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World Health Day 2015 Working across sectors to
promote healthy and safe food
J. Breda [email protected]
WHO/Europe
8 Abril, 2015 Lisboa, Portugal
FAO/WHO World Declaration on Nutrition
(1992)
“… access to
nutritionally adequate and safe food is a right
of each individual.”
2
“Food safety is a hidden, and often overlooked, problem.”
“…our planet’s population is still affected by many food-related challenges….”
Dr Margaret Chan, WHO Director-General
3
Over 2,200 participants including:
• Representatives from more than 170 governments
• Heads of State and Government and Royals
• 85 Ministers and 23 Vice-Ministers from Foreign Affairs, Agriculture and Health
Disease burden attributable to food & nutrition in comparison
with other risk factors in 2010 (Lim et al, Lancet, 2012; 380: 2224-60, corrected)
GBD – PORTUGAL - 50%
8
• More than 200 diseases are spread through food.
• Foodborne diseases are caused by microorganisms (bacteria, viruses, fungi, prions, parasites) or chemicals, radioactivity or even physical agents.
• Foodborne and waterborne diarrhoeal diseases kill an estimated 2 million people annually, many whom are children.
• In 2013, in the EU/EEA alone, there were over 310 000 reported cases of bacterial foodborne disease, of which 322 people died.
• It is estimated that 3% of foodborne disease cases can lead to long-term health problems.
• Very severe consequences, some of which can be long term, including kidney and liver failure, brain and neural disorders, reactive arthritis, cancer, septicaemia and death, can be caused by contaminated food.
Foodborne disease – a serious public health
challenge
9
• Foodborne diseases are very common, even in the most developed countries.
• Reported foodborne disease represents only the tip of the iceberg, and mild cases are often not reported.
• There are limitations to existing surveillance and reporting systems.
• WHO is working to:
– Strengthen the surveillance systems through capacity-building
– Improve estimates of the burden of foodborne diseases through the Foodborne Disease Burden Epidemiology Reference Group.
“It must be something I ate”
10
• Commonly caused by eating food contaminated by bacteria, such as Salmonella, Campylobacter, Clostridium perfringens, Staphylococcus aureus, Bacillus cereus, or Escherichia coli (E. coli), or a virus, such as norovirus.
• Symptoms, which may begin soon after eating the contaminated food, include: nausea, vomiting, diarrhoea and/or stomach cramps.
• Most people with food poisoning get better without medical treatment. They should rest, and drink plenty of fluids.
Acute foodborne disease – causes, symptoms,
treatment
Campylobacter fetus. Photo:
CDC/Janice Carr
• Non-communicable diseases – the
leading cause of death and disability
in the European region & largely
preventable
• Body weight, unhealthy diets and
physical inactivity fundamentally
important risk factors
Global status report on NCDs, 2014
• NCDs currently cause more
deaths than all other causes
combined
• NCD deaths are projected to
increase to 52 million by 2030
• Four major NCDs responsible
for 82% of NCD deaths
A problem that starts at a young age…
49
45 45
34 34 32
30 29 28 26 25 25 24 24 24 23
0
10
20
30
40
50
60
GRC ITA** ESP MLT* MKD PRT SVN NOR** BGR IRL HUN LVA LTU CZE SWE BEL
* 6-year-olds
** 8-year-olds
Are we winning the battle with childhood obesity
in Europe?
Prevalence of overweight among boys aged 7 years - COSI 2010, by country
%
Source: HBSC Survey 2002. Data for 32 Member States
of the WHO European Region in 2002
15%≤ BMI-for-age <20%
10%≤ BMI-for-age <15%
BMI-for-age >10%
BMI-for-age ≥20%
No information
Prevalence of overweight (BMI -for-age +1SD)
among European adolescents (11, 13 and 15 years old boys and girls) in 2002
Prevalence of overweight (BMI -for-age +1SD)
among European adolescents (11, 13 and 15 years old boys and girls) in 2006
Source: HBSC Survey 2006. Data for 32 Member
States of the WHO European Region in 2006
15%≤ BMI-for-age <20%
10%≤ BMI-for-age <15%
BMI-for-age >10%
BMI-for-age ≥20%
Prevalence of overweight (BMI -for-age +1SD)
among European adolescents (11, 13 and 15 years old boys and girls) in 2010
Source: HBSC Survey 2010. Data for 32 Member
States of the WHO European Region in 2010
15%≤ BMI-for-age <20%
10%≤ BMI-for-age <15%
BMI-for-age >10%
BMI-for-age ≥20%
19
• Globalized food/animal trade, travel and migration – long-distance transmission of pathogens and long and complex food chains.
