Challenges for nutrition in the WHO European Region. João Breda WHO Regional Office for Europe

Transcription

1 Challenges for nutrition in the WHO European Region João Breda WHO Regional Office for Europe

2 Delegates from 159 countries and the European Community pledged to eliminate or substantially reduce: starvation and famine; widespread chronic hunger; undernutrition, especially among children, women and the aged; micronutrient deficiencies, especially mineral and vitamin deficiencies; diet-related communicable and non-communicable diseases; impediments to optimal breastfeeding.

3 We have changed a lot since 1992!!

4 Challenges Double burden of malnutrition Food supply chain Monitoring and surveillance Policy

5 GBD attributable for 20 RF 2010 as % DALY 15 out of 20 RF linked with nutrition and PA Lim & al. 2012

6 Nutrition National Survey - Tajikistan 30% Stunting 28% (42% Dushanbe) overweight women reproductive age Micronutrient deficiencies (iron, vit. D, iodine, vit. A )

7 80 Overweight in adults 2008 ( % pre-obesity and obesity global estimates WHO) Austria Belgium Bulgaria Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Ireland Italy Latvia Lithuania Eu 27 countries Luxembourg Malta Netherlands Poland Portugal Romania Slovakia Slovenia Spain Sweden UK of GB and N-Ireland Source: Global Health Observatory Data Repository. The World Health Statistics Geneva, World Health Organization ( accessed 23 August 2011). Overweight includes obesity: BMI >=25.0 kg/m 2

8 Age standardized prevalence of overweight (%) among adult males >20 years of age (2008) WHO European Region Kazakhstan Belarus Russian Federation Azerbaijan Georgia Ukraine Armenia Uzbekistan Turkmenistan Kyrgyzstan Republic of Moldova Tajikistan Source: Global Health Observatory Data Repository. The World Health Statistics Geneva, World Health Organization ( accessed 23 August 2011). Overweight includes obesity: BMI >=25.0 kg/m 2

9 Prevalence of obesity in adults 2008 (%) - non EU

10 Survey characteristics: country, year, age range Tajikistan, 2003, Switzerland, 2007, 15+ Austria, , Norway, , 16+ Italy, 2006, 18+ Denmark, 2005, 16+ Cyprus, 2003, 15+ Sweden, 2009, Albania, , Belgium, 2008, 18+ Ireland, 2007, 18+ France, 2009, 15+ Republic of Moldova, 2005, Netherlands, 2009, 20+ Georgia, 2009, Armenia, 2005, Slovenia, , Finland, 2008, Estonia, 2008, Spain, 2006, 18+ Russian Federation, 2005, Latvia, 2006, Lithuania, 2008, Portugal, , Azerbaijan, 2006, Luxembourg, 2008, 16+ Greece, 2003, Poland, , Germany, , Czech Republic, 2008, 20+ United Kingdom: Wales, 2009, 16+ Bulgaria, 2004, 20+ Malta, , 18+ Serbia, 2006, 20+ United Kingdom: England, , 16+ Croatia, 2003, 18+ Turkey, 2008, Hungary, 2009, 18+ United Kingdom: Scotland, 2008, Men Women Obese, measured data Pre-obese, measured data Obese, self-reported data Pre-obese, self-reported data Percentage (%) WHO, 2010.

11 Percentage distribution Projected obesity distribution to 2030 (adult males) 50% 45% 40% 35% 30% 25% 20% % 10% 5% 0%

12 Challenges Double burden of malnutrition Food supply chain Monitoring and surveillance Policy

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15 Salt intake for men or total (g per capita/day) Germany France Finland Estonia Denmark Czech Republic Cyprus Bulgaria Belgium Austria Lithuania Latvia Italy Ireland Hungary TURKEY = 18 g/d Sweden Spain Slovenia Slovakia Romania Portugal Poland Netherlands UK of GB and N-Ireland

