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Strategy Aims For More Activity And Better Diets

11 February 2002

New Health Strategy Aims For More Activity And Better Diets

A new strategy addressing the burgeoning health consequences of lack of physical activity and increasing obesity is being released for public comment by the Ministry of Health today.

A lot had been done to encourage healthier lifestyles for many New Zealanders, there was now compelling evidence for doing more, and doing it now, said Ministry of Health spokesman Dr Colin Tukuitonga.

"We're facing epidemics of obesity and diabetes. It appears children are becoming less active and we are seeing the consequences of this in the earlier onset of diseases such as diabetes.

"We want to see all New Zealanders, their families and communities supported in new and practical ways to lead physically active lives, eat well and maintain a healthy body weight."

The new strategy looks at improving environments and lifestyles so it is easier for New Zealanders to be active and access a healthier diet.

The Ministry of Health is circulating the discussion document to key groups in the public and private sectors. Healthy Action - Healthy Eating: Oranga Pumau - Oranga Kai will incorporate sector feedback in a final version, expected later this year. This strategy will define the Government's key priorities for physical activity, nutrition and reducing obesity over the next five years.

"We need to increase our efforts to break down the social, economic, cultural and environmental barriers that prevent people from eating well, living physically active lives and maintaining a healthy body weight," Dr Tukuitonga, Director of Public Health, said.

Many of New Zealand's most serious diseases and conditions, such as heart disease, stroke, hypertension, type 2 diabetes, some cancers, osteoporosis, anaemia and dental caries are closely associated with physical inactivity, poor nutrition and obesity. Maori and Pacific people and people of low socioeconomic status are disproportionately affected.

"People are becoming ill and dying early or suffer years of debilitating illness which impose enormous human and social costs. In addition, many of these conditions require costly, long-term treatment and support. The cost to the health sector will become unsustainable if we are not able to address the causes of these diseases," Dr Tukuitonga said.

"New Zealand needs innovative and integrated solutions. These solutions won't be just lifestyle changes that individuals make for themselves, but will require major commitment and change in areas such as transport, local government, the food industry and the workplace so that a healthy, more active lifestyle is more achievable for everyone."



Why are physical activity, nutrition and healthy weight important to health? Physical activity generally benefits health by acting on the intermediary physiological factors that affect health status (for example, heart rate, blood pressure, oxygen uptake, functioning of the metabolism, strengthening muscles). Physical activity needs to be regular to benefit health. Taking one example, physical activity can reduce the risk of heart disease and strokes by improving circulation of oxygen to the coronary arteries and stabilising the cells inside the arteries, reducing the likelihood of clots.

Good nutrition obtained through consumption of a balanced diet (meats, dairy products, breads and cereals, vegetables and fruit) plays three roles in relation to degenerative diseases: (1) poor nutrition can accelerate their development; (2) good nutrition can help prevent them; and (3) nutrition therapy can ease the impact of disease if they occur. In addition, a diet that is low in fatty and sugary foods helps prevent the deposition of body fat which can increase the risk of many degenerative diseases (type 2 diabetes, cardiovascular disease etc). Vegetables and fruits are high in anti-oxidants that protect the body from carcinogens that can cause cancer. They are also high in fibre which gives bulk to food and help make them filling, a characteristic that benefits people trying to keep their energy intakes low for weight control. Diets high in fibre also help keep the digestive tract healthy and carry harmful substances out of the body. Healthy food supplies key micro nutrients such as iron, sodium and folate. Breastfeeding for six months is recognised as being key to ensuring infants have optimal nutrition and therefore a healthy start to life.

What are some key facts and figures on inactivity, nutrition and obesity? PHYSICAL ACTIVITY · One third of New Zealand adults are not physically active at levels to benefit their health. · As many as 2600 people per year are estimated to have died prematurely in New Zealand because of physical activity which is equivalent to 8 percent of all deaths. · 30 minutes of physical activity of moderate intensity on most days of the week can benefit health. · When regularity is taken into account only 40 percent of the adult population are regularly active (on five or more days a week). · Overall men and women appear equally physically active. · New Zealand European, Mäori and Pacific adults are almost equally likely to be physically active, although inactive Mäori and those from 'other' ethnic groups are more likely to be sedentary (do no activity). · The highest levels of physical activity are among 15?24-year-olds and 65?74-year-olds. · Among school-aged children and young people, physical activity levels decline significantly after age 16?17, particularly among young women. · Physical inactivity has not been associated with socioeconomic status in New Zealand. However people with no qualifications are more likely to be sedentary than those with school and post-school qualifications.

