Maailma Terviseorganisatsioon ja toitumine ning toiduturundus lastele Marge Reinap Maailma Terviseorganisatsioon Esindus Eestis
Sissejuhatus Maailma Terviseorganisatsiooni (WHO) lühitutvustus Millega WHO tegeleb toitumise valdkonnas Rasvumine ja ülekaalulisus kui probleem Võimalikud lahendused Kõrge rasva-, soola- ja suhkru sisaldusega toitude turundamine lastele
Maailma Terviseorganisatsioon Ühinenud Rahvaste Organisatsiooni (ÜRO) spetsialiseerunud allorganisatsioon Loodud - 1948 aastal 193 liikmesriiki, Eesti liige alates 1993 aastast Kolmetasandiline struktuur: Globaalne tasand peakontor Genfis, Regionaalne tasand 6 regiooni, Euroopa regionaalbüroo asub Kopenhaagenis, Riigi tasand Euroopas 29 esindust, sh Eestis
Maailma Terviseorganisatsiooni eesmärk ja funktsioonid WHO eesmärk: aidata kaasa kõigi rahvaste võimalikult hea terviseseisundi saavutamisele WHO funktsioonid: olla juhtfiguur globaaltervise teemadel, luua ning jagada teadmisi, seada norme ja standardeid, pakkuda tõenduspõhiseid poliitikavalikuid, pakkuda riikidele sisulist ekspertabi, seirata ja hinnata tervisetrende.
WHO ja toitumine
Globaalne poliitikaraamistik
Toitumisalase teabe loomine ja jagamine Taustainformatsioon, publikatsioonid, aruanded, teabelehed erinevatel teemadel Sõnumite kujundamine ja kommunikatsioon. Globaalne toitumisteemaline koduleht: http://www.who.int/topics/nutrition/en/ http://www.who.int/dietphysicalactivity/en/ Euroopa regiooni koduleht: http://www.euro.who.int/en/what-we-do/healthtopics/disease-prevention/nutrition
Toitumisalased normid ja standardid Tõenduspõhiste toitumissoovituste ja toitainete nõuete väljatöötamine, sh koostöös FAO-ga http://www.who.int/nutrition/topics/nutrecomm/en/index.html Trace elements in human nutrition and health (WHO/FAO/IAEA), Fats and oils in human nutrition (FAO/WHO), Preparation and use of food-based dietary guidelines (WHO/FAO), Carbohydrates in human nutrition (FAO/WHO) http://www.who.int/publications/guidelines/nutrition/en/ind ex.html WHO Nutrition Guidance Expert Advisory Group (NUGAG), http://www.who.int/nutrition/topics/advisory_group/en/inde x.html Ekspertkohtumised konkreetsetel teemadel
Näiteks: WHO Scientific Update on Trans Fatty Acids (TFA) Koostati kuus eraldi analüüsi: 1.General historical background of the work related to TFA and the Global Strategy. 2.Health effects of TFA: Experimental and observational evidence. 3.Quantitative effects on cardiovascular risk factors and coronary heart disease risk of replacing partially hydrogenated vegetable oils with other fats and oils. 4.Feasibility of recommending certain replacement or alternative fats. 5.Assessing approaches to removing TFA in the food supply in industrialized countries and in developing countries. 6.Summary and conclusions of the Scientific Update. http://www.nature.com/ejcn/journal/v63/n2s/index.html
European Journal of Clinical Nutrition (2009) 63, S68 S75 http://www.nature.com/ejcn/journal/v63/n2s/pdf/ejcn200915a.pdf
Toitainete klassifitseerimise ja järjestamise teadus tulenevalt nende tervisemõjust. Töö selles vallas on veel käimas Näiteks: http://www.who.int/nutrition/publications/profiling/who_iaso_report2010.pdf
