World Health Day 2015 Working across sectors to

promote healthy and safe food

J. Breda jbr@euro.who.int

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.”

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“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

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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%

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• 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

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• 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”

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• 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…

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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%

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• 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

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• 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

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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.

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Public Health 2014

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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

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“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

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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

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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

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• 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

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• 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

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• 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

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• 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.

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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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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

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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

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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

jbr@euro.who.int

Nutrition, Physical Activity and Obesity

Division of Noncommunicable Diseases & Life-course

WHO Regional Office for Europe, Copenhagen

http://www.euro.who.int/nutrition