Summer 2006    Vol. 14, Issue 1


WHO Strategy on Diet, Physical Activity and Health Targets Global Chronic-Disease Burden

policyChronic, noncommunicable diseases, such as cancers, heart disease and diabetes, are currently the leading causes of death, disability and disease worldwide, except in sub-Saharan Africa. They account for about 60 percent of all deaths and 47 percent of the global burden of disease, with 66 percent of the deaths attributed to noncommunicable diseases occurring in developing countries, usually among younger people than in developed countries.

The World Health Organization (WHO) projects that the global epidemic of chronic diseases and their common risk factors will escalate and worsen, leading to 73 percent of all deaths and 60 percent of the global disease burden respectively by 2020, unless decisive, effective actions are taken at international, regional, national and local levels. An international public health policy instrument could contribute significantly to the prevention and reduction in the risk of selected cancers and other chronic diseases by improving national dietary (and physical activity) practices.

An International Policy Framework
In response to this challenge, the World Health Assembly (WHA) developed and adopted the WHO Global Strategy on Diet, Physical Activity and Health (DPAS) in May 2004. (WHO does not have a separate strategy for diet, physical activity and cancer prevention since DPAS addresses two of the major risk factors common to cancers, heart disease and other chronic diseases.)

DPAS builds upon several prior WHA policy statements such as the 2003 WHO/Food and Agriculture Organization (FAO) report on diet, nutrition and the prevention of chronic diseases, in addition to agreements and declarations made at the regional level of WHO. A comprehensive set of policy options, DPAS calls upon all stakeholders – governments, educators, nongovernmental organizations (NGOs) and the private sector – to take action.

Governments have a central leadership and stewardship role in shaping national public health policies, including national food availability, affordability and quality. DPAS calls on governments to develop, implement and evaluate actions appropriate to national circumstances that promote individual and population health through improved diets and increased physical activity to reduce the risks and incidence of chronic diseases, including cancer.

Within a multisectoral national framework, ministries of health have responsibility to convene, coordinate and facilitate active participation of other agencies and stakeholders. Ministries and institutions that should contribute include those responsible for policies on food, agriculture, youth, recreation, sports, education, commerce and industry, finance, transportation, media and communications, social affairs, local government, and environmental and urban planning.

DPAS also calls on civil society and NGOs to inform and influence individual and community behaviours, and monitor the activities of governments, the private sector, and organizations and institutions that are involved in promoting healthy diets. NGOs can also help to ensure that governments provide support for healthy lifestyles, and that the food industry provides healthier products and better information about these products.

In addition, as responsible employers, manufacturers of food and drink products, providers of information and advocates for healthy lifestyles, the private sector, including the food industry, retailers, catering companies, sporting-goods manufacturers, advertising and recreation businesses, pharmaceutical companies and the media, all have important roles to play in preventing and reducing the risk of chronic disease. Because many companies operate globally, international collaboration is crucial. Initiatives by the food and drink industries to reduce the fat, sugar and salt content of processed foods and introduce innovative and nutritious food choices could significantly improve the quality of food available in the market place.

National Food and Nutrition Action Plans and Dietary Guidelines
DPAS recommends that nations develop and implement their own national food-based dietary guidelines as interventions for the prevention of cancers and other chronic diseases.

National food and nutrition action plans and Food Based Dietary Guidelines are available and promoted in many countries by WHO and FAO. These guidelines provide evidence-based recommendations for improving national diets, including advice on measures to reduce cancer risk (e.g. increase consumption of fruits and vegetables), as well as actions to discourage practices which heighten cancer risk (e.g. reduce consumption of red or preserved meat). Dietary and nutritional interventions are more likely to be effective if the public policy agenda includes supportive actions by all relevant sectors such as agriculture and education.

Implications for Global and Regional Food Policies
International trade in food is a substantial global economic activity constituting 11 percent of global trade, thereby exceeding international trade in fuel, according to a 2001 article by Pinstrep-Andersen and Babinard. Processed foods in developed countries are produced by only a few transnational corporations. Much of this food is high in salt, sugar and fat, is actively marketed globally, and comprises predominantly energy-dense nutrient-poor (EDNP) items; there is little promotion of healthy foods. Partly in response to the adoption of DPAS, however, several large global food and beverage manufacturers are beginning to change the composition of some products and/or introduce healthier options.

While most of the food consumed in developing countries is grown or produced locally, processed foods are becoming increasingly popular, partly because they are often cheaper than locally produced foods. Developing countries already face growing challenges to limit the exposure of populations to EDNP foods as these nations begin to manage the dual burden of sharing the chronic diseases of developed countries, while struggling to bring hunger and malnutrition under control.

Concerned by the rising levels of chronic diseases worldwide, parents and public health groups argue that voluntary and self-regulatory actions to limit the promotion and consumption of EDNP foods are inadequate and that national legislative interventions and international action are needed to stem the tide. This grassroots outcry, coupled with the growing role of public health issues in investment decisions, may help to encourage food and beverage manufacturers to continue to improve their product portfolio.

Challenges of Implementation
Implementation of DPAS at the global level presents major challenges, primarily due to the lack of appreciation of the social and economic costs of chronic diseases on individuals, families and nations, as revealed in a 2006 WHO report. Political commitment to the prevention of chronic diseases and their risk factors at all levels is a low priority. For example, in a recent assessment by WHO, less than half of its member states have implemented or plan to implement DPAS recommendations.

Furthermore, some of the interventions proposed by DPAS conflict with the interests of stakeholders, such as the food and non-alcoholic beverage industries and advertisers. Recommendations to reduce salt, sugar and fats have been met with some resistance. Activities promoting healthy diets should therefore use a multi-stakeholder approach, be culture-specific, include information about energy balance, and emphasize the importance of physical activity.

New and innovative solutions are needed to challenge the established roles of and relationships in the health sector. Crucial for improving national diets are effective partnerships between public and private sectors (especially food and non-alcoholic beverage industries) to ensure that affordable and healthy food choices are available. Such partnerships remain largely undeveloped because public health agencies are uncertain about the influence of the private sector on their standard-setting and regulatory roles.

National and international agricultural policies and guidelines must take note of public health rather than just food security and trade issues. For example, the agricultural sector needs to seriously promote increased production of fruits and vegetables instead of publicly bemoaning the production of sugar and animal-based products. A WHO/FAO workshop held in Rome in May 2006 underlined the need for agricultural policies to promote public health. Encouraging the production and consumption of locally produced and unprocessed foods will be an important part of this process – and a good start.


Center for Communications, Health and the Environment
4437 Reservoir Road, NW, Washington, DC 20007
Tel: (202) 965-5990 . Fax: (202) 965-5996