Towards a Global Strategy on Diet, Physical Activity and Health

Transcription

1 Source: WHO, World Health Report 1 Towards a Global Strategy on Diet, Physical Activity and Health Death, by broad cause group Total deaths: 55,694, Noncommunicable Injuries (9.1%) conditions (59.%) Deaths due to CVD by WHO Region, % Deaths 3 Ingrid Keller, MSc, MPH Non Communicable Disease Prevention and Health Promotion Department, Geneva Communicable diseases, maternal and perinatal conditions and nutritional deficiencies (31.9%) Source: WHO, World Health Report 1 SEAR WPR AMR AFR EMR EUR Strokes Heart attacks Source: WHO, World Health Report 1 Contents Burden of Non-Communicable diseases The main risk factors: diet & physical activity Prevention works: evidence WHO s response % Deaths, by broad cause group and WHO Region, SEAR WPR AMR AFR EMR EUR Noncommunicable conditions Injuries Communicable diseases, maternal and perinatal conditions and nutritional deficiencies The prevalence of diabetes in adults (millions of people) Afr Eur SEA W Pa Amer E Med World Health Report, 1997 The World Health is in Transition Epidemiological: Nutritional: Demographic: Globalisation: NCD overriding CD, & double burden of diseases in many developing countries. Diets are rapidly changing and physical activity reduced. Population ageing. Increasing global influences., 15,, 5, Double burden of disease in middle/low income countries DALYs India SSA Communicable, maternal/perinatal cond.,nutr. deficiencies Noncommunicable Conditions WORLD HEALTH REPORT 2 Reducing Risks, Promoting Healthy Life Latest estimates of disease burden Health effects of selected major health risks: globally and in regions Strategies to reduce risk Source: WHO/EIP Global Burden of Disease

2 World Deaths in attributable to selected leading risk factors Blood pressure Tobacco Cholesterol Underweight Unsafe sex Fruit and vegetable intake High Body Mass Index Physical inactivity Alcohol Unsafe water, sanitation, and hygiene Indoor smoke from solid fuels Iron deficiency Urban air pollution Zinc deficiency Vitamin A deficiency Unsafe health care injections Occupational risk factors for injury Number of deaths (s) Source: WHR 2 High Mortality Developing Countries Deaths in attributable to selected leading risk factors Underweight Unsafe sex Blood pressure Unsafe water, sanitation, and hygiene Cholesterol Tobacco Indoor smoke from solid fuels Low fruit and vegetable intake Zinc deficiency Vitamin A deficiency Iron deficiency Physical inactivity Alcohol High Body Mass Index Unsafe health care injections Urban air pollution Number of deaths (s) Source: WHR 2 % BMI >= WOMEN S OBESITY AND SES Latin America and Caribbean: HAITI BOLIVIA GUATEMALA 98 25% less educated 25% more educated DOM REP COLOMBIA PERU BRAZIL 96 MEXICO Source: Monteiro & Popkin 3 7 out of the main risk factors relate to diet and physical activity Blood pressure Tobacco Cholesterol Fruit and vegetable intake Alcohol High BMI Physical Activity Global prevalence of underweight and obesity in adults for year by level of development Prevalence (%) Global Least developed Developing Economies in Developed countries (45) countries (75) transition (27) market economy countries (24) BMI < 17. BMI > 3. BMI = Body Mass Index Source: WHO, SDE/NHD, Lifestyle Transition Emerging epidemic of NCDs is to a great extent a consequence of rapid changes in the diets, of declining physical activity and of increase of tobacco use The determinants of these changes are urbanisation, changes in occupations and many global influences The transition concerns adults and children Risks are increasingly accumulating in lower socio-economic groups of the population Low Mortality Developing Countries Deaths in attributable to selected leading risk factors Blood pressure Tobacco Cholesterol Alcohol Low fruit and vegetable intake High Body Mass Index Indoor smoke from solid fuels Physical inactivity Urban air pollution Underweight Unsafe health care injections Unsafe water, sanitation, and hygiene Unsafe sex Occupational particulates Iron deficiency Occupational risk factors for injury Lead exposure Illicit drugs Number of deaths (s) Source: WHR 2 Obesity Patterns Across the Developing World BMI>25 8 BMI>3 25<BMI<3 M Male F Female Percentage F M F M F M F M F M F M F Mexico Brazil Morocco Egypt S Africa Thailand China GNP 384 GNP 463 GNP 124 GNP 129 GNP 33 GNP 216 GNP 75 Source: Popkin (2) Pub Health Nutr. 5 :93-3. CVD, CANCER AND CHRONIC RESPIRATORY DISEASES RISK FACTORS Non-modifiable Risk Factors Age Sex Genes Behavioural Risk Factors Tobacco Diet Alcohol Physical Activity Socio-economic, Cultural & Environmental Conditions Intermediate Risk Factors Hypertension Blood lipids Obesity / Overweight Glucose Intolerance Endpoints Coronary heart disease Stroke Peripheral vascular disease Several cancers COPD/emphysema

