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DPAS-Asia+Report_21.04.2010

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					                                           SUMMARY



      A workshop on the Implementation of the Global Strategy on Diet, Physical Activity and
Health (DPAS) in Asian Countries was held in Manila, Philippines from 10 to13 October 2006.
This was the second workshop on the DPAS implementation in the Western Pacific Region.

      The objectives of the workshop were:

      (1) to review progress on the prevention of obesity, diabetes and related chronic diseases
in Asian countries;

      (2) to agree on priority actions for DPAS implementation at the national and local levels;
and

      (3) to propose priority areas for collaboration at a regional level.

       All countries represented at the workshop had data on diet and physical activity patterns
from recent surveys, such as STEPS, or had surveys underway or planned. Almost all countries
had existing national plans related to the aims of DPAS, two thirds had dietary guidelines, and
half had physical activity guidelines. The workshop examined the opportunities for improving
nutrition and physical activity through policy, legislation and environmental change and then
specifically examined opportunities presented by urban planning, community action, schools,
workplaces and the health system. Country experiences in each of these areas were shared.
The cross-cutting issues of situation analysis, population monitoring, programme evaluation,
advocacy and communication, and mobilizing resources were also discussed, along with relevant
country examples in each session.

       Significant progress in nutrition and physical activity interventions was already underway
in Australia and New Zealand, as well as in wealthier Asian countries in the Region, such as
Japan, Singapore and the Republic of Korea. Some progress was also noted in countries such as
China, the Philippines and Malaysia, whereas for countries such as Cambodia,
the Lao People’s Democratic Republic and Viet Nam, noncommunicable disease control is not
yet high enough up on the political and public agenda to make DPAS implementation a priority
for those governments.

       Each country worked on developing its own top three priorities for action and, for each
area, objectives, evaluation indicators, next steps in the process, and the evidence needed to make
the case were developed. This gave each country a tangible set of priority actions to work on to
advance the DPAS agenda following the workshop.

       Priority actions were also identified for the Region and recommendations were made for
WHO, Member States, the private sector and civil society. The priority areas for technical
support for nutrition action were in the development of policies and regulations on food
labelling, food standards, and reducing food and beverage marketing to children. For physical
activity, support was requested for the development and promotion of physical activity
guidelines and the development of regional physical activity networks. For the cross-cutting
areas, the priorities for support were for programme evaluation training, the establishment of
health promotion foundations, and training in the effective use of advocacy and social marketing
to support national policies and programmes.
                                                  - ii -




       Member States were urged to place a high priority on DPAS implementation by
committing resources and creating the policies needed to make a difference. This is a
fundamental investment for the health and economic well-being of citizens, as well as providing
substantial savings on health care costs, personal costs and reduced productivity due to chronic
diseases and disability. The private sector, including major food and beverage companies, were
also urged to support national and regional efforts to harmonize nutrient labelling, set food
nutrition standards and reduce marketing to children. The importance of the national and
international advocacy efforts of civil society was stressed as a key driver for DPAS
implementation.

Recommendations

       Workshop participants strongly endorsed the DPAS principles for action and strategic
directions and made the following recommendations for action in Asian countries.

      (1)       Recommendations for WHO

             a. Health leadership and engaging partners

                •   Promote DPAS implementation as a high priority for Asian countries.

                •   Facilitate the use of an Asia-Pacific Physical Activity network and provide
                    continued support for the Mobilization of Allies in Noncommunicable
                    Disease (MOANA) network.

             b. Standard-setting and prioritizing and monitoring implementation

                •   Work with Member States and the private sector to achieve harmonization of
                    food standard setting and food labelling regulations across the Region.

                •   Lead further work on providing regulatory options for countries on reducing
                    commercial promotion of food and beverages to children.

                •   Provide technical support on using STEPS and other data collection systems
                    to assess diets, nutrition and physical activity in countries and monitor the
                    implementation of DPAS.

             c. Technical support for catalyzing change, building institutional capacity, and
                advocacy

                •   Provide technical support for developing plans and guidelines, especially for
                    physical activity.

                •   Provide technical support for establishing health promotion foundations.

                •   Support capacity-building in the Region for key skill development in
                    advocacy, leadership and programme evaluation.

                •   Provide technical guidance on effective and cost-effective ways of using
                    social marketing to support DPAS policies and programmes.
                                             - iii -




(2)        Recommendations for Member States

      a. Implement DPAS as a high priority by adapting and enriching existing national
         plans, policies and activities where possible.

      b. Allocate more public funding and human resources and advocate for more
         private funding to improve nutrition and physical activity as an excellent
         investment for the population’s future health and economic well-being.

      c. Ensure that funding is allocated for DPAS activities to be evaluated as outlined
         in using the DPAS Framework to Monitor and Evaluate Implementation.

      d. Provide sufficient funds and support for primary health care (including health
         professional training and review of curricula) to implement DPAS goals and
         activities.

      e. Using the experience of tobacco and alcohol control, consider fiscal measures to
         promote physical activity and healthy food choices and to discourage unhealthy
         choices.

      f.   As a central strategy to create a healthy food environment for children, develop
           and implement regulations to reduce the commercial promotions of foods and
           beverages that target children.

      g. Consider establishing health promotion foundations as a source of sustainable
         financing for DPAS implementation.

      h. Ensure that DPAS implementation, while led by the health sector, collaborates
         with other sectors, such as agriculture, transportation, and education, and is
         linked with the promotion of healthy environments and preservation of natural
         resources.

      i.   Ensure that DPAS is implemented in a way that reduces health inequalities and
           considers differences in ethnicity, gender and age.

      j.   Ensure that social marketing is used in ways that are effective and cost-effective,
           linked to DPAS policies and programmes, and evaluated.

      k. Implement DPAS activities throughout the government health sector so that it
         acts as a role model for wider DPAS implementation.

      l.   Identify a senior person as the focal point for DPAS implementation.

      m. Identify and support high profile champions, such as prominent political or
         public figures, to promote healthy eating and physical activity.

      n. Engage and establish relationships with the key national and international
         nongovernmental organizations (NGOs) on the prevention of chronic diseases.

(3)        Recommendations for the private sector

      a. Reformulate food and beverage products to reduce fats, saturated fat, trans-fatty
         acids, sugar and salt content wherever possible.
                                           - iv -




      b. Support country and regional efforts to harmonize food labelling regulations.

      c. Support country and regional efforts to provide healthy food environments for
         children, including reductions in commercial promotions that target children.

      d. Provide healthy environments for diet and physical activity for employees.

      e. Include the promotion of healthy eating and physical activity as part of corporate
         social responsibility efforts.

(4)       Recommendations for civil society

      a. Increase advocacy efforts for DPAS implementation as an urgent priority for
         population health and economic well-being.

      b. Identify, support, and promote champions for DPAS actions.

      c. Link with national, regional, and global coalitions and alliances (e.g. Global
         Prevention Alliance, Healthy Cities Alliance, Oxford Health Alliance, Global
         Alliance on Physical Activity) to advocate for DPAS implementation.

(5)       Next steps for regional collaborations

      a. WHO to convene a meeting with key food and beverage companies and related
         bodies in the Region and create a plan on harmonizing food standards and
         labelling and regulations on marketing of food and beverages to children.

      b. WHO to work with the Global Alliance on Physical Activity on a set of
         resources to help countries develop and promote Physical Activity Guidelines.

      c. WHO to work with the FAO and other agencies to produce and disseminate
         guides for the communication and use of dietary guidelines to promote the
         availability, accessibility, affordability and consumption of healthy foods.

      d. WHO to provide support for the Asia-Pacific Physical Activity network and the
         MOANA network.
                                      1. INTRODUCTION



1.1   Background

       Chronic diseases such as cardiovascular diseases, diabetes and cancer account for almost
                                                                         1
60% of the deaths annually worldwide and 47% of the burden of disease. In the Western Pacific
Region, some 25 000 people die every day from chronic diseases, compared to about 200 from
HIV AIDS. Most of these deaths are in lower income countries and they occur at a younger age
than in high income countries.