Lapseaegne ülekaal/rasvumine Tasakaalustamata toit ja ebatervislike toitumisharjumuste muutmine Energiarikka toidu tarbimise vähendamine Kõrgekalorlusega vahepalade tarbimise vähendamine Puu ja juurvilja tarbimise suurendamine Rakendused Toidupakendi esikülje märgistus Lastele suunatud reklaami kontrollimine MUDELID Määratlemine, mis on tervislik toit ja saab vastava märgi Määratlemine, mis on ebatervislik toit ja mida reguleeritakse
Tõenduspõhised poliitikavalikud Toitumisalaste sekkumiste tõendus: e-library of Evidence for Nutrition Actions (elena) http://www.who.int/elena/en/index.html
Ekspertabi riikidele http://www.euro.who.int/en/what-wedo/health-topics/diseaseprevention/nutrition/activities/technicalsupport-to-member-states
Tervisetrendide jälgimine Health for all database - tervise info http://www.euro.who.int/en/what-we-do/data-andevidence/databases/european-health-for-all-database-hfa-db2 Nutrition Landscape Information System (NLiS) Kehamassi indeksi andmebaas http://apps.who.int/bmi/index.jsp The WHO Global InfoBase mittenakkuslikest haigustest ja riskifaktoritest https://apps.who.int/infobase/report.aspx WHO Global Database on Child Growth and Malnutrition http://www.who.int/nutgrowthdb/database/countries/en/index.html Vitamin and Mineral Nutrition Information System (VMNIS) http://www.who.int/vmnis/en/
Probleem: Laste ja täiskasvununute ülekaalulisus ja rasvumine WHO Euroopa regioonis
Tajikistan, 2003, 25 49 Switzerland, 2007, 15+ Austria, 2007 2008, 18 65 Norway, 2008 2009, 16+ Italy, 2006, 18+ Denmark, 2005, 16+ Cyprus, 2003, 15+ Sweden, 2009, 16 84 Albania, 2008 2009, 15 49 Belgium, 2008, 18+ Ireland, 2007, 18+ France, 2009, 15+ Republic of Moldova, 2005, 15 49 Netherlands, 2009, 20+ Georgia, 2009, 15 49 Armenia, 2005, 15 49 Slovenia, 2007 2008, 18 65 Finland, 2008, 15 64 Estonia, 2008, 16 64 Spain, 2006, 18+ Russian Federation, 2005, 20 49 Latvia, 2006, 15 64 Lithuania, 2008, 20 64 Portugal, 2003 2005, 20 74 Azerbaijan, 2006, 15 49 Luxembourg, 2008, 16+ Greece, 2003, 20 70 Poland, 2003 2005, 20 74 Germany, 2005 2007, 18 80 Czech Republic, 2008, 20+ United Kingdom: Wales, 2009, 16+ Bulgaria, 2004, 20+ Malta, 2006 2007, 18+ Serbia, 2006, 20+ United Kingdom: England, 2007 2008, 16+ Croatia, 2003, 18+ Turkey, 2008, 15 49 Hungary, 2009, 18+ United Kingdom: Scotland, 2008, 16+ Survey characteristics: country, year, age range (years) 22.2 Men 8.7 13.0 11.0 10.4 11.8 12.9 13.0 8.5 13.3 16.0 13.9 11.2 18.3 15.4 17.5 15.5 14.5 16.9 14.6 18.3 26.0 21.2 20.5 23.9 21.0 25.2 21.6 26.7 26.0 14.2 19.5 11.8 4.9 37.6 39.0 43.0 43.8 40.9 41.0 41.0 44.8 40.6 43.0 38.5 41.3 41.3 40.4 38.8 44.5 31.1 45.8 44.5 44.9 38.3 44.4 41.1 40.4 45.5 42.8 41.0 39.3 49.7 36.3 40.7 46.7 36.0 42.5 18.5 20.8 22.0 27.0 26.8 26.4 26.9 27.0 29.6 26.0 28.0 26.0 23.3 29.5 24.1 26.9 30.3 27.6 26.3 30.2 25.4 27.5 26.4 33.9 29.5 30.6 29.9 27.9 29.5 29.2 31.0 32.4 33.9 36.0 29.2 35.5 34.5 31.1 34.3 7.1 7.8 9.0 8.0 9.9 11.0 11.8 12.0 9.7 Women 14.4 13.0 15.1 18.2 12.4 18.0 15.5 12.4 16.0 18.3 15.0 20.1 18.1 19.7 13.3 17.9 17.2 18.2 22.4 21.1 22.3 21.0 19.6 19.3 17.4 27.7 22.7 23.9 30.0 27.5 Obese, measured data Pre-obese, measured data Obese, self-reported data Pre-obese, self-reported data 80 60 40 20 0 20 40 60 80 Percentage (%) WHO, 2010.
