The Global Strategy on Diet Physical Activity and

The Global Strategy on Diet, Physical Activity and Health: A School Policy Initiative Outcomes of the Expert Roundtable A/Prof. Roya Kelishadi Vancouver, 7 June 2007 Satellite Expert Roundtable on DPAS School Policy Initiative

in close collaboration with Public Health Agency Canada & Health Canada Satellite Expert Roundtable on DPAS School Policy Initiative

Participants Temporary advisers: • Ms Kelly Stone (Chairperson) • Associate professor Roya Kelishadi (Rapporteur) • Dr Mary Mc. Kenna (Background paper nutrition) • Dr Claire MA Le. Blanc (Background paper physical activity) • Dr Carmen Aldinger • Ms Louise Aubrey • Dr Goof Buijs • Professor Ji Chengye • Dr Anniza de Villiers • Mr Joe Doiron • Ms Ann Ellis • Dr Lawrence St. Leger • Ms Lisa Mawani • Dr Sonia Mc. George • Associate professor Ladda Mo-Suwan • Ms Patricia Walsh WHO Secretariat: • Ms Tilly de Bruin • Dr Ulla Uusitalo (Nutrition-Friendly Schools Initiative) Satellite Expert Roundtable on DPAS School Policy Initiative

Agenda • Background • Satellite Expert Roundtable • Next steps Satellite Expert Roundtable on DPAS School Policy Initiative

Did You Know? 35 000 people died worldwide from chronic diseases in 2005 Satellite Expert Roundtable on DPAS School Policy Initiative

Main Causes of Death 1. Cardiovascular disease (mainly heart disease & stroke) 2. Cancer 3. Chronic respiratory diseases 4. Diabetes Source: WHO, Preventing Chronic Diseases, 2005 Satellite Expert Roundtable on DPAS School Policy Initiative

Not only in Rich Countries Source: WHO, Preventing Chronic Diseases, 2005 Satellite Expert Roundtable on DPAS School Policy Initiative

Causes of Chronic Diseases 80% 40% N. A. 80% Satellite Expert Roundtable on DPAS School Policy Initiative

Risks are Increasing Source: WHO, Preventing Chronic Diseases, 2005 Satellite Expert Roundtable on DPAS School Policy Initiative

The Global Strategy on Diet Physical Activity and Health www. who. int/dietphysicalactivity Satellite Expert Roundtable on DPAS School Policy Initiative

Objectives of DPAS 1. 2. 3. 4. Reduce risk factors for chronic diseases that stem from unhealthy eating and physical inactivity through public health actions; Increase awareness and understanding of importance healthy eating and physical activity on health; Develop, strengthen, implement global, regional, national policies, plans etc to improve healthy eating and increase physical activity that are sustainable, comprehensive and actively engage all sectors; Monitor science and promote research on healthy eating and physical activity. Satellite Expert Roundtable on DPAS School Policy Initiative

What has WHO done? Activities at the global level: 1. • Tools • • • Physical activity Fruit and vegetables Monitoring and Evaluation Reducing salt intake in population Global interactions: • • Private sector UN Agencies Activities at the regional level: 2. • Implementation workshops in the Americas, South-East Asia and Western Pacific; • Implementation workshop in the Eastern-Mediterranean region and Africa in 2007; • Ministerial Conference on Counteracting Obesity in Istanbul (EURO) Satellite Expert Roundtable on DPAS School Policy Initiative

Although there already many school initiatives… There is not yet a global WHO policy tool: • aimed at governments (macro-level) • focused on how to improve healthy eating and increase physical activity • via the school setting. A considerable amount of knowledge and experience is available to build upon: • incorporate this knowledge • make sure DPAS School Policy Initiative follows from these initiatives. Member States need a DPAS School Policy Initiative Satellite Expert Roundtable on DPAS School Policy Initiative

Agenda • Background • Satellite Expert Roundtable • Next steps Satellite Expert Roundtable on DPAS School Policy Initiative

Goal of the school policy initiative To primarily guide policy makers at (sub)national level in the development and implementation of policies that promote healthy eating and physical activity in the school setting, through environmental, behavioral and educational changes Specific characteristics: • Macro level: policy makers at (sub)national level • Focus on healthy eating and physical activity • Focus at school setting • Development and implementation • Global tool that is applicable both in developed countries as in developing countries Satellite Expert Roundtable on DPAS School Policy Initiative

