Global status report on physical activity 2022: web annex: global action plan on physical activity monitoring framework, indicators and data dictionary

Global action plan on physical activity monitoring framework, indicators and data dictionaryWEB ANNEX GLOBAL STATUS REPORT ON PHYSICAL ACTIVITY 2022 Global status report on physical activity 2022. Web Annex. Global action plan on physical activity monitoring framework, indicators and data dictionary ISBN 978-92-4-005917-7 (electronic version) © World Health Organization 2022 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by- nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. 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IN T R O D U CT IO N 3 The Data Dictionary for the WHO Global action plan on physical activity (GAPPA) monitoring framework provides full details on all indicators proposed for and reported in the Global status report on physical activity (2022). • There are a total of 29 indicators. • The indicators are presented and organized by their alignment with the 20 policy recommendations and within the four strategic objectives outlined in the GAPPA. • For each indicator the following information is provided: the indicator name, the exact metric, the definition, the data source and question/s (with original question number as used in the source survey), method of computation, availability of baseline data and additional notes if needed. • Please note that indicator name and numbering as shown in this document follows the order of the policy recommendations as listed in GAPPA. That is the GAPPA strategic objective number, followed by policy action number, followed by indicator number. For example if an indicator is under GAPPA Strategic Objective 1, Policy Action 1.1, and is the first indicator, it is denoted as 1.1.1. This order of indicators and numbering has not been changed to align with the Global status report. • The format of this GAPPA Monitoring Framework Data Dictionary is based on the documentation styles used by WHO NCD Surveillance Unit and WHO Global Health Observatory to ensure alignment and reporting coherence. How to navigate this document? To assist your use of this Data Dictionary document, for each indicator, a cross reference has been provided to the Global status report chapter in table 1. 4TA B LE 1 Strategic objective 4: ACTIVE SYSTEMS INDICATOR GLOBAL STATUS REPORT SECTION 24 Operational national NCD policy which includes physical activity 4.1.1 Section 4 25 Operational national physical activity policy, strategy, or action plan 4.1.2 Section 4 26 National guidelines on physical activity 4.1.3 Section 4 27 National physical activity target 4.1.4 Section 4 28 National coordination mechanism for NCDs 4.1.5 Section 4 29 National surveillance of physical activity 4.2.1 Section 4 Strategic objective 3: ACTIVE PEOPLE INDICATOR GLOBAL STATUS REPORT SECTION 16 National protocols/standards for the management of physical inactivity through primary care 3.2.1 Section 7 17 Implementing national policies to promote physical activity in childcare settings 3.3.1 Section 7 18 Implementing national policies to promote physical activity in the workplace 3.3.2 Section 7 19 Implementing national policies to promote community-based physical activity and sports initiatives 3.3.3 Section 7 20 Implementing national policies to promote physical activity in public open spaces (including parks) 3.3.4 Section 7 21 Implementing national policies to promote walking and cycling 3.3.5 Section 7 22 Implementing national policies to promote physical activity as part of active aging 3.4.1 Section 7 23 National mHealth initiative 4.3.1 Section 7 Strategic objective 2: ACTIVE ENVIRONMENTS INDICATOR GLOBAL STATUS REPORT SECTION 6 National policy on walking and cycling 2.2.1 Section 6 7 National policy on public transport 2.2.2 Section 6 8 National road design standards 2.2.3 Section 6 9 National road safety strategy 2.2.4 Section 6 10 Road safety assessment on existing road networks 2.2.5 Section 6 11 Road safety assessment of new road infrastructure projects 2.2.6 Section 6 12 Legislation on speed limits meeting best practice 2.3.1 Section 6 13 Legislation on drink-driving meeting best practice 2.3.3 Section 6 14 Legislation on distracted driving (mobile phone use) 2.3.5 Section 6 15 Legislation on distracted driving (drug use) 2.3.5 Section 6 Strategic objective 1: ACTIVE SOCIETIES INDICATOR GLOBAL STATUS REPORT SECTION 1 National communication campaigns on physical activity 1.1.1 Section 5 2 National communication campaigns on physical activity with integrated links to community- based initiatives 1.1.2 Section 5 3 National communication campaigns on physical activity supported by environmental changes 1.1.3 Section 5 4 National physical activity communication campaigns promoting co-benefits of physical activity 1.2.1 Section 5 5 National mass participation events on physical activity 1.3.1 Section 5 St ra te gi c ob je ct iv e 1: A CT IV E SO CI ET IE S 5 Metric % of countries that have implemented national community-wide public education and awareness campaigns on physical activity in the past 2 years. Definition Country has completed at least one recent national public awareness programme on physical activity (defined as within the last 2 years). Data source WHO NCD Country Capacity Survey (CCS). Completed every two years by country representative. Questions NCD CCS Module II – Q28 Q28 Has your country implemented any national public education and awareness campaign on physical activity within the past 2 years? Yes No Don’t Know    If No: Go to Question 26 If Yes: 28a) Does the campaign integrate with community-based programmes? Yes No Don’t Know 28b) Is the campaign supported by any environmental changes to enable physical activity? Yes No Don’t Know Computation Yes if Q28 = yes, and the supporting documents and follow up verification provided evidence demonstrating meeting any of the below criteria: i. Conducted public education campaign on PA using mass media channels (i.e. traditional, digital, or both), at a national or large, sub-national scale (this excluded campaigns implemented at only a city/town/community/ village scale); where available, evidence of a PA campaign name (‘tag line' or branding) was also recorded. ii. Conducted public education activities on PA through participation in a regional or sub regional (multi-country) campaigns which included promotion of PA through media and events and may vary in duration (from one week or one month or longer). iii. Conducted public education activities on PA through implementation of multiple promotional days which included a clear dedicated message(s) aimed to promote PA; these may be recurrent days (i.e. regular days) designated to promote physical activity such as through walking/cycle/car free/sports or multiple days on different aspects of PA, or aimed at different populations, and/or conducted as part of thematic international health days (such as