NATIONALNATIONAL STRATEGYSTRATEGY ONON DIET,DIET, PHYSICALPHYSICAL ACTIVITYACTIVITY ANDAND HEALTHHEALTH ININ BRAZILBRAZIL Paulo M. Buss, MD, MPH President of The Oswaldo Cruz Foundation, MoH Brazil Member of The National Academy of Medicine HEALTHHEALTH STATUSSTATUS –– BRAZIL,BRAZIL, 20062006 • Brazil has a very complex social situation due to its large population, continental territory, vast environmental and cultural diversity and its profound economic and social inequalities and iniquities, which strongly affects the health situation • Brazil is currently undergoing major epidemiological, demographical and dietary transitions. EPIDEMIOLOGICALEPIDEMIOLOGICAL TRANSITIONTRANSITION BRAZIL,BRAZIL, 19301930--20032003 100% 90% Proportional Mortality 80% in Brazilian States 70% capitals 60% 50% • Infectious and 40% parasitic diseases: 30% 46% in 1930 20% 5% in 2003 10% 0% • Cardiovascular dis.: 1930 1940 1950 1960 1970 1980 1985 1990 1995 2000 2003 12% in 1930 Infecciosas e parasitárias Neoplasias Causas externas Aparejo circulatório Otras enfermidades 31% in 2003 * Until 1970, data refered only to State capitals Fonte Barbosa da Silva e cols. In: Rouquairol & Almeida Filho: Epidemiologia & Saúde, 2003 pp. 293. DEMOGRAPHICALDEMOGRAPHICAL TRANSITIONTRANSITION • Increase of life expectancy due to the reduction of infant and child mortality and the growth of 60+ population • Fertility decreasing: 2.2 children/women, although bigger in poorer regions and underprivileged social strata • Stabilization of population in 2025 • Urbanization: 85%. In more rich regions, 90-95% NUTRITIONALNUTRITIONAL TRANSITIONTRANSITION BBrarazzilil,, 19751975--20002000 50 Desn. Inf. rural 40 Desn. inf. - urb 30 Bócio % 20 Anemia 10 Sobrep. e 0 Obes. 1975/1980 1985/1990 1995/2000 Font: Filho, Malaquias A- Goiter (visible or touchable) in students (% de municipios) Batista e Rissin, Anete. Cad. Saúde Pública, B- Anemia < 5 years old, Sao Paulo 2003 C- Low heights for age (< -2DP) en < 5 anos, Brasil urbano D- Low heights for age (< -2DP) en < 5 anos, Brasil rural E- Overweight and obesity, adult women OBESITYOBESITY ANDAND OVERWEIGHTOVERWEIGHT BrazilBrazil,, 20022002--20032003 Prevalence of overweight (Body Mass Index ≥ 25) Population of 15 years of age or older in 16 Brazilian Capitals, 2002-2003 CONSUMPTION OF FRUITS, LEGUMES AND VEGETABLES % 100 90 80 < 1 vez/dia 70 IN 16 STATES CAPITALS, BRAZIL 2002 60 POPULATION 15 YEARS OLD + 50 40 30 1 < 3 vezes/dia 5 ou + vezes/dia 20 10 0 Manaus 3 < 5 vezes/dia Fonte: Inquérito domiciliar 2002-2003 - SVS/INCA Fortaleza Natal - 2003 Recife Aracaju Campo Grande Distrito Federal Belo Horizonte Capitais Rio de Janeiro Curitiba Porto Alegre PREVALENCE OF PHYSICAL INACTIVITY* IN ADULTS IN 16 STATE CAPITALS 100 80 60 Percentual 40 20 38 - BRAZIL, 2002 0 28 *Sedentaries and irregularly actives 42 Fonte: (SVA/INCA) Manaus 31 55 Fortaleza 41 Natal - 34 -2003 Recife 34 Aracaju 35 39 Campo Grande 32 Distrito Federal 44 Belo Horizonte 35 Capitais 40 Rio de Janeiro 44 Curitiba 30 37 Porto Alegre TOTAL TOBACCOTOBACCO USEUSE ININ BRAZILBRAZIL 20022002--20032003 Percentage of regular cigarette smokers per region 15 years of age or older in 15 Brazilian capitals and the Federal District (2002-2003) The National Strategy on Diet, Physical Activity and Health The Brazilian Experience NATIONALNATIONAL STRATEGYSTRATEGY ONON DIET,DIET, PHYSICALPHYSICAL ACTIVITYACTIVITY ANDAND HEALTHHEALTH ININ BRAZILBRAZIL 9Brazil adopted the WHO Global Strategy on Diet, Physical Activity and Health (2004) 9Inter-ministerial Commission to define and implement the National Strategy (2004) 9Consultations with several areas of MoH to define healthy diet and physical activity policies and acctions (2005) 9 To start the implementation of the National Policy on Health Promotion and on Prevention and Control of Chronic Non-Communicable Diseases (March 2006) PHYSICALPHYSICAL ACTIVITIESACTIVITIES ACTIONSACTIONS ATAT MoHMoH LEVELLEVEL 9 Projeto “Pratique Saude” (`Make Health`) – Social communication initiatives, envolving several media, to stimulate physical activities and healthy diet. 9 Financial support for municipalities to local projects concerning physical activities, including facilities rebuilding, training of primary health workers, development of educational material and communication actions. 9 In 2005, MoH provided around USD 2,3 million for selected municipalities NATIONALNATIONAL SURVEYSURVEY ONON STUDENTSSTUDENTS HEALTHHEALTH To be performed first time in 2006 and reaplyed each year 7200 students 13-15 years old in all 27 State capitals of the country Self-apliccable structured inquiry, consisted by thematic modules: social and demographic characteristics, diet, physical activity, smoking habits, alcohol and drugs consumption, self-image and body perception, oral health, formal and informal protection networks accessed by the student, sexual behavior, and injuries. MONITORINGMONITORING ANDAND RESEARCHRESEARCH ONON PHYSICALPHYSICAL ACTIVITIESACTIVITIES 9Guide of CNCD Programes Evaluation 9Observatory on CNCD Policies 9Financing academic institutions to evaluate local iniciatives of physical activities 9Participation in the Committee on Applying Evidence-Based Physical Activity Recommendations in Brazil, together CDC, Agita São Paulo and other institutions NACIONALNACIONAL POLICYPOLICY OFOF FOODFOOD ANDAND NUTRITIONNUTRITION Officially adopted in 1999 Set of public policies to become concrete the human right on food and nutrition Purpose: to assure the quality of food, to promote healthy diet habits and to prevent and control nutrition- related diseases DIETARYDIETARY GUIDEGUIDE FORFOR THETHE BRAZILIANBRAZILIAN POPULATIONPOPULATION •Published in 2005: first official dietary recommendation for the adult Brazilian population •Advices for a healthy diet and on nutrition-related illnesses, based on the doble burden of malnutrition •Priorities: consumption of fruits and vegetables, estimulating regional food (Brazilian biodiversity) •Book: Brazilian regional food HEATHYHEATHY FOODFOOD ININ SCHOOLSSCHOOLS ¾Working group btw MoH and MoE to propose an comprehensive Initiative on Schools` Healthy Food ¾Development by MoH and MoE of the Guide on Healthy Food in Schools IMPROVEMENTIMPROVEMENT OFOF THETHE REGULATORYREGULATORY ENVIRONMENTENVIRONMENT • Comprehensive and participatory process to increase the existing regulation on marketing and advertisement of foods, mainly those targeted to children • Labelling to provide information on the content of food in order to avoid consumer make healthy choices • Salt iodinization and addition of folic acid to flours.