Pekka Puska is President of the International Association of National Public Health Institutes. He has also served as the Director for Non-Communicable Disease Prevention and Health Promotion at the World Health Organization; Chair of the Governing Council of the International Agency for Cancer Research; and President of the World Heart Federation.
This week’s World Health Assembly coincides with the 10th anniversary of the adoption of the Global Strategy on Diet, Physical Activity & Health by the World Health Organization (WHO) in May 2004. As someone who was closely involved in developing the strategy, this seems an appropriate moment to reflect on the progress made during the past decade and the challenges that remain.
In the late 1990s studies confirmed the rise of non-communicable diseases (NCDs) as a major global health problem. So an expert group was convened with me as chair, to create the World Health Organization’s first ever Global Strategy on Non-Communicable Diseases.
This strategy, which was adopted by the World Health Assembly in 2000, highlighted the potential of preventing these diseases – especially cancer, cardiovascular diseases, chronic obstructive pulmonary diseases, and diabetes – and called for an integrated approach whereby all four main modifiable risk factors of NCDs (tobacco, unhealthy diet, physical inactivity and alcohol) are tackled as a group.
Soon after, when I joined WHO as Director for NCD Prevention and Health Promotion, I argued that as the negotiations for a Framework Convention on Tobacco Control were underway, the organization now needed to take more effective action on unhealthy diet and physical inactivity.
This led to the Global Strategy on Diet, Physical Activity and Health, built on a solid science base which – despite lobbying from some Member States and industry (particularly the US soft drinks giants) against restrictions on foods such as sugar, palm oil and salt – was adopted by the World Health Assembly in 2004.
This Global Strategy provided a “menu of options” for every Member State for effective action to improve national diets and increase physical activity to help prevent NCDs. But what has happened since the adoption of this strategy in 2004?
Progress since the adoption of the strategy in 2004
Internationally, the UN High Level Meeting on NCDs in New York in 2011 was a landmark event. Its political declaration asked the World Health Organization to take stronger action on NCDs and put NCD prevention higher up the global political agenda. Last year, the WHO adopted a Global NCD Action Plan 2013-20 that includes voluntary global targets and indicators, including items from the Global Strategy on Diet and Physical Activity.
The Global Strategy can also be used as a tool for reaching the Global NCD Action Plan targets. Nationally, NCDs are now receiving much stronger political attention – especially in the low and middle income countries that are facing the growing burden with limited resources. However, the actions are still weak, considering the magnitude of the problem and the potential for prevention. In addition, the WHO’s resources for effective NCD work have remained marginal.
More actions, than words, are needed
The adopted targets, monitoring of indicators and international coordination are positive steps, but they are more words than practical action. The determinants (unhealthy diet, inactivity, tobacco and alcohol) of the global NCD epidemic are global; so the means through which to tackle them (marketing, multinational industry, trade agreements etc) also need to be addressed at the global level.
More effective government policies and strong health promotion are needed for good implementation of the recommendations of the WHO Global Strategy on Diet, Physical Activity and Health. Policies should particularly deal with food labelling, health claims, formulation of product (salt, fat, sugar), marketing, child and school food policies and possibly use instruments like the soft drink and candy tax in Finland.
Finally, government action without support of people is difficult; strong health promotion by NGOs, health services, educational institutions, experts etc. is vital to mobilize people to push governments and industry for sustainable changes in national diets for better public health.
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