The challenge of noncommunicable diseases for health in Europe: Implications for dietitians

The challenge of

noncommunicable

diseases for health in

Europe: Implications for

dietitians

The challenge of noncommunicable diseases for health in Europe: Implications for dietitians

8 November 2013

Trudy Wijnhoven

Technical Officer

Nutrition, Physical Activity and Obesity Programme

Division of Noncommunicable Diseases and Life-course

Outline

1. Introduction to WHO

2. Policy and global monitoring

frameworks

3. Burden of noncommunicable

diseases


8 November 2013

4. Nutrition policy actions in the

European Region

5. Role of dietititans


8 November 2013

1. INTRODUCTION TO WHO

Structure

• Specialized agency within the Charter of the United Nations (1948)

• 194 Member States

• One WHO, but decentralized structure:


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• One WHO, but decentralized structure:

– Headquarters - Regional Offices - Country Offices

• Governing bodies:

– World Health Assembly - Executive Board

WHO Country and Regional

offices


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WHO is primarily responsible for:

• Providing leadership on global health matters

• Shaping the health research agenda

• Setting norms and standards


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• Setting norms and standards

• Articulating evidence-based policy options

• Providing technical support to countries

• Monitoring and assessing health trends


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2. POLICY AND GLOBAL

MONITORING FRAMEWORKS

Political declaration on NCDs:

Surveillance: Calls for a monitoring framework and global and national

targets and indicators.

Prevention: Calls on Member States to accelerate the implementation of

the WHO FCTC, the Global Strategy on Diet, Physical Activity and

Health, and the Global Strategy to Reduce the Harmful Use of Alcohol

and cost-effective interventions.


8 November 2013

and cost-effective interventions.

Management: Calls on Member States to strengthen health systems that

support primary care and prioritise early detection and treatment and

improve access to affordable essential medicines for NCDs.

Comprehensive global monitoring framework


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Nutrition, obesity and physical activity:major achievements but big challenges

European Charter on Counteracting

Obesity and the Food and Nutrition Policy

Action Plan

• Established and scaled-up monitoring and

surveillance systems


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surveillance systems

• 49 Member States developed or updated

national policies

• Several Member States evaluated

national policies

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

RENEWED

MANDATE FOR

ACTION


8 November 2013


8 November 2013

3. BURDEN OF

NONCOMMUNICABLE

DISEASES

Noncommunicable diseases

and risk factors


8 November 2013

NCDs increasing….


8 November 2013

Source:

http://www.who.int/mediac

entre/factsheets/fs310/en/i

ndex.html

NCDs as leading causes of mortality


8 November 2013

Source: http://www.who.int/mediacentre/factsheets/fs310/en/index.html

Source: Capewell S, O’Flaherty M. Rapid

mortality falls after risk-factor changes in

populations. The Lancet Published Online

March 16, 2011 DOI:10.1016/S0140-

6736(10)62302-1.

“Extensive empirical and trial evidence shows that substantial reductions in substantial reductions in mortality can occur within months of decreases in smoking, and within 1–3 years of dietary changes…”

GBD – attributable for 20 risk

factors as % DALY - 2010

15 out of 20 risk factors linked with nutrition and PA Source: Lim & al. 2012

Prevalence of overweight (%) among adult men (BMI ≥25.0 kg/m2)

50

55

60

65

70

Austria, 20+Belgium, 18+Denmark, 16+Estonia, 16–64Finland, 15–64France, 15+Germany, 18+Ireland, 18+Italy, 18+Latvia, 15–64United Kingdom, Scotland, 16–64Lithuania, 20–64Luxembourg, 16+


8 November 2013

25

30

35

40

45

1994 1997 2000 2003 2006 2009 2012

Prevalence of overweight (%) among adult men (BMI >25.0 kg/m2)

Luxembourg, 16+Netherlands, 20+Norway, 16+Portugal, 18–64Spain, 18+Sweden, 16–84Switzerland, 15+United Kingdom, Wales, 16+United Kingdom, England, 16+

Source: WHO

Regional Office for

Europe

Prevalence of overweight (%) among adult women (BMI ≥25.0 kg/m2)

50

55

60

65

70Armenia, 15–49Austria, 20+Belgium, 18+Denmark, 16+Estonia, 16–64Finland, 15–64France, 15+Germany, 18+Ireland, 18+Italy, 18+Latvia, 15–64Lithuania, 20–64Luxembourg, 16+Netherlands, 20+