• Changes in agriculture and food industry – intensification and industrialization of agriculture, new technologies, and handling infected animals during food production.
• Increasing vulnerability of humans – ageing population, people who are immunosuppressed, poverty, migration, emergencies and extreme weather events.
• Changing lifestyles – urbanization, eating food prepared outside the home, and consuming more raw food.
Trends affecting food safety
Globalization: increasing risk of international food
safety events
21
• Linked to contaminated fenugreek sprouts.
• Cases reported in 14 countries in Europe and 2 in North America.
• Some 4000 reported cases, resulting in approximately 1000 cases of haemolytic uraemic syndrome.
• Led to 55 deaths.
• Caused US$ 1.3 billion in losses to farmers and industries.
• EU member States received US$ 236 million in emergency aid payments.
* enterohaemorrhagic E. coli
Health and economic impact of 2011 –
EHEC* outbreak in Europe
Globalization of trade: the world on your plate
Herb butter:
Chicken Kiev Courtesy: A. Reilly, Food Safety Authority of Ireland
Chicken breast:
Batter:
Breadcrumbs:
Salted butter – Ireland Garlic purée – China, Spain, USA Garlic salt – China, Spain, USA Lemon – USA Parsley – France, UK Pepper – Indonesia Water – Ireland
Chicken – Belgium, France, Ireland, UK, etc.
Flour – Belgium, France Water – Ireland
Breadcrumbs – Ireland, UK Rapeseed oil – Australia, Eastern Europe, EU
0,0
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Gra
ms
Country
Salt intake per person per day for adults in the WHO European Region from individual country-based surveys, various years
WHO/FAO RECOMMENDATION - <5 grams
No data
Food & diet as a major risk factor in Europe
Trans-fatty acids, TF and SF
WHO new Sugar Recommendations – what's new?
Association between SSB intakes and measures of body fatness in children
Te Morenga L et al. BMJ 2013;346:bmj.e7492 ©2013 by British Medical Journal Publishing Group
Per capita sugar
consumption and
prevalence of
diabetes mellitus
– global and
regional
associations.
Weeratunga P. BMC
Public Health 2014
0,0
10,0
20,0
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70,0
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Prevalence of exclusive breastfeeding under or at 6 months of age in the WHO European Region from individual country-based
surveys, various years
No data
Dietary inadequacies in European
girls and women HIGH LOW
Children 5-9 protein, fat, SFA, sugars, salt PUFA, vit D
Children 10-14 fat, SFA, sugars, salt vit D, folates, iron
Adolescents fat, SFA, sugars, salt vit D, folate, iron, PUFA,
magnesium, iodine
Adults Fat, SFA, sugars, salt calcium, magnesium and iron
Elderly Fat, sugars, salt vit D, α-tocopherol, folate,
calcium, magnesium, iron
Source : European Nutrition Report
2009
33
“Today, the journey from where our food comes from to how it ends on our plate is longer and more complex than ever before. Food safety risks exist at every step. Our food safety and control systems must adapt and work together across sectors, along the entire food chain.”
Dr Zsuzsanna Jakab, WHO Regional Director for Europe
Food safety and control systems must adapt
34
Food can be contaminated at any stage of the food chain.
“Ensuring safety throughout the increasingly complex food chain requires collaboration between the health sector, agriculture, food transport, food service establishments and the food industry.” – Health 2020
A long and increasingly complex food
chain
Consumers
Retail
Processing
Slaughter
Farm
Feed
Environment
35
Working together, the health and agriculture sectors have the power to address
avoidable communicable and noncommunicable disease and antimicrobial
resistance, to support sustainable development, and to ensure that those
living in urban and rural communities are able to access nutritious and safe food.
Intersectoral “wins” – agriculture & health
Photo: US Department of Agriculture
36
• Apply a holistic, risk-based, whole-food-chain
approach.
• Ensure that foodborne diseases and zoonoses, as
well as antimicrobial resistance, are addressed at
their root.
• Establish relevant monitoring systems in the food
chain.
• Ensure the hygienic production, processing and
distribution of food.
How the agriculture sector can improve health
through action on nutrition, food security & food
safety?
Photo: US Department of Agriculture
Photo: SuperManu
37
• Strengthen the surveillance of foodborne diseases in humans to enable the
agriculture sector to better prevent and respond to major foodborne diseases.
• Apply a “One Health” approach to foodborne and zoonotic diseases, as well as
antimicrobial resistance.
