Evaluating implementation of the WHO set of recommendations on the marketing of foods and non-alcoholic beverages to children: Progress, challenges and guidance for next steps in the WHO European Region

This paper describes the status of the implementation of the WHO Set of Recommendations on the Marketing of Foods and Non-alcoholic Beverages to Children (2010). The Set of Recommendations, adopted by the World Health Assembly, urges Member States to reduce the impact on children of the marketing of energy-dense, highly processed foods and beverages that are high in saturated fats, trans fats, free sugars and/or salt (HFSS). A growing body of independent monitoring and research indicates that existing policies and regulations are markedly insufficient to address the continuing challenges in this field. This report identifies loopholes, ongoing challenges, and factors that Member States need to consider to effectively limit the harmful impact that HFSS food marketing has on children, their health and their rights. Policies and regulations tend to use narrow definitions and criteria (they frequently apply to pre-digital media only, to younger children and not to adolescents, and to “child-directed” media, rather than those with the greatest child audiences), and they almost never address the complex challenges of crossborder marketing. This situation can be explained, in part, by the strong scrutiny and opposition that countries have faced from parts of the private sector, and by weak self-regulatory schemes. As a result, and in order to ensure that States uphold their legal obligations to protect the child’s right to health and related rights, the World Health Assembly requested that WHO provides additional technical support to Member States in implementing the Set of Recommendations. This report identifies challenges States need to address

Tackling food marketing to children in a digital world: trans-disciplinary perspectives. Children’s rights, evidence of impact, methodological challenges, regulatory options and policy implications for the WHO European Region

There is unequivocal evidence that childhood obesity is influenced by marketing of foods and non-alcoholic beverages high in saturated fat, salt and/or free sugars (HFSS), and a core recommendation of the WHO Commission on Ending Childhood Obesity is to reduce children’s exposure to all such marketing. As a result, WHO has called on Member States to introduce restrictions on marketing of HFSS foods to children, covering all media, including digital, and to close any regulatory loopholes. This publication provides up-to-date information on the marketing of foods and non-alcoholic beverages to children and the changes that have occurred in recent years, focusing in particular on the major shift to digital marketing. It examines trends in media use among children, marketing methods in the new digital media landscape and children’s engagement with such marketing. It also considers the impact on children and their ability to counter marketing as well as the implications for children’s rights and digital privacy. Finally the report discusses the policy implications and some of the recent policy action by WHO European Member States

Sodium, potassium and iodine intake, in a national adult population sample of the Republic of Moldova

In the Republic of Moldova, more than half of all deaths due to noncommunicable diseases (NCDs) are caused by cardiovascular disease (CVD). Excess salt (sodium) and inadequate potassium intakes are associated with high CVD. Moreover, salt iodisation is the preferred policy to prevent iodine deficiency and associated disorders. However, there is no survey that has directly measured sodium, potassium and iodine consumption in adults in the Republic of Moldova. A national random sample of adults attended a screening including demographic, anthropometric and physical measurements. Sodium, potassium and iodine intakes were assessed by 24 h urinary sodium (UNa), potassium (UK) and iodine (UI) excretions. Knowledge, attidues and behaviours were collected by questionnaire. Eight-hundred and fifty-eight participants (326 men and 532 women, 18–69 years) were included in the analysis (response rate 66%). Mean age was 48.5 years (SD 13.8). Mean UNa was 172.7 (79.3) mmoL/day, equivalent to 10.8 g of salt/day and potassium excretion 72.7 (31.5) mmoL/day, equivalent to 3.26 g/day. Only 11.3% met the World Health Organization (WHO) recommended salt targets of 5 g/day and 39% met potassium targets (>90 mmoL/day). Whilst 81.7% declared limiting their consumption of processed food and over 70% not adding salt at the table, only 8.8% looked at sodium content of food, 31% still added salt when cooking and less than 1% took other measures to control salt consumption. Measures of awareness were significantly more common in urban compared to rural areas. Mean urinary iodine was 225 (SD: 152; median 196) mcg/24 h, with no difference between sexes. According to WHO criteria, 41.0% had adequate iodine intake. Iodine content of salt table was 21.0 (SD: 18.6) mg/kg, lower in rural than urban areas (16.7, SD = 18.6 vs. 28.1, SD = 16.5 mg/kg, p < 0.001). In most cases participants were not using iodised salt as their main source of salt, more so in rural areas. In the Republic of Moldova, salt consumption is unequivocally high, potassium consumption is lower than recommended, both in men and in women, whilst iodine intake is still inadequate in one in three people, although severe iodine deficiency is rare. Salt consumed is often not iodised. View Full-Tex

Monitoring food marketing to children: A joint Nordic monitoring protocol for marketing of foods and beverages high in fat, salt and sugar (HFSS) towards children and young people

The protocol describes methods for how to monitor marketing of foods and beverages high in fat, salt and sugar towards children and young people at a given time as cross-sectional studies, as well as allowing for monitoring of trends. The data provided could also be used for evaluation purposes, for instance providing relevant data for evaluating regulation practices and schemes in the respective countries; to study advertising and marketing practices, contents and forms over time. In addition to being a tool for monitoring purposes within each country, the protocol will also enable comparisons between the Nordic countries by establishing a joint understanding on how each marketing channel should be monitored. The protocol has been developed as a Nordic project between representatives and experts from Iceland, Finland, Sweden, Denmark and Norway together with international experts

