Gros tale om ernæring


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Her følger den uredigerte versjonen av WHO-sjef Gro Harlem Brundtlands tale om ernæring i Roma 23. april.

Director-General Diouf, distinguished guests, colleagues, ladies and gentlemen,

The Expert Report on Diet, Nutrition and the Prevention of Chronic Diseases is significant for many reasons. We face a growing global epidemic of premature death and disability from chronic diseases. Last year, these killed 46 million people around the world - almost 60 percent of the total premature deaths.

Cardiovascular disease, diabetes, cancers, obesity - these are no longer rich country problems. The majority of the chronic disease burden affects people in the developing world. And most of it can be prevented through simple changes in diet, by being more active and by not smoking. Next month Member States will adopt the WHO Framework Convention on Tobacco Control. That will lead to increased focus and attention being given to one major risk - tobacco. This report and the actions it will stimulate, address two other major risks: unhealthy diet and physical inactivity.

This Report is significant because it contains the best currently available scientific evidence on the relationship of diet, nutrition and physical activity to chronic diseases.

The Report is significant because we will be using it as the critical science-based foundation for the Global Strategy on Diet, Physical Activity and Health, which we are preparing to address this growing problem. This report is significant because it has global relevance to people's lives, and can lead to major long-term shifts in what we choose to eat, and the quality of what is available to eat.

And it is significant because it highlights the enhanced co-operation between WHO and the Food and Agricultural Organization. The official launch of this report today is an excellent example of inter-agency collaboration for the greater public good. We believe this will translate into stronger interaction between the health and agricultural communities at country level; interaction that we hope will lead to the development of more human-centred and sustainable patterns of agriculture.

I would like to thank the 30 experts and their peers, as well as Director General Diouf and his staff, and my own staff at WHO, who have devoted so much skill, time and intellectual energy to this Joint Consultation. We will be working hard over the coming months and years to integrate these recommendations into our global public health agenda for chronic disease prevention and health promotion. The burden of chronic diseases is rapidly increasing worldwide. Indeed, cardiovascular diseases are even now more numerous in India and China than in all economically developed countries in the world added together. And rates of overweight and obesity are annually increasing in most developing regions. Recent data from São Paulo, Brazil, for example, indicates that three-quarters of the people are remarkably inactive. Dealing with the suffering and disability of this growing number of patients is adding greatly to social and health care costs worldwide. But by addressing this problem, we can reverse this and actually see concrete results in economic development.

The Expert Report Conclusions

The Report addresses cardiovascular diseases, several forms of cancer, diabetes, obesity, osteoporosis and dental disease. It emphasizes that a diet low in saturated fats, sugars and salt, and high in vegetables and fruits, together with an increase in physical activity, will have a major impact by considerably reducing this high toll of death and disease.

The Expert Report's specific recommendations on diet include limiting fat to between 15 and 30 percent of total daily energy intake, and saturated fats to less than 10 percent. It suggests that carbohydrates should provide the bulk of energy requirements - between 55 and 75 percent of daily intake, but that added sugars should remain beneath 10 percent. People should restrict their daily intake of salt to less than five grams a day, and that salt should be iodized. Finally, people should eat at least 400 grams of fruit and vegetables every day.

It also notes that ideally, people should spend one hour on most days of the week engaged in moderate-intensity activity, such as walking, to maintain a healthy body weight. There is also evidence that physical activity reduces the risks for some cancers, and for diabetes.

The Global Strategy

So where we do we go from here? Many of the Report's conclusions are not new, but our evidence base has been strengthened and confirmed by the latest research. We have known for a long time that foods high in saturated fats, sugars, and salt, are unhealthy; that we are, globally, increasingly sedentary. And that these factors - together with tobacco use - are the leading causes of the great surge we have seen in the incidence of chronic diseases worldwide.

What is new, is that we are laying down the foundation for a global policy response. WHO Member States have set this as a priority issue. With this report, we are now ready with a strong science base to develop the Strategy, which will be presented to the WHA in May 2004.

