Workshop on the Implementation of the Global Strategy on Diet, Physical Activity and Health in the Pacific, 3-6 April 2006, Suva, Fiji
Summary
A workshop on the Implementation of the Global Strategy on Diet, Physical Activity and Health in the Pacific was held in Suva, Fiji from 3 to 6 April 2006. This workshop was organized by the World Health Organization, in partnership with the Secretariat of the Pacific Community (SPC) and the Food and Agriculture Organization (FAO) of the United Nations. This workshop followed on from an earlier workshop on Obesity Prevention and Control Strategies in the Pacific, held in Apia, Samoa in 2000. At this conference, a call for action on obesity was announced and a strategic approach agreed upon to curb the obesity epidemic in the region.
The objectives of the Suva workshop were to:
(1) Review progress and share experiences in the prevention and control of obesity, diabetes and related chronic diseases in the Pacific; and
(2) Identify priority actions on which countries and territories should focus to achieve maximum impact in the implementation of the Global Strategy on Diet, Physical Activity and Health (DPAS).
An invitation to participate in the forum was extended to two participants from each of 21 Pacific island countries: a senior health officer responsible for the prevention and control of obesity and noncommunicable disease and a senior policy-maker in agriculture/fisheries, food trade, sports and recreation, urban planning, education, economic development, or finance. Representatives from 19 Pacific island countries and partner agencies attended the workshop. Others at the meeting included resource persons, temporary advisers, observers and the WHO and SPC secretariat.
Prior to the workshop a questionnaire was sent to the representatives in each of the participating countries. The questionnaire asked representatives to identify initiatives currently being utilized and those which they felt would be useful in their countries for the prevention and control of obesity, diabetes and related chronic diseases. In consultation with relevant officials in their country, representatives were also asked to develop a specific strategy for obesity prevention that could be further developed during the workshop. This strategy could be a new initiative, or build on an existing strategy in the country. Participants were asked to prepare a two-page summary of their proposed strategy.
The workshop objectives were achieved through individual presentations and group discussion. The workshop started with an overview of the DPAS followed by an update on current regional and national initiatives in relation to the Pacific Diet and Physical Activity Strategy. These presenters indicated that there have been many strategies developed in the past few years around the implementation of the global strategy at the global, regional and subregional level. Many of these are applicable to Pacific countries and Pacific island countries should use these to strengthen their current strategies
The remaining workshop presentations were divided into a number of sessions that included: macro-level (national), micro-level (local), and health promotion strategies. International and regional examples of strategies were provided where appropriate.
At the macro-level, most of the discussion centred on creation of regional standards and guidelines which countries could then adopt and adapt for their own use. Food-based dietary guidelines that were developed by SPC have been adopted and adapted for local use in most Pacific island countries. Country representatives requested similar guidelines for physical activity. Micro-level strategies included mainly settings approaches such as healthy schools, workplaces, churches and communities. There was broad agreement among countries currently involved in curriculum-based health promotion in schools for a need to shift to a “whole school” approach that reinforces curriculum learning, with a supportive school environment that involves management, parents and the community. For example, lessons on healthy eating in the classroom should be accompanied by selling healthy foods in school tuck shops.
A Health Promoting Workplace is a common strategy undertaken in the Pacific and works well when combined with role modelling by health workers and other leaders. The Non-Communicable Disease (NCD) Mini-Steps initiative developed in Fiji is recommended as an excellent entry point to promoting a healthy workplace. Examples of Health Promoting Churches in Fiji and Tonga and a Health Promoting Village in Samoa were provided. The participants agreed that the implementation of Health Promoting Communities in Pacific countries has great potential as a tool to promote healthy eating and physical activity.
Health promotion topics centred on social marketing, advocacy, and Health Promotion Foundations. The experiences of Fiji, French Polynesia, Tonga and Vanuatu were helpful in the discussion of these topics. The need for social marketing strategies in the Pacific was highlighted during the Samoa workshop in 2000. Unfortunately, social marketing is currently being underutilized in the region. There is a need for training in social marketing and WHO and SPC have been asked to give workshops at the sub-regional or in-country level. Adequate funding for health promotion activities remains a problem in many Pacific island countries. The establishment of Health Promotion Foundations in Pacific island countries, funded through taxes on unhealthy foods, tobacco, and alcohol, may be one mechanism to provide sustainable funding.