16 Saturated fat intake 2007 (% of calories in total diet) Austria Belgium Bulgaria Denmark Estonia Finland France Germany Greece Hungary Ireland Italy Latvia Eu 27 countries Lithuania Luxembourg Malta Netherlands Poland Portugal Romania Slovenia Spain Sweden UK of FB and N-Ireland

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18 Challenges Double burden of malnutrition Food supply chain Monitoring and surveillance Policy

19 Nutrition, PA and Obesity International highlights from the HBSC 2009/2010 International Report

20 The HBSC Report of health among 11, 13 and 15 year olds in 39 countries Social determinants and inequalities according to family affluence, gender and age

21 Key findings: age changes 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

22 Primary prevention of CVD with a Mediterranean Diet end point Estruch et al. 2013

23 Challenges Double burden of malnutrition Food supply chain Monitoring and surveillance Policy

24 WHO/EUROPE: mandate for action

25 The Main Search Page 25

26 Overview Policy Actions Implementation - some Member States Food Based Dietary Guidelines Guidelines Physical Activity Subsidized School Fruit Scheme No Action Partly Implemented Fully Implemented 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

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28 To properly evaluate polices

29 Capacity to measure National 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

30 Salt policies and inequalities 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.

31 Key findings: family affluence Health behaviours Health behaviours appear to be affected by family affluence such that positive behaviour is associated with better material conditions: Eating fruit - higher prevalence associated with higher affluence Eating breakfast - higher prevalence associated with higher affluence

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33 Marketing opportunities have greatly increased in the last decade New policy initiatives to restrict the marketing of food and beverages to children across the European region have been developed Impact on children s food choices and diets strengthens the evidence to justify action.. Many countries with recent developments..

34 Marketing food to children in the NIS & Georgia ARM AZE BLR GEO KAZ KGZ MDA RUS TJK TKM UKR UZB No Partly Fully

35 Matrix for price/fiscal policy Tobacco Alcohol Foods Evidence Current Practice 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 Social Impact Regressivity Effects on different SEG What is the health impact? Competitiveness

36 Outcomes of the 2011 UN General Assembly High-level Meeting on NCDs

37 Best buys package population-based approaches Reducing salt intake and salt content of food Replacing trans-fat in food with unsaturated fat Promoting public awareness about diet and physical activity

38 Comprehensive Global Monitoring Framework Mortality & Morbidity Unconditional probability of dying between ages 30 and 70 years from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases Cancer incidence by type of cancer per population Risk Factors Harmful use of Alcohol (3) Fruits and Vegetables Physical Inactivity (2) Salt Saturated Fat Tobacco use (2) Blood glucose/diabetes Blood Pressure Overweight and Obesity (2) Total Cholesterol National Systems Response Cervical cancer Screening Drug therapy and counseling Essential NCD Medicines Hepatitis B Vaccine HPV Vaccine Marketing to children Access to palliative care Policies to limit SFA and virtual elimination of PHVO

39 Harmful use of alcohol 10% reduction Premature mortality from NCDs 25% reduction Essential NCD medicines and technologies 80% Physical inactivity 10% reduction Drug therapy and counseling 50% Salt/ sodium intake 30% reduction Tobacco use 30% reduction Raised blood pressure 25% reduction Diabetes/ obesity 0% change Mortality and morbidity Risk factors for NCDs National systems response

40 Health 2020: a European policy framework supporting action across government and society for health and wellbeing

41 Health 2020 strategic objectives Working to improve health for all and reducing the health divide Improving leadership, and participatory governance for health Health 2020: Four common policy priorities for health Investing in health through a life course approach and empowering people Tackling Europe s major health challenges of non communicable diseases and communicable diseases Strengthening people-centred health systems and public health capacities, and emergency preparedness, surveillance and response Creating resilient communities and supportive environments

42 Ministerial Conference will achieve 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

43 WHO European Ministerial Conference on Nutrition and NCD in the Context of Health 2020