Innovations in Obesity: A Policy Perspective

Transcription

1 Innovations in Obesity: A Policy Perspective Nutrition & Health Foundation October 2011 Dr Tony Holohan, Chief Medical Officer

2 Overview Where we are now - health status and the reform programme Priorities Policy response public health and obesity Next steps

3 Where are we now Health service reform programme HSE, HIQA, DoHC Contractual frameworks Patient safety and quality Clinical leadership and governance Roles of other agencies/regulators Re-organisation of delivery of care Primary care, mental health etc. Re-organisation of hospitals Patient safety a key driver Emergence of standards Older people, symptomatic breast, mental health Service user involvement Service planning, performance monitoring, reporting in public

4 What are we getting? Life expectancy Mortality Disease specific Infant and maternal Morbidity Health care associated infections Pandemic, vaccinations etc.

5 The case for change Disease burden Demography, epidemiology Global trends shaping health and illness Practice changes teamworking, specialisation etc. Policy developments - patient safety Public perception Technology - medical and ICT Cost Third era of health care

6 Programme for Government Special delivery unit Universal health insurance Care/cure split Hospital trusts Patient Safety Authority Emphasis on prevention e.g. obesity

7 Age Population Pyramid for Ireland Male 000s Female 000s

8 Age Population Pyramid for Ireland Male 000s Female 000s

9 Life Expectancy 2006/2007 Data, CSO 2010

10 Profile of Adult Risk Factors in Ireland (SLÁN 2007)

11 Preventability 60% disease burden due to tobacco, alcohol, cholesterol, high blood pressure, diet, overweight & physical inactivity 80% chronic disease (cardiac, stroke, diabetes) avoidable Unacceptable levels chronic disease over next decades

12 Barton & Grant 2005

13 Conditions for Health Income Housing Transport Education Environment Food Alcohol Justice Social Support Leisure Culture

14 % of 9 Year Olds Chronic illness & mother s education Lowest Income Group 2nd 3rd 4th Highest Income Group

15 Food

16 We shape our environments thereafter they shape us.

17 How chronic disease is managed Rule of halves Few patients adequately identified Few receive proper care in the appropriate setting Insufficient attention to prevention Poor self-management support Discontinuity between primary care and hospital Evidence-based guidelines not followed Poor compliance High readmission rates to hospital Diagnostic registries incomplete

18 Conclusions Need to promote positive health and well-being We have the knowledge to prevent more effectively The case for change is clear Third era of health care brings a renewed focus on health as distinct from health services Chronic disease a major challenge Public health system has become weakened Morale Systems People The ideas and ideals are not wrong! The methods need to be examined

19 OBESITY

20 Obesity health risks Coronary heart disease Type 2 diabetes Cancers (endometrial, breast, and colon) Hypertension (high blood pressure) Dyslipidemia (for example, high total cholesterol or high levels of triglycerides) Stroke. Liver and Gallbladder disease Sleep apnea and respiratory problems Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint) Gynecological problems (abnormal menses, infertility) Overweight is defined as a body mass index (BMI) of 25 or higher Obesity is defined as a BMI of 30 or higher.

21 Obesity Trends for Adults 61% of Irish adults ( years ) are overweight or obese 70% men and 52% women Levels of overweight and obesity have increased 1990 to 2011 Overall 51% to 61% Men 59% to 70% Women 41% to 52%.

22 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1985 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14%

23 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1986 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14%

24 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1987 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14%

25 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1988 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14%

26 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1989 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14%

27 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1990 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14%

28 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1991 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19%

29 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1992 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19%

30 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1993 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19%

31 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1994 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19%

32 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1995 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19%

33 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1996 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19%

34 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1997 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20%

35 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1998 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20%

36 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1999 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20%

37 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 2000 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20%

38 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 2001 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25%

39 Obesity Trends* Among U.S. Adults BRFSS, 2002 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25%

40 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 2003 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25%

41 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 2004 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25%

42 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 2005 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30%

43 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 2006 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30%

44 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 2007 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30%

45 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 2008 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30%

46 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 2009 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30%

47 Obesity- a complex picture Genes Diet Physical Activity Maternal diet Diet in first 1,000 days of life Parental influence/role model Individual v Environment

48 Irish diet High in fat High in saturates High in salt High in sugar Low in omega 3 fats Low in iron, calcium, folate and vitamin D

49 % of 9-year-olds Child s weight and BMI Non Overweight Overweight Obese Professional/Managerial Semi-skilled/Unskilled Manual Other Non-Manual/Skilled Manual

50 Nutrition & Physical Activity 60% of adults eat more fat than recommended (50% of teenagers exceed recommendations) Average adult intake from Top Shelf of Food Pyramid is 7.3 servings daily, more than double recommended level Children s calorie intake mainly derived from bread, biscuits, soft drinks, milk/dairy, potatoes Salt current adult consumption levels 8.9g/day Physical Activity in adults were physically active for 8 hours per week. In 2001, the level is 5.9 hours per week.

