Multisectoral action to improve nutrition throughout the life course for the prevention of NCD

1. WHO – Lausanne University Seminar on Non Communicable Diseases Geneva, 12 August 2010 Multisectoral action to improve nutrition throughout the life course for the prevention of NCD F.Branca Director, Department of Nutrition for Health and Development WHO

2.  Nutritional influences throughout the life course

3. United Nations Subcommittee on Nutrition Fourth Report on the World Nutrition Situation, 2000

4. Mentaldevelopment and function Early nutritional exposure Stature and mass Body composition Work capacity Obesity Diabetes Hypertension Heart disease Cancer CHO metabolism Fat metabolism Blood pressure

5. Life course influences on nutrition Adolescence FetalLife Infancy andChildhood Adult Life Elderly Established adult risky behaviours Diet/Physical activity, Tobacco, Alcohol Biological risks Socioeconomic status Environmental conditions Breast Feeding SES Infection PEM Micronutrients Growth rate Tallness Physical Activity Food behaviour TV viewing Soft drinks WHO/NMH/NPH/ALC, 2001 Obesity Smoking Physical Activity Food behaviour TV viewing Soft drinks Development of Malnutrion SES Mother’s Nutrition Growth birth weight Accumulated risk Genetic susceptibility to Malnutrition Age

6.  The multifaceted challenge of malnutrition Malnutrition should be dealt in all its forms (underweight, wasting, stunting and overweight, as well as micronutrient deficiencies and nutrition-related chronic diseases)

7. Percent low birth weightUNICEF/WHO estimates circa 2000(187 countries)

8. Exclusive breastfeeding rates in children <6 months are stalling Global Trend

9. Children 6-23 months receiving the minimum number of food groups in sub-Saharan Africa (percent)

10. 186 million children under 5 are stunted Prevalence of Stunting

11. Category of public health significance (anaemia prevalence) Normal (<5.0%) Mild (5.0-19.9%) Moderate (20.0-39.9%) Severe (≥40.0%) No Data 293 million children under 5 are anemic Source: WHO Global database on Anaemia, 2006

12. Over 400 million adultsare obese

13. The double burden of malnutrition Source: WHO Global Database on Child Growth and Malnutrition

14. Households with double burden (Caballero B. NEJM 352:1514 2005)

15. Early stunting and adolescent obesity in South Africa Source : Kimani-Murage et al. BMC Public Health 2010, 10:158

16.  Changing food systems

17. Changes in food systems Source : FAO, 2004

18. Growth of transnational food companies • Greater availability, greater accessibility, lower prices and greater desirability for energy-dense processed and fast foods • Transformation of the food supply chain and food systems as a whole by stimulating new forms of competition, introducing new ways to sell and promote foods, and creating new cultural identities for different foods Source : Hawkes, 2007

19. Growth of supermarkets • Shifting demand for home-produced foods or foods purchased in open markets to increased dependence on store-bought foods supplied by transnational food companies • Expanding available food choices, especially of processed foods (e.g., soft drinks, snacks, baked goods and dairy products) Source : Hawkes, 2007

20. Foreign Direct Investment • the allocation of investment has shifted away from products for export to the home market and products produced by primary processing, towards highly processed foods for sale in the host market • FDI has played a role in the nutrition transition by increasing the amount of highly processed foods in the global diet

21. The food crisis • Dramatic rise of food prices coupled with shortages of food stocks, seeds, fertilizers, finance and high fuel prices threat global food and nutrition security • Creates various humanitarian, human rights, socio-economic, health and political-related challenges • Rise of food prices not due to any specific climate shock or other emergency • Results from cumulative effects of long-term trends e.g. lack of agricultural sector investment, rising demand for food due to economic growth, trade distorting subsidies, bio-fuels

22. Food systems affected by financial volatility and recession Source: Joachim von Braun, IFPRI, October 2009. Data from IMF 2009; Ratha, Mohapatra, and Silwal. 2009; UNCTAD 2009, and World Bank 2009

23.  Interventions and strategies

24. Integrated food and nutrition action • Inadequate foetal development • Lack of breastfeeding • Inappropriate complementary feeding • Child under nutrition • Low fruit and vegetable intake • High salt (NaCl) intake • Saturated fat and trans fatty acid intake • High blood pressure • High cholesterol • Overweight and obesity • Physical inactivity

25. Evidence based maternal nutrition interventions • All Countries • Iron folate supplementation • Maternal supplements of multiple micronutrients • Maternal iodine through iodization of salt • Maternal calcium supplementation • Interventions to reduce tobacco consumption or indoor air pollution • Specific Situational Contexts • Maternal supplements of balanced energy and protein • Maternal iodine supplements • Maternal deworming in pregnancy • Intermittent preventative treatment for malaria • Insecticide-treated bednets

26. Effective actions to improve fetal development ?

27. Infant and Young Child Feeding • Protection, promotion and support of appropriate IYCF • Exclusive breast feeding for 6 months • Complementary feeding (need strengthening and support for use of local foods, food fortification, micronutrient supplementation) • Feeding of IYC in difficult circumstances (HIV, malnutrition, emergencies, LBW) • Health services • Baby Friendly Hospital Initiative • Pre-service education and in-service training • Maternity protection • Code of marketing of breastmilk substitutes • Monitoring and evaluation

28. ACTION AREAS • Supporting a healthy start • Ensuring safe, healthy and • sustainable food supply • Providing comprehensive • information and education • to consumers • Implementing integrated actions • Strengthening nutrition and • food safety in the health sector • Monitoring and evaluation • HEALTH CHALLENGES • Diet related noncommunicable diseases • Obesity in children • and adolescents • Micronutrient deficiencies • Foodborne diseases The European Food And Nutrition Action Plan