       This burden is placing an enormous financial strain on the Region in terms of health care
costs, personal costs, lost productivity and impaired economic growth. The case for reducing this
burden of chronic disease is compelling and prevention efforts through improved nutrition and
physical activity are key.

       WHO Member States and other stakeholders developed the Global Strategy on Diet,
                                        2
Physical Activity and Health (DPAS) over a two-year consultative process, which was endorsed
at the World Health Assembly in May 2004 (resolution WHA57.17.). The current challenge for
countries, with the support of WHO and other agencies, is to implement and evaluate DPAS
actions. Most countries have some assessment of the size and nature of the burden of poor
nutrition and physical inactivity and most countries also have some existing plans, such as
nutrition plans for action, related to DPAS. For the DPAS implementation stage, most countries
will need to review and adapt their existing national plans to meet DPAS goals. However, all
countries will need to significantly increase their commitment to intervention efforts if reductions
in the health and economic burdens through improved nutrition and physical activity are to be
realized.

       The WHO Regional Office for the Western Pacific organized a workshop on the
Implementation of the Global Strategy on Diet, Physical Activity and Health in Asian countries,
held in Manila, Philippines from 10 to 13 October 2006.

1.2   Objectives

      The objectives of the workshop were as follows.

      At the end of the workshop, participants will have:

      (1) reviewed progress and shared experiences in the prevention and control of obesity,
          diabetes and related chronic diseases in Asian countries;

      (2) reviewed, discussed and agreed on priority actions at the national and local level to
          achieve maximum impact in the implementation of DPAS; and

      (3) proposed priority areas for collaboration at a regional level.
      1
       World Health Report 2002. Reducing Risks, Promoting Healthy Life. World Health
Organization, Geneva 2002
      2
        Global Strategy for Diet, Physical Activity and Health.
http://www.who.int/nmh/wha/59/dpas/en/
                                                  -2-




1.3   Organization

      The workshop was sponsored by Australian Government Overseas Aid Program (AusAid)
and organized by the Nutrition Programme, at the WHO Regional Office for the Western Pacific.
The complete agenda for the workshop is provided in Annex 1.

       The workshop started with an outline of the DPAS framework and a review of the current
progress in Member States in the Region. The recently released framework for assessing,
monitoring and evaluating DPAS activities was also outlined. The remainder of the first day
covered specific opportunities for policies and programme action on healthy eating and physical
activity. These presentations and country examples provided the basis for discussion around
priority areas for action. The second day covered opportunities for action in specific settings,
such as schools, workplaces, health systems, cities and communities. Country presentations on
each setting provided valuable examples for discussion. Day three provided an opportunity for
group work and the development of country priorities for action. Presentations and country
examples were covered in three sessions on cross-cutting areas: assessment, monitoring and
evaluation; advocacy and communication; and mobilizing resources. In group work, each
country focused on identifying the three top priorities for action and defining the objectives,
indicators, processes for the next steps and evidence needed to make the case for action. The
final day continued the work on country priorities and a session on the contribution of global
agencies and alliances. Finally, in plenary session, the recommendations for the meeting were
finalized, opportunities to access seed funds and priorities for Regional action were discussed.

1.4   Participants and resource persons

      A full list of workshop attendees is attached in Annex 2. A workshop on DPAS
implementation was held in Suva, Fiji in October 2006 for Pacific countries with attendees from
the Asian countries in the WHO Western Pacific Region along with attendees from Australia and
New Zealand.




                                      2. PROCEEDINGS



2.1   Preliminaries

      Dr Richard Nesbit, Acting Director, WHO Regional Office for the Western Pacific,
welcomed participants to the workshop and placed the objectives of the workshop in the global
context. He noted the dramatic increases in chronic diseases in the Region and quoted
projections of the type two diabetes prevalence in China which is expected to double by 2030 to
more than 42 million cases, and to more than double in Malaysia, Philippines and Viet Nam in
the same period. The likely economic impacts of these disease burdens are equally alarming.
For example, China alone is estimated to lose over US$550 billion from lost productivity
between the years 2005 and 2015, due to death and disability associated with noncommunicable
diseases. Improvements in population nutrition and physical activity levels, therefore, need to be
major strategies for achieving development and economic goals.

      The challenge now lies with Member States to greatly increase their commitment to
achieving the DPAS objectives. The scale up required at a country level is substantial, both in
                                                 -3-




programme funding and policy implementation. This is particularly the case for the
Western Pacific Region, where the extremely high prevalence of obesity among Pacific
populations, and increasing prevalence in the complex and rapidly growing mega-cities in
several Asian countries present serious challenges.

      The overarching framework has been provided by DPAS and its accompanying support
resources, but Member States must implement and evaluate the serious actions needed to
improve nutrition and physical activity.

2.2   DPAS framework and national plans of action

       Dr Tommaso Cavalli-Sforza reviewed the DPAS objectives and strategies and the
STEPwise approach to chronic disease control at national and community levels and through
clinical services. He also provided the results of a pre-workshop survey filled out by country
representatives on the current state of implementation of DPAS strategies. Almost all countries
had existing DPAS-related plans such as nutrition action plans or chronic disease prevention
plans. Healthy eating and physical activity were both covered in most plans. The two countries
without such plans were planning to develop them. For some countries, such as Cambodia and
Viet Nam, undernutrition still prevailed, whereas for most other countries, overnutrition was
already a major problem. Two thirds of countries had national dietary guidelines, whereas about
half had physical activity guidelines. As expected, the clustering of risk factors was
predominantly among middle-aged urban dwellers with obesity and low physical activity, often
more common among women, with less healthy diets predominant for men. Some strategies are
already underway in many countries, but in general, intersectoral collaboration was low and very
few strategies were rated as high intensity.

       Dr Tim Armstrong, from WHO Headquarters, Geneva presented the newly released
Framework to Monitor and Evaluate DPAS Implementation. This document is a tool to guide
the development of key process, output and outcome indicators for each of the areas of DPAS
implementation. Many countries have made good progress in the assessment of behaviours and
risk factors for chronic disease through STEPS and other surveys. It is now important that these
and other sources of data are turned into ongoing monitoring systems to track the overall
progress of DPAS and that specific DPAS policies and programmes are properly evaluated for
impact.

2.3   Frameworks for healthy nutrition

       Professor Boyd Swinburn from Deakin University, Melbourne provided an overview of
the intervention options for improving nutrition. He showed that for the control of almost all
epidemics, a strong policy backbone is required to set rules, change environments and fund
programmes , all which have significant impacts on behaviours. By contrast, education or social
marketing strategies on their own usually have a weak impact on behaviours, but it is these
strategies to which policy-makers most commonly turn for solutions. Several countries
presented their progress to date on improving nutrition. Most countries had dietary guidelines
and were promoting these in various ways. The most common approaches included health
promotion and education through schools, workplaces, community events and health care
settings. Very few broader policy-based initiatives were underway. The long-standing
comprehensive programmes in Singaporean schools and the recent “traffic light” system that
bans “junk food” sales in NSW and Queensland schools in Australia were seen as important
examples of such policy-based actions.
                                                      -4-




      When asked to select potential interventions to discuss in more detail, participants most
wanted to debate the differences between effective and ineffective social marketing and how to
implement three key policy initiatives in their countries: nutrition labelling, setting food
standards and regulations to reduce food marketing to children. Professor Swinburn went
through key points for each of these.

      (1) Effective social marketing is not primarily about education but about motivating
          people to “exchange” a behaviour change (e.g. saying no to children’s requests for
          sweets) in return for something of value (e.g. stronger children’s teeth).

      (2) Social marketing needs to link to on-the-ground activities and/or policies and needs to
          be evaluated.

      (3) Unlinked and unevaluated awareness-raising advertising campaigns, while quick,
          visible and common, are not recommended.

      (4) Nutrition information panels on manufactured foods are required by law in most
          affluent countries but often strenuous advocacy was required to overcome food
          industry opposition to achieve this. Similar advocacy action is likely to be needed to
          achieve nutrition labelling regulations in less affluent countries.

      (5) Setting nutrition standards (e.g. for food sold in schools) is a policy strategy which is
          rapidly gaining momentum in some countries and could be addressed at regional level
          for Asian countries.