World Heart Day) or national health days (International Walking Day). iv. Reported some activities aimed at promoting participation in physical activity but did not meet the above criteria; programmes may be in specific settings and/or on sub national/local scale, and/or of limited duration. No if Q28 = no or don’t know, or the supporting documents and verification did not provide evidence demonstrating meeting any of the above criteria. Policy Action 1.1 Implement best practice communication campaigns, linked with community-based programmes, to heighten awareness, knowledge and understanding of, and appreciation for, the multiple health benefits of regular physical activity and less sedentary behaviour, according to ability, for individual, family and community well-being. Baseline Available in 194 countries. Trend data available from new modified question from 2019. Notes This question in NCD CCS has been modified over different years - so careful attention is required if looking at trend data. Original question included from 2013 and was modified in 2019 to reflect WHO NCD Best Buys (updated 2018 and GAPPA 2018) and further explain and align with the definition and specific criteria of communication campaigns. New supplementary questions added in 2019 to capture links with the community, environmental changes and campaigns that promote non health / co-benefits of physical activity. WHO NCDs “Best Buy” Interventions recommends: “Implement a community wide public education and awareness campaign for physical activity which includes a mass media campaign combined with other community-based education, motivational and environmental programs aimed at supporting behavioural change of physical activity levels”. GAPPA Policy Action 1.1 recommends: “Implement best practice communication campaigns, linked with community- based programmes, to heighten awareness, knowledge and understanding of, and appreciation for, the multiple health benefits of regular physical activity and less sedentary behaviour, according to ability, for individual, family and community well-being”. 1.1.1 National communication campaigns on physical activity. St ra te gi c ob je ct iv e 1: A CT IV E SO CI ET IE S 6 Policy Action 1.1 Implement best practice communication campaigns, linked with community-based programmes, to heighten awareness, knowledge and understanding of, and appreciation for, the multiple health benefits of regular physical activity and less sedentary behaviour, according to ability, for individual, family and community well-being. 1.1.2 National physical activity communication campaigns with integrated links to community-based initiatives. Metric % of countries that have implemented national physical activity campaigns for physical activity with community links. Definition Country has completed a national campaign on physical activity (defined as using mass media channels and including links to community programmes or environmental supports) Data source WHO NCD CCS. Completed every two years by country representative. Questions Modified Item in NCD CCS Module II – Q28 Q28 Has your country implemented any national public education and awareness campaign on physical activity within the past 2 years? Yes No Don’t Know If Yes: 28a) Does the campaign integrate with community-based programmes? Yes No Don’t Know 28b) Is the campaign supported by any environmental changes to enable physical activity? Yes No Don’t Know Analysis Coding Descriptive analyses were undertaken with the responses to Q28a and Q28b for those countries meeting “achieved” as identified for Indicator 1.1, that is they reported conducting a national campaign on physical activity. Computation Countries report a national PA campaign with links to community programmes Yes if both Q28 and Q28a = yes No if Q28 = no or don’t know or Q28 = yes And Q28a = no Baseline Available in 194 countries. Trend data available from 2019. Note Modified question from 2019 adding sub question to capture links with the community, environmental changes and campaigns that promote non health / co-benefits of physical activity. 1.1.3 National physical activity communication campaigns supported by environmental changes. Policy Action 1.1 Implement best practice communication campaigns, linked with community-based programmes, to heighten awareness, knowledge and understanding of, and appreciation for, the multiple health benefits of regular physical activity and less sedentary behaviour, according to ability, for individual, family and community well-being. Metric % of countries that have implemented national physical activity campaigns for physical activity which includes supportive environment links. Definition Country has completed a national campaign on physical activity (defined as using mass media channels and including environmental changes or supports). Data source WHO NCD CCS. Completed every two years by country representative. Questions Modified Item in NCD CCS Module II – Q28 Q28 Has your country implemented any national public education and awareness campaign on physical activity within the past 2 years? Yes No Don’t Know If Yes: 28b) Is the campaign supported by any environmental changes to enable physical activity? Yes No Don’t Know Analysis Coding Descriptive analyses were undertaken with the responses to Q28a and Q28b for those countries meeting “achieved” as identified for Indicator 1.1, that is they reported conducting a national campaign on physical activity. Computation Countries report a national PA campaign with environmental support Yes if both Q28 and Q28b = yes No if Q28 = no or don’t know or Q28 = yes And Q28b = no Baseline Available in 194 countries. Trend data available from 2019. Note Modified question from 2019 adding sub question to capture links with the community, environmental changes and campaigns that promote non health / co-benefits of physical activity. St ra te gi c ob je ct iv e 1: A CT IV E SO CI ET IE S 7 Metric % of countries which have conducted a public education and awareness campaign focused on promoting the co-benefits of physical activity. Definition Country has conducted public education and awareness campaign focused on promoting the co-benefits of physical activity. Co-benefits of physical activity refer to social (better social cohesion through physical activity), environmental (such as reducing the carbon footprints or helping climate change) and economic benefits of physical activity (such as reduced sick leaves or more active at work and hence, increase productivity), in addition to the health benefits. Data source WHO NCD CCS. Completed every two years by country representative. Questions NCD CCS Module II – Q28 Q28 Has your country implemented any national public education and awareness campaign on physical activity within the past 2 years? Yes No Don’t Know    If No: Go to Question 29 If Yes: 28c) Does the campaign address any of the social, environmental and economic benefits of physical activity, in addition to the health benefits? Yes No Don’t Know Analysis Coding Descriptive analyses were undertaken with the responses to Q28c for those countries meeting “achieved” as identified for Indicator 1.1, that is they reported conducting a national campaign on physical activity. Computation Countries report a national PA campaign promoting the co-benefits of physical activity Yes if both Q28 and Q28c= yes No if Q28 = no or don’t know or Q28 = yes and Q28c = no Policy Action 1.2 Conduct national and community-based campaigns to enhance awareness and understanding of, and appreciation for, the social, economic, and environmental co- benefits of physical activity, and particularly more walking, cycling and other forms of mobility involving the use of wheels (including wheelchairs, scooters and skates) and thereby make a significant contribution to achievement of the 2030 Agenda for Sustainable Development (SDGs 2, 3, 4, 5, 9, 10, 11, 13, 15 and 16). 