Global Strategy on Diet Physical activity and Health: Adaptation at local and national levels to the Americas Dr Godfrey Xuereb Team Leader Population-based Prevention Department of Chronic Diseases and Health Promotion xuerebg@who.int

World Health Organization 1 April 2017 Noncommunicable disease and risk factors Tobacco use Unhealthy diets Physical inactivity Harmful use of alcohol Heart disease and stroke  Diabetes Cancer Chronic lung disease 60% of global deaths due to NCDs This is just to remind ourselves that the focus of the GS and the HLM and its political declaration is on the four groups of NCDs that constitute around 80%of NCD deaths and that share the same risk factors and therefore also the same strategies

High blood pressure continues to go up 40% 30% High-income countries Upper Middle-income countries % of population Lower middle-income countries 20% Low-income countries 10% 1980 2008 Raised blood pressure (2008) Source: WHO NCD Country Profiles (2010)

Overweight continues to increase 70% 60% 50% High-income countries 40% Upper Middle-income countries % of population Lower middle-income countries 30% Low-income countries 20% 10% 0% Overweight (2008) Source: WHO NCD Country Profiles (2010) 1980 2008

WHO Mandates to date 2000 2003 2004 2008 Global Strategy for the Prevention and Control of Noncommunicable Diseases Global Strategy on Diet, Physical Activity and Health Action Plan on the Global Strategy for the Prevention and Control of NCDs 2010 2009 2011 Global Strategy to Reduce the Harmful Use of Alcohol WHO Global Status Report on NCDs Political Declaration on NCDs 2012+ Realizing the commitments made in the Political Declaration

"Best buys" interventions to address NCDs 01/04/2017 "Best buys" interventions to address NCDs Population-based interventions addressing NCD risk factors   Tobacco use Excise tax increases Smoke-free indoor workplaces and public places Health information and warnings about tobacco Bans on advertising and promotion Harmful use of alcohol Excise tax increases on alcoholic beverages Comprehensive restrictions and bans on alcohol marketing Restrictions on the availability of retailed alcohol Unhealthy diet and physical inactivity Salt reduction through mass media campaigns and reduced salt content in processed foods Replacement of trans-fats with polyunsaturated fats Public awareness programme about diet and physical activity Individual-based interventions addressing NCDs in primary care Cancer Prevention of liver cancer through hepatitis B immunization Prevention of cervical cancer through screening (visual inspection with acetic acid [VIA]) and treatment of pre-cancerous lesions Cardiovascular disease and diabetes Multi-drug therapy (including glycaemic control for diabetes mellitus) for individuals who have had a heart attack or stroke, and to persons at high risk (> 30%) of a cardiovascular event within 10 years Providing aspirin to people having an acute heart attack 6

The General Assembly adopted by consensus the resolution titled "Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases" (document A/66/L.1).

What does the Political Declaration say on Diet & PA

What does the Political Declaration say on Diet & PA

Physical Inactivity

Physical inactivity - 4th leading risk factor for global mortality Source: WHO's report on "Global health risks" 1.5 billion adults are insufficiently active

Percentage of insufficient physical activity comparable country estimates, 2008 Age standardized; by WHO Region and World Bank income group, men and women Source: Global Status Report on NCDs, WHO, 2001

Prevalence of insufficient physical activity Prevalence of insufficient physical activity*, ages 15+ age standardized Males, 2008 Source: Global Status Report on NCDs, WHO, 2001

Prevalence of insufficient physical activity Prevalence of insufficient physical activity*, ages 15+ age standardized Females, 2008 Source: Global Status Report on NCDs, WHO, 2001

Being inactive costs the country and the individual New study* just released on the health care costs of physical inactivity in Canadian adults shows that the estimated direct, indirect and total health care costs in 2009 were: Direct: 2.4 billion C$ (3.8% of overall health care costs) Indirect: 4.3 billion C$ Total Costs: 6.8 billion C$ (3.7% of overall health care costs) Other studies** have shown that 19% of the coronary artery disease cases in Canadian men are due to physical inactivity * Janssen, 2012, Appl. Physiol. Nutr. Metab. ** Katzmarzyk and Janssen, 2004 Can.J. Appl. Physiol.

What does the Global Strategy Say

Global recommendations on PA for Health 5-17 yrs old At least 60 minutes of moderate to vigorous intensity PA daily. +18 yrs old: At least 150 minutes of moderate-intensity aerobic PA spread throughout the week or At least 75 minutes of vigorous-intensity aerobic PA spread throughout the week or an equivalent combination. 65yrs old & above: Should perform PA to enhance balance and prevent falls on 3 or more days/ week. When they cannot do the recommended amounts of PA due to health conditions, they should be as physically active as their abilities and conditions allow.

What does the Global Strategy Say

National strategies on diet and physical activity Conduct a situation analysis - GSHS Mexico GSHS Cuba Dominican Republic Belize Honduras Guatemala Nicaragua El Salvador Guyana Costa Rica Venezuela Suriname Panama Columbia Ecuador Anguilla Antigua and Barbuda Bahamas Barbados British Virgin Islands Cayman Islands Dominica Grenada Guyana Jamaica Montserrat St. Kitts and Nevis St. Lucia St. Vincent and the Grenadines Trinidad and Tobago Peru Brazil Bolivia Paraguay Chile Completed Survey Implementation Workshop Data collection underway Uruguay Argentina* Data collection complete

National strategies on diet and physical activity Establish a coordinating team to develop the policy/ strategy/ programme Review of Policies in selected Low and Middle Income Countries

National strategies on diet and physical activity Multisectoral collaboration: Coordinating mechanism headed or chaired by ministry of health. Multisectoral collaboration containing representation from all key sectors.

What does the Global Strategy Say

School Policies and programs CARICOM supports Physical Education Standards for all Caribbean States – Feb 2011, Port of Spain.

Recommended actions for Member States Introduce transport policies that promote active and safe methods of travelling to and from schools, such as walking or cycling; Ensure that walking, cycling and other forms of physical activity are accessible to and safe for all;

Recommended actions for Member States Improve sports, recreation and leisure facilities

Recommended actions for Member States Increase the number of safe spaces available for active play

Recommended actions for Member States Urban Planning

The Floor is Yours ! http://www.who.int/dietphysicalactivity/en/ 28