However, Member States recognised the complex challenges involved, and the need to develop a Strategy that addresses the wide range of national and regional variations in cultural diet and physical activity practices worldwide. They therefore specifically asked WHO to develop the strategy in consultation and collaboration with all of the major stakeholders involved in food, diet, physical activity and their links with chronic disease. Thus, in addition to Member States, other UN and international organizations and health professionals, we have also been talking with representatives from the private sector and from civil society. Several Member States have sought WHO guidance on how best to work with food companies, and what type of regulatory regime to introduce to better promote healthy eating.

Next month, I will meet with senior executives from a number of major food and beverage companies, and also with representatives of the key professional and consumer NGOs, to discuss these challenges. We have prepared a consultation document and other background papers, which have been circulated to interested stakeholders; we are facilitating a Civil Society online Internet forum to encourage public debate. All of this input will be considered in developing the Strategy, to be finalized for the Executive Board in January 2004.

We have made this process as transparent and inclusive as possible, while remaining committed to our constitutional mandate to improve global public health. Member State Consultations

Our primary responsibility remains to our Member States and their people. We are now halfway through our Regional Consultations on the Strategy. Our meetings so far have reaffirmed, both the importance of what we are doing, and the range of different problems countries face.

For example, last month in Harare, our colleagues from countries in Africa stressed to us that while under-nutrition and food security remain key problems, diet-related chronic diseases co-exist and are on the rise. They noted that the problems are initially emerging among city-dwellers, who are increasingly less active and adopting different diets. They stressed the importance of a life-course approach, which factors in the influence of maternal malnutrition and low birth weight on overweight problems in later ages. Of course they reminded us of the impact of HIV/AIDS on their societies, with the need to preserve the health of elderly caregivers.

And Africa is the only one of our six regions where infectious diseases still dominate - for our other five regions, chronic diseases are the major killers.

At our SEARO meeting in New Delhi, for example, we heard that in some urban areas of India, from one-quarter to one-third of the population is overweight. Many of the SEARO countries are suffering from a double burden - of undernutrition, but also of the consequences of a rapid transition to unbalanced diets and overeating. Most developing countries simply do not have the resources to deal with the growing burden of chronic disease on top of their existing health problems. Diet and physical activity provide a cost-effective, preventive way of improving public health. In many countries, this means supporting traditional healthy diets and physical activity.

The Policy Implications

In developing the Global Strategy, we are addressing complex issues, which have major implications for governments, health professionals, consumer groups, and ultimately for global health. And in particular, for those involved at all levels in the chain of food production, manufacturing and distribution. It is for this reason that we have committed to working closely with FAO on diet and chronic disease prevention.

Our most recent regional consultation, with our European Member States, for example, concluded that appropriate economic and regulatory instruments should be used to help healthy diets and regular physical activity - to create an environment in which the healthy choice is the easy choice. Doing so has significant implications: for advertising and marketing regulation, for recreation, education, transport, agriculture, trade and fiscal policies. These Member States emphasized that decisions on agricultural and other policies should also be assessed in terms of their impact on health.

WHO and governments cannot act alone. The combined energy, resources and expertise of the other relevant UN agencies, health and nutrition professionals, the private sector and civil society, will all be essential to sustained progress. Our experience shows us that even modest, but population-wide interventions on diet and physical activity, can produce significant changes in the overall chronic disease burden in a surprisingly short period. However, long-term progress will take time. We need to look decades ahead; and make a commitment now, to the health of current and future generations throughout the globe.

The work we are embarked upon could lead to one of the largest positive shifts in population health ever undertaken. The Joint Consultation Report on Diet, Nutrition and the Prevention of Chronic Diseases is a major contribution to this work. Again, I thank the experts for their time and commitment, and the staffs of the FAO and WHO for their professionalism and commitment in seeing this project through.

Thank you.