      (6) Regulations to reduce food and beverage marketing to children needs to be a central
          policy strategy for countries, but it is highly controversial because of its high potential
          to be effective in reducing the consumption of energy dense foods and beverages
          heavily marketed to children.

      (7) In a recent analysis of 13 potential interventions to reduce obesity in children and
          adolescents, a Victorian State Government-funded study in Australia found that bans
          on food and beverage television advertising to children was by far the most effective
                             3
          and cost-effective.

2.4    Frameworks for physical activity

      Dr Tim Armstrong presented on the Action Framework to Improve Physical Activity: a
guide for population-based approaches to increase levels of physical activity.

       This guide is intended to assist ministry of health staff and other stakeholders in the
development and implementation of a national physical activity plan and provide guidance on
policy options for effective promotion of physical activity at national level and sub-national
level. The key elements are:

      (1) high-level political commitment

      (2) integration of policies


3
  Haby MM, Vos T, Carter R, Moodie M, Markwick A, Magnus A, Tay-Teo KS, Swinburn B: A new
approach to assessing the health benefit from obesity interventions in children and adolescents: the
assessing cost-effectiveness in obesity project. Int J Obes (Lond) 2006, 30(10):1463-1475.
                                                    -5-




      (3) access to funding sources

      (4) stakeholder support

      (5) cultural sensitivities

      (6) coordination and administrative support

      (7) integration of physical activity into other related sectors.

       Planning is to be followed by a series of implementation steps, core (most critical) steps,
expanded (enhanced) steps. An example of developing and implementing national guidelines for
health-enhancing physical activity using this process was presented and discussed. Discussion
then focused on the priority areas for action, and how and when countries might start this
process.

2.5     The role of schools

       Dr Karen Heckert from the WHO Regional Office for the Western Pacific presented on the
Nutrition-Friendly School Initiative (NFSI), which is an additional layer to the already well
adopted Health Promoting School (HPS) programme. A HPS is one which is constantly
strengthening its capacity as a healthy setting for living, learning and working. The goal of HPS
and the new NFSI is to increase the number of schools in the Region that are health promoting
with strong physical activity and nutrition policies, environments and promotions. The NFSI,
which is still under development, provides a framework for improving the health and nutritional
status of school age children by undertaking an assessment (using the new School Assessment
Tool – SAT) and implementing strategies in the following areas:

      (1)   written school policies

      (2)   awareness and capacity-building for the school community

      (3)   curriculum development and modification

      (4)   supportive school environment

      (5)   school nutrition and health services.

       Examples of HPS activities were then presented briefly using both the Urbani school
health kit example, where schools are provided with a health promotion kit, a resource to
encourage health promotion activities, and the Hong Kong (China) school health awards scheme
example, where schools are awarded gold, silver or bronze status based on the level of their
activities.

      Country examples of HPS were then presented by a number of participants. In 1995,
Malaysia adopted HPS, with a nationwide programme being launched in 1997. Major issues
encountered by Malaysia were limited resources and manpower to implement the programme,
and difficulty among implementers as to what the HPS were, with rapid turnover of trained staff
and no supervisory panel to oversee the implementation and evaluation of the programme.
School administrators also had many other priorities to juggle which impacted the success and
uptake of the programme.
                                                     -6-




       New Zealand presented a brief outline of the activities undertaken in school settings,
including fruit in schools and nutritional guidelines in schools. Hong Kong (China) presented
their school based Healthy Eating Health Promotion programme. It was discussed how the
success of this programme was due in part to the collaboration of schools parents and food
traders, the use of comprehensive strategies to reinforce messages and the engagement of key
players both within and without the health sector.

2.6   The role of workplaces

        Ms Marion Dunlop, Temporary Advisor, and Dr Karen Heckert presented on the role of
promoting physical activity and healthy diets in workplaces. This is recognized as important for
preventing obesity, but also a great challenge for both developing and developed countries.
Several Australian examples and a United States of America example of implementing health
workplaces were discussed and shown how they have adopted broad workplace health promotion
activities, which include diet and physical activity components. While the rationale for using the
workplaces setting is clear and the potential benefits to employees and business were significant,
it is clear that there are many barriers to full implementation. Workplace health programmes are
often difficult to establish because they are not seen as a priority by management, and difficult to
sustain unless they become an intrinsic part of the workplace structures and policies with a high
level mandate. There are significant economic gains from increased productivity due to less sick
leave, absenteeism and “presenteeism” (reduced productivity from present workers) in health-
promoting workplaces, in addition to the reductions in illness and injuries experienced by
employees.

       The well-established workplace health programmes from Singapore were presented and
the value of a high level of political support and integration with other activities (e.g. nutrition
signposting, events, social marketing, and health promoting schools) was evident. Promising
workplace initiatives from Malaysia and Brunei Darussalam were also presented.

2.7   The role of health systems

       Dr Colin Sindall from the Australian Government Department of Health and Ageing (on
secondment to The WHO Western Pacific Regional Office) identified that health systems are
important settings for prevention, and are therefore a significant resource for prevention efforts,
such as for overweight and obesity. In addition, health services are major employers of national
workforces and should become role models for workplace promotion of physical activity and
diet. Two Australian examples were also discussed: the Smoking, Nutrition, Alcohol, Physical
activity, Obesity (SNAPO) framework for general practice and the Lifescripts programme.

       The barriers to implementing prevention through primary care were multiple—at both the
practice/provider level and funder/government level. Foremost among them is the funding
regime for primary care, with the fee-for-service approach being particularly ill-suited to
population prevention involving something as complex as nutrition.

       In addition, a number of Member States in the Region have already begun activities
engaging with health systems and health care setting specific to diet and physical activity with
some success. The Hong Kong (China) experience included their version of exercise
prescriptions and a comprehensive engagement with health professionals to increase physical
activity among the population.
                                                   -7-




2.8   Staying active and healthy in changing cities

       Professor Adrian Bauman and Dr Tom Schmid presented on aspects of urbanization and
the impact of the urban environment on physical activity—the theme that reoccurred throughout
the meeting. It is well documented how the urban environment can impact physical activity and
how this then impacts the burden of noncommunicable disease. The first session was on the
impact of urbanization on physical activity, especially how low walkability, poor public transport
and urbanization contributes to more sedentary behaviours. There is a need for the health sector
to engage with urban planning and transport departments to find solutions for urbanization that
increase, not reduce, physical activity. The example of Bogotá, Columbia was used to
demonstrate that healthy urbanization is possible in large developing country cities using
strategies such as increasing open space for leisure, increasing capacity for public transport,
reducing car use and promoting physical activity through free classes and activities.

      The second section of this session discussed the impact of urban environments and
socioeconomic status on nutrition. As environments become more urbanized, access to
supermarkets is reduced and distances travelled increases, with a trend to increasing car
dependency for food access. An example of a whole of community approach to increasing
healthy diet and physical activity was provided, from the Be Active Eat Well project in
Colac, Australia. Representatives from the Republic of Korea and the Philippines and also
presented on their progress towards healthy cities.

2.9   Assessment, monitoring and evaluation

       Luke Atkin, Temporary Advisor from Australia, gave a brief overview of assessment and
monitoring and planning for evaluation and then three Member States, Japan, Mongolia, and the
Philippines, presented their experiences of monitoring, either using their own systems or adapted
STEPS survey tools. From the discussion it was evident that all Member States present were
conducting or planning monitoring surveys around diet and physical activity risk factors;
although the range was wide from Japan’s long-standing annual national nutrition survey to
others, such as the Lao People’s Democratic Republic with first surveys being planned.

       The second part of this session dealt with evaluation. One of the first requirements for
good evaluation is having objectives that are SMART (Specific, Measurable, Achievable,
Relevant, and Time-bound). The two common pitfalls in this area are writing objectives that are
too ambitious for capacity to achieve and cannot be evaluated. An exercise followed in which
participants worked in their country groups to write objectives for the three top priorities for
DPAS implementation in their country.

2.10 Advocacy and communication

       Dr Colin Sindall led this session with a framework for advocacy and the example of how
celebrity chef, Jamie Oliver, started a revolution in the provision of healthy school lunches in the
United Kingdom. Other countries also gave their examples of advocacy and communications
campaigns before participants broke into small groups for an advocacy exercise. This involved
taking one or two priority areas and then planning an advocacy campaign by identifying
stakeholders, building a case for action and defining what types of evidence they might require to
advocate successfully for their chosen area.

