Analysis of Nutrition Policy Environment for Prevention and Control of Non Communicable Diseases Judith Siambe

Gerald Yonga Aga Khan University Hospital Nairobi NCD Research to Policy Unit

∗ Background information ∗ Dietary situation and trend in East Africa ∗ NCD risk factors- diet and nutrition ∗ Policy agenda ∗ Strategies that worked ∗ Objectives of the study ∗ The policy process ∗ Methodology ∗ Expected results

Outline

Communicable diseases and non communicable diseases have brought a double burden of disease to the sub - Saharan Africa.(WHO 2014)

Background Information

NCDs rising as CDs drop

MoH, 2011

∗ Globally 4 diseases contribute to 60% of morbidity & mortality from NCDs

∗ Cardiovascular disease, Cancer, Diabetes and Chronic Lung Disease

∗ 4 simple, modifiable behavioral risk factors account for 80% of the cases of NCDs (Cardiovascular disease, Diabetes, Cancer & Chronic lung disease)

∗ Smoking, Unhealthy diet (high in salt, sugar & fat and low in vegetables & fruits), inadequate physical activity & excessive alcohol consumption

THE NCD 4 BY 4

∗ Diet and nutrition has been suggested to be the cornerstone in prevention and onset of NCDs

∗ The world is witnessing rapid shifts in diet(Popkin, Adair et al. 2012)

∗ larger numbers of meals are eaten outside home ∗ staple foods are becoming more refined and processed ∗ Sugar, fat and salt intake is increasing ∗ processed foods are consumed more than before

∗ The dietary transition is associated with the escalating trends of NCDs

Risk Factor: Diet and Nutrition

Fast Food vs traditional foods

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10

20

30

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50

60

6-7 Servings 4-5 Servings 1-3 Servings

Fruit %

Vegetable %

Fruits & vegetable intake – Nairobi school children

∗ Knowledge and Attitudes to foods ∗ Agricultural practices & Policies ∗ Healthy food availability & Prices ∗ Food information & labeling ∗ Marketing activities and global trade

FACTORS INFLUENCING DIET

∗ Of the four major risk factors for NCD unhealthy dietary patterns account for the highest percentage of risk (Lock, Pomerleau et al. 2005)

∗ The government of Kenya has policies and regulation to control and monitor harmful use of alcohol and smoking(Kenya Gazette 2007, 2010)

∗ There are no regulation that the government of Kenya has put in place to regulate the dietary patterns of the population

The Policy Agenda

Successful strategies

∗ Norway successfully reversed the population shift towards high fat, energy dense diets by using a combination of food subsidies, price manipulation, retail regulations, clear nutrition labeling, and public education focused on individuals(Matheson et al. 2013

∗ North Karelia used a broad range of approaches by designing multi-sectoral project(Puska 2002).

∗ media campaigns ∗ collaboration with the food industry ∗ agricultural reforms ∗ education sector making

North Karelia

To review the policy environment for promotion of healthy diets in the Kenyan population and inform the formulation and implementation of nutrition policy for prevention and control of the non communicable diseases

Objective

The Policy Process Problem formulation and agenda format

Search for alternatives

Forecast the future environment

Model the impact of the alternatives

Evaluate the alternatives

∗ Quantitative and qualitative research focusing on policy analysis using the Walt and Gilson policy triangle

∗ Will be conducted in two phases Phase 1 1. Data collection through stakeholder analysis and key

informant interviews 2. Direct observation of the environment for activities related to

diets and nutrition will be done by GIS mapping and spatial analysis together with physical tours

Methodology

1. strengths and weaknesses of the alternatives generated in phase 1

2. Analyse the economic financial and political opportunities and obstacles to the policy alternatives and

3. Identify the potential impact of the prospective policy.

Phase 2

Quantitative data ∗ Compile data on an excel spread sheet and SPSS and run

descriptive analyses Qualitative data ∗ This analysis will be done using Nvivo 10 together with the Walt

& Gilson’s Policy Triangle Framework. ∗ The themes will be analyzed for content, actors, context, and

process .

Data analysis

CONTEXT eg food production ACTORS Individuals Government officials Private sector representatives Groups Civil society Consumer associations Organizations Learning institutions Health research institutions CONTENT eg PROCESS eg Accurate labeling Regulation

Walt and Gilson policy triangle

∗ Availability of effective nutrition policy framework for NCD prevention

∗ Diminished population prevalence of obesity ∗ Evidence of change in lifestyle • Long term decrease in NCDs related deaths.

Expected Results

THANK YOU

QUESTIONS??