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25

30

35

40

45

1994 1997 2000 2003 2006 2009 2012

Netherlands, 20+Norway, 16+Portugal, 18–64Spain, 18+Sweden, 16–84Switzerland, 15+Turkey, 15–49United Kingdom, Wales, 16+United Kingdom, England, 16+United Kingdom, Scotland, 16–64

Source: WHO

Regional Office for

Europe

HBSC – key findings 2009/2010

– age changes

• Health behaviours – all worsen

• Overweight and obesity – all increase

• Breakfast – decreases in both boys and girls


8 November 2013

• Breakfast – decreases in both boys and girls

• Fruit – decreases in both boys and girls

• Physical activity – decreases in both boys

and girls

10.0

12.0

14.0

16.0

18.0

20.0

Gra

ms

Salt intake per person per day for adults in the WHO European

Region from individual country-based surveys, various years

Source: WHO

Regional Office for

Europe


8 November 2013

0.0

2.0

4.0

6.0

8.0

10.0

TU

R

HU

N

HR

V

MK

D

CZ

E

BG

R

SV

N

PR

T

RO

U

SW

E

ES

T

ES

P

ITA

LUX

FR

A

CH

E

LTU

IRL

GB

R

DN

K

NO

R

AU

T

NLD

SV

K

FIN IS

L

DE

U

AN

D

LVA

BE

L

ISR

PO

L

CY

P

ALB

AR

M

AZ

E

BLR BIH

GE

O

GR

C

KA

Z

KG

Z

MLT

MC

O

MN

E

MD

A

RU

S

SM

R

SR

B

TJK

TK

M

UK

R

UZ

B

Gra

ms

Country

WHO/FAO RECOMMENDATION - <5 grams

No data

40.0

50.0

60.0

70.0

Prevalence of exclusive breastfeeding under or at 6

months of age in the WHO European Region from

individual country-based surveys, various years

Source: WHO

Regional Office for

Europe


8 November 2013

0.0

10.0

20.0

30.0

AN

D

ES

T

FR

A

MC

O

RU

S

SM

R

GB

R

GR

C

BG

R

ITA

IRL

LUX

SV

N

BE

L

BLR

AU

T

SW

E

GE

O

TK

M ISR

AZ

E

NO

R

CY

P

RO

U

CH

E

SR

B

FIN

LVA

BIH

CZ

E

NLD

UK

R

MN

E

ISL

PO

L

DE

U

MK

D

TJK

UZ

B

LTU

ES

P

SV

K

KA

Z

PR

T

AR

M

MLT

HU

N

ALB

TU

R

MD

A

HR

V

KG

Z

DN

K

Pe

rce

nta

ge

Country

No data

Europe

Nutrition National Survey -

Tajikistan• 30% Stunting

• 28% (42% Dushanbe) overweight women reproductive


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reproductive age

• Micronutrient deficiencies (iron, vit. D, iodine…)


8 November 2013

4. NUTRITION POLICY

ACTIONS IN THE EUROPEAN

REGION

Overview Policy Actions Implementation 53 WHO/Europe Member States – 2012/13

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


8 November 2013

Po

licy

Acti

on

s

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

No Action Partially implemented Fully implemented

Source: WHO Regional Office for Europe

No action

reported

Partially or fully

implemented

Countries (N) 20 33

Great progress in certain areas

MKT HFSS foods policies


8 November 2013

20 33

No action

reported

Partially or fully

implemented

Countries (N) 23 30

Salt reduction policies

Brinsden et al. Surveys of the salt content in UK bread: progress made and

further reductions possible. BMJ Open 2013

Salt content in bread in repeated surveys - UK, 2001–2011


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5. ROLE OF DIETITIANS

Vienna Declaration (1)

• Priority area 1 - Create healthy food and

drink environments and encourage

physical activity for all population

groups


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groups


• Priority area 2 - Promote the health

gains of a healthy diet throughout the

life-course, especially for the most

vulnerable


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vulnerable


• Priority area 3 - Reinforce health

systems to promote health and to

provide services for NCDs


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• Priority area 4 - Support surveillance,

monitoring, evaluation and research of

the population’s nutritional status and

behaviours


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behaviours


• Priority area 5 - Strengthen governance,

alliances and networks and empower

communities to engage in health

promotion and prevention efforts


8 November 2013

promotion and prevention efforts

Contact: [email protected]


8 November 2013

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The challenge of noncommunicable diseases for health in Europe: Implications for dietitians

Health & Medicine