2.11 Mobilizing resources

      Mr Dorjsuren Bayarsaikhan, Regional Advisor in Health Care Planning, WHO Regional
Office for the Western Pacific, presented an overview of options for financing DPAS
                                                   -8-




implementation. He discussed two broad areas needed for action: Integrating DPAS into health
care funding (see below) and creating the demand for DPAS implementation in various settings.
An amalgam of both private and public funding sources should be sought, and identifying these
potential sources of funding is crucial to resource mobilization. Increasing overall awareness and
political engagement in DPAS activities are essential to integrate DPAS programmes within
health financing plans. Providing DPAS with an identity and backing up the need for sources of
funding with specific evidence of both problems and benefits of intervention are very important.

      Integrating DPAS into Health funding

    (1) Revenue collection

          •   use traditional sources

          •   shift priorities for funding within the health sector (i.e. treatment to prevention
              services)

          •   use innovative strategies like tobacco taxation.

    (2) Revenue pooling

          •   national and local health funds

          •   health promotion foundations

          •   insurance sector

          •   external sources.

    (3) Purchasing services

          •   reorient services towards DPAS actions

          •   reorient infrastructure funding towards DPAS needs.

       Country presentations of funding models were very informative. Singapore’s programmes
are mainly managed by the Health Promotion Board which, while not in the Ministry of Health,
receives more than 90% of its funding from the Ministry. Having a separate entity with long
term, sufficient funding is a good model if it can be achieved.

       The Republic of Korea has had a statutory Health Promotion Fund since 1995 funded from
tobacco taxation. The levy has increased over the last decade from US$ 0.2 cents to US$ 69
cents per pack. It is managed and operated by the Minister of Health and Welfare and most of
the funds (65%) support health insurance, with only a minority for healthy lifestyles (3%) and
disease prevention (14%). About US$ 0.5 million/y of the healthy lifestyles component is
allocated to the promotion of nutrition (90%) and physical activity (10%). Therefore, while this
fund has great potential to support DPAS, its structure and allocations means that only about
US$ 50 000 is spent on promoting physical activity for the country.

       The legislation for Malaysia’s Health Promotion Board was passed earlier this year. This
does not use a directly allocated (hypothecated) tax from tobacco but uses an indirect allocation
that passed through the consolidated fund. Such an organization does provide a degree of
                                                    -9-




distance from the government and allows it to include NGOs, academic and others from the
private sector as members of the board.

2.12 Linking with global alliances and agencies

       This session focused on the way forward from this meeting and there was discussion about
setting up a voluntary regional network to support DPAS activities using a similar vision to the
Asia Pacific Physical Activity Network (APPAN). The main points included:

      (1) making practitioners and policymakers aware of DPAS activities;

      (2) establishing a communication network;

      (3) creating a clearing house; providing information, evidence-based reviews and technical
          support;

      (4) document DPAS policies and best practices across the Region;

      (5) build capacity, using training courses.

        Presentations from the Oxford Health Alliance and the World Diabetes Foundation

showed the contributions of two key international NGOs and how countries might engage with

them.


2.13 Country plans

       Participants were given the opportunity to develop action plans around priority areas they
had identified for healthy diet and physical activity within their countries. There were two
streams to the action plans; those that focused on large-scale plans such as “developing
guidelines for physical activity” and those which focused on more specific aspects of DPAS,
such as “mandatory nutritional content labelling for foods”. There was discussion in this session
around how guidelines are very expensive and timely to develop and may not change behaviours,
and that policies can be more powerful at changing specific behaviours. While cultures and
ethnicity might vary across the Region, the specifics of guidelines and policies might be similar
and countries should be able to work together and support each other as they try to further
develop their action plans.


                                       3. CONCLUSIONS



3.1     The ways forward for Asian countries

       The great range in the size and affluence of Asian countries in the Region makes it
difficult to generalize on the ways forward because these will be very diverse. However, the
DPAS and its implementation and evaluation guides provide excellent frameworks for countries
to adapt to their own circumstances. The diversity of progress across the Region can also be
used as a strength for networks (see below).
                                                 - 10 -




       Having noted the diversity, the commonalities were also striking. Most countries
identified the following areas in need of more work.

    (1) Need for more advocacy to lift DPAS higher on the public and political agendas:

        (a)    Use of the economic case for DPAS implementation.

        (b)    Linkages between NGOs as advocacy coalitions.

    (2) Need to engage with other sectors, especially:

          •   Urban planning

          •   Transport

          •   Education

    (3) Need to develop the “PA policy backbone” for DPAS:

          •   Active transport

          •   Active recreation

    (4) Need for a regional approach to policies on food and beverages, especially:

          •   Labelling (nutrition information panels on manufactured foods);

          •   Standards (nutrition standards for specific foods e.g. “traffic light” system for food
              sold in schools);

          •   Marketing to children (statutory regulations to reduce the high volume of
              commercial promotions that target children through many forms of media, e.g.
              sponsorships and competitions).

    (5) Need for financial structures to ensure sufficient, long-term funding for DPAS

          •   Funding for prevention

          •   Funding of primary care systems

    (6) Need to build the skills of the workforce in many areas, but especially:

          •   Advocacy

          •   Social marketing

          •   Programme/guidelines development and evaluation

    (7) Need to build and maintain regional networks:

       The way forward, therefore, is to step up ongoing efforts in countries, with support from
other countries in the Region (those more advanced in DPAS implementation supporting those at
earlier stages) and the WHO Regional Office for the Western Pacific.
                                                    - 11 -




3.2     Regional networks

       Those countries with the experience, expertise and capacity (such as Japan and Singapore
and to some extent the Republic of Korea, Malaysia and the Philippines) can support other
countries where chronic disease prevention is not yet very high on the political agenda and where
the infrastructure and funding for programmes and population monitoring is still low. China, as
always, is a special case because of its size and diversity, however, strengthening the ties with
Hong Kong (China) and Macao (China) is a logical and potentially important network.

      Australia and New Zealand can provide valuable expertise and examples of policies and
programmes to consider, but the cultural and financial contexts are often quite different and an
“Asia helping Asia” approach may be more fruitful.

        Two specific networks were identified as priorities in the Region:

      (1) Support the establishment of an Asia-Pacific Physical Activity network which is being
          developed by Professor Adrian Bauman and would be based with his group but serving
          the wider Asia-Pacific Region. The WHO Regional Office for the Western Pacific was
          asked to widely promote the PA network to people in the Region.

      (2) Continue the support for the MOANA network from the WHO Regional Office for the
          Western Pacific now that Dr Gauden Galea (who developed it) has moved to Europe.
          This was seen as a valuable network, but it does require the commitment of WHO
          personnel time to make it work.

3.3     Regional support for DPAS implementation

      A modest amount of seed funding had been secured by the WHO Regional Office for the
Western Pacific and this was made available for countries or groups of countries to start some
DPAS activities. The nature of the actions for which the funding could be spent is up to the
countries but it should meet these criteria:

      (1) be part of a larger NCD or nutrition plan, or, help develop such plan if it was not in
          place;

      (2) be endorsed by the health authority, showing commitment by government; and

      (3) amount to a maximum of US$ 10 000

       There is about US$40 000 to be used for seed grants to get countries started with activities
that they consider high priority, such as the development of health promotion foundations or
other financing mechanisms to sustain the promotion of healthy diets and physical activity.
These seed grants may lead to larger proposals for funding and the WHO Regional Office for the
Western Pacific could facilitate this process as well, by linking up projects with potential donors.

       In addition to these grants and the regional networks, the country representatives were
keen to ensure that a regional approach was taken on the three key nutrition policy issues of food
labelling, food standards and marketing to children. It was felt that there was more force behind
a regional approach and, in these areas, harmonization across the Region was important. It
should also be of value for food manufacturers to have common standards and regulations in
Asian countries. The WHO Regional Office for the Western Pacific was asked to facilitate this
process and this would probably involve establishing an ongoing dialogue with some of the key
                                                 - 12 -




food and beverage companies in the Region and to canvas some of the key Member States about
taking this forward as a Regional initiative.


