Fortification, NCD, food safety and food security in the Pacific

1. Fortification, NCD, food safety and food security in the Pacific Presentation on �Adding Value to Pacific Food� Mtg Sydney 05 � 07 Nov Dr Chen Ken

2. Outline Pacific Health Status The current efforts & responses The challenges for this meeting

3. Like global health, Pacific health is also in transition Epidemiologically NCD is overriding CD with injury emerging making it the triple burden of disease in some of our pacific island countries. The people in the pacific are aging and nutritionally diets have dramatically changed from what used to be fresh local foods traditionally prepared to mostly manufactured foods with ease of preparation that sometimes are not as healthy. Urbanization and globalization also have their effects.Like global health, Pacific health is also in transition Epidemiologically NCD is overriding CD with injury emerging making it the triple burden of disease in some of our pacific island countries. The people in the pacific are aging and nutritionally diets have dramatically changed from what used to be fresh local foods traditionally prepared to mostly manufactured foods with ease of preparation that sometimes are not as healthy. Urbanization and globalization also have their effects.

4. In doing NCD STEPS survey in the pacific there has been categorization of high risk for NCD as defined in the bottom of the slide and a significant proportion of the populations in countries surveyed had more than three of the major risk factors and classified as high risk. One of the main risk factors as mentioned before is reduced consumption of fruits & vegetables In doing NCD STEPS survey in the pacific there has been categorization of high risk for NCD as defined in the bottom of the slide and a significant proportion of the populations in countries surveyed had more than three of the major risk factors and classified as high risk. One of the main risk factors as mentioned before is reduced consumption of fruits & vegetables

5. Like global health, Pacific health is also in transition Epidemiologically NCD is overriding CD with injury emerging making it the triple burden of disease in some of our pacific island countries. The people in the pacific are aging and nutritionally diets have dramatically changed from what used to be fresh local foods traditionally prepared to mostly manufactured foods with ease of preparation that sometimes are not as healthy. Urbanization and globalization also have their effects.Like global health, Pacific health is also in transition Epidemiologically NCD is overriding CD with injury emerging making it the triple burden of disease in some of our pacific island countries. The people in the pacific are aging and nutritionally diets have dramatically changed from what used to be fresh local foods traditionally prepared to mostly manufactured foods with ease of preparation that sometimes are not as healthy. Urbanization and globalization also have their effects.

7. A battle with two frontlines Over nutrition � NCD Under nutrition Vitamin and mineral deficiencies (VMD) Affect a substantial proportion of Pacific island populations. Iron deficiency anemia (IDA) A moderate or severe public health problem in 18 PICs Vitamin A deficiency (VAD) in 5 PICs and in Micronesia and the Marshall Islands some of the highest rates in the world have be recorded.

8. The prevalence of anemia in the PICs as shown by this slide is indicative of the micronutrient deficiencies that still poses a problem in the pacific. WHO considers any anemia prevalence above 5% as a public health problem.The prevalence of anemia in the PICs as shown by this slide is indicative of the micronutrient deficiencies that still poses a problem in the pacific. WHO considers any anemia prevalence above 5% as a public health problem.

9. The consequences of VMD may be invisible But it may cause serious problems Iron and iodine can result in reduced cognitive and intellectual development in children and in decreased physical productivity among adults VAD can lead to increased morbidity and mortality among children under 5 years of age Folate is associated with increased rates of neural tube defects at birth.

