From European projects to Hungarian National Policies Prof. Dr. Éva Martos Hungarian Society for Sports Medicine, Budapest, Hungary Representative of Hungary in the European High Level Group on Nutrition and Physical activity NUTRITION AND PHYSICAL ACTIVITY How European Union contributes to public health priorities including Obesity CHAFEA Cluster meeting, Budapest, Hungary 30 November to 2 December 2016
Presentation outline Challenges-Public health data in Hungary Legislative measures in the field of nutrition Public Health Product Tax CIII Act/2011 Limitation of industrial TFA in foods /2013 Decree on the nutritional standards of public catering/2015 EU-funded projects ENHRII InForm Prevact Key messages
CHALLENGES Adult obesity prevalence (BMI>30 ) * 2016 * 30% (Based on measured data, OTÁP2014 )
CHALLENGES - Prevalence of overweight and obesity in 7 year old schoolchildren In 2010 20% of 7-year-old boys and 25% of 7-year-old girls OW / OB Overweight Obese Overweight + Obese Boy (n=562) 12.1% 7.8% 19.9% Girl (n=707) 16.8% 7.9% 24.7% Source: WHO Childhood Obesity Surveillance Initiative, 2010
CHALLENGES Salt intake of the Hungarian adults Source: http://ec.europa.eu/health/nutrition_physical_activity/docs/salt_report1_en.pdf (p16 Figure 1) Hungary Female: Male: 12.0 g/day 17.2 g/day
The proportion of soft drink consumers by nutritional status (7 year old children - WHO/COSI 2010) 60% Mean consumption: 3,7 dl/day 50% 40% Proportion 30% 20% 42% 43% 51% 56% 10% 0% Underweight Normal Overweight Obese
Public Health Product Tax (Act CIII of 2011) Came into force from 1 September 2011 Specific excise tax on a per unit measure (kg, liter) Based on sugar, salt and methylxantine content of products-in case of exceeding a certain level Pre-packaged foods only Non-staple foods Only products that have healthier alternatives Tax rate: 0.02-1.6 Euro/kg or liter
Changes in consumer behaviour Public health product tax impact assessment, 2012* *Source: Impact Assessment of the PHPT, National Institute for Health Development, 2013
PHPT impact* PHPT encouraged product reformulation Consumption of unhealty food decreased It has had a long-term impact The health literacy of consumers has improved Most of those who made substitutions chose a healthier alternative The planned revenues have been realised year by year * Findings of two formal impact assessments supported by WHO Region for Europe, 2012, 2014
Termék neve; Gyártó/Forgalmazó High risk: TFA content of foods TFA [mg/100g termék] TFA [g/100g zsír] Húsvéti tojás mintás, Üreges figura kakaós tejmasszából; Foltin Globe Kft. (2013) 14426 37,3 Rizses süti; Édes Világ 2003. Kft. (2012) 5883 21,9 GranMaster Sütő-főző margarinkrém; König-Trade Kft. (2012) 5403 9,0 Lekváros fehércsokis puszedli; Édes Világ 2003. Kft. (2012) 3399 30,2 Fehér golyó; Édes Világ 2003. Kft. (2012) 3276 29,8 Mogyorós csemege; Baranyai Pékség és Cukrászat (2012) 2984 9,0 Cukros levélke; Édes Világ 2003. Kft. (2012) 2717 13,6 Mini mini keksz; Édes Világ 2003. Kft. (2012) 2457 12,3 Dekor karika; Édes Világ 2003. Kft. (2012) 2347 10,9 Kakaós levélke; Édes Világ 2003. Kft. (2012) 2271 10,4 Csokiba mártott csillag; Édes Világ 2003. Kft. (2012) 2170 10,5 Csokiba mártott levélke; Édes Világ 2003. Kft. (2012) 1920 9,1 Domino; Vállalkozás A-tól Z-ig (2012) 1898 4,9 Ring tejszínes rácsos; Édes Világ 2003. Kft. (2012) 1857 7,7 Kókusz csemege; Baranyai Pékség és Cukrászat (2012) 1758 4,8 Chihotki kókuszkrémes; Édes Világ 2003. Kft. (2012) 1722 6,9 Csoki ZOTT perec; Édes Világ 2003. Kft. (2012) 1488 7,5 Kávés szelet; Vállalkozás A-tól Z-ig (2012) 1446 7,2 No Stressz szelet; Tortás Cukrászati Kft. (2013) 1401 5,2 Pisztáciás szelet; Vállalkozás A-tól Z-ig (2012) 1338 6,8 Puncs torta; Vállalkozás A-tól Z-ig (2012) 1250 5,8 Norbi Update - Csokis croissant; Norbi Update International Kft. (2012) 1195 7,4 Piramis; Vállalkozás A-tól Z-ig (2012) 1163 5,7 Sajtos roló; Bello Futuro Kft./Lipóti Pékség (2012) 1160 6,9 Narancsos szelet; Vállalkozás A-tól Z-ig (2012) 1128 6,5 Csokis szelet; Vállalkozás A-tól Z-ig (2012) 1123 4,4 Dobos torta; Vállalkozás A-tól Z-ig (2012) 1108 6,1 Meggyes szelet; Vállalkozás A-tól Z-ig (2012) 1040 5,3 Gesztenyerolád; Vállalkozás A-tól Z-ig (2012) 1035 6,6 Darálós keksz; Zimányi Édesipari Kft. (2012) 1024 3,5 Lúdláb; Vállalkozás A-tól Z-ig (2012) 1008 5,5
Impact of TFA regulation 2009-2013 2015 >2 g TFA 22%
The evidence base National Nutritional Environment Surveys in Schools and in Pre-Schools (2008,2009 and 2013) Public catering does not meet healthy nutritional requirements. Legislative measures with nutritional standards are needed to reduce the significant nutritional risk posed by the present practice.
Nutritional standards of public catering (2015) Priority of NCD risk factors (salt, sugar, saturated fat, F/V) Food based standards Number of meals Age specific portion size Prohibition/mandatory daily provision of certain food groups Display of menu
Project No 2006128 under EU Health Programme 2008-2013 ENHR II A comprehensive report on the nutrition and health situation in Europe Identification of major nutrition and health problems in the EU regions The European nutrition and health report 2009 provided information on food supply/availability/consumption, energy and nutrient intake, diet-related health indicators and status, food and nutrition policies in 25 European countries International comparability Main Beneficiary: Universität Wien Project Leader: Ibrahim Elmadfa
Project No 2006128 under EU Health Programme 2008-2013 Comparable data of mineral intake in children aged 10-14 years of European countries
Associated Partners: Bulgaria, Finland, Norway, Austria, Slovenia, United Kingdom, Hungary, Italy Co-funded by EC Health Program 2008-2013
Train-the-trainers obesity experts (international summer camp, manual) Social marketing campaign
Prevact Expert Level Conference on Member States Activities on Nutrition, Physical Activity and Smoking related Health Issues Co-financed by the European Commission (through the European Health Programme 2008-2013) and the Government of the Republic of Hungary.
Conference Conclusion the need for better actions to close the health gap between Member States the importance of co-ordinated strategies and actions at international level the need for closer collaboration of national focal points the importance of better monitoring and evaluation of outcomes of public health policies and actions more focus should be paid on making the healthy option available the strength of social media as a means of conveying public health messages to the population in a cost-effective way.
Key messages- project specific added values Innovative tools and solutions Age specific messages The use of social media Know how for the engagement of different stakeholders High quality monitoring activity
Key messages-common general added values The share of good practices among the countries of different public health system International multisectorial cooperation Knowledge exchange and networking of the high level experts of different backgrounds
The way forward