                                  4. RECOMMENDATIONS



       Workshop participants strongly endorsed the DPAS principles for action and strategic
directions and made the following recommendations for action in Asian countries.

      (1) Recommendations for WHO:

          (a)   Health leadership and engaging partners

                •   Promote DPAS implementation as a high priority for Asian countries.

                •   Facilitate the use of an Asia-Pacific Physical Activity network and provide
                    continued support for the MOANA network.

          (b)   Standard setting and prioritizing, monitoring implementation

                •   Work with Member States and the private sector to achieve harmonization of
                    food standard setting and food labelling regulations across the Region.

                •   Lead further work on providing regulatory options for countries on reducing
                    commercial promotion of food and beverages to children.

                •   Provide technical support on using STEPS and other data collection systems
                    to assess diets, nutrition and physical activity in countries and monitor the
                    implementation of DPAS.

          (c)   Technical support for catalyzing change, building institutional capacity, and
                advocacy

                •   Provide technical support for developing plans and guidelines, especially for
                    physical activity.

                •   Provide technical support for establishing health promotion foundations.

                •   Support capacity-building in the Region for key skills development in
                    advocacy, leadership and programme evaluation.

                •   Provide technical guidance on effective and cost-effective ways of using
                    social marketing to support DPAS policies and programmes.

      (2) Recommendations for Member States

          (a)   Implement DPAS as a high priority by adapting and enriching existing national
                plans, policies and activities where possible.
                                         - 13 -




   (b)   Allocate more public funding and human resources and advocate for more
         private funding to improve nutrition and physical activity as an excellent
         investment for the population’s future health and economic well-being.

   (c)   Ensure that funding is allocated for DPAS activities to be evaluated as outlined
         in using the DPAS Framework to Monitor and Evaluate Implementation.

   (d)   Provide sufficient funds and support for primary health care (including health
         professional training and review of curricula) to implement DPAS goals and
         activities.

   (e)   Using the experience of tobacco and alcohol control, consider fiscal measures to
         promote physical activity and healthy food choices and to discourage unhealthy
         choices.

   (f)   As a central strategy to create a healthy food environment for children, develop
         and implement regulations to reduce the commercial promotions of foods and
         beverages that target children.

   (g)   Consider establishing health promotion foundations as a source of sustainable
         financing for DPAS implementation.

   (h)   Ensure that DPAS implementation, while led by the health sector, collaborates
         with other sectors, such as agriculture, transportation, and education, and is
         linked with the promotion of healthy environments and preservation of natural
         resources.

   (i)   Ensure that DPAS is implemented in a way that reduces health inequalities and
         considers differences in ethnicity, gender and age.

   (j)   Ensure that social marketing is used in ways that are effective and cost-
         effective, linked to DPAS policies and programmes, and evaluated.

   (k)   Implement DPAS activities throughout the government health sector so that it
         acts as a role model for wider DPAS implementation.

   (l)   Identify a senior person as the focal point for DPAS implementation.

   (m)   Identify and support high profile champions, such as prominent political or
         public figures, to promote healthy eating and physical activity.

   (n)   Engage and establish relationships with the key national and international
         NGOs on the prevention of chronic diseases.

(3) Recommendations for the private sector

   (a)   Reformulate food and beverage products to reduce fats, saturated fat, trans-fatty
         acids, sugar and salt content wherever possible.

   (b)   Support country and regional efforts to harmonize food labelling regulations.

   (c)   Support country and regional efforts to provide healthy food environments for
         children, including reductions in commercial promotions that target children.
                                             - 14 -




    (d)   Provide healthy environments for diet and physical activity for employees.

    (e)   Include the promotion of healthy eating and physical activity as part of
          corporate social responsibility efforts.

(4) Recommendations for civil society

    (a)   Increase advocacy efforts for DPAS implementation as an urgent priority for
          population health and economic well-being.

    (b)   Identify, support, and promote champions for DPAS actions.

    (c)   Link with national, regional, and global coalitions and alliances (e.g. Global
          Prevention Alliance, Healthy Cities Alliance, Oxford Health Alliance, Global
          Alliance on Physical Activity) to advocate for DPAS implementation.

(5) Next steps for regional collaborations

    (d)   WHO to convene a meeting with key food and beverage companies and related
          bodies in the Region and create a plan on harmonizing food standards and
          labelling and regulations on marketing of food and beverages to children.

    (e)   WHO to work with the Global Alliance on Physical Activity on a set of
          resources to help countries develop and promote Physical Activity Guidelines.

    (f)   WHO to work with the Food and Agriculture Organization and other agencies
          to produce and disseminate guides for the communication and use of dietary
          guidelines to promote the availability, accessibility, affordability and
          consumption of healthy foods.

    (g)   WHO to provide support for the Asia-Pacific Physical Activity network and the
          MOANA network.
                                                                               ANNEX 1

                                              - 15 -



   WORLD          HEALTH                               ORGANISATION MONDIALE
        ORGANIZATION                                           DE LA SANTE

                      REGIONAL OFFICE FOR THE WESTERN PACIFIC
                      BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL



WORKSHOP ON THE IMPLEMENTATION
WPR/ICP/NUT/2.2/001/NUT(3)/2006.1
OF THE GLOBAL STRATEGY ON DIET,                                       6 October 2006
PHYSICAL ACTIVITY AND HEALTH
IN ASIAN COUNTRIES                                                    ENGLISH ONLY




Manila, Philippines
10-13 October 2006

                      TENTATIVE PROGRAMME OF ACTIVITIES



Tuesday, 10 October 2006

08:00                   Registration

08:30 – 09:30           Opening

09:30 – 10:00           Break

10:00 – 10:20           Objectives and structure of the workshop

10:20 – 11:00           Policy frameworks for diet and physical activity
                           National plans of action on nutrition, NCD plans and other
                           plans
                           The situation in the Region

11:00 – 12:00           The DPAS framework as a tool to assess, monitor and evaluate
                        progress in DPAS implementation

12:00 – 13:00           Lunch

13:00 – 15:00           Action frameworks for healthy nutrition
                           An action framework to improve diet
                           Country examples
                           Discussion on action framework
                                           - 16 -




15:00 – 15:15        Break

15:15 – 17:15        Action frameworks for physical activity
                        An action framework to improve physical activity: A guide for
                        population-based approaches to increase levels of physical
                        activity
                        Regional and global physical activity guidelines
                        Country examples
                        Discussion on action framework

17:30                Reception

Wednesday, 11 October 2006

Settings for improving diet and physical activity

08:00 – 10:00        Role of schools in promoting physical activity, healthy diets
and                         preventing obesity
                     Action framework
                        WHO Health Promoting Schools
                        Nutrition Friendly Schools
                        The Urbani Health Kit
                     Country examples
                     Discussion on action framework

10:00 – 10:15        Break

10:15 – 12:15        Role of workplaces in promoting physical activity, healthy
                     diets and preventing obesity
                     Action framework
                         Physical activity as part of the working day
                         Healthy cafeterias
                         Building partnerships with employers and employee
                         organizations
                     Country examples
                     Discussion on action framework

12:15 – 13:15        Lunch

13:15 - 15:15        Role of health systems and health care settings in promoting
                     physical activity, healthy diets, and treating overweight and
                     obesity
                     Action framework
                        Health services as role models
                        Enhancing the role of primary health care
                        Health workforce
                        Health insurance
                     Country examples
                     Discussion on action framework
                                          - 17 -




15:15 – 15:30       Break

15:30 – 17:30       Staying active and healthy in changing cities
                    Action frameworks
                       Urban planning and policy instruments for physical activity
                       Urban planning and policy instruments for healthy diets
                       Special events (e.g. walk/ride to work days)
                    Country examples
                    Discussion on action frameworks

17:30               Walk on Intramuros walls or Rizal Park, Manila

Thursday, 12 October 2006

Building capacity and strengthening infrastructure

08:00 – 10.00       Assessment, monitoring and evaluation
                       Status of STEPS surveys and other surveys on NCD risk
                       factors, diet, and physical activity in countries
                       Programme monitoring and evaluation
                       Review targets and indicators in DPAS framework
                    Country examples
                    Discussion on
                    o Data collection needs
                    o Training needs

