Nutrition, diet and health in the WHO European Region Progress and opportunities for further action to achieve SDGs by 2030 João Breda Head, WHO European Office for Prevention and Control of Noncommunicable Diseases
A snapshot of progress and challenges How has the epidemiological situation been involving? What data do we have and where are there still gaps? What action have Member States taken to: Create healthy food and drink environments? Promote good nutrition and healthy diets through life course? Reinforce health systems to promote healthy diets? Develop the surveillance and monitoring systems required? Promote collaboration across sectors?
50 Member States (more than 25% of WHO) are on track to achieve Target 3.4 Regional Snapshot TARGET 3.4
Global targets for NCDs 2025
Global Nutrition Targets 2025 Comprehensive implementation plan on maternal, infant and young child nutrition. Endorsed by WHA 65, 2012
WHO European Region MS achieving global targets around nutrition & physical inactivity by 2025 - updated Adult obesity Salt reduction Breastfeeding Physical inactivity Childhood obesity 0% 20% 40% 60% 80% 100% On track off track
Are we on track to achieve our targets? Most countries have made some good progress, but high risk of not achieving some of the targets
HIGHLIGHTS ON THE EPIDEMIOLOGICAL SITUATION
% Overweight and Obesity in European adolescents Trends and inequalities 25 20 15 10 2002 2006 2010 2016 5 0 Western Europe Southern Europe Eastern Europe Northern Europe
BEL BUL CZH DEN EST GRE HUN IRE LTU LVA MAT MDA MKD MNE POR SPA SRB SVN TJK TKM TUR ALB AUT CRO ITA KAZ NOR POL ROM SMR SWE Childhood Obesity Surveillance Initiative - 2017 25,0% 20,0% 15,0% 10,0% Boys Girls 5,0% 0,0% 7-year-olds 8-year-olds 10
Childhood Obesity Surveillance Initiative 2017 7 & 8 years old - 31 countries (overweight including obesity) 100% 80% 10 6 60% 40% 20% 0% 18 3 Boys 19 6 Girls 30% 20% & <30% < 20% 11
Overweight (%) Overweight among under 5s - early life challenge Regional trends (2000-2015): prevalence of overweight in children under 5 years of age 14 12 Sharp increase 10 8 6 4 2 2000 2005 2010 2015 0 EUR AMR EMR AFR SEAR WPR Source: Joint Child Malnutrition Estimates, 2016, UNICEF, WHO, WB
But efforts needed on coverage and quality of data Source: Jones et al, Overweight and Obesity in Children under 5 Years: Surveillance Opportunities and Challenges for the WHO European Region
% of countries (n=48) Availability of representative dietary intake data 0% 27% 31% 15% 31% 23% 6%
Exclusive Breastfeeding at 6 months % 100 90 80 70 60 50 40 30 20 10 0 *No data for Albania, Andorra, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Estonia, France, Georgia, Germany, Ireland, Kazakhstan, Kyrgyzstan, Macedonia, Moldova, Monaco, Montenegro, Romania, Russia, San Marino, Serbia, Slovenia, Tajikistan, Turkey, Turkmenistan, Ukraine, Uzbekistan.