10. THE COMMON LINK IS FOOD Over nutrition � NCD Under nutrition � many other health problems.

11. Health in the Pacific: Double burden of disease and double burden of nutrition Noncommunicable diseases (NCD) are the leading causes of death (75% of all deaths) whilst Communicable Disease is still plaguing the population Obesity rates in the PICs are some of the highest in the region and the world but at the same time, under nutrition is still a public health problem in the Pacific region. The pacific generally faces a double burden of disease in that NCD has overridden CD as major cause of morbidity and mortality. For nutrition, whilst on one hand we have high rates of obesity which is an intermediate risk factor for NCD, there is still coexistence of vitamin and mineral deficiencies in sometimes the same individual, family, community and nation. Protein energy malnutrition still exists as well in some of the countries in PICs. It is important to realize that a common link to all these is FOOD and DIET The pacific generally faces a double burden of disease in that NCD has overridden CD as major cause of morbidity and mortality. For nutrition, whilst on one hand we have high rates of obesity which is an intermediate risk factor for NCD, there is still coexistence of vitamin and mineral deficiencies in sometimes the same individual, family, community and nation. Protein energy malnutrition still exists as well in some of the countries in PICs. It is important to realize that a common link to all these is FOOD and DIET

12. The costs of treating NIC in some Pacific communities compared to the costs of treating other diseases

13. This slide emphasizes the double burden of nutrition. High rates of obesity coupled with accompanying relatively high rates of anemia in the same countryThis slide emphasizes the double burden of nutrition. High rates of obesity coupled with accompanying relatively high rates of anemia in the same country

14. Current Efforts and Responses

15. Healthy Islands, should be places where... children are nurtured in body and mind; environments invite learning and leisure; people work and age with dignity; ecological balance is a source of pride. Yanuca Declaration (1995) In the first meeting of Ministers of Health in the Pacific in Yanuca in Fiji in 1995, the theme or vision of �healthy islands� was coined and defined as such. This is an important envisioning by Leaders in health and signaled the start of holistic look at the health of the pacific and began a process which has resulted in a lot of important milestone development in health in the pacific including this important meeting and dialogueIn the first meeting of Ministers of Health in the Pacific in Yanuca in Fiji in 1995, the theme or vision of �healthy islands� was coined and defined as such. This is an important envisioning by Leaders in health and signaled the start of holistic look at the health of the pacific and began a process which has resulted in a lot of important milestone development in health in the pacific including this important meeting and dialogue

16. In 2004 the WHO DPAS was passed in the General Health Assembly and has been implemented in the pacific and I have included three recommendations as examples of what is contained within the strategy and has been implemented in the pacific In 2004 the WHO DPAS was passed in the General Health Assembly and has been implemented in the pacific and I have included three recommendations as examples of what is contained within the strategy and has been implemented in the pacific

17. Food Summit - Vanuatu Commitment - Convene a Food Summit at the Pacific regional level or at the sub-regional level with representatives from concerned ministries such as Health, Agriculture, Trade and Finance. Due considerations to the health implications of economic development and trade Support in principle the establishment of a regional fortification programme for the Pacific island countries to help alleviate VMD in the Pacific. There has been a biennial meeting of ministers ever since 1995 in Fiji organized by WHO and SPC and during the latest one in Vanuatu in 2007 certain recommendations were made and two important ones I have included in this slideThere has been a biennial meeting of ministers ever since 1995 in Fiji organized by WHO and SPC and during the latest one in Vanuatu in 2007 certain recommendations were made and two important ones I have included in this slide

18. THE PACIFIC FORTIFICATION PARTNERS GROUP (PFPG) Headed and approved by Pacific leaders Provides the technical direction - Decides what foods should be fortified Establishes a regional fortification standard for each food selected Develops model national legislation for mandatory fortification of certain foods and for voluntary fortification of other foods Develops a regional fortification agreement for inclusion in the Pacific Plan Monitors and evaluates the Fortification Programme Defines roles and responsibilities of the PFPG, allocation of resources and timelines.