1.2.1 National communication campaigns promoting co-benefits of physical activity. Baseline Available in 194 countries. Trend data available from 2019. Note Modified question from 2019 adding sub question to capture campaigns that promote non-health / co-benefits of physical activity. St ra te gi c ob je ct iv e 1: A CT IV E SO CI ET IE S 8 Metric % of countries which have conducted at least one free mass participation event on physical activity. Definition Country has completed at least one recent (with the last 2 years) free national or subnational mass participation events to encourage physical activity by the general community (people of all ages and abilities). Data source WHO NCD CCS. Completed every two years by country representative. Questions NCD CCS Module II – Q29 Q29 Has your country implemented any national or subnational mass participation events to encourage participation by the general public in free opportunities for physical activity within the past 2 years? Examples of mass participation events include national walk to school days/weeks; other free events; cycling, yoga, Tai chi, dance. Note this does NOT include hosting of major competitive sporting events like marathons, which require paid participation. Yes No Don’t Know 29a) Please provide details of the event(s): .......................................................... ......................................................................................................................................... Analysis coding Simple descriptive frequency counts of the number of countries reporting implementing a mass participation (free) community event. For countries reporting yes, the supporting information was reviewed to assess against the following criteria: 1. Participation in the event(s) was free (no cost); 2. Participation by the general public was encouraged; and 3. Was not solely a competitive sports events such a marathon or sports team competitions. Computation Yes if Q29= yes No if Q29 = no or don’t know Policy Action 1.3 Implement regular mass-participation initiatives in public spaces, engaging entire communities, to provide free access to enjoyable and affordable, socially and culturally appropriate experiences of physical activity. 1.3.1 National mass participation events on physical activity. Baseline Available in 194 countries. Trend data available from 2019. Note New question in 2019. This question provided opportunity to report PA initiatives which did not meet communication campaign definition according to NCD Best Buys and GAPPA and yet may be events which are conducted in the community aimed at mass participation, involve advocacy and may be of different durations and repetition e.g. day/week/month in duration and repeated weekly, monthly, or annually. St ra te gi c ob je ct iv e 2: A CT IV E EN V IR O N M EN T S 9 Metric % of countries with national policy on walking and/or cycling. Definition Country has national policy on walking and/or cycling. (desirable to modify the existing question to separate out walk and cycle into 2 questions) Data source WHO Global Status Report on Road Safety: Respondents’ Questionnaire. Data collected every three years, latest data collection: 2017, published 2018. Questions Q19. Are there national policies that encourage walking and/or cycling as an alternative to car travel? Yes No, but sub-national policies exist No Don’t know Computation Yes if Q19 = yes Yes, Sub-national if Q19 = No, but sub-national policies exist No if Q19 – no or don’t know Baseline Available since 2009. In 2017 in 175 countries, of which one is not a WHO Member State and has not been included in the present analysis. Note This indicator assesses the policy priority for W&C. It does not however provide any direct measure of the actual infrastructure for W&C nor its quality. It is therefore a tracer indicator. Link: https://www.who.int/violence_injury_prevention/road_traffic/en/ Policy Action 2.2 Improve the level of service* provided by walking and cycling network infrastructure, to enable and promote walking, cycling, other forms of mobility involving the use of wheels (including wheelchairs, scooters and skates) and the use of public transport, in urban, peri-urban and rural communities, with due regard for the principles of safe, universal and equitable access by people of all ages and abilities, and in alignment with other commitments. 2.2.1 National policy on walking and cycling. *Level of service = the attributes of safety, quality, connectedness and completeness; assessment instruments for walking and cycling are available in many countries. Metric % of countries with national policies and investment in increasing access to public transport. Definition Country has policy and investment in increasing access to public transport. Data source WHO Global Status Report on Road Safety: Respondents’ Questionnaire. Data collected in 2017. Questions Q21. Are there national policies and supporting investment in public transport to increase the percentage of urban population that have convenient access to public transport? Yes No Don’t know Computation Yes if Q21 = yes No if Q21 = no or don’t know Baseline Available since 2009. In 2017 in 175 countries, of which one is not a WHO Member State and has not been included in the present analysis. Note This indicator assesses the policy priority. It does not provide a direct measure of the public transport infrastructure or the quality/efficiency of its service. 