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

Satellite Expert Roundtable on DPAS School Policy Initiative

A/Prof. Roya Kelishadi Vancouver, 7 June 2007

The Global Strategy on Diet, Physical Activity and Health: A School Policy

Initiative

Outcomes of the Expert Roundtable


in close collaboration with

Public Health Agency Canada & Health Canada


Participants

Temporary advisers:• Ms Kelly Stone (Chairperson)• Associate professor Roya Kelishadi (Rapporteur)• Dr Mary McKenna (Background paper nutrition)• Dr Claire MA LeBlanc (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 McGeorge• Associate professor Ladda Mo-Suwan• Ms Patricia Walsh

WHO Secretariat:• Ms Tilly de Bruin• Dr Ulla Uusitalo (Nutrition-Friendly Schools Initiative)


• Background

• Satellite Expert Roundtable

• Next steps

Agenda


Did You Know?

35 000 000

people died worldwide

fromchronic diseases

in 2005


1. Cardiovascular disease (mainly heart disease & stroke)

2. Cancer

3. Chronic respiratory diseases

4. Diabetes

Main Causes of Death

Source: WHO, Preventing Chronic Diseases, 2005


Not only in Rich Countries



Causes of Chronic Diseases

80%80%

80%80%

80%80%

40%40%

N.A.N.A.


Risks are Increasing



www.who.int/dietphysicalactivity

The Global Strategy on Diet Physical Activity and Health


1. Reduce risk factors for chronic diseases that stem from unhealthy eating and physical inactivity through public health actions;

2. Increase awareness and understanding of importance healthy eating and physical activity on health;

3. 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;

4. Monitor science and promote research on healthy eating and physical activity.

Objectives of DPAS


1. Activities at the global level:• Tools

• Physical activity• Fruit and vegetables• Monitoring and Evaluation• Reducing salt intake in population

• Global interactions:• Private sector• UN Agencies

2. Activities at the regional level:• 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)

What has WHO done?


Although there are 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


• Background


• Next steps

Agenda


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


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


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)


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


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)


Policy Policy Option Evidence Effective (E) Promising (P)

Daily quality PE Raise quantity PE to daily K12 Sallis: ↑ grade 6-8 PE daily + school PA lower BMI boys (E)

Ensure students active most of PE class time

McKenzie: PE curriculum more vigorous PA students > active in PE class not outside school (E)

Daily PA 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)

Community Outreach Develop partnerships with community recreation

Moody: 50% community rec. centers have elementary after school programs: vs 11% middle ; 0% High school (P)

Physical activity options (tested)


Policy Area Untested Policy Option Best Practice ExampleCurricular 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 program

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 SchoolsSaskatoon 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 SchoolsSaskatoon in Motion

School Staff Promote health benefits of physical activity to school staff Hudson-Collins P: CDC funded coordinated school health 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

Physical activity options (untested)


Healthy eating policy options

Policy Policy OptionLegislation and regulation

• Direct policies that address all foods• Direct policies that address some but not all foods• Indirect policies that address the quality of all foods

Financing • Use of money or food to shape food consumption (school food programs, water and food pricing)

Built environment • Nutrition standards Coordination of food availability• Local foods Food availability near schools• Food preparation Sustainable food practices• Student access to fruits and vegetables Food marketing• Use of foods Food and beverages contracts

Health services • 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


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


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


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


• Document changes due to policy

• Enhance support for policy

• Allocate resources

• Provide accountability

• Inform decision-making

• Contribute to evidence base (promote research)

Purpose of Monitoring and Evaluation (M&E)


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 School-based student Health Survey (and use as baseline data)

Satellite Expert Roundtable on DPAS School Policy Initiative8 Global Strategy on Diet, Physical Activity and Health. A Framework to Monitor and Evaluate Implementation. World Health Organization Geneva, 2006

WHO Framework for M&E


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


Outline

Unconventional

…your suggestions would be very much appreciated!


…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


• Background


• Next steps

Agenda


Next steps

1. Prepare background papers on diet and physical activity, both focusing on:• Effective policy options for the school setting • Roles of different stakeholders• Monitoring and evaluation

April – May 2007

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


Further involvement?

Please contact Tilly de Bruin Technical officer in WHO on the Global Strategy

on Diet, Physical Activity and [email protected]+41 22 79 13235

Documents

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