 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Measures to affect food prices Labelling ‐ signposting Reformulation ‐ less sugar and salt Promote Active Travel for school‐children Marketing HFSS foods to children ‐ restrictions Salt reduction initiatives School Fruit Scheme (SFS) or similar Programs in schools (inc. vending machines) Baby Friendly Hospital Initiative Physical Activity Policy incl. Guidelines Breastfeeding promotion and protection policies Food Based Dietary Guidelines Labelling ‐ nutritional information No Action Partially implemented Fully implemented
- 37. Diet as a major risk factor in Europe
- 38. 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 TUR HUN HRV MKD CZE BGR SVN PRT ROU SWE EST ESP ITA LUX FRA CHE LTU IRL GBR DNK NOR AUT NLD SVK FIN ISL DEU AND LVA BEL ISR POL CYP ALB ARM AZE BLR BIH GEO GRC KAZ KGZ MLT MCO MNE MDA RUS SMR SRB TJK TKM UKR UZB Grams Country Salt intake per person per day for adults in the WHO European Region, individual country-based surveys, various years WHO RECOMMENDATION - <5 grams No data
- 39. 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 AND EST FRA MCO RUS SMR GBR GRC BGR ITA IRL LUX SVN BEL BLR AUT SWE GEO TKM ISR AZE NOR CYP ROU CHE SRB FIN LVA BIH CZE NLD UKR MNE ISL POL DEU MKD TJK UZB LTU ESP SVK KAZ PRT ARM MLT HUN ALB TUR MDA HRV KGZ DNK Percentage Country Prevalence of exclusive breastfeeding ≤ 6 months of age in the WHO European Region, individual country-based surveys, various years No data
- 42. Selected examples of policy options in new Food and Nutrition Action Plan Priority policy options Objective Strong controls on marketing, including television advertising Reduce exposure of children to marketing of foods high in fat, salt and sugar, including foods high in free sugars; use of nutrient profile for marketing (WHO) Fiscal measures and price policies Explore policies that affect the price of foods for consumers at point of purchase Consumer-friendly front-of-pack labelling Identify foods whose consumption should be limited or promoted through interpretative labelling, including foods high in free sugars; encourage product reformulation Calorie reduction and smaller portion sizes Reformulate food products; introduce smaller portion sizes to prevent over-consumption Healthier food retail environment, including in schools Improve availability and affordability of healthier food products
- 43. 5 priority areas • Create healthy food and drink environments • Promote the gains of a healthy diet throughout life, especially for the most vulnerable groups • Reinforce health systems to promote healthy diets • Support surveillance, monitoring, evaluation and research • Strengthen governance, alliances and networks to ensure a health-in-all-policies approach
- 44. 11 years since adoption of the WHO Framework Convention on Tobacco Control 44
- 45. Tobacco policy in Europe: countries moving in the right direction Action 2007 2008 2012 Ratification 42 45 50 Taxes 0 15 25 Smoke-free places 4 4 9 Smoking cessation 4 7 7 Ban on advertising 1 1 3 Large pictorial warnings 0 0 2 45
- 46. Tobacco taxes: win–win for health and the economy
- 48. 125 112 95 88 82 75 29 81 137 174 202 215 3.6 9.1 13.1 15.3 16.6 17.9 10.1 9.2 8.7 8.6 8.35 8.1 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 0 50 100 150 200 250 2008 2009 2010 2011 2012 2013 2008–2013 tobacco tax increased by 650%, revenue increased by 400%, cigarette sales decreased by 32%, number of smokers decreased by 20% Cigarette sales, bln sticks Average excise per 1000 cigarettes Tobacco excise revenue, bln UAH Number of daily smokers, mln
- 50. Alcohol policy implementation in Europe • 51 Member States have a blood–alcohol- concentration limit of 0.5 g/L or less for driving • 47 Member States have a legally binding regulations on alcohol advertising • 46 Member States are using random breath-testing • 43 Member States have a minimum 18-year age limit for off-premise sales of alcohol • 38 Member States have a written national or subnational alcohol policy
- 51. Alcohol policy implementation in Europe • 36 Member States have a legally binding restrictions on alcohol product placement • 15 Member States require health warnings on alcohol advertising • 13 Member States adjust taxation for inflation • 9 Member States require product information on alcohol containers
- 52. To summarize: interventions for better NCD outcomes • Political will • Enlightening policy frameworks • Evidence • Management • Training and capacity building • Investment (particularly in children) • Tangible, effective actions • Surveillance and better data • Interventions that work (innovation and technology) • Collaboration with stakeholders • Reaching the most difficult groups • Intersectoral coordination • Sustainability • Inspiring guidelines
- 53. Thank you