Transcript General

The Global Strategy on Diet, Physical
Activity and Health: A School Policy Initiative
Outcomes of the
Expert Roundtable
A/Prof. Roya Kelishadi
Vancouver, 7 June 2007
Satellite Expert Roundtable on DPAS School Policy Initiative
in close collaboration with
Public Health Agency Canada & Health Canada
Satellite Expert Roundtable on DPAS School Policy Initiative
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)
Satellite Expert Roundtable on DPAS School Policy Initiative
Agenda
• Background
• Satellite Expert Roundtable
• Next steps
Satellite Expert Roundtable on DPAS School Policy Initiative
Did You Know?
35 000 000
people died
worldwide from
chronic diseases
in 2005
Satellite Expert Roundtable on DPAS School Policy Initiative
Main Causes of Death
1. Cardiovascular disease (mainly
heart disease & stroke)
2. Cancer
3. Chronic respiratory diseases
4. Diabetes
Source: WHO, Preventing Chronic Diseases, 2005
Satellite Expert Roundtable on DPAS School Policy Initiative
Not only in Rich Countries
Source: WHO, Preventing Chronic Diseases, 2005
Satellite Expert Roundtable on DPAS School Policy Initiative
Causes of Chronic
Diseases
80%
80%
40%
N.A.
80%
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Risks are Increasing
Source: WHO, Preventing Chronic Diseases, 2005
Satellite Expert Roundtable on DPAS School Policy Initiative
The Global Strategy on Diet
Physical Activity and Health
www.who.int/dietphysicalactivity
Satellite Expert Roundtable on DPAS School Policy Initiative
Objectives of DPAS
1.
Reduce risk factors for chronic diseases that stem from
unhealthy eating and physical inactivity through public health
actions;
2.
Increase awareness and understanding of importance healthy
eating and physical activity on health;
3.
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;
4.
Monitor science and promote research on healthy eating and
physical activity.
Satellite Expert Roundtable on DPAS School Policy Initiative
What has WHO done?
1.
Activities at the global level:
•
Tools
•
•
•
•
•
Global interactions:
•
•
2.
Physical activity
Fruit and vegetables
Monitoring and Evaluation
Reducing salt intake in population
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)
Satellite Expert Roundtable on DPAS School Policy Initiative
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
Satellite Expert Roundtable on DPAS School Policy Initiative
Agenda
• Background
• Satellite Expert Roundtable
• Next steps
Satellite Expert Roundtable on 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
Satellite Expert Roundtable on DPAS School Policy Initiative
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
Satellite Expert Roundtable on DPAS School Policy Initiative
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)
Satellite Expert Roundtable on DPAS School Policy Initiative
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
Satellite Expert Roundtable on DPAS School Policy Initiative
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)
Satellite Expert Roundtable on DPAS School Policy Initiative
Physical activity options (tested)
Policy
Policy Option
Evidence
Effective (E) Promising (P)
Raise quantity PE to daily K12
Sallis: ↑ grade 6-8 PE daily + school PA  lower
BMI boys (E)
Ensure students active most of PE class
time
McKenzie: PE curriculum more vigorous PA 
students > active in PE class not outside school
(E)
Integrate benefits of PA into regular
curriculum
Gortmaker: Curriculum = healthy foods and PA.
Girls ⇩BMI (E)
Integrate PA into curriculum
Mahar: Daily 10 min energizers K grade 4: ↑
PA and ↑on task behaviour (E)
Extracurricular PA
Provide a variety of PA opportunity
outside of PE
Ernst: “PLAY” ↑ PA outside of PE. ↑ PA levels;
girls > interest PA (E)
Training
Ensure adequate training for teachers of
PE classes
Sallis: “SPARK” Specialist PE > trained teachers
> control teachers  ↑ girls fitness (E)
Active Transportation
Ensure safe walking & cycling to and from
school
Rosenberg: leaner students actively commuted
(P)
Facilities
Ensure adequate facilities & equipment
for PA
Sallis: better facilities & adult supervision 
kids ↑PA ~ 4-5 x control (P)
Community Outreach
Develop partnerships with community
recreation
Moody: 50% community rec. centers have
elementary after school programs: vs 11%
middle ; 0% High school (P)
Daily quality PE
Daily PA
Satellite Expert Roundtable on DPAS School Policy Initiative
Physical activity options (untested)
Policy Area
Untested Policy Option
Best Practice Example
Curricular and extracurricular activities
Make physical activity enjoyable, respectful of all children & promote fair
play and maximum participation
Action Schools! BC (Promising)
Nova Scotia Health Promoting Schools (Promising)
Safety
Ensure adequate safety precautions to prevent physical activity injuries and
illness.