Other discussions focused on the need to increase the production of local fruits and vegetables for consumption in Pacific island countries, a regional approach to food labelling, and the need for increased training of health workers especially around physical activity.
Country representatives presented their proposals at the end of the meeting. In the evaluation of the workshop, most of the respondents indicate that they were confident they could implement their proposal but would have to discuss it with management at home before progressing further.
Recommendations
(1) School-based interventions need to change from being solely curriculum-based to whole school initiatives.
(2) Pacific Islands Forum Secretariat be approached by WHO to suggest that Health Promoting Schools in the Pacific be included as an agenda item for the Education Ministers’ Meeting to be convened in Nadi, Fiji in October 2006.
(3) Forum member countries are encouraged to apply for Pacific Regional Initiatives for the delivery of basic Education Project (PRIDE) for funding support of their health promoting curriculum activities.
(4) Regional Food-based Dietary Guidelines developed by SPC should be adopted by Member States after being adapted for local needs. Training be provided for health care workers, including ways to communicate the guidelines to the public.
(5) WHO-SPC Regional Guidelines on Physical Activity be developed and these guidelines be adopted by Member States after being adapted for local needs.
(6) Clinical Practice Guidelines for the Management of Overweight and Obesity should be used for education of doctors, nurses, nutritionists and other allied health workers, where appropriate and relevant.
(7) Regional training be carried out in these key areas.
a. Physical Activity: SPC has run three workshops and should evaluate them for impact and use this information to assist in designing future training workshops.
b. Communication strategy and behaviour change communication should be linked with training on physical activity and nutrition and should be country specific with multi-year plan instead of just one-off training, which is not cost-effective, as competencies attained are not sustained.
c. Specific training on monitoring and evaluation of programmes is required. This training needs to be country specific and to include training on statistical software usage (e.g. Epi-Info).
(8) Countries considering Healthy Workplace initiatives are encouraged to use the NCD Mini-STEPS initiative as an entry point to their engagement of management and workers. It also provides an excellent surveillance and evaluation tool.
(9) Community settings continue to be an opportune setting and Pacific island countries are encouraged to explore and utilize this platform to implement their diet and physical activity strategies.
(10)Relevant issues in the context of DPAS should be brought to the attention of the next Pacific Agricultural Ministers Meeting. One of the issues noted by the meeting was the need to augment the production of fruit and vegetables for local consumption and support this by promoting integrated nutrition education in a gardening/horticulture programme.
(11)The group supports the need for the Codex Alimentarius Commission to consider the major food issues underlying the burden of illness in the Pacific caused by NCDs.
(12)The group agreed upon the importance of food labelling as a mechanism to assist consumers in making choices to reduce dietary risk factors as identified by DPAS. Any labelling for the Pacific should be carefully adapted to local needs and be supported by an appropriate education campaign.
(13)Research Intervention: recognizes the strong evidence that Type 2 diabetes can be prevented with lifestyle intervention through diet and physical activity with maximum risk reduction in older age groups. There is a lack of evidence from Pacific island countries as to the benefit of lifestyle interventions. NCD STEPS and other surveys indicate that populations in Pacific island countries would benefit from lifestyle interventions. The group, therefore, supports initiation of a regional research intervention on the prevention of diabetes in high-risk individuals through lifestyle intervention and encourages appropriate countries to participate. Regional and international organizations may be willing to provide assistance.
(14)Consideration should be given to a regional approach to food labelling in the Pacific. It was noted that this is an important issue for the regional Codex Coordinating Committee as well as the Standards and Conformance work by the Forum Secretariat.
(15)Health Promotion Foundation establishment be advocated as an effective mechanism for sustainable funding of health promotion activities. The meeting congratulates French Polynesia, Fiji, Kiribati, Tonga and Vanuatu for the important work they are doing in this regard and encourages other countries to do so, advocating for the establishment of taxes on unhealthy foods, tobacco and alcohol as a mechanism for raising funds for health promotion programmes and for ensuring their sustainability.
(16)NCD STEPS continues to be a key factor in NCD strategic planning and advocacy and WHO, Fiji School of Medicine and other relevant agencies should continue to work together with countries to expedite the process.
(17)A network of information sharing for physical activity should be established for the Pacific region. It could be similar to the current Pacific Nutrition network (PACNUT). This could be started with the Asia-Pacific Physical Activity Network (APPAN), which seeks to stimulate, inform and support implementation, evaluation of studies and surveillance of physical activity in as many Pacific island countries as possible.