2.2.2 National policy on public transport. Policy Action 2.2 Improve the level of service* provided by walking and cycling network infrastructure, to enable and promote walking, cycling, other forms of mobility involving the use of wheels (including wheelchairs, scooters and skates) and the use of public transport, in urban, peri-urban and rural communities, with due regard for the principles of safe, universal and equitable access by people of all ages and abilities, and in alignment with other commitments. *Level of service = the attributes of safety, quality, connectedness and completeness; assessment instruments for walking and cycling are available in many countries. St ra te gi c ob je ct iv e 2: A CT IV E EN V IR O N M EN T S 10 Metric % of countries with design standards for: managing speed where pedestrians and cyclists are present; safe crossings for pedestrians and cyclists; and separation of pedestrians and cyclists from vehicular traffic. Definition Country has roads design standards for: managing speed where pedestrians and cyclists are present; safe crossings for pedestrians and cyclists; and separation of pedestrians and cyclists from vehicular traffic. Data source WHO Global Status Report on Road Safety: Respondents’ Questionnaire. Data collected every three years, latest data collection: 2017. Questions Q20. On roads where pedestrians and cyclists are present, do design standards provide for: 20.1 Managing speed to safe system outcomes (e.g. 20 mph or 30 km/h) Yes No 20.2 Safe crossings for pedestrians and cyclists Yes No 20.3 Separation of pedestrians and cyclists from vehicular traffic Yes No Computation Yes if Q20.1, or Q20.2, or Q20.3 = yes No if Q20.1, or Q20.2, or Q20.3 = no or don’t know Yes meets all three if Q20.1 AND Q20.2 AND Q20.3 = yes Policy Action 2.2 Improve the level of service* provided by walking and cycling network infrastructure, to enable and promote walking, cycling, other forms of mobility involving the use of wheels (including wheelchairs, scooters and skates) and the use of public transport, in urban, peri-urban and rural communities, with due regard for the principles of safe, universal and equitable access by people of all ages and abilities, and in alignment with other commitments. 2.2.3 National road design standards. Baseline Available since 2009. In 2017 in 175 countries, of which one is not a WHO Member State and has not been included in the present analysis. Note This indicator is introduced as new indicator in 2017 as part of the WHO Global Status Report on Road Safety Questionnaire. *Level of service = the attributes of safety, quality, connectedness and completeness; assessment instruments for walking and cycling are available in many countries. St ra te gi c ob je ct iv e 2: A CT IV E EN V IR O N M EN T S 11 Metric % of countries with national funded road safety strategy. Definition Country has fully funded national road safety strategy/ies. Data source WHO Global Status Report on Road Safety: Respondents’ Questionnaire. Data collected every three years, latest data collection: 2017. Questions 5. Is there a national strategy for road safety in your country? Yes (please submit relevant source document/s) No (skip to Section C) Don’t know (skip to Section C) 5.1 If yes, does this strategy comprise: (please tick all that apply) 5.1.1 One national strategy 5.1.2 Multiple national strategies (e.g. one in health, one in transport) 5.1.3 Multiple provincial/state level strategies 5.1.4 Other (please specify)........................................................................................................................ 5.2 Are funds available to implement part or all of this/these strategy/ strategies? Yes, fully funded Partially funded Not funded Don’t know Computation Yes-fully funded if Q5 = yes AND Q5.2 = fully funded Yes-partially funded if Q5 = yes AND Q5.2 = partially funded No if Q5 = no or don’t know Policy Action 2.3 Accelerate implementation of policy actions to improve road safety and the personal safety of pedestrians, cyclists, people engaged in other forms of mobility involving the use of wheels (including wheelchairs, scooters and skates) and public transport passengers, with priority given to actions that reduce risk for the most vulnerable road users in accordance with the safe systems approach to road safety, and in alignment with other commitments. 2.3.4 National road safety strategy. Baseline Available since 2009. In 2017 in 175 countries, of which one is not a WHO Member State and has not been included in the present analysis. Note This is consistent with WHO road safety indicators. This provides indication of policy and level of funding for road safety. This indicator stays in policy action 2 as well as can also be part of policy action 4.5 but it will be only road safety and not including funding for other sectors such as budget for education, physical activity, sport, etc. St ra te gi c ob je ct iv e 2: A CT IV E EN V IR O N M EN T S 12 Metric % of countries with road safety star rating [or safety rating] assessments for existing road networks. Definition Country requires road safety assessments for existing road networks. Data source WHO Global Status Report on Road Safety: Respondents’ Questionnaire. Data collected every three years, latest data collection: 2017. Questions Q17. Are EXISTING road networks required to undergo the following on a regular basis? 17.1 Maintenance safety inspections 17.2 Formal road safety inspections/ assessments 17.3 Star rating/ safety rating assessments If yes, what proportion of national road networks undergoes star rating/ safety rating assessments: < 20% 20-50% > 50% Computation Yes if Q17.1 AND Q17.2 = yes No if Q17.1 = yes and Q17.2 = no, or Q17.1 = no and 17.2 = yes, or both Q17.1 and Q17.2 = no or don’t know Baseline Available since 2017. In 2017 in 175 countries, of which one is not a WHO Member State and has not been included in the present analysis. Note The 3* rating scheme (or equivalent) is recommended and used by WHO Road Safety Indicators and reporting. Policy Action 2.2 Accelerate implementation of policy actions to improve road safety and the personal safety of pedestrians, cyclists, people engaged in other forms of mobility involving the use of wheels (including wheelchairs, scooters and skates) and public transport passengers, with priority given to actions that reduce risk for the most vulnerable road users in accordance with the safe systems approach to road safety, and in alignment with other commitments. 2.2.5 Road safety assessment on existing road networks. *Level of service = the attributes of safety, quality, connectedness and completeness; assessment instruments for walking and cycling are available in many countries. Metric % of countries with road safety audit [star/safety rating] assessment prior to construction in the design or plans of new road infrastructure. Definition Country requires road safety assessments for new road networks. Data source WHO Global Status Report on Road Safety: Respondents’ Questionnaire. Data collected every three years, latest data collection: 2017. Questions Q16. Do designs (plans) for NEW road infrastructure projects require a formal road safety audit and/or star/ safety rating assessment prior to construction? (see Instruction booklet for more details) Yes Yes, but for some parts of the road network only No Don’t know Computation Fully if Q16 = yes Partially if Q16 = Yes, but for some parts of the road network only No if Q16 = no or don’t know Baseline Available since 2017. In 2017 in 175 countries, of which one is not a WHO Member State and has not been included in the present analysis. Note The 3* rating scheme (or equivalent) is recommended and used by WHO Road Safety indicators and reporting. *Level of service = the attributes of safety, quality, connectedness and completeness; assessment instruments for walking and cycling are available in many countries. 