WORLD HEALTH ORGANIZATION FIFTY-SEVENTH WORLD HEALTH ASSEMBLY A57/47 22 May 2004
Third report of Committee A Committee A held its eighth meeting on 22 May 2004 under the chairmanship of Dr Ponmek Dalaloy ( Lao People’s Democratic Republic). It was decided to recommend to the Fifty-seventh World Health Assembly the adoption of the attached resolutions relating to the following agenda items: 12. Technical and health matters 12.8 Health promotion and healthy lifestyles One resolution 12.6 Global strategy on diet, physical activity and health One resolution 12.14 Human organ and tissue transplantation One resolution 12.11 Health systems, including primary health care One resolution entitled: – International migration of health personnel: a challenge for health systems in developing countries
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Agenda item 12.8
Health promotion and healthy lifestyles The Fifty-seventh World Health Assembly, Recalling resolutions WHA42.44 and WHA51.12 on health promotion, public information and education for health and the outcome of five global conferences on health promotion, from Ottawa (1986), Adelaide, Australia (1988), Sundsvall, Sweden (1991), Jakarta (1997), to Mexico City (2000), and the Ministerial Statement for the promotion of health (2000), and the adoption of the WHO Framework Convention on Tobacco Control (2003); Having considered the report on health promotion and healthy lifestyles;1 Noting that The world health report 20022 addresses major risks to global health, and highlights the role of behavioural factors, notably unhealthy diet, physical inactivity, tobacco consumption and the harmful use of alcohol as key risk factors for noncommunicable diseases which constitute a rapidly growing burden; Noting that promotion of mental health constitutes an important component of overall health promotion; Recognizing that the need for health promotion strategies, models and methods is limited neither to a specific health issue nor to a specific set of behaviours, but applies to a variety of population groups, risk factors and diseases, and in various cultures and settings; Recognizing that, in general, the overriding efforts in health promotion should be geared to reducing health inequalities by comprehensively tackling the determinant chain, including societal structures, environmental factors and lifestyles; Recognizing the need for Member States to strengthen the policies, human and financial resources, and institutional capability for sustainable and effective health promotion that addresses the major determinants of health and their related risk factors, with a view to building national capacity, strengthening evidence-based approaches, developing innovative means of financing, and drawing up guidelines for implementation and evaluation; Recalling the importance of primary health care and the five areas of action set out in the Ottawa Charter for Health Promotion, 1. URGES Member States: (1) to strengthen existing capability at national and local levels for the planning and implementation of gender sensitive and culturally appropriate, comprehensive and multisectoral 1 2
Document A57/11. The world health report 2002. Reducing risks, promoting healthy life. Geneva, World Health Organization, 2002.
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health-promotion policies and programmes, with particular attention to poor and marginalized groups; (2) to set up appropriate mechanisms to collect, monitor and analyse national experiences in order to strengthen the evidence base for the effectiveness of health promotion interventions as an integral part of health systems with a view to achieving effective societal and lifestyle changes; (3) to give high priority to promoting healthy lifestyles among children and young people – boys and girls both in and out of school or other educational institution – including healthy and safe recreational opportunities and creation of supportive environments for such lifestyles; (4) to include harmful use of alcohol in the list of lifestyle-related risk factors as stated in The world health report 2002, and to give attention to the prevention of alcohol-related harm and promotion of strategies to reduce the adverse physical, mental and social consequences of harmful use of alcohol, especially among young people and pregnant women, in the workplace, and when driving; (5) to set up tobacco-cessation programmes;
(6) to consider actively, where necessary and appropriate, the establishment of innovative, adequate and sustainable financing mechanisms for health promotion with a firm institutional base for the management of health promotion; 2. REQUESTS the Director-General: (1) to give health promotion highest priority in order to support its development within the Organization as requested in resolution WHA51.12, with a view to supporting Member States, in consultation with involved stakeholders, more effectively to address the major risk factors to health, including harmful use of alcohol and other major lifestyle-related factors; (2) to continue to advocate an evidence-based approach to health promotion and to provide technical and other support to Member States in building their capacity for the implementation, monitoring, evaluation and dissemination of effective health promotion programmes at all levels; (3) to provide support and guidance to Member States in relation to the challenges and opportunities stemming from the promotion of healthy lifestyles and the management of related risk factors, as outlined in The world health report 2002; (4) to provide support to all Member States for development and implementation of tobacco-cessation programmes; (5) to support Member States, where necessary and appropriate, in their attempt to establish an innovative, adequate and sustainable financing mechanism with a firm institutional base in order to coordinate effectively and monitor systematically their health promotion efforts; (6) to report on progress made in the promotion of healthy lifestyles to the Executive Board at its 115th session and to the Fifty-eighth World Health Assembly, including a report on the Organization’s future work on alcohol consumption.
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Agenda item 12.6
Global strategy on diet, physical activity and health The Fifty-seventh World Health Assembly, Recalling resolutions WHA51.18 and WHA53.17 on prevention noncommunicable diseases, and WHA55.23 on diet, physical activity and health; 1
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Recalling The world health report 2002, which indicates that mortality, morbidity and disability attributed to the major noncommunicable diseases currently account for about 60% of all deaths and 47% of the global burden of disease, which figures are expected to rise to 73% and 60%, respectively, by 2020; Noting that 66% of the deaths attributed to noncommunicable diseases occur in developing countries where those affected are on average younger than in developed countries; Alarmed by these rising figures that are a consequence of evolving trends in demography and lifestyles, including those related to diet and physical activity; Recognizing the existing, vast body of knowledge and public health potential, the need to reduce the level of exposure to the major risks resulting from unhealthy diet and physical inactivity, and the largely preventable nature of the consequent diseases; Mindful also that these major behavioural and environmental risk factors are amenable to modification through implementation of concerted essential public-health action, as has been demonstrated in several Member States; Acknowledging that malnutrition, including undernutrition and nutritional deficiencies, is still a major cause of death and disease in many parts of the world, especially in developing countries, and that this strategy complements the important work of WHO and its Member States in the overall area of nutrition; Recognizing the interdependence of nations, communities and individuals and that governments have a central role, in cooperation with other stakeholders, to create an environment that empowers and encourages individuals, families and communities to make positive, life-enhancing decisions on healthy diet and physical activity; Recognizing the importance of a global strategy for diet, physical activity and health within the integrated prevention and control of noncommunicable diseases, including support of healthy lifestyles, facilitation of healthier environments, provision of public information and health services, and the major involvement in improving the lifestyles and health of individuals and communities of the health and relevant professions and of all concerned stakeholders and sectors committed to reducing the risks of noncommunicable diseases;
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The world health report 2002. Reducing risks, promoting healthy life. Geneva, World Health Organization, 2002.