Hudson-Collins P: CDC funded coordinated school health program
School Staff
Collect medical information from students & parents to ensure safe
participation in physical activity
Scheier LM: School Health Report Cards
Ensure family & community members can take part in planning and
decision-making
Action Schools! BC
Nova Scotia Health Promoting Schools
Saskatoon in Motion (http://www.saskatchewaninmotion.ca/)
Provide opportunities for family & community members to advocate for &
participate in activities & services offered through schools
Action Schools! BC
Nova Scotia Health Promoting Schools
Saskatoon in Motion
Promote health benefits of physical activity to school staff
Hudson-Collins P: CDC funded coordinated school health program
Provide school staff with opportunities to be physically active with
colleagues
Hudson-Collins P: CDC funded coordinated school health program
Referral from health
care professionals
Make recommendations on physical activity for students with disorders or
disabilities
American Academy of Pediatrics (AAP)
Canadian Pediatric Society (CPS)
Recognition
Recognize schools, administrators, teachers, parents and students who
make significant advancement of physical activity and physical education in
schools
CAHPERD
Monitoring and
Evaluation
Monitor and assess policy implementation, as well as physical activity levels
and fitness
Action Schools! BC
Nova Scotia Health Promoting Schools
Satellite Expert Roundtable on DPAS School Policy Initiative
Healthy eating policy options
Policy
Policy Option
Legislation and regulation
• Direct policies that address all foods
• Direct policies that address some but not all foods
• Indirect policies that address the quality of all foods
Financing
• Use of money or food to shape food consumption (school food programs, water
and food pricing)
Built environment
• Nutrition standards
• Local foods
• Food preparation
• Student access to fruits and vegetables
• Use of foods
Health services
• Counseling or other nutrition services in schools or school-community
partnerships that address student health needs
Advocay
Identifying and reducing barriers to school nutrition policies at an individual or
systematic level
Community mobilization
Education and infrastructure required for school nutrition policies:
• nutrition education
• staff qualifications and training
• nutrition and health infrastructure
Satellite Expert Roundtable on DPAS School Policy Initiative
Coordination of food availability
Food availability near schools
Sustainable food practices
Food marketing
Food and beverages contracts
Advocating for action
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Healthy children lead to a healthy and productive
communities
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Use economic arguments to get buy-in
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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
Satellite Expert Roundtable on DPAS School Policy Initiative
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
Satellite Expert Roundtable on DPAS School Policy Initiative
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
Satellite Expert Roundtable on DPAS School Policy Initiative
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)
Satellite Expert Roundtable on DPAS School Policy Initiative
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 Schoolbased studentSatellite
Health
Survey
(and
useInitiative
as baseline data)
Expert Roundtable
on DPAS
School Policy
WHO Framework for M&E
Satellite Expert Roundtable on DPAS School Policy Initiative
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
Satellite Expert Roundtable on DPAS School Policy Initiative
Outline
Unconventional
…your suggestions would be very much appreciated!
Satellite Expert Roundtable on DPAS School Policy Initiative
…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
Satellite Expert Roundtable on DPAS School Policy Initiative
Agenda
• Background
• Satellite Expert Roundtable
• Next steps
Satellite Expert Roundtable on DPAS School Policy Initiative
Next steps
1.
Prepare background papers on diet and physical activity, both
focusing on:
•
•
•
April – May 2007
Effective policy options for the school setting
Roles of different stakeholders
Monitoring and evaluation
2.
Satellite Expert Round-table to draft an outline
6-7 June 2007
3.
Draft the Framework
June – Sept 2007
4.
Consultation Process
Oct – Dec 2007
5.
Finalize the Framework
Jan 2008
6.
Translate, printing and launch
Feb – March 2008
Satellite Expert Roundtable on DPAS School Policy Initiative
Further involvement?
Please contact Tilly de Bruin
Technical officer in WHO on the Global Strategy
on Diet, Physical Activity and Health
[email protected]
+41 22 79 13235
Satellite Expert Roundtable on DPAS School Policy Initiative