2.2.6 Road safety assessment of new road infrastructure projects. Policy Action 2.2 Accelerate implementation of policy actions to improve road safety and the personal safety of pedestrians, cyclists, people engaged in other forms of mobility involving the use of wheels (including wheelchairs, scooters and skates) and public transport passengers, with priority given to actions that reduce risk for the most vulnerable road users in accordance with the safe systems approach to road safety, and in alignment with other commitments. St ra te gi c ob je ct iv e 2: A CT IV E EN V IR O N M EN T S 13 Metric % of countries with the national/ provincial/state speed legislations met the best practice criteria. Definition Countries with the national/ provincial/state speed legislations met the best practice criteria. Data source WHO Global Status Report on Road Safety: Respondents’ Questionnaire. Data collected every three years, latest data collection: 2017. Questions Q22. In your country is there legislation that specifies national speed limits set FOR PRIVATE PASSENGER CARS? Yes No Don’t know Secondary document analysis of countries responded “yes” to road safety survey Q22 (n=169) was conducted to see if the national legislations meeting the best practice criteria on low speed limits. Three best practice criteria were used in the assessment of legislation on speed laws as defined in WHO 2018 Global Status Report on Road Safety: 1. Presence of a national speed limit law; 2. Local authorities having the power to modify speed limits (to adapt to different contexts); and 3. Urban speed limits not exceeding 50km/h (based on research, lower limits are recommended for urban areas and 30 km/h for residential areas and areas with high pedestrian activity). Computation Legislation Yes if Q22 = yes Legislation no if Q22 = no or don’t know Best practice if Q22 = yes AND local authorities having the power to modify speed limits (to adapt to different contexts) ; AND urban speed limits not exceeding 50km/h (based on research, lower limits are recommended for urban areas and 30 km/h for residential areas and areas with high pedestrian activity) 2.3.1 Legislation on speed limits meeting best practice. Policy Action 2.3 Accelerate implementation of policy actions to improve road safety and the personal safety of pedestrians, cyclists, people engaged in other forms of mobility involving the use of wheels (including wheelchairs, scooters and skates) and public transport passengers, with priority given to actions that reduce risk for the most vulnerable road users in accordance with the safe systems approach to road safety, and in alignment with other commitments. Baseline Available since 2013. In 2017 in 175 countries, of which one is not a WHO Member State and has not been included in the present analysis. Note Calculation was done according to criteria used by road safety team. St ra te gi c ob je ct iv e 2: A CT IV E EN V IR O N M EN T S 14 Metric % of countries with national/provincial/state drink driving legislations met the best practice criteria. Definition Countries with the national/provincial/state drink driving legislations met the best practice criteria. Data source WHO Global Status Report on Road Safety: Respondents’ Questionnaire. Data collected every three years, latest data collection: 2017. Questions Q27. Is there a national drink-driving law in your country? Yes No Don’t know Secondary document analysis of countries responded “yes” to road safety survey Q27 was conducted to see if the national legislations meeting the best practice criteria on drink driving laws. Three best practice criteria were used in the assessment of legislation on drink driving laws as defined in WHO 2018 Global Status Report on Road Safety: 1. Presence of a national drink-driving law (Q27); 2. BAC limit for the general population not exceeding 0.05 g/dl; and 3. BAC limit for young and novice drivers not exceeding 0.02 g/dl. Computation Legislation Yes if Q27 = yes Legislation no if Q27 = no or don’t know Best practice if Q27 = yes AND BAC limit for the general population not exceeding 0.05 g/dl; AND BAC limit for young and novice drivers not exceeding 0.02 g/dl 2.3.3 Legislation on drink-driving meeting best practice. Policy Action 2.3 Accelerate implementation of policy actions to improve road safety and the personal safety of pedestrians, cyclists, people engaged in other forms of mobility involving the use of wheels (including wheelchairs, scooters and skates) and public transport passengers, with priority given to actions that reduce risk for the most vulnerable road users in accordance with the safe systems approach to road safety, and in alignment with other commitments. Baseline Available since 2013. In 2017 in 175 countries, of which one is not a WHO Member State and has not been included in the present analysis. Note Calculation was done according to criteria used by road safety team. St ra te gi c ob je ct iv e 2: A CT IV E EN V IR O N M EN T S 15 Metric % of countries with the national/provincial/state legislation on distracted driving. Definition Countries with the national/provincial/state legislation on distracted driving. Data source WHO Global Status Report on Road Safety: Respondents’ Questionnaire. Data collected every three years, latest data collection: 2017. Questions Q34. Is there a national law that restricts the use of drugs while driving? Yes No, but laws are set at provincial/state level No Don’t know 50. Is there NATIONAL legislation in your country regulating the use of mobile phones while driving? Yes No, No, but legislation set at provincial/state level No Don’t know Computation Driving and Drugs: Yes if Q34 = yes No if Q34 = no, laws at provincial, or no or don’t know Mobile phone use: Yes if Q50 = yes No if Q50 = no, laws at provincial, or no or don’t know 2.3.5 Legislation on distracted driving. Policy Action 2.3 Accelerate implementation of policy actions to improve road safety and the personal safety of pedestrians, cyclists, people engaged in other forms of mobility involving the use of wheels (including wheelchairs, scooters and skates) and public transport passengers, with priority given to actions that reduce risk for the most vulnerable road users in accordance with the safe systems approach to road safety, and in alignment with other commitments. Baseline Available since 2017. In 2017 in 175 countries, of which one is not a WHO Member State and has not been included in the present analysis. Note Calculation was done according to criteria used by road safety team. St ra te gi c ob je ct iv e 3: A CT IV E PE O PL E 16 Metric % countries with national guidelines/protocols/standards for management of physical inactivity in primary health care. Definition Countries report national guidelines/protocols/standards available for the management of physical activity through a primary care approach recognized/ approved by government or competent authorities. Data source WHO NCD CCS. Completed every two years by country representative. Questions NCD CCS 2019- Module IV - Q1b 1b) Please indicate whether evidence-based national guidelines/protocols/ standards are available for the management of each of the following NCD risk factors (risk factors listed include physical inactivity) through a primary care approach recognized/approved by government or competent authorities. 