19. WHO and FAO has done work together in the area of food and nutrition and one of the recent events was the meeting on Food Standards in 2007 which resulted in a paper presented at the CODEX meeting last week in Tonga with recommendations to to establish guidance on what levels of fat, trans-fat, sugar and salt in foods should be labelled as �high�; to advance work on an international consumer-friendly nutrient content food labelling system; provide guidance to Pacific island countries on a common approach to reducing the role that processed foods plays as a NCD risk factor; and discuss the important role that food fortification can play in alleviating VMD where imported processed foods play a major role. Colleague from FAO will talk more on Food securityWHO and FAO has done work together in the area of food and nutrition and one of the recent events was the meeting on Food Standards in 2007 which resulted in a paper presented at the CODEX meeting last week in Tonga with recommendations to to establish guidance on what levels of fat, trans-fat, sugar and salt in foods should be labelled as �high�; to advance work on an international consumer-friendly nutrient content food labelling system; provide guidance to Pacific island countries on a common approach to reducing the role that processed foods plays as a NCD risk factor; and discuss the important role that food fortification can play in alleviating VMD where imported processed foods play a major role. Colleague from FAO will talk more on Food security

20. NCD in the PACIFIC2-1-22 Pacific NCD Programme -WHO-SPC initiative: 2008 � 2011- Programme of support for PICTs in NCD Prevention and Control that focuses on 5 pillars on intervention: Environmental (Policy, social and built) Lifestyle Clinical Surveillance Advocacy The Pacific NCD Framework formed the basis for the 2-1-22 Pacific NCD Programme of activities to support PICTs in their efforts to address NCDs with support from AusAID and NZAID. Under the concept of 2 organisations, working together as 1 Team for 22 PICTs, the programme aims to improve coordination and harmonisation of efforts to support the countries better in their respective NCD prevention and control efforts. There are 5 main pillars of intervention which include Environmental (both policy and built), Lifestyle, Clinical, Surveillance and advocacy. It has set itself the goal of reducing morbidity, disability and mortality rates of NCDs and their risk factors within the Pacific � so as to contribute to the global goal of reducing death rates from NCDs by 2% per year over and above existing trends until 2015. The Pacific NCD Framework formed the basis for the 2-1-22 Pacific NCD Programme of activities to support PICTs in their efforts to address NCDs with support from AusAID and NZAID. Under the concept of 2 organisations, working together as 1 Team for 22 PICTs, the programme aims to improve coordination and harmonisation of efforts to support the countries better in their respective NCD prevention and control efforts. There are 5 main pillars of intervention which include Environmental (both policy and built), Lifestyle, Clinical, Surveillance and advocacy. It has set itself the goal of reducing morbidity, disability and mortality rates of NCDs and their risk factors within the Pacific � so as to contribute to the global goal of reducing death rates from NCDs by 2% per year over and above existing trends until 2015.

21. This meeting is important and timely NCDs are the leading courses of death and morbidity in Pacific islands. There is double burden of nutritional problems in the pacific Current efforts are on-going by member states, WHO and partners on education and promotion of healthy food. 2008 global food crisis We have supports from leaders.

22. There is a need to do more Other sectors Other ministries Private sectors including industry Communities and individuals actions

23. This meeting is special. This meeting is different. Topic: Food and NCD, Food and nutrition, Food and health, food and health and multi-sectors approach/efforts � Adding Value to Pacific Island Foods Participants: Health authorities, food industry, international and regional organizations, academic institutions, development partners Outcome: work together, take action together

24. We may have a lot of differences. But our final purpose is the same: for health and wellbeing of Pacific people. Recognize the difference Find out the common points and common interests. Get agreement on those common points. Take actions together on those areas with common interests.

25. More and Less More healthy food Fruits, Vegetables, V and M rich food Less unhealthy food Fat food, sugar, salt

26. More than more and less How to benefit health and prevention of disability and diseases Regulation Taxation Advocacy Participation and partership

28. The five E�s of healthy lifestyle forms the basis of our action in this meeting � It needs to start Early, made Easy, Exciting & Enjoyable and done everywhere. WE NEED TO MAKE THE HEALTHIEST CHOICE ALSO THE EASIEST CHOICE in regards to food.The five E�s of healthy lifestyle forms the basis of our action in this meeting � It needs to start Early, made Easy, Exciting & Enjoyable and done everywhere. WE NEED TO MAKE THE HEALTHIEST CHOICE ALSO THE EASIEST CHOICE in regards to food.