Ministers approve declaration: day 2 of nutrition and NCD conference

Childhood obesity and the monitoring and surveillance of noncommunicable diseases (NCDs) related to diet and physical activity were discussed on the final day of the WHO European Ministerial Conference on Nutrition and Noncommunicable Diseases in the Context of Health 2020.

Childhood obesity and inequalities

In his keynote address during the session on childhood obesity and inequalities, Mr John Ryan, from the European Commission Directorate-General for Health and Consumers, noted that obesity rates in children are increasing at an alarming rate: of those aged 6–9 years in European Union (EU) countries, a quarter were overweight or obese in 2008 but a third in 2010.

The European Commission strategy for Europe on nutrition, overweight and obesity-related health issues (2007) is a key EU instrument. A recent external review of the strategy showed the need to give particular focus to promoting physical activity, to take more action on targeting and labelling food products, and to consider carefully the effects of action on groups with low socioeconomic status. Indeed, Mr Ryan revealed that a quarter of obesity in men and half in women in the EU can be attributed to socioeconomic differences.

He also emphasized the importance of intersectoral action, and highlighted the work of the EU platform for action on diet, physical activity and health, which brings together international organizations, representatives of the food and drink industries, public health nongovernmental organizations, professional organizations and consumer groups. The 32 platform members develop commitments that are voluntary, public and measureable, with the other members assessing progress. At present, 29 commitments focus on children, mainly related to food education, labelling, marketing, reformulation and portion sizes.

From Istanbul to Vienna

Speaking on developments since the European Charter on Counteracting Obesity was signed in Istanbul, Turkey in 2006, Dr Francesco Branca, WHO headquarters, noted that some signs of progress in the fight against obesity could be seen at the community level, but that any progress in tackling the epidemic had not included low-income groups.

Other developments included: further evidence that economic tools work, recognition that the marketing of food products to children must be a key focus and that the obesity epidemic is starting even earlier in life than previously thought. Maternal nutrition is very important, as is a focus on breastfeeding and the food environment for infants and young children.

Country achievements on childhood obesity

During the subsequent ministerial panel discussion, ministers and high-level participants shared developments and policy interventions to address childhood obesity in their countries.

  • Latvia had taken a wide range of initiatives, including legislation banning sweet drinks and salty snacks in schools and nurseries, and the introduction of new health checks for children aged 9–11 years. General practitioners (GPs) check children’s weight, blood pressure, and blood glucose and cholesterol levels.
  • The Russian Federation gave top priority to protecting children’s health through a series of preventive measures, which include health checks for pregnant women and support in breastfeeding.
  • A participant from Albania highlighted that some European countries must address a double burden of stunting and anaemia on the one hand, and obesity on the other.
  • Azerbaijan focused on changing behaviour patterns in young people; a participant noted the importance of public opinion in catalysing change.
  • Recognizing its considerable obesity challenge, Malta conducted a range of activities, such as increasing the number of hours of physical activity in schools. A participant underlined the need for better monitoring of the food and drink available to children in the vicinity of schools, not just in them.

Monitoring and surveillance of diet- and physical-activity-related NCDs

Professor Adrian Bauman of the University of Sydney, Australia, a keynote speaker at the session on monitoring and surveillance, explained the importance of measuring all kinds of physical activity, not just sport and exercise. He drew attention to the Finbalt (Finland and the Baltic states) monitoring initiative, which showed that people in these countries are engaging in more physical activity in their leisure time but less at work and related to transport.

Professor Bauman highlighted the time people spend sitting as a significant risk factor for NCDs, unrelated to how much physical activity an individual takes. Total sitting time is 300 minutes daily on average, and highest among the youngest and oldest age groups; it is a risk factor for all causes of mortality. In the European Region, more than 35% of people sit for seven hours or more per day. Interestingly, there is a north–south gradient across the Region, with greater sitting time in the north. In contrast, levels of physical activity are lowest in the south and highest in the north.

In conclusion, Professor Bauman called for standardized surveillance systems in countries and the inclusion of new measures such as sitting time.

Launch of evaluation of Norwegian nutrition policy

In a short informal session, Ms Zsuzsanna Jakab, WHO Regional Director for Europe, and Ms Nina Tangnæs Grønvold, State Secretary, Ministry of Health and Care Services of Norway, launched a new report evaluating the Norwegian nutrition policy, which contains an assessment of options for future policy recommendations. Ms Jakab invited other countries to undertake similar evaluations with support from WHO/Europe.

NCD Free campaign winners

Before the conference, the NCD Free campaign, a grassroots global social movement, invited members of the public to send in short videos on their concerns about NCDs and statements to ministers. Of the videos received, two winners were identified, and their makers were invited to take part in the Conference.

Dr James Cook, from the United Kingdom, is interested in working in cardiology and public health, having just finished medical school at Nottingham University. His key area of interest is health promotion, tackling the major risk factors of NCDs.

Ms Nora Buenemann grew up in the Netherlands, has a bachelor’s degree in European public health from Maastricht University and will start studying for a Master’s in health care, policy, innovation and management in September. Diagnosed with cancer aged 18, she fought the disease and won. After this experience, Ms Buenemann decided to make a lifetime contribution to the fight against NCDs, focusing on health promotion in the early stages of life.

Dr Gauden Galea, Director of the Division of Noncommunicable Diseases and Health Promotion at WHO/Europe, thanked the winners for supporting WHO’s fight against NCDs and their participation in the Conference.

NCDs and the role of the private sector

At a lunchtime session, Ms Eve Heyn of GBC Health, a global coalition of over 200 private-sector companies working to improve global health, spoke of the role of the private sector. Although noting the limited progress made so far, she argued that Europe is at a tipping point, and that the private sector is increasingly engaging in public health issues. She called on other companies to become part of the collective momentum, and recognized the need for multisectoral action and an engaged public to make progress.

Vienna Declaration signed

Following lengthy discussions, ministers signed the Vienna Declaration, committing countries in the European Region to address the root causes of obesity and diet-related NCDs and to empower citizens to make healthy choices.

Conference closing

In her concluding comments, Ms Zsuzsanna Jakab, WHO Regional Director for Europe thanked Mr Alois Stöger, Federal Minister of Health of Austria, for hosting the Conference, and all participants for their active engagement. She called the Vienna Declaration “a milestone in the landscape of WHO nutrition policies”; it will be submitted for adoption to the 2013 session of the WHO Regional Committee for Europe in Izmir, Turkey, in September.

Mr Stöger highlighted the common thread running through the Conference: a multidisciplinary, life-course approach to policy-making, with targeted interventions and particular focus on addressing inequalities. He hoped that the Vienna Declaration would give new impetus to Health 2020.