29. PAHO regional strategy on nutritionin health and development (2006-2015) • Food and Nutrition in Health and Development • Objective: To promote integration of nutrition into social and economic policies and plans in order to meet nutritional needs throughout the life course and to tackle nutrition transition problems at regional, subregional, national, and local levels • Suboptimal Nutrition and Nutritional Deficiencies • Objective: To reduce nutritional deficiencies and suboptimal nutrition through prevention and treatment strategies targeted towards vulnerable groups throughout the life course and in the event of disasters • Nutrition and Physical Activity in Obesity and Nutrition-related Chronic Diseases • Objective: To promote the adoption of healthy dietary habits, active lifestyles, the control of obesity- and nutrition-related chronic diseases.

31. Eastern Mediterraneandraft nutrition strategy and plan of action 2010-2019 • Increasing political commitment for nutrition • Supporting a healthy start by promoting and protecting the nutritional well-being of women and children and ensure good nutrition throughout the life-cycle for all age groups • Ensuring a safe, healthy and sustainable food supply • Promoting food with adequate micronutrient content • Providing comprehensive information and education to the public • Carrying out integrated actions to address noncommunicable disease related determinants • Strengthening nutrition and food safety • Improving nutrition services and capacity building in the health sector • Monitoring, evaluating and conducting research into nutrition • Building capacity for nutritional care and support in emergency situations

32.  Country strategies and plans

33. Global Review of food and nutrition policies • Questionnaire circulated to 193 WHO Member States • 117 respondents (Ministry of Health) • Additional sources for data validation and integration

34. 90 79 80 75 70 67 66 65 62 62 60 57 57 55 52 52 51 50 50 50 50 47 46 46 % 43 40 35 32 31 28 30 24 22 18 20 10 5 3 1 0 EMR AFR EUR SEAR WPR AMR Components of food and nutrition policies Underweight Overweight IYCN Vitamins and Minerals All four areas

35. Labelling Components of overweight policies 100 100 95 89 88 88 86 86 80 80 77 77 80 75 75 73 73 71 71 70 70 70 69 68 62 60 57 60 % 50 50 50 50 43 43 43 39 39 38 40 28 25 25 25 23 20 7 6 0 AFR EUR WPR AMR EMR SEAR FBDG Marketing Food and beverages Reporting policies Promotioin of fruits and vegetables Media Counselling in Primary Care

36. 100 92 90 80 73 70 66 63 60 55 50 45 % 40 30 25 17 20 15 14 9 8 7 10 4 2 0 0 0 0 AFR EUR WPR AMR EMR SEAR Nutrition governance President or Prime Ministers Office Ministry of Health Ministry of Agriculture

37. Country "readiness to act" Ready Good opportunity to accelerate action Need to help build capacity Readiness Factor MCU groups (from stunting and anemia level and trend)

38. Slovenia : health in all policies(FNAP 2005-10) • CAP Fruit School Scheme (2009/10) : 75 % participating primary schools, involving agriculture, education and health sector. • Education sector : School nutrition programs. In 2008 - all children 1-18 eat up to four cooked meals per day in the public education institutions. Up to one third of meals are distributed for free and the rest of them are subsidized by the state budget. • Finance : differentiation in taxation of different types of foods • Culture : reducing marketing pressure to children • Social affairs : nutrition for undeprivileged population groups. • Activities with private sector (with public health leadership) : reformulation of food products,

39. France : Plan National Nutrition et Santé • information, communication and education • action in the health system • intervention over the economic stakeholders and consumers • Multistakeholder representation (Ministries of agriculture, education, consumption, research young and sports, health agencies, research institutes, local and regional governments, food industry, mass caterers, retailers, producers and consumers)

40. France A federative logo For local governments Municipalities and districts

41. Norway : Diet Action Plan (2007 – 2011) • Improved availability of healthy food and hinder access to unhealthy food/drinks 2. Increased knowledge in all parts of the population 3. Building competence and awareness among stakeholders and key groups 4. Stronger local basis for action through partnership and integrated public health approaches 5. Strengthening nutrition in prevention and treatment within the health and care system

42. Western Pacific – legislative action • Taxation on beverages (American Samoa, Fiji) • Taxation on foods (Fiji. PNG, Samoa, Solomon Islands) • Taxation on foods and drinks for the establishment of a prevention fund (French Polinesia) • Import laws (Cook Islands, Micronesia, Fiji) • Restrictions on the use of ingredients with little nutritonal value (Fiji) • Controls on advertising (Fiji) Source : Clarke & Mc Kenzie, WHO, 2007

43. Western Pacific - non-regulatory • School programs (American Samoa , Cook Islands, Micronesia, Fiji, French Polynesia, Marshall Islands, Niue, Palau, Samoa) • Community awareness programs (Micronesia, Samoa, Solomon Islands, Tonga, Tuvalu) • Workplace programmes (Samoa, Solomon Islands, Tonga) • Healthy stores programs (Marshall Islands) • Media awareness campaigns (Cook Islands, Fiji, French Polynesia, Marshall Islands, Solomon Islands, Tonga) • Promotion of healthy diet (French Polynesia, Guam) • Training of health professionals (French Polynesia, Tonga) • Counselling in primary care (Tuvalu, Vanuatu) • Hospital based promotion (Samoa) Source : Clarke & Mc Kenzie, WHO, 2007

44. http://www.who.int/nutrition/en/index.html