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Recognizing that for the implementation of this global strategy, capacity building, financial and technical support should be promoted through international cooperation in support of national efforts in developing countries; Recognizing the socioeconomic importance and the potential health benefits of traditional dietary and physical activity practices, including those of indigenous peoples; Reaffirming that nothing in this strategy shall be construed as a justification for the adoption of trade-restrictive measures or trade-distorting practices; Reaffirming that appropriate levels of intakes for energy, nutrients and foods, including free sugars, salt, fats, fruits, vegetables, legumes, whole grains, and nuts shall be determined in accordance with national dietary and physical activity guidelines based on the best available scientific evidence and as part of Member States’ policies and programmes taking into account cultural traditions, and national dietary habits and practices; Convinced that it is time for governments, civil society and the international community, including the private sector, to renew their commitment to encouraging healthy patterns of diet and physical activity; Noting that resolution WHA56.23 urged Member States to make full use of Codex Alimentarius Commission standards for the protection of human health throughout the food chain, including assistance with making healthy choices regarding nutrition and diet, 1. 2. ENDORSES the Global Strategy on Diet, Physical Activity and Health annexed herewith; URGES Member States: (1) to develop, implement and evaluate actions recommended in the strategy, as appropriate to national circumstances and as part of their overall policies and programmes, that promote individual and community health through healthy diet and physical activity, and reduce the risks and incidence of noncommunicable diseases; (2) to promote lifestyles that include a healthy diet and physical activity and foster energy balance; (3) to strengthen existing, or establish new, structures for implementing the strategy through the health and other concerned sectors, for monitoring and evaluating its effectiveness and for guiding resource investment and management to reduce the prevalence of noncommunicable diseases and the risks related to unhealthy diet and physical inactivity; (4) to define for this purpose, consistent with national circumstances: (a) (b) (c) national goals and objectives, a realistic timetable for their achievement, national dietary and physical activity guidelines,
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(d) measurable process and output indicators that will permit accurate monitoring and evaluation of action taken and a rapid response to identified needs, (e) measures to preserve and promote traditional foods and physical activity;
(5) to encourage mobilization of all concerned social and economic groups, including scientific, professional, nongovernmental, voluntary, private-sector, civil society, and industry associations, and to engage them actively and appropriately in implementing the strategy and achieving its aims and objectives; (6) to encourage and foster a favourable environment for the exercise of individual responsibility for health through the adoption of lifestyles that include a healthy diet and physical activity; (7) to ensure that public policies adopted in the context of the implementation of this strategy are in accordance with their individual commitments in international and multilateral agreements, including trade and other related agreements, so as to avoid trade-restrictive or trade-distorting impact; (8) to consider, when implementing the strategy, the risks of unintentional effects on vulnerable populations and specific products; 3. CALLS UPON other international organizations and bodies to give high priority within their respective mandates and programmes to, and invites public and private stakeholders including the donor community to cooperate with governments in, the promotion of healthy diets and physical activity to improve health outcomes; 4. REQUESTS the Codex Alimentarius Commission to continue to give full consideration, within the framework of its operational mandate, to evidence-based action it might take to improve the health standards of foods consistent with the aims and objectives of the strategy; 5. REQUESTS the Director-General: (1) to continue and strengthen the work dedicated to undernutrition and micronutrient deficiencies, in cooperation with Member States, and to continue to report to Member States on developments made in the field of nutrition (resolutions WHA46.7, WHA52.24, WHA54.2 and WHA55.25); (2) to provide technical advice and mobilize support at both global and regional levels to Member States, when requested, in implementing the strategy and in monitoring and evaluating implementation; (3) to monitor on an ongoing basis international scientific developments and research relative to diet, physical activity and health, including claims on the dietary benefits of agricultural products which constitute a significant or important part of the diet of individual countries, so as to enable Member States to adapt their programmes to the most up-to-date knowledge; (4) to continue to prepare and disseminate technical information, guidelines, studies, evaluations, advocacy and training materials so that Member States are better aware of the
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cost/benefits and contributions of healthy diet and physical activity as they address the growing global burden of noncommunicable diseases; (5) to strengthen international cooperation with other organizations of the United Nations system and bilateral agencies in promoting healthy diet and physical activity throughout life; (6) to cooperate with civil society and with public and private stakeholders committed to reducing the risks of noncommunicable diseases in implementing the strategy and promoting healthy diet and physical activity, while ensuring avoidance of potential conflicts of interest; (7) to work with other specialized United Nations and intergovernmental agencies on assessing and monitoring the health aspects, socioeconomic impact and gender aspects of this strategy and its implementation and to brief the Fifty-ninth World Health Assembly on the progress of this activity; (8) to report on the implementation of the global strategy at the Fifty-ninth World Health Assembly.
ANNEX GLOBAL STRATEGY ON DIET, PHYSICAL ACTIVITY AND HEALTH
1. Recognizing the heavy and growing burden of noncommunicable diseases, Member States requested the Director-General to develop a global strategy on diet, physical activity and health through a broad consultation process.1 To establish the content of the draft global strategy, six regional consultations were held with Member States, and organizations of the United Nations system, other intergovernmental bodies, and representatives of civil society and the private sector were consulted. A reference group of independent international experts on diet and physical activity from WHO’s six regions also provided advice. 2. The strategy addresses two of the main risk factors for noncommunicable diseases, namely, diet and physical activity, while complementing the long-established and ongoing work carried out by WHO and nationally on other nutrition-related areas, including undernutrition, micronutrient deficiencies and infant- and young-child feeding.
THE CHALLENGE 3. A profound shift in the balance of the major causes of death and disease has already occurred in developed countries and is under way in many developing countries. Globally, the burden of 1
Resolution WHA55.23.