Adult nutrient intakes from current dietary surveys of European populations

The World Health Organisation (WHO) encourages countries to undertake national dietary survey (NDS), but implementation and reporting is inconsistent. This paper provides an up-to-date review of adult macro and micronutrient intakes in European populations as reported by national diet surveys (NDS). It uses WHO Recommended Nutrient Intakes (RNIs) to assess intake adequacy and highlight areas of concern. NDS information was gathered primarily by internet searches and contacting survey authors and nutrition experts. Survey characteristics and adult intakes by gender/age group were extracted for selected nutrients and weighted means calculated by region. Of the 53 WHO Europe countries, over a third (n=19), mainly Central & Eastern European countries (CEEC), had no identifiable NDS. Energy and nutrient intakes were extracted for 21 (40%) countries, but differences in age group, methodology, under-reporting and nutrient composition databases hindered inter-country comparisons. No country met more than 39% WHO RNIs in all age/gender groups; macronutrient RNI achievement was poorer than micronutrient. Overall RNI attainment was slightly worse in CEEC, and lower in women and female elderly. Only 40% countries provided adult energy and nutrient intakes. The main gaps lie in CEEC, where unknown nutrient deficiencies may occur. WHO RNI attainment was universally poor for macronutrients, especially for women, the female elderly and CEEC. All countries could be encouraged to report a uniform nutrient set and sub-analyses of nationally representative nutrient intakes

Forecasting Future Trends in Obesity across Europe: The Value of Improving Surveillance

Objective: To project the prevalence of obesity across the WHO European region and examine whether the WHO target of halting obesity at 2010 levels by 2025 is achievable. Methods: BMI data were collected from online databases and the literature. Past and present BMI trends were extrapolated to 2025 using a non-linear categorical regression model fitted to nationally representative survey data. Where only 1 year of data was available, a flat trend was assumed. Where no data were available, proxy country data was used adjusted for demographics. Results: By 2025, obesity is projected to increase in 44 countries. If present trends continue, 33 of the 53 countries are projected to have an obesity prevalence of 20% or more. The highest prevalence is projected for Ireland (43%, 95% confidence interval (CI): 28-58%). Lithuania, Finland, and the Netherlands were each estimated to have an absolute increase of 2 percentage points in the prevalence of obesity between 2015 and 2025. Discussion: The quality of BMI data across Europe is highly variable, with fewer than 50% of the 53 countries having measured nationally representative data and often not enough data to interpret projections meaningfully. Nevertheless, the prevalence of obesity in the European Region appears to be increasing in most countries and, with it, the health and economic burden of its associated diseases. This paints a concerning picture of the future burden of obesity-related noncommunicable diseases across the region. Greater and continued effort for the implementation of effective preventive policies and interventions is required from governments

Designing programs for eliminating canine rabies from islands: Bali, Indonesia as a case study

&lt;p&gt;Background: Canine rabies is one of the most important and feared zoonotic diseases in the world. In some regions rabies elimination is being successfully coordinated, whereas in others rabies is endemic and continues to spread to uninfected areas. As epidemics emerge, both accepted and contentious control methods are used, as questions remain over the most effective strategy to eliminate rabies. The Indonesian island of Bali was rabies-free until 2008 when an epidemic in domestic dogs began, resulting in the deaths of over 100 people. Here we analyze data from the epidemic and compare the effectiveness of control methods at eliminating rabies.&lt;/p&gt; &lt;p&gt;Methodology/Principal Findings: Using data from Bali, we estimated the basic reproductive number, R0, of rabies in dogs, to be ~1·2, almost identical to that obtained in ten–fold less dense dog populations and suggesting rabies will not be effectively controlled by reducing dog density. We then developed a model to compare options for mass dog vaccination. Comprehensive high coverage was the single most important factor for achieving elimination, with omission of even small areas (&#60;0.5% of the dog population) jeopardizing success. Parameterizing the model with data from the 2010 and 2011 vaccination campaigns, we show that a comprehensive high coverage campaign in 2012 would likely result in elimination, saving ~550 human lives and ~$15 million in prophylaxis costs over the next ten years.&lt;/p&gt; &lt;p&gt;Conclusions/Significance: The elimination of rabies from Bali will not be achieved through achievable reductions in dog density. To ensure elimination, concerted high coverage, repeated, mass dog vaccination campaigns are necessary and the cooperation of all regions of the island is critical. Momentum is building towards development of a strategy for the global elimination of canine rabies, and this study offers valuable new insights about the dynamics and control of this disease, with immediate practical relevance.&lt;/p&gt

Children’s exposure to television advertising of unhealthy foods and beverages across four countries of WHO European Region

Abstract Objective: To compare the frequency and healthfulness of foods being advertised to children and adolescents in four countries of WHO European region. Design: Cross-sectional quantitative study, guided by an adapted version of the WHO protocol. All recorded food advertisements were categorised by categories and as either ‘permitted’ or ‘not permitted’ for advertising to children in accordance with WHO Regional Office for Europe Nutrient Profile Model. Settings: Four countries: Russia, Turkey, Kazakhstan and Kyrgyzstan Participants: TV channels most popular among children and adolescents Results: Analysis included 70 d of TV broadcasting for all channels, during which time there were 28 399 advertisements. The mean number of advertisements per hour varied from eleven in Turkey and Kazakhstan to eight and two in Russia and Kyrgyzstan. In all countries, the majority of the food and beverages advertised should not be permitted for advertising to children according to the WHO Nutrient Profile Model. The mean number of non-permitted food and beverage advertisements per hour was high in Turkey and Kazakhstan (8·8 and 8·5 ads) compared with Russia (5·1) and Kyrgyzstan (1·9). Turkey was the only country where nutritional information was fully available, and no values were missing that prevented coding for some product categories. Conclusions: Results revealed that children and adolescents in four countries are exposed to a considerable volume of food and beverage advertisements, including sugary products on broadcast television. As such, policymakers should consider protecting youth by developing regulations to restrict these marketing activities within media popular with children. </jats:sec