80 70 60 50 40 30 20 10 0 16-24 25-34 35-44 45-54 55-64 Rasvunud ja ülekaalus Eesti elanike osakaal (%) rahvastikus 0 10 20 30 40 50 Mehed 2000 2002 2004 2006 2008 2010 Naised 16-24 25-34 35-44 45-54 55-64 60 70 80 Allikas: Täiskasvanud elanikkonna tervisekäitumise uuring (TKU)
Ülekaaluliste laste osakaal on kasvanud järsult Ülekaaluliste laste osakaal, % 20 18 16 14 12 10 8 6 4 2 0 40% 50% 13 13 9 7 19 18 225% 80% 13 10 14 40% 5 5 4 80% 11 9 9 tüdrukud poisid tüdrukud poisid tüdrukud poisid 11-aastased 13-aastased 15-aastased 2001/2002 2005/2006 2009/2010 16 Allikas: Kooliõpilaste tervisekäitumise uuring (HBSC), WHO/Europe
Ülekaaluliste laste osakaalus on Eesti tõusmas riikide edetabelis 2001/2002 2005/2006 2009/2010 13 A 15 A 11 A 13 A 15 A 11 A 13 A 15 A 30. 30. 27. 28. MLT USA 18. USA 12. USA 35 riigist 35 riigist 41 riigist 41 riigist 41 riigist 39 riigist 39 riigist 39 riigist Allikas: Kooliõpilaste tervisekäitumise uuring (HBSC) 38. 26.
Mida teha, et elanikkonna rasvumistrendi peatada?
WHO/EUROPE: tegevusemandaat
Mida konkreetselt teha? Planning & oversight Health in all policies Healthy Settings Secondary prevention National plan Fiscal policies Marketing Workplaces & Schools Cardiometabolic risk assessment & management Health info sys with social determinants disaggregation Salt Trans-Fat Active Mobility Early detection of cancer Health Promotion
Toidusoovitused Kehalise aktiivsuse soovitused Subsideeritud puuvili ja juurvili koolis Ülevaade poliitikate rakendamisest EL liikmesriikides Müügiautomaadid koolis Aktiivse liikumise toetamine Soolevähendamise sekkumised Tervislike töödeldud toidu osakaalu suurendamine Rakendamata Osaliselt rakendatud Täiesti rakendatud Poliitikameetmed Hinnakujundus Energiasisalduse tähistamise seadusandlus Toiduainete tähistamine Turunduse reguleerimine Beebisõbralik haigla Rinnaga toitmise soodustamine EL liikmesriigid
Tegevus lastele suunatud kõrge rasva, suhkru ja soolasisaldusega toidu ja mitte-alkohoolsete jookide turunduse suunal
Kommunikatsioonimaailm
Osakaal 11-aastastest lastest, kes vaatavad rohkem kui 2 tundi päevas televiisorit, 2010 Allikas: Kooliõpilaste tervisekäitumise uuring (HBSC), WHO/Europe
http://www.kelloggs.co.uk/whatson/cocopopspromise/pro mise/video.html
Marketing Spending Trends Kulutused onlineturundusele kasvavad Spending on online display advertising (% change) from 2009 428 336 163 225 47 69 106 McDonald's PepsiCo General Mills Coca-cola Kellogg Wendy's Dr. Pepper
Turundamise piiramise põhjendus rahvatervise vaatevinklist Kõrge suhkru-, rasva- ja soolasisaldusega toidu reklaam on väga laialdane ja efektiivne Reklaam muudab toidueelistusi ja toitumisharjumusi Maitsemeelele ja toitumisharjumustele pannakse alus lapsepõlves ning hiljem on seda oluliselt keerulisem muuta Uuringud on näidanud, et piirangud kõrge suhkru-, rasvaja soolasisaldusega toidu reklaamile on mõjusad reklaami mõju ja ulatuse vähendamisele ning kuluefektiivne meetod lapseaegse rasvumisega võitlemisega.
