By Prof Robert Beaglehole

1. 4/11/2013
1
GLOBAL NCD CHALLENGES:
DIET AND PHYSICAL INACTIVITY
Robert Beaglehole, Auckland, New
Zealand
26 March, 2013
Key messages: diet and physical
inactivity
 NCDs a global and national crisis
 Plans and strategies – global (WHO), regional
and national –necessary, but not sufficient
 Policy implementation is critical, including
regulation of unhealthy commodities
 Accountability, including national goals and
targets – missing link

2. 4/11/2013
2
Leading risk factors for DALYS
Malaysia, GBD 2010
UN High-Level Meeting on NCDs
September, 2011
A major step forward
 Provide leadership
 Establish multi-sectoral
national plans by 2013
 Integrate NCDs into the
development agenda
 Set national targets for
prevention and treatment
 Measure results
 Increase domestic resources

3. 4/11/2013
3
WHO global voluntary NCD targets
Physical
inactivity
10%
Salt/
sodium intake
30%
Tobacco use
30%
Drug therapy to
reduce high CVD risk
50% coverage
Obesity and
diabetes
Halt the
rise
Alcohol
10%
Generic
medicines and
technologies
80%
Blood
pressure
25%
Premature mortality from NCDs
25% reduction
Target (goal) adopted by the World Health Assembly May 2012
Priority targets Other targets
Measuring progress on NCDs: global goal and 5 targets
NCDs and Sustainable DevelopmentBeaglehole et al. Lancet, 2012

4. 4/11/2013
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Country actions: a stepwise approach
 A simple, phased national
response to the political
declaration involves 3
steps:
 planning,
 implementation, and
 accountability
The Lancet NCD Action GroupBonita et al. Lancet, 2013 at http://www.lancet.com/series/non-communicable-diseases
Tobacco control:
the key to NCD prevention
 40% of men use tobacco in Malaysia
 Accelerated implementation of the Framework
Convention on Tobacco Control (especially price
increases)
 WHO target of reducing tobacco use by 30% by
2025
 The longer-trem goal of:
A world essentially free (< 5% prevalence)
from tobacco by 2040

5. 4/11/2013
5
Diet and NCDs: the “facts”
 Diet a major determinant of DALYs in Malaysia
 Energy imbalance the fundamental cause of
obesity and contributes to diabetes/CVD and
some cancers
 Fat (total intake) an important cause of obesity
 Type of fats influence CVD risk (eg replacing sat.
fat with polyunsaturated fat improves lipid profile)
 Sugar a major cause of dental caries and a cause
of obesity; guidelines – WHO (10% energy),
Malaysia
 Salt a major cause of elevated blood pressure and
thus CVD
 Alcohol an under-appreciated cause of NCDs
Diet and NCDs: a systems
approach
 The food environment conditions food choices
 Transnational corporations are major drivers of
NCD epidemics and profit from unhealthy
commodities
 The answer to diet caused diseases are
government policies
 The politics of food is the most challenging area
for public health

6. 4/11/2013
6
Profits and pandemics: Key messages
 Unhealthy commodity industries should have no role in the
formation of national or international policy for NCD policy
 There is no evidence to support the effectiveness of self-
regulation and public–private partnerships to improve public
health
 Public regulation and market intervention are the only
evidence-based mechanisms that can prevent harm caused by
unhealthy commodity industries
Moodie, et al. Lancet 2013
Reduction in Malaysian sugar
subsidy
“Moderate intake of sugar is acceptable.
However, if taken excessively, it may be harmful.
In this regard, the Government proposes to
reduce the subsidy on sugar by RM0.20 per kg,
effective from 29 September 2012.
The Government urges the business community
not to burden the rakyat by increasing the price
of sugar but instead reduce the content of sugar
in food and beverage.”

7. 4/11/2013
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New threats to growing
obesity problem in
Malaysia
Diet and NCD: other challenges
 Restrict marketing of unhealthy products
 Increase quality of food in schools
 Food labelling; front of pack (traffic lights)
 Increased funding for prevention
 Multisectoral leadership and action
 Accountability: review, monitoring, action

8. 4/11/2013
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Physical activity challenges
 Key NCD risk factor – GBD 2010
 Importance of multisectoral action; city
planning
 Transport – public and private
 Community-based (schools) interventions a
good starting point
 Community-based research; SEACO
The global context: from MDGs to
SDGs
 MDGS established in 2000, for
2015
 Three health goals – unfinished
agenda
 NCDs not included although they
undercut MDGs
 Post 2015: “Sustainable Human
Development Goals” (SDGs),
including NCDS

9. 4/11/2013
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Next steps: Putting the pieces
together
 Rapid progress is possible with
cheap and effective interventions
 Use a step-wise approach
 Use overall risk approach to
determine treatment of risk
factors
 Regulation necessary to control
processed food industries
 Accountability for UN
commitments essential -
monitoring, review and action -
focus on equity