1. Are they available? 2. Are they being utilized in at least 50% of health care facilities 3. Do they include referral criteria? Response options: Yes No Don’t Know Computation Yes if Q1b for physical inactivity = yes No if Q1b for physical inactivity = no or don’t know Primary descriptive analyses were conducted. Those that answered Yes were required to highlight if it was utilized in at least 50% of facilities (Q1bii) and if it includes referral criteria (Q1biv). Descriptive analyses were conducted for Q1bii and Q1biv. 3.2.1 National protocols/standards for the management of physical activity through primary care. Policy Action 3.2 Accelerate implementation of policy actions to improve road safety and the personal safety of pedestrians, cyclists, people engaged in other forms of mobility involving the use of wheels (including wheelchairs, scooters and skates) and public transport passengers, with priority given to actions that reduce risk for the most vulnerable road users in accordance with the safe systems approach to road safety, and in alignment with other commitments. Baseline Available in 194 countries. Trend data available from 2019-2021. Note Confirmed. This item is reintroduced in as a new question in WHO NCD CCS in 2019, it was introduced in 2013 and then removed. The indicator does not measure the physical activity assessment and counselling directly. However, presence of national counselling protocols or guidelines for physical activity provides the standardized practice for care providers in delivering the physical activity counselling. No additional specific validation or sourcing of documentation in response to Q1b has yet been undertaken. St ra te gi c ob je ct iv e 3: A CT IV E PE O PL E 17 Metric % of countries implementing national policies promoting population physical activity in childcare settings. Definition Country reports implementing national policy actions to promote physical activity in childcare settings. Data source WHO NCD CCS. Completed every two years by country representative. Questions Q27. Is your country implementing any national policies in the following areas to promote population physical activity? This question refers to national policy actions by Ministry of Health or Ministry of Transport or Ministry of Education or Ministry of Sport, Recreation, Leisure, or Ministry of Labour or Ministry of Social Welfare or Ministry of Planning or other related ministries, or municipalities or local authorities. The policy actions taken should be formal and sustained national initiatives or programmes but do NOT include ad hoc events. Walking and cycling Yes No Don’t Know Workplace physical activity initiatives Yes No Don’t Know Active aging Yes No Don’t Know Community-based physical activity and sports initiatives Yes No Don’t Know Public open spaces (including parks) Yes No Don’t Know Childcare settings Yes No Don’t Know Computation Yes if Q27 for childcare settings = yes No if Q27 for childcare settings = no or don’t know Baseline 194 countries. New NCD CCS question in 2021. Note - 3.3.1 Implementing national policies promoting physical activity in childcare settings. Policy Action 3.3 Enhance provision of, and opportunities for, more physical activity programmes and promotion in parks and other natural environments (such as beaches, rivers and foreshores) as well as in private and public workplaces, community centres, recreation and sports facilities and faith-based centres, to support participation in physical activity, by all people of diverse abilities. Metric % of countries implementing national policies on physical activity in the workplace. Definition Country reports implementing national policy actions to promote physical activity in the workplace. Data source WHO NCD CCS. Completed every two years by country representative. Questions Q27. Is your country implementing any national policies in the following areas to promote population physical activity? This question refers to national policy actions by Ministry of Health or Ministry of Transport or Ministry of Education or Ministry of Sport, Recreation, Leisure, or Ministry of Labour or Ministry of Social Welfare or Ministry of Planning or other related ministries, or municipalities or local authorities. The policy actions taken should be formal and sustained national initiatives or programmes but do NOT include ad hoc events. Walking and cycling Yes No Don’t Know Workplace physical activity initiatives Yes No Don’t Know Active aging Yes No Don’t Know Community-based physical activity and sports initiatives Yes No Don’t Know Public open spaces (including parks) Yes No Don’t Know Childcare settings Yes No Don’t Know Computation Yes if Q27 for workplace physical activity initiatives = yes No if Q27 for workplace physical activity initiatives = no or don’t know Baseline 194 countries. New NCD CCS question in 2021. Note - 3.3.2 Implementing policies to promote physical activity in the workplace. Policy Action 3.3 Enhance provision of, and opportunities for, more physical activity programmes and promotion in parks and other natural environments (such as beach, rivers and foreshores) as well as in private and public workplaces, community centres, recreation and sports facilities and faith-based centres, to support participation in physical activity, by all people of diverse abilities. St ra te gi c ob je ct iv e 3: A CT IV E PE O PL E 18 Metric % of countries implementing national policies on community-based physical activity and sports initiatives. Definition Country reports implementing national policy actions to promote physical activity through community-based physical activity and sports initiatives. Data source WHO NCD CCS. Completed every two years by country representative. Questions Q27. Is your country implementing any national policies in the following areas to promote population physical activity? This question refers to national policy actions by Ministry of Health or Ministry of Transport or Ministry of Education or Ministry of Sport, Recreation, Leisure, or Ministry of Labour or Ministry of Social Welfare or Ministry of Planning or other related ministries, or