10:00 - 10:15       Break

10:15 - 12:15       Advocacy and communication: influencing decision-makers
and                       working with the media to support DPAS
implementation
                    Action framework
                       Clarifying objectives
                       Identifying stakeholder needs and interests
                       Marshalling the evidence and preparing the arguments
                       Execution and delivery (tools and techniques)
                    Country examples
                    Discussion of capacity-building for effective advocacy and
                           communication over the longer term

12:15 – 13:15       Lunch

13:15 - 15:15       Mobilizing resources: securing sustainable sources of funding
for                        DPAS implementation
                    Action framework
                       Health Promotion Foundations
                       Public sector budgets
                       Health insurance funds
                       Private sector
                                        - 18 -




                   Country examples
                   Discussion on action framework

15:15 - 15:30      Break

15:30 - 17:30      Working groups on country plans
                   Discuss collaboration between countries and "twinning
opportunities"

Friday, 13 October 2006


08:30 - 10:30      Country Reports on Plans

10:30 - 10:45      Break

10:45 - 11:45      Contributions of agency representatives and observers

11.45 – 12.30      Discussion on use of seed funds for supporting country plans
and                       initiatives

12:30 - 13:30      Lunch

13:30 - 14:30      The way forward
                      Regional support to DPAS implementation
                      Regional networks

14:30 - 15:30      Conclusions, recommendations and discussion

15:30              Closing
                                           - 19 -



                                                                             ANNEX 2


   WORLD          HEALTH                            ORGANISATION MONDIALE
        ORGANIZATION                                         DE LA SANTE

                      REGIONAL OFFICE FOR THE WESTERN PACIFIC
                      BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL



WORKSHOP ON THE IMPLEMENTATION
WPR/ICP/NUT/2.2/001/NUT(3)/2006/IB/2
OF THE GLOBAL STRATEGY ON DIET,                      13 October 2006
PHYSICAL ACTIVITY AND HEALTH
IN ASIAN COUNTRIES                                   ENGLISH ONLY

Manila, Philippines
10-13 October 2006
                       INFORMATION BULLETIN NO. 2
            FINAL LIST OF PARTICIPANTS, TEMPORARY ADVISERS,
             REPRESENTATIVES, OBSERVERS, AND SECRETARIAT




                                1. PARTICIPANTS


BRUNEI DARUSSALAM                Dr Hjh Norhayati bte Hj Md Kassim
                                 Head
                                 Health Promotion and Education Division
                                 Department of Health Services
                                 Ministry of Health
                                 Jalan Menteri Besar BB3910
                                 Tel. No.: 673-2-230 037 or + 673-2-230039
                                 Fax No.: 673-2-230 037
                                 Email: yatts@hotmail.com



CAMBODIA                         Dr Thach Varoeun
                                 Deputy Director
                                 Preventive Medicine Department
                                 Ministry of Health
                                 #151-153 Kampuchea Krom Street
                                 Phnom Penh
                                 Tel. No.: +855 (0) 11 886 906
                                 Fax No.: +855 (0) 23 880 532
                                 Email: varoeun@yahoo.com
                              - 20 -




CHINA               Dr Li Guanglin
                    Section Chief
                    Division of Noncommunicable Diseases
                    Prevention and Control and Nutrition
                    Bureau of Disease Prevention and Control
                    Ministry of Health
                    No. 1 Nanlu, Xizhimenwai
                    Beijing 100044
                    Tel. No.: + 86-10-68792369
                    Fax No.: + 86-10-68792514
                    Email: hnlgl@163.com


                    Ms Yao Fang
                    Deputy Section Chief
                    Development Planning Division
                    Development Planning Department
                    Ministry of Agriculture
                    11 Nongzhanguan Nanli
                    Beijing 100026
                    Tel. No.: 0086-10-64192561
                    Fax No.: 0086-10-64192534
                    Email: yaofanger@hotmail.com


CHINA (HONG KONG)   Dr Chong Shing Kan, Patrick
                    Senior Medical and Health Officer
                    (Health Promotion)2
                    Department of Health, Hong Kong SAR
                    Government, China
                    7/F, Southorn Centre
                    130 Hennessy Road, Wan Chai
                    Hong Kong
                    Tel. No.: + (852) 2835 1828
                    Fax No.: + (852) 2591 6127
                    Email: smohp2@dh.gov.hk


CHINA (MACAO)       Dr Chan Tan Mui
                    Coordinator
                    Health Promotion Division
                    Center for Disease Control and Prevention
                    Health Bureau, Macao SAR, China
                    P.O. Box 3002
                    Macao
                    Tel. No.: + (853) 533525
                    Fax No.: + (853) 533524
                    Email: tmchan@ssm.gov.mo
                              - 21 -




JAPAN               Ms Makie Kawabata
                    Associate Professor
                    Research Institute of Nursing Care
                    for People and Community
                    University of Hyogo
                    c/o I.H.D. Centre Building, 9th Floor
                    5-1, I-chome Wakinohama-Kaigandori Chuo-Ku
                    Kobe, 651-0073
                    Tel. No.: +81-78-230-3128
                    Fax No.: +81-78-230-3178
                    Email: kawabatam@wkc.who.int
                            makie_kawabata@nifty.com


                    Ms Sakiko Kanbara
                    Assistant Professor
                    Research Institute of Nursing Care
                    for People and Community
                    University of Hyogo
                    13-71 Kitaohji-cho, Akashi
                    Hyogo, 673-8588
                    Tel. No.: + 81-78-925-9628
                    Fax No.: + 81-78-925-9670
                    Email: sakiko_kanbara@cnas.u-hyogo.ac.jp


REPUBLIC OF KOREA   Dr Youngtaek Kim
                    Director
                    Division of Chronic Disease Surveillance
                    Korea Centre for Disease Control and Prevention
                    5 Nokbeon-dong, Eunpyung-gu
                    Seoul 122-701
                    Tel. No.: + (822) 380 2160
                    Fax No.: + (822) 355 2539
                    Email: ruyoung@cdc.go.kr


                    Ms Kyungwon Oh
                    Senior Researcher
                    Division of Chronic Disease Surveillance
                    Korea Centre for Disease Control and Prevention
                    5 Nokbeon-dong, Eunpyung-gu
                    Seoul 122-701
                    Tel. No.: + (822)-380-1447
                    Fax No.: + (822) 355 2539
                    Email: kwoh@cdc.go.kr
                                - 22 -




LAO PEOPLE'S          Dr Bounpheng Sodouangdenh
DEMOCRATIC REPUBLIC   Deputy Director
                      Curative Department
                      Department of Curative Medicine
                      Ministry of Health
                      Vientiane
                      Tel. No.: +856 21.214011
                      Fax No.: +856 21.217848
                      Email: curativedpt@lpdr.com


MALAYSIA              Mr Edmund Ewe
                      Project Manager
                      Malaysia Health Promotion Board
                      c/o Health Education Division
                      Ministry of Health
                      Level 2, Block E10, Parcel E
                      Federal Government Administrative Center
                      62590 Putrajaya
                      Tel. No. : +60 3 8883 4530
                      Fax No.: + 60 3 8888 6200
                      Email: eetteik57@yahoo.com


                      Ms Zainab bt Tambi
                      Deputy Director
                      Nutrition Section
                      Family Health Development Division
                      Ministry of Health
                      Level 7, Block E10, Parcel E
                      Federal Government Administrative Center
                      62590 Putrajaya
                      Tel. No.: + 60 3 8883 4081
                      Fax No.: + 60 3 8888 4647
                      Email: zainabtambi@moh.gov.my /
                              zedti88@yahoo.com


MONGOLIA              Dr Burmaa Badrakh
                      Cardiologist
                      Health Promotion Centre
                      Shastin Central Hospital
                      Ard Ayush. St.-1
                      Ulaanbaatar
                      Tel. No.: + 976-91181881
                      Fax No.: + 976-11-687886
                      Email: burmaamn@yahoo.com
                              - 23 -