Overarching key messages (I) • • • Take a positive approach to healthy eating and physical activity High level policy that will allow for national, regional and local implementation Need to turn the policy into action (political will, stakeholder engagement, human resources, financial resources etc) Both individual and environmental issues should be considered Consideration of the UN Convention on the Rights of the Child (CRC) as an underpinning for action Ownership of both education and health sectors Satellite Expert Roundtable on DPAS School Policy Initiative

Overarching key messages (II) • • • Process is critical for buy-in of all stakeholders Build upon on overarching framework of Health Promoting Schools including mental health There is no one-size-fits-all solution for low-, middle and high income countries Cultural relevant Children/school as change agents for communities (empowering children) Satellite Expert Roundtable on DPAS School Policy Initiative

Key principles • The Global Strategy on Diet, Physical Activity and Health (DPAS) • UN Convention on the Rights of the Child (CRC) • Multisectoral and multistakeholder • • Notion of engagement by youth for youth (empowerment, participation and action) Determinants of health Satellite Expert Roundtable on DPAS School Policy Initiative

Policy options • • STEP-wise approach with core, expanded and desirable interventions (example of core: whole school approach) Build upon and integrate into existing policies and programmes Comprehensive approach instead of one-off projects Integrate healthy eating and physical activity throughout the school environment (including curriculum, regulations, provisions, transportation, pre- and after school activities etc) Satellite Expert Roundtable on DPAS School Policy Initiative

Physical activity options (tested) Policy Option Evidence Effective (E) Promising (P) Raise quantity PE to daily K 12 Sallis: ↑ grade 6 -8 PE daily + school PA lower BMI boys (E) Ensure students active most of PE class time Mc. Kenzie: PE curriculum more vigorous PA students > active in PE class not outside school (E) Integrate benefits of PA into regular curriculum Gortmaker: Curriculum = healthy foods and PA. Girls ⇩BMI (E) Integrate PA into curriculum Mahar: Daily 10 min energizers K grade 4: ↑ PA and ↑on task behaviour (E) Extracurricular PA Provide a variety of PA opportunity outside of PE Ernst: “PLAY” ↑ PA outside of PE. ↑ PA levels; girls > interest PA (E) Training Ensure adequate training for teachers of PE classes Sallis: “SPARK” Specialist PE > trained teachers > control teachers ↑ girls fitness (E) Active Transportation Ensure safe walking & cycling to and from school Rosenberg: leaner students actively commuted (P) Facilities Ensure adequate facilities & equipment for PA Sallis: better facilities & adult supervision kids ↑PA ~ 4 -5 x control (P) Daily quality PE Daily PA Moody: 50% community rec. centers Develop partnerships with Satellite Expert Roundtable on DPAS School Policy Initiative have elementary after school programs: community recreation Community Outreach vs 11% middle ; 0% High school (P)

Physical activity options (untested) Policy Area Untested Policy Option Best Practice Example Curricular and extra -curricular activities Make physical activity enjoyable, respectful of all children & promote fair play and maximum participation Action Schools! BC (Promising) Nova Scotia Health Promoting Schools (Promising) Safety Ensure adequate safety precautions to prevent physical activity injuries and illness. Hudson-Collins P: CDC funded coordinated school health Collect medical information from students & parents to ensure safe participation in physical activity Scheier LM: School Health Report Cards Ensure family & community members can take part in planning and decision-making Action Schools! BC Nova Scotia Health Promoting Schools Saskatoon in Motion (http: //www. saskatchewaninmotion. ca/) Provide opportunities for family & community members to advocate for & participate in activities & services offered through schools Action Schools! BC Nova Scotia Health Promoting Schools Saskatoon in Motion Promote health benefits of physical activity to school staff Hudson-Collins P: CDC funded coordinated school health School Staff program Provide school staff with opportunities to be physically active with colleagues Hudson-Collins P: CDC funded coordinated school health program Referral from health care professionals Make recommendations on physical activity for students with disorders or disabilities American Academy of Pediatrics (AAP) Canadian Pediatric Society (CPS) Recognition Recognize schools, administrators, teachers, parents and students who make significant advancement of physical activity and physical education in schools CAHPERD Monitoring and Evaluation Monitor and assess policy implementation, as well as physical activity levels and fitness Action Schools! BC Nova Scotia Health Promoting Schools Satellite Expert Roundtable on DPAS School Policy Initiative

