A/Prof. Roya Kelishadi Vancouver, 7 June 2007

A/Prof. Roya Kelishadi Vancouver, 7 June 2007 The Global Strategy on Diet, Physical Activity and Health: A School Policy Initiative Outcomes of the Expert Roundtable

in close collaboration with Public Health Agency Canada & Health Canada

Participants Temporary advisers: • Ms Kelly Stone (Chairperson) • Associate professor Roya Kelishadi (Rapporteur) • Dr Mary McKenna (Background paper nutrition) • Dr Claire MA LeBlanc (Background paper physical activity) • Dr Carmen Aldinger • Ms Louise Aubrey • Dr Goof Buijs • Professor Ji Chengye • Dr Anniza de Villiers • Mr Joe Doiron • Ms Ann Ellis • Dr Lawrence St. Leger • Ms Lisa Mawani • Dr Sonia McGeorge • Associate professor Ladda Mo-Suwan • Ms Patricia Walsh WHO Secretariat: • Ms Tilly de Bruin • Dr Ulla Uusitalo (Nutrition-Friendly Schools Initiative)

Agenda • Background • Satellite Expert Roundtable • Next steps

Did You Know? 35 000 000 people died worldwide from chronic diseases in 2005

Main Causes of Death Cardiovascular disease (mainly heart disease & stroke) Cancer Chronic respiratory diseases Diabetes Source: WHO, Preventing Chronic Diseases, 2005

Not only in Rich Countries Source: WHO, Preventing Chronic Diseases, 2005

Causes of Chronic Diseases 80% 80% 40% N.A. 80%

Risks are Increasing Source: WHO, Preventing Chronic Diseases, 2005

The Global Strategy on Diet Physical Activity and Health www.who.int/dietphysicalactivity

Objectives of DPAS • Reduce risk factors for chronic diseases that stem from unhealthy eating and physical inactivity through public health actions; • Increase awareness and understanding of importance healthy eating and physical activity on health; • Develop, strengthen, implement global, regional, national policies, plans etc to improve healthy eating and increase physical activity that are sustainable, comprehensive and actively engage all sectors; • Monitor science and promote research on healthy eating and physical activity.

What has WHO done? • Activities at the global level: • Tools • Physical activity • Fruit and vegetables • Monitoring and Evaluation • Reducing salt intake in population • Global interactions: • Private sector • UN Agencies • Activities at the regional level: • Implementation workshops in the Americas, South-East Asia and Western Pacific; • Implementation workshop in the Eastern-Mediterranean region and Africa in 2007; • Ministerial Conference on Counteracting Obesity in Istanbul (EURO)

Although there are already many school initiatives… There is not yet a global WHO policy tool: • aimed at governments (macro-level) • focused on how to improve healthy eating and increase physical activity • via the school setting. A considerable amount of knowledge and experience is available to build upon: • incorporate this knowledge • make sure DPAS School Policy Initiative follows from these initiatives. Member States need a DPAS School Policy Initiative

Goal of the school policy initiative To primarily guide policy makers at (sub)national level in the development and implementation of policies that promote healthy eating and physical activity in the school setting, through environmental, behavioral and educational changes Specific characteristics: • Macro level: policy makers at (sub)national level • Focus on healthy eating and physical activity • Focus at school setting • Development and implementation • Global tool that is applicable both in developed countries as in developing countries

Overarching key messages (I) • Take a positive approach to healthy eating and physical activity • High level policy that will allow for national, regional and local implementation • Need to turn the policy into action (political will, stakeholder engagement, human resources, financial resources etc) • Both individual and environmental issues should be considered • Consideration of the UN Convention on the Rights of the Child (CRC) as an underpinning for action • Ownership of both education and health sectors

Overarching key messages (II) • Process is critical for buy-in of all stakeholders • Build upon on overarching framework of Health Promoting Schools including mental health • There is no one-size-fits-all solution for low-, middle and high income countries • Cultural relevant • Children/school as change agents for communities (empowering children)

Key principles • The Global Strategy on Diet, Physical Activity and Health (DPAS) • UN Convention on the Rights of the Child (CRC) • Multisectoral and multistakeholder • Notion of engagement by youth for youth (empowerment, participation and action) • Determinants of health

Policy options • STEP-wise approach with core, expanded and desirable interventions (example of core: whole school approach) • Build upon and integrate into existing policies and programmes • Comprehensive approach instead of one-off projects • Integrate healthy eating and physical activity throughout the school environment (including curriculum, regulations, provisions, transportation, pre- and after school activities etc)

Physical activity options (tested)

Physical activity options (untested)

Healthy eating policy options

Advocating for action • Healthy children lead to a healthy and productive communities • Use economic arguments to get buy-in • Need buy-in of teachers: • Better education attainment • Healthy work place • Better health for teachers (role model) • Engagement and participation in the process and required supports • Create a collaborative body to allow funding and support

What stakeholders to engage? • Education sector (students, teachers, principals, board members) • Other sectors (agriculture, building, transportation etc) • All levels of government (including traditional leaders) • Parents (including parental organizations) • Community groups • Health sector • NGOs • Media (mass media and webbased media) • Academics/researchers • Professional organizations (teachers and health) • Private sector • Faith-based leaders

How to engage stakeholders? • Create a collaborative body • Meaningful and genuine participation • Engage stakeholders already in planning and decision making • Basic requirement is that all stakeholders agree on their specific roles • Monitoring mechanisms are needed to evaluate stakeholder action

Purpose of Monitoring and Evaluation (M&E) • Document changes due to policy • Enhance support for policy • Allocate resources • Provide accountability • Inform decision-making • Contribute to evidence base (promote research)

Suggested actions for M&E • Urgent need to document the impact resulting from policies in order to inform decision-makers and contribute to the evidence base. • Need to develop better ways of incorporating qualitative research results • Provide useful models and case studies that can be adapted to different circumstances. • Include evaluation plans already in planning stage and reserve a budget line. • Communicate results of monitoring and evaluation to wider audience • Extend the reach of international data collection systems such as Health Behaviour of School Aged Children and the Global School-based student Health Survey (and use as baseline data)

WHO Framework for M&E 8 Global Strategy on Diet, Physical Activity and Health. A Framework to Monitor and Evaluate Implementation. World Health Organization Geneva, 2006

Evaluation Data for M&E • Surveillance data, policy document, policy-related communications, financial data • Stakeholders • Direct measures or self-report: food intakes and health outcomes

Outline Unconventional …your suggestions would be very much appreciated!

…some suggestions for WHO • Target the appropriate government level (national or sub-national) • School Policy Framework/Guidelines need an implementation plan (including resources) • Use of country examples to make the document practical

Next steps

Further involvement? Please contact Tilly de Bruin Technical officer in WHO on the Global Strategy on Diet, Physical Activity and Health debruinm@who.int +41 22 79 13235

A/Prof. Roya Kelishadi Vancouver, 7 June 2007