municipalities or local authorities. The policy actions taken should be formal and sustained national initiatives or programmes but do NOT include ad hoc events. Walking and cycling Yes No Don’t Know Workplace physical activity initiatives Yes No Don’t Know Active aging Yes No Don’t Know Community-based physical activity and sports initiatives Yes No Don’t Know Public open spaces (including parks) Yes No Don’t Know Childcare settings Yes No Don’t Know Computation Yes if Q27 for Community-based physical activity and sports initiatives = yes No if Q27 for Community-based physical activity and sports initiatives = no or don’t know Baseline 194 countries. New NCD CCS question in 2021. Note - 3.3.3 Implementing community-based physical activity and sports initiatives. Policy Action 3.3 Enhance provision of, and opportunities for, more physical activity programmes and promotion in parks and other natural environments (such as beach, rivers and foreshores) as well as in private and public workplaces, community centres, recreation and sports facilities and faith-based centres, to support participation in physical activity, by all people of diverse abilities. Metric % of countries implementing national policies to promote physical activity in public open spaces (including parks). Definition Country implementing national policy actions to promote physical activity in public open spaces (including parks). Data source WHO NCD CCS. Completed every two years by country representative. Questions Q27. Is your country implementing any national policies in the following areas to promote population physical activity? This question refers to national policy actions by Ministry of Health or Ministry of Transport or Ministry of Education or Ministry of Sport, Recreation, Leisure, or Ministry of Labour or Ministry of Social Welfare or Ministry of Planning or other related ministries, or municipalities or local authorities. The policy actions taken should be formal and sustained national initiatives or programmes but do NOT include ad hoc events. Walking and cycling Yes No Don’t Know Workplace physical activity initiatives Yes No Don’t Know Active aging Yes No Don’t Know Community-based physical activity and sports initiatives Yes No Don’t Know Public open spaces (including parks) Yes No Don’t Know Childcare settings Yes No Don’t Know Computation Yes if Q27 for Public open spaces (including parks) = yes No if Q27 for Public open spaces (including parks) = no or don’t know Baseline 194 countries. New NCD CCS question in 2021. Note 3.3.4 Implementing policy to promote physical activity in public open spaces (including parks). Policy Action 3.3 Enhance provision of, and opportunities for, more physical activity programmes and promotion in parks and other natural environments (such as beach, rivers and foreshores) as well as in private and public workplaces, community centres, recreation and sports facilities and faith-based centres, to support participation in physical activity, by all people of diverse abilities. St ra te gi c ob je ct iv e 3: A CT IV E PE O PL E 19 Metric % of countries implementing national policies to increase walking and cycling. Definition Country reports implementing national policy actions to promote walking and/ or cycling. Data source WHO NCD CCS. Completed every two years by country representative. Questions Q27. Is your country implementing any national policies in the following areas to promote population physical activity? This question refers to national policy actions by Ministry of Health or Ministry of Transport or Ministry of Education or Ministry of Sport, Recreation, Leisure, or Ministry of Labour or Ministry of Social Welfare or Ministry of Planning or other related ministries, or municipalities or local authorities. The policy actions taken should be formal and sustained national initiatives or programmes but do NOT include ad hoc events. Walking and cycling Yes No Don’t Know Workplace physical activity initiatives Yes No Don’t Know Active aging Yes No Don’t Know Community-based physical activity and sports initiatives Yes No Don’t Know Public open spaces (including parks) Yes No Don’t Know Childcare settings Yes No Don’t Know Computation Yes if Q27 for Walking and cycling = yes No if Q27 Walking and cycling = no or don’t know Baseline 194 countries. New NCD CCS question in 2021. Note 3.3.5 Implementing policies to promote walking and cycling. Policy Action 3.3 Enhance provision of, and opportunities for, more physical activity programmes and promotion in parks and other natural environments (such as beach, rivers and foreshores) as well as in private and public workplaces, community centres, recreation and sports facilities and faith-based centres, to support participation in physical activity, by all people of diverse abilities. Metric % of countries implementing national policies on physical activity as part of active aging. Definition Country reports implementing national policy actions to promote physical activity as part of active ageing and to address physical activity in older adults. Data source WHO NCD CCS. Completed every two years by country representative. Questions Q27. Is your country implementing any national policies in the following areas to promote population physical activity? This question refers to national policy actions by Ministry of Health or Ministry of Transport or Ministry of Education or Ministry of Sport, Recreation, Leisure, or Ministry of Labour or Ministry of Social Welfare or Ministry of Planning or other related ministries, or municipalities or local authorities. The policy actions taken should be formal and sustained national initiatives or programmes but do NOT include ad hoc events. Walking and cycling Yes No Don’t Know Workplace physical activity initiatives Yes No Don’t Know Active aging Yes No Don’t Know Community-based physical activity and sports initiatives Yes No Don’t Know Public open spaces (including parks) Yes No Don’t Know Childcare settings Yes No Don’t Know Computation Yes if Q27 for active ageing = yes No if Q27 active ageing = no or don’t know Baseline 194 countries. New NCD CCS question in 2021. Note - 3.4.1 Implementing policy to promote physical activity as part of Active Aging. Policy Action 3.4 Enhance the provision of, and opportunities for, appropriately tailored programmes and services aimed at increasing physical activity and reducing sedentary behaviour in older adults, according to ability, in key settings such as local and community venues, health, social and long-term care settings, assisted living facilities and family environments, to support healthy ageing. St ra te gi c ob je ct iv e 3: A CT IV E PE O PL E 20 4.3.1 National mHealth initiatives. Policy Action 4.3 Strengthen the national and institutional research and evaluation capacity and stimulate the application of digital technologies and innovation to accelerate the development and implementation of effective policy solutions aimed at