Reducing the burden of diet-related NCDs and all forms of malnutrition by: 1. Creating healthy food and drink environments 2. Promoting the gains of a healthy diet throughout life, especially for the most vulnerable groups 3. Reinforcing health systems to promote healthy diets 4. Supporting surveillance, monitoring, evaluation and research 5. Strengthening governance, alliances and networks to ensure a health-in-all-policies approach
New data on policy implementation in countries
Creating healthy food and drink environments Examples of priority policy options Strong controls on marketing, incl. but not limited to TV advertising Fiscal measures and price policies applied to foods and drinks Consumer-friendly front of pack labelling Reformulation, calorie reduction, smaller portions Healthier food retail environment, incl. in schools
% of countries (n=46) Food reformulation strategies: by nutrient 100% 90% 80% 70% Always mandatory Mandatory for some food and beverages categories Always voluntary 60% 50% 40% 30% 20% 10% 0% 24% 13% 2% 2% 9% 2% Saturated fatty acids Trans fatty acids Sugars Salt/sodium 28% 9% 39% 17%
% of countries (n=46) Food reformulation strategies: specific targets? 30% 15% 17% 11% Saturated fatty acids Trans fatty acids Sugars Salt/sodium
Salt reduction is working! But greater effort needed
Food categories targeted to reduce the content of salt Bread & bread products Processed meat and similar Ready-made foods and composite dishes Cheese Sauces, dips and dressings Breakfast cereals Savoury snacks More action needed Butter & margarines
Trans fatty acids mandatory legislation Countries with a current (red) or soon-to-be implemented (yellow) legislative ban on trans-fatty acids in food products
Studies implemented in 6 countries A typical biscuit wafer contained up to 170% of the WHO recommended maximum intake of trans-fats An average-sized bowl of soup contained 125% of the WHO recommended maximum intake of salt
Food reformulation assessment of progress Good progress but more needs to be done, especially on sugar in children s foods and saturated fat Efforts are needed across a broader range of product categories and for options at different price levels Consider food service outlets and other non-retail settings
Countries reporting health-related taxes in Europe 2 nd Evaluation
Evaluating impact of taxes - Hungary Proportion of people who changed consumption, according to weight status Source: WHO Europe, Assessment of the impact of a public health product tax: Hungary
Estonia building the case for action With WHO support, Estonia produced an evidence brief for policies to reduce the consumption of SSBs: Regulation of food marketing Clear labelling Tighter school food restrictions Taxation Concluded that a tax of 10-15% would reduce consumption Used to inform national policy debates, and a tax was announced and agreed by Parliament in 2017. Final agreement and adoption by government still required
Labelling: providing greater guidance to consumers
Source: http://bit.ly/pan_nutriscore Development of a new front-ofpack nutrition label in France the five colour Nutri-Score
Interpretative elements remain underused in region Nutrient declaration 90% Front-of-pack labelling 75% Consumer-friendly front-of-pack labelling based on symbols, 27% List of ingredients 98% Menu labelling 17% % of countries (n=48)
% of countries (n=47) School food policies or related standards 47 COUNTRIES IN WHO EURO REGION REPORT HAVING SHN POLICIES, PROGRAMMES OR 60% 51% 43% RELATED STANDARDS BEING IMPLEMENTED 15% 11% 9% Foods and beverages served for lunch in school canteens/cafeterias Foods and beverages served at other mealtimes All foods and beverages being sold in school shops/stores Foods and beverages available at school events Foods and beverages being sold in immediate vicinity of schools Packed lunches, and other foods or beverages brought from home
Promoting optimal infant and young child feeding Ongoing WHO project commercial complementary foods
Address excess weight gain among pregnant women Extend the duration of exclusive breastfeeding (goal 50% ) Monitor and act on the inappropriate promotion of commercial complementary foods
Reinforcing health systems to promote healthy diets Examining capacity for nutrition MS Integrating diet, physical activity and weight management services PHC Counselling on healthy diets
Nutrition counselling in primary care: target groups All users of primary health care 47% Pregnant and lactating women Adults Women of reproductive age Caregivers of children Older people Adolescents 18% 18% 16% 16% 13% 13% Overweight or obese individuals only Other 4% 7% % of countries (n=45)
% of countries (n=49) Communicating with the public: dietary guidelines 43 countries reported having NATIONAL DIETARY GUIDELINES 80% 41% 35% Food-based dietary guidelines Nutrient-based dietary guidelines Both
% of countries (n=48) Communicating with the public: media campaigns Raise awareness on... 40% 38% 17% 23% 17% 8% Health effects of high intake of fats, sugars and salt/sodium How to consume healthier diets, including how to include more F&V in the diet Portion size control How to use nutrition labels How to interpret nutrition and health claims Other