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noncommunicable diseases has rapidly increased. In 2001 noncommunicable diseases accounted for almost 60% of the 56 million deaths annually and 47% of the global burden of disease. In view of these figures and the predicted future growth in this disease burden, the prevention of noncommunicable diseases presents a major challenge to global public health. 4. The world health report 20021 describes in detail how, in most countries, a few major risk factors account for much of the morbidity and mortality. For noncommunicable diseases, the most important risks included high blood pressure, high concentrations of cholesterol in the blood, inadequate intake of fruit and vegetables, overweight or obesity, physical inactivity and tobacco use. Five of these risk factors are closely related to diet and physical activity. 5. Unhealthy diets and physical inactivity are thus among the leading causes of the major noncommunicable diseases, including cardiovascular disease, type 2 diabetes and certain types of cancer, and contribute substantially to the global burden of disease, death and disability. Other diseases related to diet and physical inactivity, such as dental caries and osteoporosis, are widespread causes of morbidity. 6. The burden of mortality, morbidity and disability attributable to noncommunicable diseases is currently greatest and continuing to grow in the developing countries, where those affected are on average younger than in developed countries, and where 66% of these deaths occur. Rapid changes in diets and patterns of physical activity are further causing rates to rise. Smoking also increases the risk for these diseases, although largely through independent mechanisms. 7. In some developed countries where noncommunicable diseases have dominated the national burden of disease, age-specific death and disease rates have been slowly declining. Progress is being made in reducing premature death rates from coronary artery disease, cerebrovascular disease and some tobacco-related cancers. However, the overall burden and number of patients remain high, and the numbers of overweight and obese adults and children, and of cases, closely linked, of type 2 diabetes are growing in many developed countries. 8. Noncommunicable diseases and their risk factors are initially mostly limited to economically successful groups in low- and middle-income countries. However, recent evidence shows that, over time, patterns of unhealthy behaviour and the noncommunicable diseases associated with them cluster among poor communities and contribute to social and economic inequalities. 9. In the poorest countries, even though infectious diseases and undernutrition dominate their current disease burden, the major risk factors for chronic diseases are spreading. The prevalence of overweight and obesity is increasing in developing countries, and even in low-income groups in richer countries. An integrated approach to the causes of unhealthy diet and decreasing levels of physical activity would contribute to reducing the future burden of noncommunicable diseases. 10. For all countries for which data are available, the underlying determinants of noncommunicable diseases are largely the same. Factors that increase the risks of noncommunicable disease include elevated consumption of energy-dense, nutrient-poor foods that are high in fat, sugar and salt; reduced levels of physical activity at home, at school, at work and for recreation and transport; and use of tobacco. Variations in risk levels and related health outcomes among the population are attributed, in part, to the variability in timing and intensity of economic, demographic and social changes at national 1
The world health report 2002. Reducing risks, promoting healthy life. Geneva, World Health Organization, 2002.
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and global levels. Of particular concern are unhealthy diets, inadequate physical activity and energy imbalances in children and adolescents. 11. Maternal health and nutrition before and during pregnancy, and early infant nutrition may be important in the prevention of noncommunicable diseases throughout the life course. Exclusive breastfeeding for six months and appropriate complementary feeding contribute to optimal physical growth and mental development. Infants who suffer prenatal and possibly, postnatal growth restrictions appear to be at higher risk for noncommunicable diseases in adulthood. 12. Most elderly people live in developing countries, and the ageing of populations has a strong impact on morbidity and mortality patterns. Many developing countries will therefore be faced with an increased burden of noncommunicable diseases at the same time as a persisting burden of infectious diseases. In addition to the human dimension, maintaining the health and functional capacity of the increasing elderly population will be a crucial factor in reducing the demand for, and cost of, health services. 13. Diet and physical activity influence health both together and separately. Although the effects of diet and physical activity on health often interact, particularly in relation to obesity, there are additional health benefits to be gained from physical activity that are independent of nutrition and diet, and there are significant nutritional risks that are unrelated to obesity. Physical activity is a fundamental means of improving the physical and mental health of individuals. 14. Governments have a central role, in cooperation with other stakeholders, to create an environment that empowers and encourages behaviour changes by individuals, families and communities, to make positive, life-enhancing decisions on healthy diets and patterns of physical activity. 15. Noncommunicable diseases impose a significant economic burden on already strained health systems, and inflict great costs on society. Health is a key determinant of development and a precursor of economic growth. The WHO Commission on Macroeconomics and Health has demonstrated the disruptive effect of disease on development, and the importance for economic development of investments in health.1 Programmes aimed at promoting healthy diets and physical activity for the prevention of diseases are key instruments in policies to achieve development goals.
THE OPPORTUNITY 16. A unique opportunity exists to formulate and implement an effective strategy for substantially reducing deaths and disease worldwide by improving diet and promoting physical activity. Evidence for the links between these health behaviours and later disease and ill-health is strong. Effective interventions to enable people to live longer and healthier lives, reduce inequalities, and enhance development can be designed and implemented. By mobilizing the full potential of the major stakeholders, this vision could become a reality for all populations in all countries.
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Macroeconomics and health: investing in health for economic development. Geneva, World Health Organization,
2001.
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GOAL AND OBJECTIVES 17. The overall goal of the global strategy on diet, physical activity and health is to promote and protect health by guiding the development of an enabling environment for sustainable actions at individual, community, national and global levels that, when taken together, will lead to reduced disease and death rates related to unhealthy diet and physical inactivity. These actions support the United Nations Millennium Development Goals and have immense potential for public health gains worldwide. 18. The global strategy has four main objectives: (1) to reduce the risk factors for noncommunicable diseases that stem from unhealthy diets and physical inactivity by means of essential public health action and health-promoting and disease-preventive measures; (2) to increase the overall awareness and understanding of the influences of diet and physical activity on health and of the positive impact of preventive interventions; (3) to encourage the development, strengthening and implementation of global, regional, national and community policies and action plans to improve diets and increase physical activity that are sustainable, comprehensive, and actively engage all sectors, including civil society, the private sector and the media; (4) to monitor scientific data and key influences on diet and physical activity; to support research in a broad spectrum of relevant areas, including evaluation of interventions; and to strengthen the human resources needed in this domain to enhance and sustain health.
EVIDENCE FOR ACTION 19. Evidence shows that, when other threats to health are addressed, people can remain healthy into their seventh, eighth and ninth decades, through a range of health-promoting behaviours, including healthy diets, regular and adequate physical activity, and avoidance of tobacco use. Recent research has contributed to understanding of the benefits of healthy diets, physical activity, individual action and population-based public health interventions. Although more research is needed, current knowledge warrants urgent public health action. 20. Risk factors for noncommunicable disease frequently coexist and interact. As the general level of risk factors rises, more people are put at risk. Preventive strategies should therefore aim at reducing risk throughout the population. Such risk reduction, even if modest, cumulatively yields sustainable benefits, which exceeds the impact of interventions restricted to high-risk individuals. Healthy diets and physical activity, together with tobacco control, constitute an effective strategy to contain the mounting threat of noncommunicable diseases. 21. Reports of international and national experts and reviews of the current scientific evidence recommend goals for nutrient intake and physical activity in order to prevent major noncommunicable diseases. These recommendations need to be considered when preparing national policies and dietary guidelines, taking into account the local situation.
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22.
For diet, recommendations for populations and individuals should include the following: • achieve energy balance and a healthy weight • limit energy intake from total fats and shift fat consumption away from saturated fats to unsaturated fats and towards the elimination of trans-fatty acids • increase consumption of fruits and vegetables, and legumes, whole grains and nuts • limit the intake of free sugars • limit salt (sodium) consumption from all sources and ensure that salt is iodized.