How the health sector can support agriculture through
action on nutrition, food security & food safety?
Photo: Tim1965
38
• Practise good personal hygiene.
• Protect fields from animal faecal
contamination.
• Use treated faecal waste.
• Evaluate and manage risks from irrigation
water.
• Keep harvest and storage equipment clean
and dry.
5 keys to growing safer fruits & vegetables
39
• Salmonella is one of the most common causes of foodborne illness,
often spread through eggs.
• Over 85 000 cases of salmonellosis are reported in the EU each year,
at a cost of up to €3 billion.
• Comprehensive Salmonella control programmes targeting poultry have
led to a fall in human salmonellosis cases by 50% over 5 years (2004–
2009) and by 19% from 2008–2012.
• Specific actions included: testing flocks for Salmonella, requiring sellers
to source eggs from farmers under a national Salmonella control
programme, and advising sellers and consumers to refrigerate eggs.
Case study – Salmonella
in Europe
Overall goals of World Health Day 2015
• Spur governments to improve food safety through public awareness campaigns, and to highlight their ongoing action.
• Encourage consumers to ensure the food on their plate is nutritious and safe safe.
41
5 keys to safer food
Key 1: Keep clean Key 2: Separate raw and cooked food Key 3: Cook thoroughly Key 4: Keep food at safe temperatures Key 5: Use safe water and safe raw materials. Video: http://youtu.be/2ZLRWg0cbMQ
WHO Recommendations
Social media campaign
#safefood People invited to engage through Twitter, Instagram, Facebook, sharing an image of their own plate, and answering the questions “What is safe food?” and “How do you ensure your food is safe?”
#safefoodchat Twitter chat with partners.
New PA data (WHO GHO 2014)
Unpublished data under confirmation:
PLEASE DO NOT QUOTE
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Perc
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Prevalence of physical inactivity (%) among adolescents (11-17 years) in the EU
Male Female
Translating this to political
commitment and concrete policy
action
Overview Policy Actions Implementation
53 WHO/Europe Member States – 2012/13
Po
lic
y
Ac
tio
ns
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Measures to affect food prices
Labelling - signposting
Reformulation - less sugar and salt
Promote Active Travel for school-children
Marketing HFSS foods to children - restrictions
Salt reduction initiatives
School Fruit Scheme (SFS) or similar
Programs in schools (inc. vending machines)
Baby Friendly Hospital Initiative
Physical Activity Policy incl. Guidelines
Breastfeeding promotion and protection policies
Food Based Dietary Guidelines
Labelling - nutritional information
No Action Partially implemented Fully implemented
50
From farm to plate, make food safe
How can we support national efforts? WHO provides upstream policy advice to set national targets
6 global targets for nutrition to be attained by 2025
-40% 40% reduction in number of children
under-5 who are stunted
-30% 30% reduction in low birth weight
≥ 50% Increase the rate of
exclusive breastfeeding in the first six months to at
least 50%
-50% 50% reduction of anaemia in women reproductive age
0% No increase in childhood
overweight
<5% Reduce and
maintain childhood
wasting to less than 5%
From Health 2020 to the FNAP & PAS
Health 2020 Vienna Declaration
Physical Activity Strategy (PAS) & FNAP
2012 2013 2014 2015
Ministerial Conference on
Nutrition & NCDs, Vienna “…contribute significantly to the
reduction of NCDs by addressing
…..excessive intake of energy, saturated
fats and trans fats, free sugars and salt, as
well as low consumption of vegetables and
fruit..”
“Development of a new food and
nutrition action plan”
“Mandate the development of a physical
activity strategy”
European Food
and Nutrition
Action Plan
2015-2020
European Food and Nutrition Action
Plan 2015-2020 – priority areas 1. Create healthy food and drink
environments
2. Promote the gains of a healthy diet throughout life, especially for the most vulnerable groups
3. Reinforce health systems to promote healthy diets
4. Support surveillance, monitoring, evaluation and research
5. Strengthen governance, alliances and networks to ensure a health-in-all-policies approach
Websites
• WHO/Europe World Health Day website:
http://www.euro.who.int/whd2015
• Food safety in the European Region:
http://www.euro.who.int/foodsafety
• World Health Day global site:
http://www.who.int/campaigns/world-health-
day/2015/event/en/
Dr João Breda Programme Manager
Nutrition, Physical Activity and Obesity
Division of Noncommunicable Diseases & Life-course
WHO Regional Office for Europe, Copenhagen
http://www.euro.who.int/nutrition