MONGOLIA (Cont'd)   Dr Tungalag Jambal
                    Chairman
                    Department for Physical Education
                    and National Sport Development
                    Mongolian State Committee of
                    Physical Education and Sports
                    Central Sport Palace
                    P.O. Box 121
                    Ulaanbaatar-210640
                    Tel. No.: + 976-99292399
                    Fax No.: + 976-11-325234
                    Email:


NEW ZEALAND         Dr Kumanan Rasanathan
                    Research Fellow/Public Health Medicine Registrar
                    School of Population Health
                    University of Auckland
                    Private Bag 92019
                    Auckland
                    New Zealand
                    Tel. No.: +64 21 508 589
                    Fax No.: +64 9 373 7624
                    Email: k.rasanathan@auckland.ac.nz


                    Ms Nicola Chilcott
                    Executive Officer
                    Agencies for Nutrition Action
                    P.O. Box 5680
                    Wellington
                    Tel. No.: +64 4 499 6362 / 027 442 2051 (mobile)
                    Fax No.:
                    Email: nicola@ana.org.nz


PHILIPPINES         Ms Frances Prescilla Cuevas
                    Chief Health Program Officer
                    Degenerative Disease Office
                    National Center for Disease Prevention and Control
                    Department of Health
                    3rd Floor Bldg. 13, San Lazaro Compound
                    Sta. Cruz, Manila
                    Tel. No.: +632 7322493
                    Fax No.: +632 7322493
                    Email: prescyncd@gmail.com
                                  - 24 -




PHILIPPINES (Cont'd)   Ms Thelma Santos
                       Director
                       School Health and Nutrition Center
                       Department of Education
                       Meralco Avenue
                       Pasig City, Metro Manila
                       Fax: No. c/o + 632 7313914
                       Tel. No.: +632 9325458
                       Email:


SINGAPORE              Ms Yam Yoke-Yin
                       Deputy Director
                       Physical Activity Department
                       Health Promotion Board
                       3 Second Hospital Avenue
                       Singapore, S168937
                       Tel. No.: +65 6435 3665
                       Fax No.: +65 6438 3609
                       Email: yam_yoke_yin@hpb.gov.sg

                       Ms Yeap Bee Leng Janice
                       Senior Executive
                       Health Promotion Board
                       3 Second Hospital Avenue
                       Singapore, S168937
                       Tel. No.: + 65 6435 3272
                       Fax No.: + 65 6438 8226
                       Email: janice_yeap@hpb.gov.sg


VIET NAM               Dr Le Xuan Thuy
                       Staff of Professional Department
                       National Center of Communication
                       and Health Education
                       Ministry of Health
                       366 Doi Can Street, Ba Dinh District
                       Ha Noi
                       Tel. No.: + (844) 8328994
                       Fax No.: + (844) 8329241
                       Email: lexuanthuymd@yahoo.com


                       Dr Le Van Kham
                       Expert/Government Official
                       Department of Therapy
                       Ministry of Health
                       138ª Giang Vo St, Ba Dinh District
                       Ha Noi
                       Tel. No.: + (844) 846 4416 Ext. 422
                       Fax No.: c/o + (844) 943 3740
                       Email: khamlevan@yahoo.com
               - 25 -




2. TEMPORARY ADVISERS


    Dr Luke Atkin
    Public Health Fellow
    WHO Collaborating Centre on Obesity Prevention
    5 Thompson Dr
    Barwon Heads 3227
    Australia
    Tel. No.: +61 3 9251 7096
    Tel. No.: +61 3 52542425 (Res), 0438700171 (mobile)
    Fax No.: +61 3 9244 6640
    Email: lukeatkin@optusnet.com.au


    Professor Adrian Bauman
    Director
    NSW Centre for Physical Activity and Health
    Level 2, Medical Foundation Building K25
    University of Sydney,
    Sydney, 2006 NSW
    Australia
    Tel. No.: +61 2 9036 3247
    Fax No.: +61 2 8569 0940
    Email: adrianb@health.usyd.edu.au
            adrian.bauman@gmail.com


    Ms Marion Dunlop
    Adviser to the Pedestrian Council of Australia and
    Board Member Kinect Australia (formerly VicFit)
    GPO Box 2437
    Canberra City, ACT 2601
    Australia
    Tel. No.: +61 2 62810981
    Fax No.: +61 2 62810981
    E-mail: marion.dunlop@bigpond.com


    Dr Thomas L. Schmid
    Senior Evaluation Specialist
    Division of Nutrition and Physical Activity,
    Centers for Disease Control and Prevention
    4770 Buford Highway, NE, Mailstop K-46
    Atlanta, GA 30341
    United States of America
    Tel. No.: +770-488-5471
    Fax No.: +770-488-5473
    E-mail: tls4@cdc.gov
                                    - 26 -




                        3. RESOURCE PERSON


                          Dr Boyd Swinburn
                          Professor of Population Health
                          School of Exercise and Nutrition Sciences
                          WHO Collaborating Centre for the Prevention
                          of Obesity and Related Research and Training
                          Deakin University
                          221 Burwood Highway
                          Melbourne 3125, Australia
                          Tel. Nos.: +61 3 9251 7096, 0407 53 99 41 (mobile)
                          Fax Nos.: +61 3 9244 6640
                          Email: boyd.swinburn@deakin .edu.au


                 4. OBSERVERS/REPRESENTATIVES


CHINESE UNIVERSITY OF     Ms Mandy Ho
HONG KONG, THE            Health Promotion Coordinating Officer
                          Centre for Health Education and Health Promotion
                          Faculty of Medicine, School of Public Health
                          The Chinese University of Hong Kong
                          4/F Lek Yuen Health Center,
                          9, Lek Yuen Street, Shatin, NT
                          Hong Kong, China SAR
                          Tel No .: + (852) 2693-3708
                          Fax No.: + (852) 2694-0004
                          Email: mandyho@cuhk.edu.hk
                          website: http://www.cuhk.edu.hk/med/hep/


FOOD AND NUTRITION        Ms Felicidad Velandria
RESEARCH INSTITUTE        Supervising Science Research Specialist
                          Food and Nutrition Research Institute
                          Department of Science and Technology
                          Gen Santos Avenue, Bicutan
                          Taguig City, Metro Manila, Philippines
                          Tel. No.: + (632) 837-2071 loc 2299 or 2288
                                    09189396233 (mobile)
                          Fax No.: + (632) 837 3164
                                    - 27 -




NATIONAL INSTITUTE OF    Dr Nobuo Yoshiike
HEALTH AND NUTRITION     Director, Center for Collaboration and Partnership
                         National Institute of Health and Nutrition
                         1-23-1 Toyama, Shinjuku-ku,
                         Tokyo, Japan
                         Tel. No.: +81-3-5272-7730
                         Fax No.: +81-3-3202-3278
                         Email: nobuoyos@nih.go.jp


OXFORD HEALTH            Dr Stig Pramming
ALLIANCE, THE            Director
                         Oxford Health Alliance
                         1st Floor, 28 Margaret Street
                         London, WIW 8RZ
                         United Kingdom
                         Tel. No.: 44 (0) 20 7637 4330 / + 45 30 79 65 34
                         Fax No.: 44 (0) 20 7637 4336
                         Email: stig.pramming@oxha.org


PHILIPPINE ASSOCIATION   Dr Rodolfo Florentino
FOR THE STUDY OF         Board Member
OVERWEIGHT AND           Philippine Association for the
OBESITY                  Study of Overweight and Obesity
                         18 May Street, Congressional Village
                         Quezon City, Philippines (Res)
                         Tel. No.: + (632) 926 7838
                         Fax No.: + (632) 926 7838
                         Email: rff@pacific.net.ph


PHILIPPINE ASSOCIATION   Dr Josefina Tuazon
OF DIABETES EDUCATORS    Vice-President
                         Philippine Association of Diabetes Educators
                         c/o UP College of Nursing
                         Pedro Gil St., Ermita
                         Manila, Philippines
                         Tel. No.: + (632) 5231472 / 0917 8000587 (mobile)
                         Fax No.: + (632) 5231485 / 6318807 (Res)
                         Email: jatuazon@pldtdsl.net
                                     - 28 -