23. Physical activity is a key determinant of energy expenditure, and thus is fundamental to energy balance and weight control. Physical activity reduces risk for cardiovascular diseases and diabetes and has substantial benefits for many conditions, not only those associated with obesity. The beneficial effects of physical activity on the metabolic syndrome are mediated by mechanisms beyond controlling excess body weight. For example, physical activity reduces blood pressure, improves the level of high density lipoprotein cholesterol, improves control of blood glucose in overweight people, even without significant weight loss, and reduces the risk for colon cancer and breast cancer among women. 24. For physical activity, it is recommended that individuals engage in adequate levels throughout their lives. Different types and amounts of physical activity are required for different health outcomes: at least 30 minutes of regular, moderate-intensity physical activity on most days reduces the risk of cardiovascular disease and diabetes, colon cancer and breast cancer. Muscle strengthening and balance training can reduce falls and increase functional status among older adults. More activity may be required for weight control. 25. The translation of these recommendations, together with effective measures to prevent and control tobacco use, into a global strategy that leads to regional and national action plans, will require sustained political commitment and the collaboration of many stakeholders. This strategy will contribute to the effective prevention of noncommunicable diseases.
PRINCIPLES FOR ACTION 26. The world health report 2002 highlights the potential for improving public health through measures that reduce the prevalence of risk factors (most notably the combination of unhealthy diets and physical inactivity) of noncommunicable diseases. The principles set out below guided the drafting of WHO’s global strategy on diet, physical activity and health and are recommended for the development of national and regional strategies and action plans. 27. Strategies need to be based on the best available scientific research and evidence; comprehensive, incorporating both policies and action and addressing all major causes of noncommunicable diseases together; multisectoral, taking a long-term perspective and involving all sectors of society; and multidisciplinary and participatory, consistent with the principles contained in the Ottawa Charter for Health Promotion and confirmed in subsequent conferences on health,
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promotion,1 and recognizing the complex interactions between personal choices, social norms and economic and environmental factors. 28. A life-course perspective is essential for the prevention and control of noncommunicable diseases. This approach starts with maternal health and prenatal nutrition, pregnancy outcomes, exclusive breastfeeding for six months, and child and adolescent health; reaches children at schools, adults at worksites and other settings, and the elderly; and encourages a healthy diet and regular physical activity from youth into old age. 29. Strategies to reduce noncommunicable diseases should be part of broader, comprehensive and coordinated public health efforts. All partners, especially governments, need to address simultaneously a number of issues. In relation to diet, these include all aspects of nutrition (for example, both overnutrition and undernutrition, micronutrient deficiency and excess consumption of certain nutrients); food security (accessibility, availability and affordability of healthy food); food safety; and support for and promotion of six months of exclusive breastfeeding. Regarding physical activity, issues include requirements for physical activity in working, home and school life, increasing urbanization, and various aspects of city planning, transportation, safety and access to physical activity during leisure. 30. Priority should be given to activities that have a positive impact on the poorest population groups and communities. Such activities will generally require community-based action with strong government intervention and oversight. 31. All partners need to be accountable for framing policies and implementing programmes that will effectively reduce preventable risks to health. Evaluation, monitoring and surveillance are essential components of such actions. 32. The prevalence of noncommunicable diseases related to diet and physical activity may vary greatly between men and women. Patterns of physical activity and diets differ according to sex, culture and age. Decisions about food and nutrition are often made by women and are based on culture and traditional diets. National strategies and action plans should therefore be sensitive to such differences. 33. Dietary habits and patterns of physical activity are often rooted in local and regional traditions. National strategies should therefore be culturally appropriate and able to challenge cultural influences and to respond to changes over time.
RESPONSIBILITIES FOR ACTION 34. Bringing about changes in dietary habits and patterns of physical activity will require the combined efforts of many stakeholders, public and private, over several decades. A combination of sound and effective actions is needed at global, regional, national and local levels, with close monitoring and evaluation of their impact. The following paragraphs describe the responsibilities of those involved and provide recommendations deriving from the consultation process.
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See resolution WHA51.12 (1998).
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WHO 35. WHO, in cooperation with other organizations of the United Nations system, will provide the leadership, evidence-based recommendations and advocacy for international action to improve dietary practices and increase physical activity, in keeping with the guiding principles and specific recommendations contained in this strategy. 36. It will hold discussions with the transnational food industry and other parts of the private sector in support of the aims of this global strategy, and of implementing the recommendations in countries. 37. WHO will provide support for implementation of programmes as requested by Member States, and will focus on the following broad, interrelated areas: • facilitating the framing, strengthening and updating of regional and national policies on diet and physical activity for integrated noncommunicable disease prevention • facilitating the drafting, updating and implementation of national food-based dietary and physical activity guidelines, in collaboration with national agencies and drawing upon global knowledge and experience • providing guidance to Member States on the formulation of guidelines, norms, standards and other policy-related measures that are consistent with the objectives of the global strategy • identifying and disseminating information on evidence-based interventions, policies and structures that are effective in promoting healthy diets and optimizing the level of physical activity in countries and communities • providing appropriate technical support to build national capacity in planning and implementing a national strategy and in tailoring it to local circumstances • providing models and methods so that interventions on diet and physical activity constitute an integral component of health care • promoting and providing support for training of health professionals in healthy diets and an active life, either within existing programmes or in special workshops, as an essential part of their curricula • providing advice and support to Member States, using standardized surveillance methods and rapid assessment tools (such as WHO’s STEPwise approach to surveillance of risk factors for noncommunicable diseases), in order to measure changes in distribution of risk – including patterns in diet, nutrition and physical activity – and to assess the current situation, trends, and the impact of interventions. WHO, in collaboration with FAO, will provide support to Member States in establishing national nutrition surveillance systems, linked with data on the content of food items • advising Member States on ways of engaging constructively with appropriate industries. 38. WHO, in close collaboration with organizations of the United Nations system and other intergovernmental bodies (FAO, UNESCO, UNICEF, United Nations University and others), research
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institutes and other partners, will promote and support research in priority areas to facilitate programme implementation and evaluation. This could include commissioning scientific papers, conducting analyses, and holding technical meetings on practical research topics that are essential for effective country action. The decision-making process should be informed by better use of evidence, including health-impact assessment, cost-benefit analysis, national burden-of-disease studies, evidence-based intervention models, scientific advice and dissemination of good practices. 39. It will work with FAO and other organizations of the United Nations system, the World Bank, and research institutes on their evaluation of implications of the strategy for other sectors. 40. The Organization will continue to work with WHO collaborating centres to establish networks for building up capacity in research and training, mobilizing contributions from nongovernmental organizations and civil society, and facilitating coordinated, collaborative research as it pertains to the needs of developing countries in the implementation of this strategy.
