This document discusses the growing challenge of noncommunicable diseases (NCDs) like heart disease, cancer and diabetes in Europe and implications for dietitians. It notes that NCDs are the leading cause of death in Europe and risk factors like obesity, unhealthy diets and physical inactivity are increasing. While some policies have helped like restricting marketing of unhealthy foods to children, more action is still needed on issues like salt reduction and nutrition labeling. The document concludes by emphasizing dietitians have an important role to play in several priority areas outlined in the Vienna Declaration, including promoting healthy diets and nutrition, supporting policy efforts and surveillance, and empowering communities for prevention.

1. The challenge of
noncommunicable
diseases for health in
Europe: Implications for
dietitians
Trudy Wijnhoven
Technical Officer
Nutrition, Physical Activity and Obesity Programme
Division of Noncommunicable Diseases and Life-course
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

2. Outline
1. Introduction to
WHO
2. Policy and
global monitoring
frameworks
4. Nutrition policy
actions in the
European Region
3. Burden of
noncommunicable
diseases
5. Role of
dietititans
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

3. 1. INTRODUCTION TO WHO
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

4. Structure
• Specialized agency within the Charter of the
United Nations (1948)
• 194 Member States
• One WHO, but decentralized structure:
– Headquarters - Regional Offices - Country
Offices
• Governing bodies:
– World Health Assembly - Executive Board
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

5. WHO Country and Regional
offices
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

6. WHO is primarily responsible for:
• Providing leadership on global health matters
• Shaping the health research agenda
• Setting norms and standards
• Articulating evidence-based policy options
• Providing technical support to countries
• Monitoring and assessing health trends
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

7. 2. POLICY AND GLOBAL
MONITORING FRAMEWORKS
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

8. Political declaration on NCDs:
Surveillance: Calls for a monitoring framework and global and national
targets and indicators.
Prevention: Calls on Member States to accelerate the implementation of
the WHO FCTC, the Global Strategy on Diet, Physical Activity and
Health, and the Global Strategy to Reduce the Harmful Use of Alcohol
and cost-effective interventions.
Management: Calls on Member States to strengthen health systems that
support primary care and prioritise early detection and treatment and
improve access to affordable essential medicines for NCDs.
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

9. Comprehensive global monitoring framework
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

10. Nutrition, obesity and physical activity:
major achievements but big challenges
European Charter on Counteracting
Obesity and the Food and Nutrition Policy
Action Plan
• Established and scaled-up monitoring and
surveillance systems
• 49 Member States developed or updated
national policies
• Several Member States evaluated
national policies
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

11. WHO European Ministerial Conference
on Nutrition and NCD in the Context of
Health 2020
RENEWED
MANDATE FOR
ACTION
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

12. 3. BURDEN OF
NONCOMMUNICABLE
DISEASES
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

13. Noncommunicable diseases
and risk factors
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

14. NCDs
increasing
….
Source:
http://www.who.int/mediac
entre/factsheets/fs310/en/i
ndex.html
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

15. NCDs as leading causes of mortality
Source: http://www.who.int/mediacentre/factsheets/fs310/en/index.html
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

16. Source: Capewell S, O’Flaherty M. Rapid
mortality falls after risk-factor changes in
populations. The Lancet Published Online
March 16, 2011 DOI:10.1016/S01406736(10)62302-1.
“Extensive empirical and
trial evidence shows that
substantial reductions in
mortality can occur within
months of decreases in
smoking, and within 1–3
years of dietary
changes…”

17. GBD – attributable for 20 risk
factors as % DALY - 2010
15 out of 20 risk factors linked with nutrition and PA
Source: Lim & al. 2012

18. Prevalence of overweight (%) among
adult men (BMI ≥25.0 kg/m2)
70
Austria, 20+
Belgium, 18+
Denmark, 16+
Estonia, 16–64
Finland, 15–64
France, 15+
Germany, 18+
Ireland, 18+
Italy, 18+
Latvia, 15–64
United Kingdom, Scotland, 16–64
Lithuania, 20–64
Luxembourg, 16+
Netherlands, 20+
Norway, 16+
Portugal, 18–64
Spain, 18+
Sweden, 16–84
Switzerland, 15+
United Kingdom, Wales, 16+
United Kingdom, England, 16+
65
60
55
50
45
40
35
Prevalence of overweight (%) among adult men (BMI >25.0 kg/m2)
30
25
1994
1997
2000
2003
2006
2009
2012
Source: WHO
Regional Office for
Europe
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