3 The impact of risk factors on diseases and deaths I High Blood Pressure: causes 62% of all cerebro-vascular diseases and 49% of ischaemic heart diseases causes 7.1 million deaths / year (13%) High cholesterol: causes 18% of the cerebro-vascular diseases and 56% of ischaemic heart diseases causes 4.4 million deaths / year (8%) NCDs are to a great extent preventable diseases Medical evidence for prevention exists. Population-based prevention is the most cost-effective and the only affordable option for major public health improvement in NCD rates. Major changes in population rates can take place in a surprisingly short time. WHO/FAO Expert Report on Diet, Nutrition and the Prevention of Chronic Diseases Report of the joint WHO/FAO expert consultation in Geneva, Switzerland 28 January - 1 February 2 Source: WHR 2 The impact of risk factors on diseases and deaths II High salt (NaCl) intake : sodium intake is directly associated with HBP Saturated fats and trans fatty acids: raises total and LDL cholesterol usually animal fat based or hardened vegetable oil replacement by unsaturated vegetable oils effectively lowers blood cholesterol and coronary heart disease risk Source: WHR 2 Diet and risk of NCD Up to 8 % of cases of coronary heart disease and up to 9 % of type 2 diabetes could be avoided through changing lifestyle factors. About one third of cancers could be prevented by eating healthily, maintaining normal weight and being physically active throughout the life span. Evidence for risk factors and protective factors concerning obesity Risk Convincing Probable High intake of energy-dense Sugar-sweetened soft drinks foods and fruit juices Physical inactivity/sedentary Heavy marketing of energydense foods, & fast food lifestyle outlets Adverse social & economic conditions High intake of non-starch polysaccharides (dietary fibre) Fruits (including berries) & vegetables Physical activity, regular Exclusive breastfeeding Home & school environments that support healthy food choices for children The impact of risk factors on diseases and deaths III Obesity: 58% of DM, 21% of ischaemic heart diseases and 8-42% of certain cancers are attributable globally to a BMI > 21 kg/m 2 Low fruit and vegetable intake: causes 19% of gastro-intestinal cancers and 31% of ischaemic heart diseases causes 2.7 million deaths / year (5%) Diet and risk of NCD Trials in China, US, and Finland show that among high-risk individuals, close to 6 % of type 2 diabetes cases could be prevented by modest changes in diet and physical activity. The impact of these measures can be double that of drug intervention. Major changes in rates of CHD and diabetes can bee seen in a few years. Evidence for risk factors and protective factors concerning CVD Risk Convincing Probable Saturated fatty acids Dietary cholesterol Trans-fatty acids Unfiltered boiled coffee Myristic & palmitic acid High sodium intake High alcohol intake Overweight & obesity Linoleic acid Fish and fish oils (EPA & DHA) Potassium Fruits (including berries) & vegetables Low to moderate alcohol intake Physical activity, regular Plant sterols and stanols a-linolenic acid Oleic acid Nuts (unsalted) High intake of non-starch polysaccharides (dietary fibre) Wholegrain cereals Folate Source: WHR 2

