Transcript Document
SCN 33rd SESSION Working Group on Household Food Security
Stretegies for preventing obesity and reducing inequalities: the experience in Europe
Francesco Branca Joceline Pomerleau Cecile Knai Nutrition and Food Security WHO Regional Office for Europe Copenhagen
The Ministerial Conference on counteracting obesity
• • •
Istanbul on 15-17 November 2006, hosted by the Ministry of Health of Turkey Participants : Health Ministers and representatives from the agriculture, trade, transport, environment, education sectors International partners : European Commission, Council of Europe, FAO, The World Bank, UNICEF
Expert consultations
Evidence of effective prevention policies – Athens, June 2005 (with EASO) The role of physical activity – Amsterdam, June 2005 (with The role of local governments – Bursa, Turkey, September 2006 Inequalities and Obesity – London, 13-14 December 2005 School policies – Florence, 11-12 March 2006 (with HBSC) Marketing to children of food and drinks in Europe – Oslo, May 2006
The mothers Women ’s BMI in Russia, Poland, Czech Republic By Education Obesity trends by social class in women: England 1993-2001 32 31 30 29 28 27 26 25 24 Russia Poland Primary Secondary Czech Vocational University H. Pikart: HAPIEE study, 2003/2004
15 10 5 0 35 30 25 20 Women 1993 Women 2001
Health Survey for England
I II IIInm IIIm IV V
INCOME France (2-17 y) INDEX OF MULTIPLE DEPRIVATION England (2-10 y) 8 6 4 2 0 18 16 14 12 10 Least deprived 2nd 3rd
The children
4th Most deprived Jotangia et al., 2005 ETHNICITY Germany Crude odds ratio (OR) for other nationality OR 2.23
OR for other nationality after adjusting for education of mother OR after additional adjustment for watching TV on weekdays OR after full adjustment 1.52
1.37
1.30
Kuepper-Nybelen et al (2005)
Policy framework - 1
“There is a need to identify and deal with high risk environments rather than high risk […] groups” ( Kuepper-Nybelen et al 2005)
The responsibility for obesity cannot rest on the shoulders of individuals Individuals, particularly those in disadvantaged situations, face structural, social, organisational, financial and other constraints in making the healthy choice Key considerations: accessibility, availability, affordability, practicality, relevance and attractiveness … a
Policy framework - 2
Focusing on more on environmental change, and less on behavioural change, can be particularly beneficial to disadvantaged groups – addresses the underlying causes and increases the potential for true prevention; – becomes structural (e.g. local government transport policies); – helps make healthy choices the normative choices; – is most likely to be sustained, particularly if backed by strong policies; – can be benefited by all (e.g. green spaces); – is less language-dependent; – is usually cost effective, even the expensive strategies such as improving active transport;
Swinburn & Egger, Obes Rev 3(4) 2002
Potential strategies: matrix
SECTORS / SETTINGS POTENTIAL ACTIONS Food and nutrition Physical activity and sedentary lifestyles Economic and psycho-social factors WHO, EU, and other intra-governmental organisations National / local government (intersectoral: food, nutrition, transport, education, health…) Food supply (manufacture, marketing, distribution, retail, catering) Media NGOs Health care services Education sites (kindergarten, school, continuing education, community centres…) Work sites Communities, neighbourhoods, homes and families
Potential strategies - 1
Global (WHO, EU, others) – With governments, examine the role of globalization on food availability and consumption; transport and urban planning; social networks; local and national economies – Promote the importance of evidence-based, independent research in the role of diet, physical activity, economic/ psychosocial factors in reducing SE inequalities in obesity National / local – Create funds for local authorities, voluntary organisations and community groups to deliver a range of local schemes such as safe routes to school, community regeneration projects, local coalitions to reducing health inequalities – Examine pricing policies to ensure that healthy foods are accessible to all and ensure that foods like fruit and vegetables are no longer luxury items
Junk food at school and in the curriculum
Example 1 : Re-prioritizing access and price
Less of this… More of this… School fruit tuck shop in Swansea
Example 2 : Programmes for vulnerable groups
In Indiana, USA, the Farmer’s Market Nutrition Program provides participants in the WIC program with checks to purchase locally grown fresh fruits and vegetables at local farmers’ market.
Potential strategies - 2
NGO – Develop programmes for low income households on how to prepare low-cost healthy meals and on how and where to access physical activity opportunities at low cost – Support local agriculture and community physical activity initiatives to promote social cohesion, sense of worth, healthier food intake and higher activity level Food supply – Encourage more farmers’ markets and grocery stores to establish themselves in low income areas, to reduce ‘food deserts’ and provide sources of healthy food within walking distance – Increase the visibility and appeal of healthy foods in supermarkets, and those accepted by particular ethnic groups
Potential strategies - 3
Media
UNDP "Teams to end Poverty"
– Attract celebrity role models in the promotion of healthy eating and physical activity – Promote a healthy lifestyle culture (e.g. incorporate positive behaviour change messages into television programmes and popular magazines) Health care – Increase health professionals’ awareness of SE inequalities in obesity – Develop partnerships between health services, social services and local authority which can provide a catalyst for increased community networks to support disadvantaged groups and liaise with existing physical activity and diet initiatives
Potential strategies - 4
Education sites – Improve access to pre-school education – Have school nutrition policies to ensure good nutritional quality of foods served in cafeterias – Incorporate physical activity into the school day as integrated in the curriculum – Develop clear policies about bullying related to body size Work sites – Include healthy food choices (e.g. subsidize healthy foods in cafeterias) and physical activity options (e.g. exercise facilities and changing rooms) at the workplace – Actively address hiring discrimination and stigmatization
Example Increase opportunities for active travel to school and work
Potential strategies - 5
Communities and families – Encourage community leaders to create councils and groups that take the initiative (e.g. raise funds) and provide guidance on preventing obesity in their communities – Increase access of low income groups to healthy foods (e.g. set up neighbourhood garden programmes and food cooperatives)
Decision-making framework for governments
Tool to formalise decision-making as a consistent process with identifiable steps A way to identify the important principles and values that guide decision-making Flexible and practical approach Appropriate to each country’s health and economic context
Developed from Swinburn et al. Obes Rev 2005; 6:23-33, and Epping-Jordan et al. Lancet 2005; 366:1667-1671.
Research needs and future directions - 1
Build a case for action – Develop standardised data collection methods – Identify particularly vulnerable groups – Examine changes over time Identify contributing factors – Study the determinants of SE inequalities in obesity in the general population and in high-risk groups – Examine the pathways through which SES affects obesity Develop surveillance systems
Research needs and future directions - 2
Design potential interventions – Through intersectoral consultation, needs assessment, health impact assessment, etc – Target the individual and the environment Evaluate these interventions – Effectiveness, cost-effectiveness, long-term impact, component analysis, etc Use guidance from organizations and countries with best practice guidelines Learn from other public health sectors e.g. tobacco-control campaigns
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