Tegevused Mais 2010 võttis WHO liikmesriikidest koosnev üldkogu vastu lastele suunatud toidu ja mittealkohoolsete jookide reklaamisoovitused WHO Euroopa regiooni liikmesriikidest on koondunud Action Network Marketing Food To Children 2012 aastal töötas WHO välja soovituste rakendamise raamistiku: A framework for implementing the set of recommendations on the marketing of foods and non-alcoholic beverages to children Üle Euroopa on riigid rakendanud erinevaid poliitikaalgatusi lastele suunatud reklaami piiramiseks http://www.who.int/dietphysicalactivity/framework_marketing_food_to_children/en/
Vanemad WHO publikatsioonid: The extent, nature and effects of food promotion to children : a review of the evidence to December 2008 (2009) Marketing food to children : changes in the global regulatory environment, 2004-2006 (2007) The extent, nature and effects of food promotion to children: a review of the evidence (2007) Marketing of food and non-alcoholic beverages to children: report of a WHO forum and technical meeting, Oslo (2006) Marketing food to children : the global regulatory environment (2004) http://www.who.int/dietphysicalactivity/publications/marketing/en/i ndex.html
Soovitused Eesmärk: Aidata liikmesriikidel välja töötada uusi ja tugevdada olemasolevaid meetmeid vähendamaks lastele suunatud kõrge küllastunud rasva-, transrasvade-, soola- ja suhkrusisaldusega toodete reklaami mõju 12 soovitust on jagatud 5 jaotusesse: Põhjendus, poliitika väljatöötamine, poliitika rakendamine, poliitika seire ja hindamine ning uuringud.
Soovitused: Põhjendus 1: The policy aim should be to reduce the impact on children of marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt. 2: Given that the effectiveness of marketing is a function of exposure and power, the overall policy objective should be to reduce both the exposure of children to, and power of, marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt.
Soovitused: Poliitika väljatöötamine (1) 3: To achieve the policy aim and objective, Member States should consider different approaches, i.e. stepwise or comprehensive, to reduce marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt, to children. 4: Governments should set clear definitions for the key components of the policy, thereby allowing for a standard implementation process. The setting of clear definitions would facilitate uniform implementation, irrespective of the implementing body. When setting the key definitions Member States need to identify and address any specific national challenges so as to derive the maximal impact of the policy.
Soovitused: Poliitika väljatöötamine (2) 5: Settings where children gather should be free from all forms of marketing of foods high in saturated fats, transfatty acids, free sugars, or salt. Such settings include, but are not limited to, nurseries, schools, school grounds and pre-school centres, playgrounds, family and child clinics and paediatric services and during any sporting and cultural activities that are held on these premises. 6: Governments should be the key stakeholders in the development of policy and provide leadership, through a multistakeholder platform, for implementation, monitoring and evaluation. In setting the national policy framework, governments may choose to allocate defined roles to other stakeholders, while protecting the public interest and avoiding conflict of interest.
Soovitused: Poliitika rakendamine 7: Considering resources, benefits and burdens of all stakeholders involved, Member States should consider the most effective approach to reduce marketing to children of foods high in saturated fats, trans-fatty acids, free sugars, or salt. Any approach selected should be set within a framework developed to achieve the policy objective. 8: Member States should cooperate to put in place the means necessary to reduce the impact of crossborder marketing (in-flowing and out-flowing) of foods high in saturated fats, trans-fatty acids, free sugars, or salt to children in order to achieve the highest possible impact of any national policy. 9: The policy framework should specify enforcement mechanisms and establish systems for their implementation. In this respect, the framework should include clear definitions of sanctions and could include a system for reporting complaints.
Soovitused: Poliitika seire ja hindamine 10: All policy frameworks should include a monitoring system to ensure compliance with the objectives set out in the national policy, using clearly defined indicators. 11: The policy frameworks should also include a system to evaluate the impact and effectiveness of the policy on the overall aim, using clearly defined indicators.
Soovitused: Uuringud 12: Member States are encouraged to identify existing information on the extent, nature and effects of food marketing to children in their country. They are also encouraged to support further research in this area, especially research focused on implementation and evaluation of policies to reduce the impact on children of marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt.