Member States 41. The global strategy should foster the formulation and promotion of national policies, strategies and action plans to improve diet and encourage physical activity. National circumstances will determine priorities in the development of such instruments. Because of the great variations in and between different countries, regional bodies should collaborate in formulating regional strategies, which can provide considerable support to countries in implementing their national plans. For maximum effectiveness, countries should adopt the most comprehensive action plans possible. 42. The role of government is crucial in achieving lasting change in public health. Governments have a primary steering and stewardship role in initiating and developing the strategy, ensuring that it is implemented and monitoring its impact in the long term. 43. Governments are encouraged to build on existing structures and processes that already address aspects of diet, nutrition and physical activity. In many countries, existing national strategies and action plans can be used in implementing this strategy; in others they can form the basis for advancing control of noncommunicable diseases. Governments are encouraged to set up a national coordinating mechanism that addresses diet and physical activity within the context of a comprehensive plan for noncommunicable-disease prevention and health promotion. Local authorities should be closely involved. Multisectoral and multidisciplinary expert advisory boards should also be established. They should include technical experts and representatives of government agencies, and have an independent chair to ensure that scientific evidence is interpreted without any conflict of interest. 44. Health ministries have an essential responsibility for coordinating and facilitating the contributions of other ministries and government agencies. Bodies whose contributions should be coordinated include ministries and government institutions responsible for policies on food, agriculture, youth, recreation, sports, education, commerce and industry, finance, transportation, media and communication, social affairs and environmental and urban planning. 45. National strategies, policies and action plans need broad support. Support should be provided by effective legislation, appropriate infrastructure, implementation programmes, adequate funding, monitoring and evaluation, and continuing research.
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(1) National strategies on diet and physical activity. National strategies describe the measures to promote healthy diets and physical activity that are essential to prevent disease and promote health, including those that tackle all aspects of unbalanced diets, including undernutrition and overnutrition. National strategies should include specific goals, objectives, and actions, similar to those outlined in the global strategy. Of particular importance are the elements needed to implement the plan of action, including identification of necessary resources and national focal points (key national institutes); collaboration between the health sector and other key sectors such as agriculture, education, urban planning, transportation and communication; and monitoring and follow-up. (2) National dietary guidelines. Governments are encouraged to draw up national dietary guidelines, taking account of evidence from national and international sources. Such guidelines advise national nutrition policy, nutrition education, other public health interventions and intersectoral collaboration. They may be updated periodically in the light of changes in dietary and disease patterns and evolving scientific knowledge. (3) National physical activity guidelines. National guidelines for health-enhancing physical activity should be prepared in accordance with the goals and objectives of the global strategy and expert recommendations. 46. Governments should provide accurate and balanced information. Governments need to consider actions that will result in provision of balanced information for consumers to enable them easily to make healthy choices, and to ensure the availability of appropriate health promotion and education programmes. In particular, information for consumers should be sensitive to literacy levels, communication barriers and local culture, and understood by all segments of the population. In some countries, health-promoting programmes have been designed as a function of such considerations and should be used for disseminating information about diet and physical activity. Some governments already have a legal obligation to ensure that factual information available to consumers enables them to make fully informed choices on matters that may affect their health. In other cases, actions may be specific to government policies. Governments should select the optimal mix of actions in accordance with their national capabilities and epidemiological profile, which will vary from one country to another. (1) Education, communication and public awareness. A sound basis for action is provided by public knowledge and understanding of the relationship between diet, physical activity and health, of energy intake and output, and healthy choice of food items. Consistent, coherent, simple and clear messages should be prepared and conveyed by government experts, nongovernmental and grass-roots organizations, and the appropriate industries. They should be communicated through several channels and in forms appropriate to local culture, age and gender. Behaviour can be influenced especially in schools, workplaces, and educational and religious institutions, and by nongovernmental organizations, community leaders, and mass media. Member States should form alliances for the broad dissemination of appropriate and effective messages about healthy diet and physical activity. Nutrition and physical activity education and acquisition of media literacy, starting in primary school, are important to promote healthier diets, and to counter food fads and misleading dietary advice. Support should also be provided for action that improves the level of health literacy, while taking account of local cultural and socioeconomic circumstances. Communication campaigns should be regularly evaluated. (2) Adult literacy and education programmes. Health literacy should be incorporated into adult education programmes. Such programmes provide an opportunity for health professionals 15
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and service providers to enhance knowledge about diet, physical activity and prevention of noncommunicable diseases and to reach marginalized populations. (3) Marketing, advertising, sponsorship and promotion. Food advertising affects food choices and influences dietary habits. Food and beverage advertisements should not exploit children’s inexperience or credulity. Messages that encourage unhealthy dietary practices or physical inactivity should be discouraged, and positive, healthy messages encouraged. Governments should work with consumer groups and the private sector (including advertising) to develop appropriate multisectoral approaches to deal with the marketing of food to children, and to deal with such issues as sponsorship, promotion and advertising. (4) Labelling. Consumers require accurate, standardized and comprehensible information on the content of food items in order to make healthy choices. Governments may require information to be provided on key nutritional aspects, as proposed in the Codex Guidelines on Nutrition Labelling.1 (5) Health claims. As consumers’ interest in health grows, and increasing attention is paid to the health aspects of food products, producers increasingly use health-related messages. Such messages must not mislead the public about nutritional benefits or risks. 47. National food and agricultural policies should be consistent with the protection and promotion of public health. Where needed, governments should consider policies that facilitate the adoption of healthy diet. Food and nutrition policy should also cover food safety and sustainable food security. Governments should be encouraged to examine food and agricultural policies for potential health effects on the food supply. (1) Promotion of food products consistent with a healthy diet. As a result of consumers’ increasing interest in health and governments’ awareness of the benefits of healthy nutrition, some governments have taken measures, including market incentives, to promote the development, production and marketing of food products that contribute to a healthy diet and are consistent with national or international dietary recommendations. Governments could consider additional measures to encourage the reduction of the salt content of processed foods, the use of hydrogenated oils, and the sugar content of beverages and snacks. (2) Fiscal policies. Prices influence consumption choices. Public policies can influence prices through taxation, subsidies or direct pricing in ways that encourage healthy eating and lifelong physical activity. Several countries use fiscal measures, including taxes, to influence availability of, access to, and consumption of, various foods; and some use public funds and subsidies to promote access among poor communities to recreational and sporting facilities. Evaluation of such measures should include the risk of unintentional effects on vulnerable populations. (3) Food programmes. Many countries have programmes to provide food to population groups with special needs or cash transfers to families for them to improve their food purchases. Such programmes often concern children, families with children, poor people, and people with HIV/AIDS and other diseases. Special attention should be given to the quality of the food items and to nutrition education as a main component of these programmes, so that food distributed 1
Codex Alimentarius Commission, document CAC/GL 2-1985, Rev. 1-1993.