Healthy eating policy options Policy Option Legislation and regulation • Financing • Built environment • Health services • Direct policies that address all foods • Direct policies that address some but not all foods • Indirect policies that address the quality of all foods Use of money or food to shape food consumption (school food programs, water and food pricing) Nutrition standards • Local foods • Food preparation • Student access to fruits and vegetables • Use of foods Coordination of food availability Food availability near schools Sustainable food practices Food marketing Food and beverages contracts Counseling or other nutrition services in schools or school-community partnerships that address student health needs Advocay Identifying and reducing barriers to school nutrition policies at an individual or systematic level Community mobilization Education and infrastructure required for school nutrition policies: • nutrition education • staff qualifications and training • nutrition and health infrastructure Satellite Expert Roundtable on DPAS School Policy Initiative

Advocating for action • • Healthy children lead to a healthy and productive communities Use economic arguments to get buy-in Need buy-in of teachers: • Better education attainment • Healthy work place • Better health for teachers (role model) • Engagement and participation in the process and required supports Create a collaborative body to allow funding and support Satellite Expert Roundtable on DPAS School Policy Initiative

What stakeholders to engage? • • • Education sector (students, teachers, principals, board members) Other sectors (agriculture, building, transportation etc) All levels of government (including traditional leaders) Parents (including parental organizations) Community groups Health sector NGOs Media (mass media and webbased media) Academics/researchers Professional organizations (teachers and health) Private sector Faith-based leaders Satellite Expert Roundtable on DPAS School Policy Initiative

How to engage stakeholders? • Create a collaborative body • Meaningful and genuine participation • Engage stakeholders already in planning and decision making • • Basic requirement is that all stakeholders agree on their specific roles Monitoring mechanisms are needed to evaluate stakeholder action Satellite Expert Roundtable on DPAS School Policy Initiative

Purpose of Monitoring and Evaluation (M&E) • Document changes due to policy • Enhance support for policy • Allocate resources • Provide accountability • Inform decision-making • Contribute to evidence base (promote research) Satellite Expert Roundtable on DPAS School Policy Initiative

Suggested actions for M&E • • • Urgent need to document the impact resulting from policies in order to inform decision-makers and contribute to the evidence base. Need to develop better ways of incorporating qualitative research results Provide useful models and case studies that can be adapted to different circumstances. Include evaluation plans already in planning stage and reserve a budget line. Communicate results of monitoring and evaluation to wider audience Extend the reach of international data collection systems such as Health Behaviour of School Aged Children and the Global Schoolbased student Health Survey (and use as baseline data) Satellite Expert Roundtable on DPAS School Policy Initiative

WHO Framework for M&E Satellite Expert Roundtable on DPAS School Policy Initiative 8 Global Strategy on Diet, Physical Activity and Health. A Framework to Monitor and Evaluate Implementation. World Health Organization Geneva, 2006

Evaluation Data for M&E • • • Surveillance data, policy document, policy-related communications, financial data Stakeholders Direct measures or self-report: food intakes and health outcomes Satellite Expert Roundtable on DPAS School Policy Initiative

Outline Unconventional …your suggestions would be very much appreciated! Satellite Expert Roundtable on DPAS School Policy Initiative

…some suggestions for WHO • • • Target the appropriate government level (national or sub-national) School Policy Framework/Guidelines need an implementation plan (including resources) Use of country examples to make the document practical Satellite Expert Roundtable on DPAS School Policy Initiative

Agenda • Background • Satellite Expert Roundtable • Next steps Satellite Expert Roundtable on DPAS School Policy Initiative

Next steps 1. Prepare background papers on diet and physical activity, both focusing on: • • • April – May 2007 Effective policy options for the school setting Roles of different stakeholders Monitoring and evaluation 2. Satellite Expert Round-table to draft an outline 6 -7 June 2007 3. Draft the Framework June – Sept 2007 4. Consultation Process Oct – Dec 2007 5. Finalize the Framework Jan 2008 6. Translate, printing and launch Feb – March 2008 Satellite Expert Roundtable on DPAS School Policy Initiative

Further involvement? Please contact Tilly de Bruin Technical officer in WHO on the Global Strategy on Diet, Physical Activity and Health debruinm@who. int +41 22 79 13235 Satellite Expert Roundtable on DPAS School Policy Initiative