51 Factors promoting weight gain (WHO) High intake energy dense foods Sugar-sweetened drinks Large portion sizes Food prepared outside the home Sedentary lifestyles Social disadvantage Food marketing

52 Bagel 20 Years Ago Today Cheeseburger 20 Years Ago Today 140 calories 350 calories 333 calories 590 calories Chips 20 Years Ago Today 210 calories 610 calories

53 Prevention strategies Increase physical activity Increase the consumption of fruits and vegetables Decrease the consumption of sugar sweetened beverages Increase breastfeeding initiation, duration and exclusivity Reduce the consumption of high energy dense foods Decrease television viewing Informed by better information and evidence

54 Individual v environmental Individual and parental responsibility Environmental support making the healthy food choice the easy choice (food reformulation - lower fat) Rapidly rising obesity rates in children factors outside immediate, conscious discretion (passive over-consumption increasing portion size) Population approach to control what and how much children eat Requires engagement and behaviour change by parents, children, those in the food chain, government

55 Supportive environments Home environment strong influence on children s habits Parental obesity strong potential predictor of child and later obesity. Access to healthy foods at home fruit & veg Parental responsibility for home food and school lunches Control snacking and intake of convenience foods Regular, family meals eaten sitting down together at a table without TV School environment- Food and Nutrition guidelines Healthy eating policies Improved nutrition knowledge through SPHE

56 Special Action Group on Obesity Established by Minister Reilly in June 2011 Priority issues Calorie Posting on Fast Food Outlet Menus Nutrition Labelling Restrictions on Food Marketing to Children Sugar Tax Vending Machines in Post-Primary Schools Physical Activity Plan Treatment Algorithm for Overweight and Obesity Opportunistic Monitoring/Surveillance of Children Treatment Centres Multimedia Campaign Revised Food Pyramid/Healthy Eating Guidelines

57 Calorie posting Over the last decade - steady increase in proportion of food eaten/prepared outside the home Evidence from US shows that people who tend to eat outside the home are heavier than those who eat at home Food eaten/prepared outside the home means no control over portion size, added fat, sugar or other ingredients

58 Sugar tax High intake of sugar-sweetened drinks Satiety levels different after eating solid and liquid foods Possibly reduce gastric distension and speed up transit times Energy in fluids not well detected by brain Leads to reduced appetite control Subsequent food intake is poorly adjusted

59 Marketing of foods and drinks to children Most food marketed to children is unhealthy Little marketing of healthy foods Major advertising spend is on TV Schools are a growing market Internet is a growing market BAI consultation

60 Adverse socio-economic conditions Socio-economic status is a key health determinant Lower income less money to spend on food This group spend a higher percentage of their total income on food Lack of skills influences food and cooking patterns More susceptible to obesogenic environment cheap low cost, high energy foods

61 The recommended diet vs the advertised diet

62 Public health framework

63 Policy response To develop a public health policy Your Health is Your Wealth: A Policy Framework for a Healthier Ireland: Tied into WHO Health 2020 To bring to reality the provisions in the Programme for Government with regard to the health and wellbeing of the whole population A healthier population Protected from public health threats Living in a healthier and more sustainable environment Increased social and economic productivity Greater social inclusion

64 Terms of reference (1) To develop a policy framework for public health which addresses wider determinants of health and health inequalities chronic disease and lifestyle inter-sectoral and cross-sectoral approaches at policy and practice level protection from and responses to public health threats.

65 Terms of reference (2) And which will encompass ethical, legal, organisational and professional practice issues for public health having regard to: the Programme for Government current resource constraints prevailing economic circumstances the views of stakeholders as identified through consultation the strength and weaknesses of the current system the policy framework for Health 2020 as set out by the WHO Euro region policies, practices, structures and other developments in other countries the evidence base for public health policy and practice.

66 Consultation - Five Strands Strand 1 National consultation day - 13 th June, RCPI WEBLINK from RCPI website Strand 2 Regional meetings to mirror national constulation day local HSE Local Authorities, schools and sporting organisations- June 2011 Strand 3 General consultation (august/september) invited organisations, as well as the general public, to respond to specific questions on public health priorities Strand 4 Targeted consultation for Health Sector engagement - HSE and funded agencies Strand 5 Bi-lateral meetings with relevant Government Departments, agencies and community/voluntary organisations

67 Three Strands Health protection Emergency planning and preparedness Communicable disease control Environmental health Food and water safety Health promotion Health inequalities Health improvement Lifestyle related risks Health service delivery Population planned services deliver to individuals A public health approach to service planning, delivery and evaluation

68 Final product Presented in three sections Analysis Plan Implementation Governance for health and well-being National and local Public health function To be completed by end year and launched by Minsiter for Health

69 Key messages First ever policy on public health in its widest sense Once in a generation opportunity Timing is good Refocusing of health system Tie into WHO Health 2020 We need you to become involved

70 Thanks for your attention