6. Strategic directions and recommendations for policy and research

6.1 Introduction

The principal goal of public health policy is to give people the best chance to enjoy many years of healthy and active life. Public health action to prevent the adverse consequences of inappropriate dietary patterns and physical inactivity is now urgently needed. To this end, the Consultation discussed how nutrient/food intake and physical activity goals could be used by policy-makers to increase the proportion of people who make healthier choices about food and undertake sufficient physical activity to maintain appropriate body weights and adequate health status. This chapter discusses ways to catalyse the long-term changes that are needed to place people in a better position to make healthy choices about diet and physical activity. Such processes require long-term changes in thinking and action at the individual and societal levels; demand concerted action by national governments, international bodies, civil society and private entities and will need insights and energies contributed by multiple sectors of society.

New scientific information will be essential to permit adjustment not only of the policy levers, but also of the strategic processes to introduce change. This constitutes an important focus for applied research that should yield useful evidence to guide effective interventions.

Three key elements need to be analysed. The first is the range of possible policy principles that would help people achieve and maintain healthy dietary and activity patterns in a simple and rewarding manner. The second is the prerequisites for possible strategies to introduce these policies in different settings. These include the need for leadership, effective communication of problems and possible solutions, functioning alliances, and ways of encouraging enabling environments to facilitate change. The third is the possible strategic actions to promote healthy diets and physical activity.

6.2 Policy principles for the promotion of healthy diets and physical activity^1,2

The Consultation recommended the consideration of the following policy principles when developing national strategies to reduce the burden of chronic diseases that are related to diet and physical inactivity.

• Strategies should be comprehensive and address all major dietary and physical activity risks for chronic diseases together, alongside other risks - such as tobacco use - from a multisectoral perspective.
• Each country should select what will constitute the optimal mix of actions that are in accord with national capabilities, laws and economic realities.
• Governments have a central steering role in developing strategies, ensuring that actions are implemented and monitoring their impact over the long term.
• Ministries of health have a crucial convening role - bringing together other ministries needed for effective policy design and implementation.
• Governments need to work together with the private sector, health professional bodies, consumer groups, academics, the research community and other nongovernmental bodies if sustained progress is to occur.
• A life-course perspective on chronic disease prevention and control is critical. This starts with maternal and child health, nutrition and care practices, and carries through to school and workplace environments, access to preventive health and primary care, as well as community-based care for the elderly and disabled people.
• Strategies should explicitly address equality and diminish disparities; they should focus on the needs of the poorest communities and population groups - this requires a strong role for government. Furthermore, since women generally make decisions about household nutrition, strategies should be gender sensitive.
• There are limits to what individual countries can do alone to promote optimal diets and healthy living. Strategies need to draw substantially on existing international standards that provide a reference in international trade. Member States may wish to see additional standards that address, for example, the marketing of unhealthy food (particularly those high in energy, saturated fat, salt and free sugars, and poor in essential nutrients) to children across national boundaries. Countries may also wish to consider means of ensuring the accessibility of healthier choices (such as fruits and vegetables) to all socioeconomic groups. WHO’s international leadership role in pushing forward the agenda on diet, physical activity and health is crucial. FAO also has an important role in this process since it deals with issues relating to the production, trade, marketing of food and agricultural commodities and provides guidelines ensuring the safety and nutritional adequacy of food and food products.

6.3 Prerequisites for effective strategies

Drawing on experience with the implementation of local and national strategies for public health matters in different settings, the Expert Consultation concluded that there are a number of prerequisites for success. These include leadership, effective communication, functioning alliances and an enabling environment

6.3.1 Leadership for effective action

Leadership is essential for introducing long-term changes. Within nations, governments have the primary responsibility for providing this leadership. In some cases leadership may be initiated by civil society organizations prior to government action. It is unlikely that there will be just one correct path to improved health: each country will need to determine the optimal mix of policies that its particular circumstances best fit. Each country will need to select measures within the reality of its economic and social resources. Within a given country, effective action may call for regional strategies.

More proactive leadership is needed, worldwide, to portray a holistic vision of food and nutritional issues as they affect overall health. Where this leadership has existed, it has been possible to make governments take notice and introduce the necessary changes. The question remains of how to develop and strengthen leadership capacity to reach a critical mass. The WHO collaborating centres in nutrition and the FAO network of centres of excellence are possible routes, although there is a clear need to strengthen existing capabilities.

Governments throughout the world have developed strategies to eradicate malnutrition, a term traditionally used synonymously with undernutrition. However, the growing problems of nutritional imbalance, overweight and obesity, together with their implications for the development of diabetes, cardiovascular problems and other diet-related noncommunicable diseases, are now at least as pressing. This applies especially to developing countries undergoing the nutrition transition; such countries bear a double burden of both overnutrition, as well as undernutrition and infectious diseases. Unless there is political commitment to spur governments on to achieve results, strategies cannot succeed. Setting population goals for nutrient intake and physical activity is necessary but insufficient. Giving people the best chance to enjoy many years of healthy and active life requires action at the community, family and individual levels.

¹ During the preparation of this report, by resolution WHA55.23 (1) in May 2002, the World Health Assembly called upon the Director-General to develop a global strategy on diet, physical activity and health (WHA55.23). The process for developing the WHO global strategy will involve formal consultation with MemberStates, United Nations agencies, civil society, and the private sector over a period of a year, prior to drafting a proposed global strategy for presentation to the Fifty-seventh World Health Assembly in 2004.

² Ensuring that people have access to adequate food which is safe and at the same time of appropriate nutritional quality is important. One of the commitments adopted by the World Food Summit convened by FAO in 1996, and reiterated in 2002 at the World Food Summit: Five Years Later, specifically endorses the implementation of policies aimed at “improving access by all, at all times to sufficient, nutritionally adequate and safe food”.

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