NUTRITION · If everyone ate five servings of vegetables and fruit a day there would be 800 fewer deaths a year · If everyone in New Zealand ate a healthy diet the health effect would be similar to the total elimination of smoking · Two-thirds of all New Zealanders eat the recommended three servings of vegetables and half the recommended two servings of fruit. Mäori and Pacific peoples are least likely to eat the recommended servings. · Less than one-sixth of all New Zealanders eat the recommended servings of breads and cereals. Consumption is higher among Mäori and Pacific peoples in more deprived areas. · 35 percent of total energy comes from fat (30 percent recommended). Mäori have higher fat intakes than non-Mäori. · The rate of full or partial breastfeeding at six months is 60 percent (62 percent New Zealand European, 53 percent Mäori, 60 percent Pacific infants). · 27 percent of New Zealanders report that the variety of food they eat is limited by lack of money; 14 percent report that food runs out sometimes or often because of lack of money. · Although micronutrient intake is appropriate for the majority of the population, some groups are more at risk of inadequate intake. Those living in the most deprived areas are at greater risk from inadequate intakes of vitamin A, riboflavin and folate. Calcium intake is inadequate among young women and men (particularly Mäori women). · Overall 49 percent of women have folate intakes lower than those recommended for pregnancy. · Other studies have suggested some children may consume too much fat and sugar and that iron deficiency may be prevalent among some children.

OBESITY · The direct cost of obesity for the health sector and wider society is conservatively estimated at $135 million per year · 37 percent of New Zealand adults are overweight and 17 percent are obese. · New Zealand data indicates the prevalence of obesity (defined as a BMI of greater than 30 kg/m2) is increasing. Between 1989 and 1997 adult obesity increased by 55 percent. · Obesity is projected to increase by a further 70 percent by 2011. It has also been estimated that by 2011 approximately 29 percent of the adult population may be obese (Ministry of Health 2002). · There are no nationally representative data on rates of obesity in New Zealand children. However, a study of 2273 Auckland school children, aged 5.0 ? 10.9 years, found that, in all, 14.3 percent of children were obese using the recommended definition of obesity (Tyrrell et al 2001). · The overall kilojoule intake for New Zealanders seems to be increasing again after dropping through the 80s.

Why focus on prevention? The treatment costs of diseases like diabetes and cardiovascular disease are unsustainable. Preventative measures are required urgently to reduce the impact of the growing numbers of people with diseases such as diabetes and obesity to reduce spiralling treatment costs. Five years ago the direct health care costs of obesity was estimated to be $135 million and as more people become obese the costs will rise further. The number of people with type 2 (non-insulin dependent) diabetes, currently 160,000 is also rising sharply, particularly among Mäori and Pacific peoples (estimated to increase by 97 percent and 117 percent respectively by 2021). Increasing physical activity, improving nutrition and reducing obesity are key preventative approaches to reduce this burden of disease.

What does Healthy Action ? Health Eating aim to achieve? The draft strategy aims to bring the three key interrelated areas of physical activity, nutrition and healthy weight together in an integrated and coordinated way.

Who is the strategy for? It is for all those sectors that affect what we eat and how physically active we are. This includes the health sector (including funders and planners like District Health Boards, public health and personal health providers such as Government, non-government, Mäori and Pacific providers), transport, education, local government, the food industry, weight loss sector, recreation, sport and fitness sector, and community groups.

Who was involved in developing the draft strategy? The draft strategy was shaped by input from people working in a range sectors, from health (public and personal health); academics and researchers; intersectoral partners from central and local government (transport, education, local and regional councils), non-government organisations, food industry, weight loss sector, recreation, sport and fitness sector, Mäori and Pacific and community groups.

Aren't there already too many health strategies? To get the best results everyone needs to work to a master plan. This draft strategy links in with a number of other priority areas and aims to do so in an integrated and coordinated way. It should not duplicate other strategies and action plans but links with them and complements them (e.g. New Zealand Disability Strategy, Maori Health Strategy etc). It links closely with work done on cardiovascular disease, diabetes and the toolkits for District Health Boards (DHBs).

What happens to the National Plan of Action for Nutrition (NPAN) now? Significant progress has already been made on nutritional issues raised in NPAN (Ministry of Health 1998). A recent evaluation of NPAN recommended a need for a stronger focus on healthy weight and physical activity while maintaining recommendations for improved nutrition. Healthy Action - Healthy Eating builds on the directions and recommendations from NPAN that have already achieved, while recognising the need for new issues to be addressed and a change in focus in some areas.

Where are the goals and targets that were in NPAN? The draft strategy does not include goals and targets at this point. However, the goals and targets in NPAN will continue to apply and the Ministry of Health will continue to monitor progress towards national targets in the series Progress on Health Outcome Targets. In addition, annual performance targets are set for DHBs in relation to the implementation of the New Zealand Health Strategy.