4 Evidence for risk factors and protective factors concerning cancer Risk Convincing Probable Chinese-style salted fish Salt-preserved foods & salt High alcohol intake Preserved meat Aflatoxins Very hot (thermally) drinks (& Overweight & obesity food) Physical activity, regular Fruits (including berries) & vegetables Physical inactivity/sedentary lifestyle Recommendation for Physical Activity A total of one hour per day on most days of the week of moderateintensity activity, such as walking, is needed to maintain a healthy body weight, particularly for people with sedentary occupations. Prevention works Japan: reduction of salt intake resulting in lower blood pressure levels and greatly reduced stroke mortality Singapore: national programme associated with decline in NCD trends Mauritius: changing cooking oil from palm to soy bean oil resulted in a 15% decrease in serum cholesterol in the population Poland: sudden change in dietary fats, related to political changes - resulted in % decline in heart disease mortality Recommendations I WHO/FAO Expert Group Shift consumption from saturated fats and transfatty acids towards unsaturated fats and, in some settings, reduce levels of total fat intake (< 3 % daily energy). Substantially increase levels of physical activity across the life span and in all domains. Increase consumption of fruit and vegetables (> 4 g/day) as well as legumes, whole grains and nuts. Various levels of physical activity and their benefits STRATEGIES TO REDUCE RISK: World Health Report 2 messages I Very substantial health gains can be made for relatively modest expenditures on interventions Changing population distributions of risk factors (like blood pressure, blood cholesterol) through general lifestyle changes CVD: Population wide strategies to lower cholesterol (Quality of Fat) and blood pressure (Salt Reduction) key Recommendations II WHO/FAO Expert Group Encourage fish, lean meats and low-fat dairy products when consuming animal-based foods. Reduce the intake of free sugars (< % daily energy). Reduce salt consumption from all sources (< 5 g/day) and ensure salt is iodized. Prevention works Age-adjusted mortality rates of coronary heart disease in North Karelia and the whole of Finland among males aged years from 1969 to Mortality/ population STRATEGIES TO REDUCE RISK: World Health Report 2 messages II Tobacco: Higher taxes, comprehensive advertisement ban Mix of population wide, high risk and secondary prevention measures, in a cost effective balance Sustained policy action Strengthening of national institutions to implement and evaluate risk reduction programmes

5 What Obstructs Prevention? Myths: diseases of affluence, of ageing, etc Prevention Potential and Quickness of Impact not well understood Low public visibility vs. sick patients needs Gains of prevention often invisible Powerful commercial interests block policies Conflicting messages, often from commercial interests Health personnel favour curative care Inertia in change: institutes, financing, services etc Global strategy on diet, physical activity and health: our mandate WHA resolution on a Global Strategy for prevention and control of NCDs () WHA discussion paper on health promotion (1) WHA resolution on diet, physical activity and health: calls for preparation of Global Strategy(2) NGOs On going dialogue and meetings comments on draft report April 2 Identification of organizations data base of 3 organizations On-line discussion via Stakeholder Forum Meeting with DG - 16 May 3 Formal consultation - 17 May 3 Healthy diet and physical activity are For the individual: an effective way to prevent disease and promote health For society: a cost effective and sustainable way to improve public health The Global Strategy on Diet, Physical Activity and Health is of great importance for global public health. Phase III Phase II Phase I Reference group The Big Picture WHO WHO Strategy on on Diet, Diet, Physical Activity and and Health UN Agencies WHA 4 EB Jan 4 Consultation Process Member states Preparation of consultation process and finalization of expert report Civil Society Secretariat Private sector UN agencies WHO/FAO consultation Reference group UN SCN meeting Chennai 3 Meeting on 4 June 3 What are we doing? WHO response Private Sector From April 2 to May 3 WHO/FAO Expert Report Engagement - 2 meetings held Approaches by individual companies DG-CEO roundtable: 9 May Consultation with industry associations: 17 June The Regional Consultations SEARO - 12 March 3 New Delhi AFRO March 3 Harare EURO 2-4 April 3 Copenhagen AMRO April 3 San José EMRO 3 Apr-2 May 3 Cairo WPRO 9-11 June 3 Kuala Lumpur

6 Principles to develop the Global Strategy comprehensive life-course perspective Helps poor populations and is gender sensitive supports Member States addresses global responses In a world filled with complex health problems, WHO cannot solve them alone. Governments cannot solve them alone. Nongovernmental organizations, the private sector and foundations cannot solve them alone. Only through new and innovative partnerships can we make a difference. Dr Gro Harlem Brundtland Director-General 13 May 2, 55th World Health Assembly, Geneva