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to, or purchased by, the families not only provides energy, but also contributes to a healthy diet. Food and cash distribution programmes should emphasize empowerment and development, local production and sustainability. (4) Agricultural policies. Agricultural policy and production often have a great effect on national diets. Governments can influence agricultural production through many policy measures. As emphasis on health increases and consumption patterns change, Member States need to take healthy nutrition into account in their agricultural policies. 48. Multisectoral policies are needed to promote physical activity. National policies to promote physical activity should be framed, targeting change in a number of sectors. Governments should review existing policies to ensure that they are consistent with best practice in population-wide approaches to increasing physical activity. (1) Framing and review of public policies. National and local governments should frame policies and provide incentives to ensure that walking, cycling and other forms of physical activity are accessible and safe; transport policies include nonmotorized modes of transportation; labour and workplace policies encourage physical activity; and sport and recreation facilities embody the concept of sports for all. Public policies and legislation have an impact on opportunities for physical activity, such as those concerning transport, urban planning, education, labour, social inclusion, and health-care funding related to physical activity. (2) Community involvement and enabling environments. Strategies should be geared to changing social norms and improving community understanding and acceptance of the need to integrate physical activity into everyday life. Environments should be promoted that facilitate physical activity, and supportive infrastructure should be set up to increase access to, and use of, suitable facilities. (3) Partnerships. Ministries of health should take the lead in forming partnerships with key agencies, and public and private stakeholders in order to draw up jointly a common agenda and workplan aimed at promoting physical activity. (4) Clear public messages. Simple, direct messages need to be communicated on the quantity and quality of physical activity sufficient to provide substantial health benefits. 49. School policies and programmes should support the adoption of healthy diets and physical activity. Schools influence the lives of most children in all countries. They should protect their health by providing health information, improving health literacy, and promoting healthy diets, physical activity, and other healthy behaviours. Schools are encouraged to provide students with daily physical education and should be equipped with appropriate facilities and equipment. Governments are encouraged to adopt policies that support healthy diets at school and limit the availability of products high in salt, sugar and fats. Schools should consider, together with parents and responsible authorities, issuing contracts for school lunches to local food growers in order to ensure a local market for healthy foods. 50. Governments are encouraged to consult with stakeholders on policy. Broad public discussion and involvement in the framing of policy can facilitate its acceptance and effectiveness. Member States should establish mechanisms to promote participation of nongovernmental organizations, civil society, communities, the private sector and the media in activities related to diet,
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physical activity and health. Ministries of health should be responsible, in collaboration with other related ministries and agencies, for establishing these mechanisms, which should aim at strengthening intersectoral cooperation at the national, provincial and local levels. They should encourage community participation, and should be part of planning processes at community level. 51. Prevention is a critical element of health services. Routine contacts with health-service staff should include practical advice to patients and families on the benefits of healthy diets and increased levels of physical activity, combined with support to help patients initiate and maintain healthy behaviours. Governments should consider incentives to encourage such preventive services and identify opportunities for prevention within existing clinical services, including an improved financing structure to encourage and enable health professionals to dedicate more time to prevention. (1) Health and other services. Health-care providers, especially for primary health care, but also other services (such as social services) can play an important part in prevention. Routine enquiries as to key dietary habits and physical activity, combined with simple information and skill-building to change behaviour, taking a life-course approach, can reach a large part of the population and be a cost-effective intervention. Attention should be given to WHO’s growth standards for infants and preschool children which expand the definition of health beyond the absence of overt disease, to include the adoption of healthy practices and behaviours. The measurement of key biological risk factors, such as blood pressure, serum cholesterol and body weight, combined with education of the population and support for patients, helps to promote the necessary changes. The identification of specific high-risk groups and measures to respond to their needs, including possible pharmacological interventions, are important components. Training of health personnel, dissemination of appropriate guidelines, and availability of incentives are key underlying factors in implementing these interventions. (2) Involvement with health professional bodies and consumer groups. Enlisting the strong support of professionals, consumers and communities is a cost-effective way to raise public awareness of government policies, and enhance their effectiveness. 52. Governments should invest in surveillance, research and evaluation. Long-term and continuous monitoring of major risk factors is essential. Over time, such data also provide the basis for analyses of changes in risk factors, which could be attributable to changes in polices and strategies. Governments may be able to build on systems already in place, at either national or regional levels. Emphasis should initially be given to standard indicators recognized by the general scientific community as valid measures of physical activity, to selected dietary components, and to body weight in order to compile comparative data at global level. Data that provide insight into within-country patterns and variations are useful in guiding community action. Where possible, other sources of data should be used, for example, from the education, transport, agriculture, and other sectors. (1) Monitoring and surveillance. Monitoring and surveillance are essential tools in the implementation of national strategies for healthy diet and physical activity. Monitoring of dietary habits, patterns of physical activity and interactions between them; nutrition-related biological risk factors and contents of food products; and communication to the public of the information obtained, are important components of implementation. Of particular importance is the development of methods and procedures using standardized data-collection procedures and a common minimum set of valid, measurable and usable indicators. (2) Research and evaluation. Applied research, especially in community-based demonstration projects and in evaluating different policies and interventions, should be promoted. Such research (e.g., into the reasons for physical inactivity and poor diet, and on key 18
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determinants of effective intervention programmes), combined with the increased involvement of behavioural scientists, will lead to better informed policies and ensure that a cadre of expertise is created at national and local levels. Equally important is the need to put in place effective mechanisms for evaluating the efficacy and cost-effectiveness of national diseaseprevention programmes, and the health impact of policies in other sectors. More information is needed, especially on the situation in developing countries, where programmes to promote healthy diets and physical activity need to be evaluated and integrated into broader development and poverty-alleviation programmes. 53. Institutional capacity. Under the ministry of health, national institutions for public health, nutrition and physical activity play an important role in the implementation of national diet and physical activity programmes. They can provide the necessary expertise, monitor developments, help to coordinate activities, participate in collaboration at international level, and provide advice to decision-makers. 54. Financing national programmes. Various sources of funding, in addition to the national budget, should be identified to assist in implementation of the strategy. The United Nations Millennium Declaration (September 2000) recognizes that economic growth is limited unless people are healthy. The most cost-effective interventions to contain the epidemic of noncommunicable diseases are prevention and a focus on the risk factors associated with these diseases. Programmes aimed at promoting healthy diets and physical activity should therefore be viewed as a developmental need and should draw policy and financial support from national development plans.
International partners 55. The role of international partners is of paramount importance in achieving the goals and objectives of the global strategy, particularly with regard to issues of a transnational nature, or where the actions of a single country are insufficient. Coordinated work is needed among the organizations of the United Nations system, intergovernmental bodies, nongovernmental organizations, professional associations, research institutions and private sector entities. 56. The process of preparing the strategy has led to closer interaction with other organizations of the United Nations system, such as FAO and UNICEF, and other partners, including the World Bank. WHO will build on its long-standing collaboration with FAO in implementing the strategy. The contribution of FAO in the framing of agricultural policies can play a crucial part in this regard. More research into appropriate agriculture policies, and the supply, availability, processing and consumption of food will be necessary. 57. Cooperation is also planned with bodies such as the United Nations Economic and Social Council, ILO, UNESCO, WTO, the regional development banks and the United Nations University. Consistent with the goal and objectives of the strategy, WHO will develop and strengthen partnerships, including through the establishment and coordination of global and regional networks, in order to disseminate information, exchange experiences, and provide support to regional and national initiatives. WHO proposes to set up an ad hoc committee of partners within the United Nations system in order to ensure continuing policy coherence and to draw upon each organization’s unique strengths. Partners can play an important role in a global network that targets such areas as advocacy, resource mobilization, capacity building and collaborative research.