Latest developments in regulatory and self regulatory actions (WHO, 2010; POLMARK) Austria Self-regulatory code of conduct since 2010. Belgium A 2007 White Paper has been partly implemented by a self-regulatory code. 2008, the Flemish Government and Parliament approved a code of conduct in which the promotion of excessive consumption of HFSS foods is not allowed. Bulgaria As of 2010, consultations were underway on national measures to reduce the advertising of unhealthy foods and beverages to children.
Cyprus A second National Nutrition Plan was adopted in 2007 involving specific actions to address marketing pressure on children.. Czech Republic In 2008, the Czech Advertising Standards Council launched a selfregulatory Code of Advertising Practice.. Denmark A self-regulatory code was launched in 2008, which applies to advertising agencies, retailers, television, magazines, the Internet and food producers, and specifically covers HFSS foods in media where the target audience is children under 13 years of age Estonia Commercial advertising is prohibited in kindergartens, primary and secondary schools and vocational schools. Otherwise no regulations Finland There are currently no specific regulations in Finland restricting the marketing of unhealthy foods to children.
France Regulations require television and radio commercials for most beverages and food products to contain one of five prescribed health messages, which advertisers can avoid by paying a tax equal to 1.5% of the annual amount paid for advertising such products. In 2009, the Ministry of Health and the Ministry of Culture and Communication adopted a charter to promote healthy diet and physical activity in television programmes and advertisements. Germany The German Advertising Federation has developed a Code of Conduct for the protection of children with regards to advertising on radio and television. Greece Currently, there is no official government measure or legislation addressing the marketing of food to children. In the private sector, however, there is a self-regulating set of rules.. Hungary There are legislative prohibitions on marketing in institutions caring for children under the age of 14 years. Advertising code of ethics, developed by the Self-regulated Marketing Body, also exists. Ireland The 2005 Children s Advertising Code entails statutory controls to regulate some aspects of television advertising of unhealthy food to children. In June 2009, a new Broadcasting Act made provision for a new Broadcasting Authority of Ireland to introduce regulations to protect children from advertising of HFSS foods through the broadcast media. The Broadcasting Authority has reviewed the Children s Commercial Communications Code and recommended (xxxx --- due early 2012).
Italy In 2007 proposals were made for the monitoring of marketing messages and the reduction of advertising through self-regulation. Latvia In 2006, regulations were adopted with the aim of restricting and controlling the marketing of beverages and foods of limited nutritional value in pre-school institutions and schools. Otherwise restrictions are based on self-regulation. Lithuania The content of vending machines in schools is restricted, and this may be extended to kindergartens and all other types of educational institutions for children. Other regulations are largely conducted through self-regulatory codes of practice. Luxembourg In 2009, Luxembourg set up a code of practice for advertising but this has no specific controls to restrict HFSS food advertising to children. Malta Malta does not have a policy in place that aims at reducing the impact of the marketing of HFSS foods to children, although the government follows a policy to reduce the impact of non-broadcast forms of advertising of HFSS foods to children - for example, these foods are not allowed to be used as sponsorship for health campaigns or any initiative that takes place within schools or that involves children.
Netherlands Government policy emphasizes self-regulation and public private partnerships. Poland A self-regulatory code is in force, but this does not specifically address HFSS food marketing to children. Portugal A self-regulatory code has specific rules for the food and drinks sector, addressing the use of celebrities and well-known characters and marketing to younger school children. Romania No statutory controls are in force, apart from regulations on food items considered as undermining healthy diets and not allowed to be sold within school premises. Slovakia No current controls to reduce the impact of the marketing of HFSS foods to children.
Rasvumisteemalistele uuringutele keskendunud uurimiskeskus IASO viimane uuring A Junk-Free Childhood 2012: Marketing foods and beverages to children in Europe tõdeb, et ebatervisliku toidu nähtavus ei ole alanenud piisavalt http://www.iaso.org/site_media/uploads/i ASO_Press_release_Junk_Food_2012.pdf
Kuidas edasi?
Tänan tähelepanu eest! Kontakt: reinapm@euro.who.int Slaididega aitas: João Breda MPH MBA PhD Programme Manager Nutrition, Physical Activity and Obesity WHO Regional Office for Europe