4/11/2013

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GLOBAL NCD CHALLENGES:

DIET AND PHYSICAL INACTIVITY

Robert Beaglehole, Auckland, New

Zealand 26 March, 2013

Key messages: diet and physical

inactivity

NCDs a global and national crisis

Plans and strategies – global (WHO), regional

and national –necessary, but not sufficient

Policy implementation is critical, including

regulation of unhealthy commodities

Accountability, including national goals and

targets – missing link

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Leading risk factors for DALYS

Malaysia, GBD 2010

UN High-Level Meeting on NCDs

September, 2011

A major step forward

Provide leadership

Establish multi-sectoral national plans by 2013

Integrate NCDs into the development agenda

Set national targets for prevention and treatment

Measure results

Increase domestic resources

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WHO global voluntary NCD targets

Physical inactivity

10%

Salt/ sodium intake

30%

Tobacco use 30%

Drug therapy to reduce high CVD risk

50% coverage

Obesity and diabetes Halt the

rise

Alcohol 10%

Generic medicines and technologies

80%

Blood pressure

25%

Premature mortality from NCDs 25% reduction

Target (goal) adopted by the World Health Assembly May 2012

Priority targets Other targets

Measuring progress on NCDs: global goal and 5 targets

NCDs and Sustainable Development Beaglehole et al. Lancet, 2012

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Country actions: a stepwise approach

A simple, phased national

response to the political

declaration involves 3

steps:

planning,

implementation, and

accountability

The Lancet NCD Action Group Bonita et al. Lancet, 2013 at http://www.lancet.com/series/non-communicable-diseases

Tobacco control:

the key to NCD prevention

40% of men use tobacco in Malaysia

Accelerated implementation of the Framework Convention on Tobacco Control (especially price increases)

WHO target of reducing tobacco use by 30% by 2025

The longer-trem goal of:

A world essentially free (< 5% prevalence)

from tobacco by 2040

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Diet and NCDs: the “facts”

Diet a major determinant of DALYs in Malaysia

Energy imbalance the fundamental cause of obesity and contributes to diabetes/CVD and some cancers

Fat (total intake) an important cause of obesity

Type of fats influence CVD risk (eg replacing sat. fat with polyunsaturated fat improves lipid profile)

Sugar a major cause of dental caries and a cause of obesity; guidelines – WHO (10% energy), Malaysia

Salt a major cause of elevated blood pressure and thus CVD

Alcohol an under-appreciated cause of NCDs

Diet and NCDs: a systems

approach

The food environment conditions food choices

Transnational corporations are major drivers of

NCD epidemics and profit from unhealthy

commodities

The answer to diet caused diseases are

government policies

The politics of food is the most challenging area

for public health

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Profits and pandemics: Key messages

Unhealthy commodity industries should have no role in the formation of national or international policy for NCD policy

There is no evidence to support the effectiveness of self-regulation and public–private partnerships to improve public health

Public regulation and market intervention are the only evidence-based mechanisms that can prevent harm caused by unhealthy commodity industries

Moodie, et al. Lancet 2013

Reduction in Malaysian sugar

subsidy

“Moderate intake of sugar is acceptable.

However, if taken excessively, it may be harmful.

In this regard, the Government proposes to

reduce the subsidy on sugar by RM0.20 per kg,

effective from 29 September 2012.

The Government urges the business community

not to burden the rakyat by increasing the price

of sugar but instead reduce the content of sugar

in food and beverage.”

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New threats to growing

obesity problem in

Malaysia

Diet and NCD: other challenges

Restrict marketing of unhealthy products

Increase quality of food in schools

Food labelling; front of pack (traffic lights)

Increased funding for prevention

Multisectoral leadership and action

Accountability: review, monitoring, action

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Physical activity challenges

Key NCD risk factor – GBD 2010

Importance of multisectoral action; city

planning

Transport – public and private

Community-based (schools) interventions a

good starting point

Community-based research; SEACO

The global context: from MDGs to

SDGs

MDGS established in 2000, for

2015

Three health goals – unfinished

agenda

NCDs not included although they

undercut MDGs

Post 2015: “Sustainable Human

Development Goals” (SDGs),

including NCDS

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Next steps: Putting the pieces

together

Rapid progress is possible with

cheap and effective interventions

Use a step-wise approach

Use overall risk approach to

determine treatment of risk

factors

Regulation necessary to control

processed food industries

Accountability for UN

commitments essential -

monitoring, review and action -

focus on equity