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58.
International partners could be involved in implementing the global strategy by: • contributing to comprehensive intersectoral strategies to improve diet and physical activity, including, for instance, the promotion of healthy diets in poverty-alleviation programmes • drawing up guidelines for prevention of nutritional deficiencies in order to harmonize future dietary and policy recommendations designed to prevent and control noncommunicable diseases • facilitating the drafting of national guidelines on diet and physical activity, in collaboration with national agencies • cooperating in the development, testing and dissemination of models for community involvement, including local food production, nutrition and physical activity education, and raising of consumer awareness • promoting the inclusion of noncommunicable disease prevention and health promotion policies relating to diet and physical activity in development policies and programmes • promoting incentive-based approaches to encourage prevention and control of chronic diseases.
59. International standards. Public health efforts may be strengthened by the use of international norms and standards, particularly those drawn up by the Codex Alimentarius Commission.1 Areas for further development could include: labelling to allow consumers to be better informed about the benefits and content of foods; measures to minimize the impact of marketing on unhealthy dietary patterns; fuller information about healthy consumption patterns, including steps to increase the consumption of fruit and vegetables; and production and processing standards regarding the nutritional quality and safety of products. Involvement of governments and nongovernmental organizations as provided for in the Codex should be encouraged.
Civil society and nongovernmental organizations 60. Civil society and nongovernmental organizations have an important role to play in influencing individual behaviour and the organizations and institutions that are involved in healthy diet and physical activity. They can help to ensure that consumers ask governments to provide support for healthy lifestyles, and the food industry to provide healthy products. Nongovernmental organizations can support the strategy effectively if they collaborate with national and international partners. Civil society and nongovernmental organizations can particularly: • lead grass-roots mobilization and advocate that healthy diets and physical activity should be placed on the public agenda • support the wide dissemination of information on prevention of noncommunicable diseases through balanced, healthy diets and physical activity
1
See resolution WHA56.23.
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• form networks and action groups to promote the availability of healthy foods and possibilities for physical activity, and advocate and support health-promoting programmes and health education campaigns • organize campaigns and events that will stimulate action • emphasize the role of governments in promoting public health, healthy diets and physical activity; monitor progress in achieving objectives; and monitor and work with other stakeholders such as private sector entities • play an active role in fostering implementation of the global strategy • contribute to putting knowledge and evidence into practice.
Private sector 61. The private sector can be a significant player in promoting healthy diets and physical activity. The food industry, retailers, catering companies, sporting-goods manufacturers, advertising and recreation businesses, insurance and banking groups, pharmaceutical companies and the media all have important parts to play as responsible employers and as advocates for healthy lifestyles. All could become partners with governments and nongovernmental organizations in implementing measures aimed at sending positive and consistent messages to facilitate and enable integrated efforts to encourage healthy eating and physical activity. Because many companies operate globally, international collaboration is crucial. Cooperative relationships with industry have already led to many favourable outcomes related to diet and physical activity. Initiatives by the food industry to reduce the fat, sugar and salt content of processed foods and portion sizes, to increase introduction of innovative, healthy, and nutritious choices; and review of current marketing practices, could accelerate health gains worldwide. Specific recommendations to the food industry and sporting-goods manufacturers include the following: • promote healthy diets and physical activity in accordance with national guidelines and international standards and the overall aims of the global strategy • limit the levels of saturated fats, trans-fatty acids, free sugars and salt in existing products • continue to develop and provide affordable, healthy and nutritious choices to consumers • consider introducing new products with better nutritional value • provide consumers with adequate and understandable product and nutrition information • practise responsible marketing that supports the strategy, particularly with regard to the promotion and marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt, especially to children • issue simple, clear and consistent food labels and evidence-based health claims that will help consumers to make informed and healthy choices with respect to the nutritional value of foods
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• provide information on food composition to national authorities • assist in developing and implementing physical activity programmes. 62. Workplaces are important settings for health promotion and disease prevention. People need to be given the opportunity to make healthy choices in the workplace in order to reduce their exposure to risk. Further, the cost to employers of morbidity attributed to noncommunicable diseases is increasing rapidly. Workplaces should make possible healthy food choices and support and encourage physical activity.
FOLLOW-UP AND FUTURE DEVELOPMENTS 63. WHO will report on progress made in implementing the global strategy and in implementing national strategies, including the following aspects: • patterns and trends of dietary habits and physical activity and related risk factors for major noncommunicable diseases • evaluation of the effectiveness of policies and programmes to improve diet and increase physical activity • constraints or barriers encountered in implementation of the strategy and the measures taken to overcome them • legislative, executive, administrative, financial or other measures taken within the context of this strategy. 64. WHO will work at global and regional levels to set up a monitoring system and to design indicators for dietary habits and patterns of physical activity.
CONCLUSIONS 65. Actions, based on the best available scientific evidence and the cultural context, need to be designed, implemented and monitored with WHO’s support and leadership. Nonetheless, a truly multisectoral approach that mobilizes the combined energy, resources and expertise of all global stakeholders is essential for sustained progress. 66. Changes in patterns of diet and physical activity will be gradual, and national strategies will need a clear plan for long-term and sustained disease-preventive measures. However, changes in risk factors and in incidence of noncommunicable diseases can occur quite quickly when effective interventions are made. National plans should therefore also have achievable short-term and intermediate goals. 67. The implementation of this strategy by all those involved will contribute to major and sustained improvements in people’s health.