Further discussions are required to decide on the most effective approach to measuring progress in the areas of physical activity, nutrition and healthy weight.

What type of concrete actions may come out of the strategy?

There are many innovative programmes already underway and many potential initiatives in the area of physical activity, nutrition and healthy weight.

Some that may be supported or expansion include:

· the Walking School Bus concept (where a "driver", usually a parent, walks children to/from school) · hikoi (popular walking programmes in Mäori communities throughout the country), · expanding the Green Prescription Scheme (possibly expanding the scheme to address nutrition). · implementation of the Health and Physical Education Curriculum including strong support from the health, recreation and local government sectors and communities

· the promotion of fruit and vegetable consumption as a means of reducing the energy density of the diet to prevent obesity and some cancers and delivery of the Baby Friendly Hospital Initiative (supporting breastfeeding).

Other potential developments could include:

· community-based programmes to encourage physical activity and good nutrition. · Partnership approaches. For example, local government and transport sector initiatives to develop and encourage safe and attractive environments for walking and cycling and encourage alternatives to using cars. · adopting policies in schools to ensure healthy food and drinks are available in schools. · promoting the importance of folate for women of childbearing age. · supporting programmes for poorly nourished children, such as breakfasts in schools in areas of need. · developing school food policies (such as discouraging of soft drink vending machines in schools and offering of low fat lunch options) to reduce consumption of fat and sugar by school children. · advertising policies that protect children from sophisticated marketing of high fat and high sugar foods.

Who is being consulted? All the key stakeholders in the areas of physical activity, nutrition and healthy weight. This includes a wide range of sectors and organisations such as health (public and personal health); academics and researchers; intersectoral partners from central and local government (transport, education, local and regional councils), non-government organisations, food industry, weight loss sector, recreation, sport and fitness sector, Mäori and Pacific and community groups.

How long is the consultation period?

Seven weeks from 11 February to 29 March 2002.

What does the Ministry hope to gain from consultation? To hear from those involved nutrition, physical activity and weight management sectors about whether the strategy is pitched at the right level, whether the priorities and actions are the rights ones to make a difference and whether it offers the right approach for meeting the goals of increasing physical activity, improving nutrition and reducing obesity.

What will happen with the feedback from consultation? Feedback from the consultation (written submissions, feedback from the consultation meetings and international peer review) will be analysed, considered and will feed into the development of a final strategy, which is planned to be complete during the middle of this year. A summary of submissions will also be made available.

How will the strategy be implemented? Annual implementation plans will be developed with the relevant agencies once the final strategy is developed. The Ministry of Health will identify an approach for measuring priority actions within clearly established timeframes as part of the development of annual implementation plans. A process for selecting priority actions for each year will be informed by the consultation on the strategy. Funding of services and programmes under the strategy is likely to involve reorientation and reprioritisation of current funding by relevant organisations and agencies.

How can I have my say? Consultation meetings are being held in these places: · February 21 - General meeting in Dunedin at the Executive Residence, University of Otago, 68 Forth Street, 2-4pm. · March 1 - Hui in Whangarei at Pehiaweri Marae, Ngunguru Rd, Glenbury, 1-3.30pm. · March 4 - Hui in Rotorua at Toi te Ora Conference Rooms, 1143 Haupapa St, 10.30am-1pm. · March 5 - Hui in Gisborne at Turanga Health, 145 Derby St, 10am-12.30pm. · March 7 - General meeting/hui/fono in Wellington at the Overseas Terminal, Oriental Parade, 9.30am-12pm · March 11 - General meeting/hui/fono in Christchurch at Nga Hau e Wha Marae, 250 Pages Road, 9.30am-12pm · March 13 - General meeting in Hamilton at Hamilton Gardens Pavillion, Cobham Drive, 2-4pm · March 14 - General meeting/hui/ in Auckland at Freemans Bay Community Centre, 52 Hepburn St, 9.30am-12pm · March 14 - Fono in Auckland at Freemans Bay Community Centre, 52 Hepburn St, 1-3pm.

Making a submission.

There are five different ways you can make a submission:

1 Complete the submission form on the Internet, which sends your comments directly to the Ministry of Health. This is the preferred method for the Ministry.

2 Complete the submission form as a Word document, and either email it to the Ministry of Health at or print it off and send it by post to the Ministry of Health (see below for postal address).

3 Write your comments directly on the submission booklet found in the centre of this document and send them to the Ministry of Health by post.

4 Write your comments on a piece of paper or as a letter or as an email and either send them to the Ministry of Health by post or by email

5 Attend a consultation meeting, hui or fono where your comments will be recorded manually.

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