19. Prevalence of overweight (%) among
adult women (BMI ≥25.0 kg/m2)
70
Armenia, 15–49
Austria, 20+
Belgium, 18+
Denmark, 16+
Estonia, 16–64
Finland, 15–64
France, 15+
Germany, 18+
Ireland, 18+
Italy, 18+
Latvia, 15–64
Lithuania, 20–64
Luxembourg, 16+
Netherlands, 20+
Norway, 16+
Portugal, 18–64
Spain, 18+
Sweden, 16–84
Switzerland, 15+
Turkey, 15–49
United Kingdom, Wales, 16+
United Kingdom, England, 16+
United Kingdom, Scotland, 16–64
65
60
55
50
45
40
35
30
25
1994
1997
2000
2003
2006
2009
2012
Source: WHO
Regional Office for
Europe
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

20. HBSC – key findings 2009/2010
– age changes
• Health behaviours – all worsen
• Overweight and obesity – all increase
• Breakfast – decreases in both boys and girls
• Fruit – decreases in both boys and girls
• Physical activity – decreases in both boys
and girls
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

21. Salt intake per person per day for adults in the WHO European
Region from individual country-based surveys, various years
20.0
18.0
Source: WHO
Regional Office for
Europe
16.0
14.0
10.0
8.0
6.0
WHO/FAO RECOMMENDATION - <5 grams
4.0
2.0
0.0
No data
TUR
HUN
HRV
MKD
CZE
BGR
SVN
PRT
ROU
SWE
EST
ESP
ITA
LUX
FRA
CHE
LTU
IRL
GBR
DNK
NOR
AUT
NLD
SVK
FIN
ISL
DEU
AND
LVA
BEL
ISR
POL
CYP
ALB
ARM
AZE
BLR
BIH
GEO
GRC
KAZ
KGZ
MLT
MCO
MNE
MDA
RUS
SMR
SRB
TJK
TKM
UKR
UZB
Grams
12.0
Country
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

22. Prevalence of exclusive breastfeeding under or at 6
months of age in the WHO European Region from
individual country-based surveys, various years
70.0
60.0
50.0
40.0
30.0
Source: WHO
Regional Office for
Europe
20.0
No data
0.0
AND
EST
FRA
MCO
RUS
SMR
GBR
GRC
BGR
ITA
IRL
LUX
SVN
BEL
BLR
AUT
SWE
GEO
TKM
ISR
AZE
NOR
CYP
ROU
CHE
SRB
FIN
LVA
BIH
CZE
NLD
UKR
MNE
ISL
POL
DEU
MKD
TJK
UZB
LTU
ESP
SVK
KAZ
PRT
ARM
MLT
HUN
ALB
TUR
MDA
HRV
KGZ
DNK
Percentage
10.0
Country
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

23. Nutrition National Survey Tajikistan
• 30% Stunting
• 28% (42%
Dushanbe)
overweight
women
reproductive
age
• Micronutrient
deficiencies
(iron, vit. D,
iodine…)
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

24. 4. NUTRITION POLICY
ACTIONS IN THE EUROPEAN
REGION
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

25. Overview Policy Actions Implementation
53 WHO/Europe Member States – 2012/13
Labelling - nutritional information
Food Based Dietary Guidelines
Breastfeeding promotion and protection policies
Physical Activity Policy incl. Guidelines
Baby Friendly Hospital Initiative
Programs in schools (inc. vending machines)
School Fruit Scheme (SFS) or similar
Salt reduction initiatives
Marketing HFSS foods to children - restrictions
Promote Active Travel for school-children
Reformulation - less sugar and salt
Policy
Actions
Labelling - signposting
Measures to affect food prices
Source: WHO
Regional Office for
Europe
0%
No Action
10%
20%
30%
Partially implemented
40%
50%
60%
70%
80%
90%
100%
Fully implemented
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

26. Great progress in certain
areas
MKT HFSS foods policies
No action
reported
Countries (N)
Partially or fully
implemented
20
33
Salt reduction policies
No action
reported
Countries (N)
Partially or fully
implemented
23
30
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

27. Brinsden et al. Surveys of the salt content in UK bread: progress made and
further reductions possible. BMJ Open 2013
Salt content in bread in repeated surveys - UK, 2001–2011

28. 5. ROLE OF DIETITIANS
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

29. Vienna Declaration (1)
• Priority area 1 - Create healthy food and
drink environments and encourage
physical activity for all population
groups
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

30. Vienna Declaration (2)
• Priority area 2 - Promote the health
gains of a healthy diet throughout the
life-course, especially for the most
vulnerable
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

31. Vienna Declaration (3)
• Priority area 3 - Reinforce health
systems to promote health and to
provide services for NCDs
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

32. Vienna Declaration (4)
• Priority area 4 - Support surveillance,
monitoring, evaluation and research of
the population’s nutritional status and
behaviours
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

33. Vienna Declaration (5)
• Priority area 5 - Strengthen governance,
alliances and networks and empower
communities to engage in health
promotion and prevention efforts
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013

34. Contact: twi@euro.who.int
The challenge of noncommunicable diseases for health in Europe: Implications for dietitians
8 November 2013