PHILIPPINE ASSOCIATION   Dr Elias Escueta
OF FOOD                  Director
MANUFACTURERS            Philippine Association of Food Manufacturers
                         c/o The Coca Cola Expert Corporation, Philippines
                         Division Headquarters
                         10th Floor King's Court Building
                         2129 Chino Roces Avenue
                         Makati City, Philippines
                         Tel. No.: + (632) 849 8272 / 0917 5285693 (mobile)
                         Fax No.: + (632) 849 8289
                         Email: eescueta@apac.ko.com


UNIVERSITI SAINS         Associate Professor Mohamed Izham Mohamed Ibrahim,
MALAYSIA                 Ph.D.
                         Coordinator
                         Healthy Campus Secretariat
                         Universiti Sains Malaysia
                         Penang, Malaysia
                         Tel. No.: +60 4 6534121
                         Fax No.: +60 4 6569298
                         Email: mizham@usm.my


UNIVERSITY OF SYDNEY     Associate Professor Ruth Colagiuri
                         Director
                         The Diabetes Unit
                         Australian Health Policy Institute
                         Victor Coppleson Building, D02
                         The University of Sydney
                         Sydney, NSW 2006
                         Australia
                         Tel. No.: +61 2 9036 6562
                         Fax No.: +61 2 9351 5204
                         Email: rcolagiuri@med.usyd.edu.au


UNIVERSITY OF THE        Professor Stella Salazar
PHILIPPINES, MINDANAO    University of the Philippines, Mindanao
                         Davao City, Philippines
                         Tel. No.:+
                         Fax No.:
                         Email:

                         Dr Anil Kapur
WORLD DIABETES
                         Managing Director
FOUNDATION
                         World Diabetes Foundation
                         Lottenborgvej 24
                         DK-2800 Kgs. Lyngby
                         Denmark
                         Tel. No.: +45 44 43 17 09, +45 30 79 57 70 (mobile)
                         Fax No.: +45 44 44 47 52
                         Email: akap@worlddiabetesfoundation.org
                      - 29 -




           5. SECRETARIAT


WHO/WPRO   Dr Tommaso Cavalli-Sforza (Responsible Officer)
           Regional Adviser in Nutrition
           WHO Regional Office for the Western Pacific
           P.O. Box 2932
           1000 Manila, Philippines
           Tel. No.: (63-2) 528 9864 (direct); 528-8001 (general)
           Fax No.: (63-2) 521 1036
           E-mail: cavalli-sforzat@wpro.who.int


           Mr Dorjsuren Bayarsaikhan
           Regional Adviser in Health Care Financing
           WHO Regional Office for the Western Pacific
           P.O. Box 2932
           1000 Manila, Philippines
           Tel. No.: (63-2) 528 9808 (direct); 528-8001 (general)
           Fax No.: (63-2) 521 1036
           E-mail: bayarsaikhand@wpro.who.int


           Mr Burke Fishburn
           Scientist/Coordinator, Special Focus on the Tobacco
           Free Initiative
           WHO Regional Office for the Western Pacific
           P.O. Box 2932
           1000 Manila, Philippines
           Tel. No.: (63-2) 528 9894 (direct); 528-8001 (general)
           Fax No.: (63-2) 521 1036
           E-mail: fishburnb@wpro.who.int


           Dr Karen Heckert
           Regional Adviser in Health Promotion
           WHO Regional Office for the Western Pacific
           P.O. Box 2932
           1000 Manila, Philippines
           Tel. No.: (63-2) 528 9854 (direct); 528-8001 (general)
           Fax No.: (63-2) 521 1036
           E-mail: heckertk@wpro.who.int
                              - 30 -




                   Ms Remedios Paulino
                   Short-term Professional in Mental Health
                   WHO Regional Office for the Western Pacific
                   P.O. Box 2932
                   1000 Manila, Philippines
                   Tel. No.: (63-2) 528 9851 (direct); 528-8001 (general)
                   Fax No.: (63-2) 521 1036
                   E-mail: paulinor@wpro.who.int


                   Dr Colin Sindall
                   Scientist, Noncommunicable Diseases
                   WHO Regional Office for the Western Pacific
                   P.O. Box 2932
                   1000 Manila, Philippines
                   Tel. No.: (63-2) 528 9866 (direct); 528-8001 (general)
                   Fax No.: (63-2) 521 1036
                   E-mail: sindallc@wpro.who.int


WHO HEADQUARTERS   Dr Timothy Armstrong
                   Technical Officer
                   Division of Noncommunicable Diseases
                   and Mental Health
                   World Health Organization
                   Avenue Appia 20
                   CH-1211 Geneva 27
                   Switzerland
                   Tel. No.: (41 22) 791 4727
                   Fax No.: (41 22) 791 4156
                   Email: armstrongt@who.int


WHO KOBE CENTRE    Dr Guojun Cai
                   Responsible Officer
                   Urbanization and Chronic NCD Prevention
                   WHO Centre for Health Development
                   Kobe, Japan
                   Tel. No.: +81 78 230 3112
                   Fax No.: +81 78 230 3178
                   Email: gcai@wkc.who.int

                   Dr Wu YanWei
WHO/CHINA
                   Programme Officer
                   Noncommunicable Diseases
                   401, Dongwai Diplomatic Office Building
                   23, Dongzhimenwai Dajie
                   Chaoyang District
                   Beijing 1000600, China
                   Tel. No.: (8610) 6532-7189
                   Fax No.: (8610) 6532-2359
                   Email: WuY@chn.wpro.who.int
                            - 31 -




WHO/PHILIPPINES   Dr John Juliard Go
                  Programme Officer
                  Noncommunicable Diseases
                  National Tuberculosis Centre Building
                  Second Floor, Bldg. 9
                  Department of Health
                  San Lazaro Hospital Compound
                  Sta. Cruz, Manila
                  Philippines
                  Tel. No.: (632) 528-9063
                  Fax No.: (632) 731-3914
                  Email: goj@phl.wpro.who.int


WHO/VIET NAM      Dr Lai Duc Truong
                  Programme Officer
                  Noncommunicable Diseases
                  63 Tran Hung Dao Street
                  Hoan Kiem District
                  Ha Noi, Viet Nam
                  Tel. No.: (844)943 3734
                  Fax No.: (844)943 3740
                  Email: truongl@vtn.wpro.who.int
                                                      CONTENTS
                                                                                                                          Page
SUMMARY....................................................................................................................... I

1. INTRODUCTION ....................................................................................................... 1
    1.1 Background........................................................................................................ 1
    1.2 Objectives .......................................................................................................... 1
    1.3 Organization ...................................................................................................... 2
    1.4 Participants and resource persons...................................................................... 2

2. PROCEEDINGS.......................................................................................................... 2
    2.1 Preliminaries...................................................................................................... 2
    2.2 DPAS framework and national plans of action ................................................. 3
    2.3 Frameworks for healthy nutrition ...................................................................... 3
    2.4 Frameworks for physical activity ...................................................................... 4
    2.5 The role of schools ............................................................................................ 5
    2.6 The role of workplaces ...................................................................................... 6
    2.7 The role of health systems ................................................................................. 6
    2.8 Staying active and healthy in changing cities.................................................... 7
    2.9 Assessment, monitoring and evaluation ............................................................ 7
    2.10 Advocacy and communication .......................................................................... 7
    2.11 Mobilizing resources ......................................................................................... 7
    2.12 Linking with global alliances and agencies ....................................................... 9
    2.13 Country plans..................................................................................................... 9

3. CONCLUSIONS ......................................................................................................... 9
    3.1 The ways forward for Asian countries .............................................................. 9
    3.2 Regional networks ........................................................................................... 11
    3.3 Regional support for DPAS implementation................................................... 11

4. RECOMMENDATIONS........................................................................................... 12


ANNEXES:

ANNEX 1           -    WORKSHOP PROGRAMME....................................................................... 15

ANNEX 2           -    FINAL LIST OF PARTICIPANTS................................................................ 19



        Key words


  Chronic disease/ Diabetes mellitus/ Diet/ Exercise/ Health/ Nutrition/ Obesity/
  Non-communicable diseases/ Asia

				
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