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Agenda item 12.14
Human organ and tissue transplantation The Fifty-seventh World Health Assembly, Recalling resolutions WHA40.13, WHA42.5 and WHA44.25 on organ procurement and transplantation; Having considered the report on human organ and tissue transplantation; Noting the global increase in allogeneic transplantation of cells, tissues and organs; Concerned by the growing insufficiency of available human material for transplantation to meet patient needs; Aware of ethical and safety risks arising in the transplantation of allogeneic cells, tissues and organs, and the need for special attention to the risks of organ trafficking; Recognizing that living xenogeneic cells, tissues or organs, and human bodily fluids, cells, tissues or organs that have had ex vivo contact with these living xenogeneic materials, have the potential to be used in human beings when suitable human material is not available; Mindful of the risk associated with xenogeneic transplantation of the transmission of known or as yet unrecognized xenogeneic infectious agents from animals to human beings and from recipients of xenogeneic transplants to their contacts and the public at large; Recognizing that transplantation encompasses not only medical but also legal and ethical aspects, and involves economic and psychological issues, I Allogeneic transplantation 1. URGES Member States: (1) to implement effective national oversight of procurement, processing and transplantation of human cells, tissues and organs, including ensuring accountability for human material for transplantation and its traceability; (2) to cooperate in the formulation of recommendations and guidelines to harmonize global practices in the procurement, processing and transplantation of human cells, tissues and organs, including development of minimum criteria for suitability of donors of tissues and cells; (3) to consider setting up ethics commissions to ensure the ethics of cell, tissue and organ transplantation;
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(4) to extend the use of living kidney donations when possible, in addition to donations from deceased donors; (5) to take measures to protect the poorest and vulnerable groups from “transplant tourism” and the sale of tissues and organs, including attention to the wider problem of international trafficking in human tissues and organs; 2. REQUESTS the Director-General: (1) to continue examining and collecting global data on the practices, safety, quality, efficacy and epidemiology of allogeneic transplantation and on ethical issues, including living donation, in order to update the Guiding Principles on Human Organ Transplantation;1 (2) to promote international cooperation so as to increase the access of citizens to these therapeutic procedures; (3) to provide, in response to requests from Member States, technical support for developing suitable transplantation of cells, tissues or organs, in particular by facilitating international cooperation; (4) to provide support for Member States in their endeavours to prevent organ trafficking, including drawing up guidelines to protect the poorest and most vulnerable groups from being victims of organ trafficking; II Xenogeneic transplantation 1. URGES Member States: (1) to allow xenogeneic transplantation only when effective national regulatory control and surveillance mechanisms overseen by national health authorities are in place; (2) to cooperate in the formulation of recommendations and guidelines to harmonize global practices, including protective measures in accordance with internationally accepted scientific standards to prevent the risk of potential secondary transmission of any xenogeneic infectious agent that could have infected recipients of xenogeneic transplants or contacts of recipients, and especially across national borders; (3) to support international collaboration and coordination for the prevention and surveillance of infections resulting from xenogeneic transplantation; 2. REQUESTS the Director-General: (1) to facilitate communication and international collaboration among health authorities in Member States on issues relating to xenogeneic transplantation;
1
Document WHA44/1991/REC/1, Annex 6.
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(2)
to collect data globally for the evaluation of practices in xenogeneic transplantation;
(3) to inform proactively Member States of infectious events of xenogeneic origin arising from xenogeneic transplantation; (4) to provide, in response to requests from Member States, technical support in strengthening capacity and expertise in the field of xenogeneic transplantation, including policymaking and oversight by national regulatory authorities; (5) to report at an appropriate time to the Health Assembly, through the Executive Board, on implementation of this resolution.
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Agenda item 12.11
International migration of health personnel: a challenge for health systems in developing countries The Fifty-seventh World Health Assembly, Recalling United Nations General Assembly resolution 2417 (XXIII) of 17 December 1968; Recalling United Nations General Assembly resolution 58/208 on International migration and development, and the decision therein that, in 2006, the General Assembly will devote a high-level dialogue to international migration and development; Further recalling resolutions WHA22.51 of 1969 and WHA25.42 of 1972; Noting that the African Union declared 2004 “Year for Development of Human Resources in Africa”; Taking note of the Commonwealth Code of Practice for the International Recruitment of Health Workers, which was adopted at the meeting of Commonwealth health ministers (Geneva, 18 May 2003); Noting the work in progress on international labour migration in the International Organization for Migration, the Global Commission on Migration, and in other international bodies; Recognizing the importance of human resources in strengthening health systems and in successful realization of the internationally agreed goals contained in the United Nations Millennium Declaration; Noting with concern that highly trained and skilled health personnel from the developing countries continue to emigrate at an increasing rate to certain countries, which weakens health systems in the countries of origin; Being aware of the work undertaken in United Nations organizations and in other international organizations with a view to strengthening the capacity of governments to manage migration flows at national and regional levels, and the need for further action to address, both at national and international levels, as an integrated part of the Sector Wide Approaches and other development plans, the issue of migration of trained health-care personnel; Noting further that many developing countries are not yet technically equipped to assess adequately the magnitude and characteristics of the outflow of their health personnel; Recognizing the significant efforts and investment made by developing countries in training and development of human resources for health; Further recognizing the efforts made to reverse the migration of health personnel from developing countries and aware of the need to increase these efforts;
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Concerned that HIV/AIDS, tuberculosis, malaria and other such communicable diseases are placing additional burdens on the health workforce; 1. URGES Member States: (1) to develop strategies to mitigate the adverse effects of migration of health personnel and minimize its negative impact on health systems; (2) to frame and implement policies and strategies that could enhance effective retention of health personnel including, but not limited to, strengthening of human resources for health planning and management, and review of salaries and implementation of incentive schemes; (3) to use government-to-government agreements to set up health-personnel exchange programmes as a mechanism for managing their migration; (4) to establish mechanisms to mitigate the adverse impact on developing countries of the loss of health personnel through migration, including means for the receiving countries to support the strengthening of health systems, in particular human resources development, in the countries of origin; 2. REQUESTS the Director-General: (1) to establish and maintain, in collaboration with relevant countries, institutions/organizations, information systems which will enable the appropriate international bodies to monitor independently the movement of human resources for health; (2) in cooperation with international organizations within their respective mandates, including the World Trade Organization, to conduct research on international migration of health personnel, including in relation to trade agreements and remittances, in order to determine any adverse effects, and possible options to address them; (3) to explore additional measures that might assist in developing fair practices in the international recruitment of health personnel, including the feasibility, cost and appropriateness of an international instrument; (4) to support Member States to strengthen their planning mechanisms and processes in order to provide for adequate training of personnel to match their needs; (5) to develop, in consultation with Member States and all relevant partners, including development agencies, a code of practice1 on the international recruitment of health personnel, especially from developing countries, and to report on progress to the Fifty-eighth World Health Assembly; (6) to support efforts of countries by facilitating dialogue and raising awareness at the highest national and international levels and between stakeholders about migration of health personnel
It is understood that, within the United Nations system, the expression “code of practice” refers to instruments that are not legally binding.
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and its effects, including examination of modalities for receiving countries to offset the loss of health workers, such as investing in training of health professionals; (7) to mobilize all relevant programme areas within WHO, in collaboration with Member States, in order to develop human resources capacity as well as improve health support to developing countries by setting up appropriate mechanisms; (8) to consult with the United Nations and specialized agencies on the possibility of declaring a year or a decade of “Human Resources for Health Development”; (9) to declare the theme of World Health Day 2006 to be “Human Resources for Health Development”; (10) to include human resources for health development as a top-priority programme area in WHO’s General Programme of Work 2006–2015; (11) to submit a report on implementation of this resolution to the Fifty-eighth World Health Assembly.
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