increasing physical activity and reducing sedentary behaviour. Metric % of countries applying mHealth in NCD prevention and management. Definition Country has implemented any national, NCD-related mHealth initiatives within the past 2 years. Data source WHO NCD CCS. Completed every two years by country representative. Questions NCD CCS Module II-Q30 30) Has your country implemented any national, NCD-related mHealth initiatives, such as tobacco cessation, hypertension management, cervical cancer screening awareness, promotion of physical activity, within the past 2 years? Yes No Don’t Know Computation Yes if Q30 = yes No if Q30 = no or don’t know Baseline Available in 194 countries. Trend data available from 2019. Note New question added to the WHO NCD CCS in 2019. The question is more generalized to all other NCD risk factors and not specific to PA and addition of supplementary question was not possible. St ra te gi c ob je ct iv e 4: A CT IV E SY ST EM S 21 Metric % of countries with operational national NCD policy, strategy and/or action plan that includes physical activity. Definition Country has a national NCD policy, strategy, and/ or action plan including physical activity. Data source WHO NCD CCS. Completed every two years by country representative. Questions NCD CCS Module II – Q3 Q3. Does your country have a national NCD policy, strategy or action plan which integrates several NCDs and their risk factors? Please note that this may be a stand-alone NCD policy, strategy or action plan, or a national health policy, strategy or action plan where NCDs comprise a significant proportion of the document. Also note that disease- and risk factor-specific policies, strategies, and action plans will be reported in other questions later in this module. Yes No Don’t Know    If No: Go to Question 4 If Yes: Is it multisectoral? Yes No Don’t Know Is it multi-stakeholder? Yes No Don’t Know Please provide the following information about the policy, strategy or action plan: 3a) Title: ................................................................................................................ 3b) Does it address one or more of the following major risk factors? Harmful use of alcohol Yes No Don’t Know Unhealthy diet Yes No Don’t Know Physical inactivity Yes No Don’t Know Tobacco Yes No Don’t Know 3f) Indicate its stage: Operational   Under development   Not in effect   Don’t know If Operational: 3f-i) What was the first year of implementation? .................................................. 3f-ii) What year will it expire? ............................................................................... 4.1.1 Operational national NCD policy which includes all four risk factors. Policy Action 4.1 Strengthen policy frameworks, leadership and governance systems, at the national and subnational levels, to support implementation of actions aimed at increasing physical activity and reducing sedentary behaviours, including multisectoral engagement and coordination mechanisms; policy coherence across sectors; guidelines, recommendations and actions plans on physical activity and sedentary behaviour for all ages; and progress monitoring and evaluation to strengthen accountability. Computation Yes if Q3 = yes and Q3b Physical inactivity = yes No if Q3 = no or don’t know, or Q3 = yes and Q3b = no or don’t know Primary descriptive analyses were conducted. Those that answered Yes were required to highlight if it includes PA (Q3b) and if it is operational (Q3f). Descriptive analyses were conducted for Q3b and Q3f. Operational if Q3 = yes and Q3b Physical inactivity = yes AND Q3f = Operational Not operational if Q3 = yes and Q3b Physical inactivity = yes AND Q3f = under development, or not in effect or don’t know. Baseline Available in 194 countries. Trend data available from 2013. Note - St ra te gi c ob je ct iv e 4: A CT IV E SY ST EM S 22 Metric % of countries with operational national PA policy, strategy or action plan on physical activity. Definition Country has a standalone national policy, strategy, or action plan on physical activity. Data source WHO NCD CCS. Completed every two years by country representative. Questions NCD CCS Module II – Q14 Q14. Is there a policy, strategy, or action plan for reducing physical inactivity and/or promoting physical activity in your country? Yes No Don’t Know    If No: Go to Question 15 If Yes: 14a) Write the title ......................................................................................... 14b) Indicate its stage: Operational   Under development   Not in effect   Don’t know If Operational: 14b-i) What was the first year of implementation?................................................. 14b-ii) What year will it expire?.............................................................................. Computation Yes if Q14 = yes No if Q13 = no or don’t know Primary descriptive analyses were conducted. Those that answered Yes were required to highlight if it is operational (Q13b). Descriptive analyses were conducted for Q13b: Operational if Q13 = yes and Q13b = Operational Not operational if Q13 = yes and Q13b = under development, or not in effect or don’t know 4.1.2 Operational national physical activity policy, strategy, or action plan. Policy Action 4.1 Strengthen policy frameworks, leadership and governance systems, at the national and subnational levels, to support implementation of actions aimed at increasing physical activity and reducing sedentary behaviours, including multisectoral engagement and coordination mechanisms; policy coherence across sectors; guidelines, recommendations and actions plans on physical activity and sedentary behaviour for all ages; and progress monitoring and evaluation to strengthen accountability. Baseline Available in 194 countries. Trend data available from 2013. Note - St ra te gi c ob je ct iv e 4: A CT IV E SY ST EM S 23 Metrics % of countries with national guidelines on physical inactivity in children aged <5, adolescents, adults, and older adults. Definition The country has national guidelines which provide recommended levels of physical activity for: (i) children under 5, (ii) adolescents (13-17 years), (ii) adults (≥ 18 years), (iv) older adults (>65 years). This is a composite measure. Data source WHO NCD CCS. Completed every two years by country representative. Questions NCD CCS Module II-Q15 Q15. Are there national guidelines which provide recommended levels of physical activity for the population or a specific segment of the population? Yes No Don’t Know    If Yes: 15a) Are there guidelines specifically addressing any of the following age groups: Children under 5 Yes No Don’t Know Children and adolescents (ages 5 – 19) Yes No Don’t Know Adults Yes No Don’t Know Older adults Yes No Don’t Know Computation Yes if Q15 = yes No if Q15 = no or don’t know Computation for each age group Yes if Q15a (for age gp) = yes No if Q15a (for age gp) = no or don’t know 4.1.3 National guidelines on physical activity. Policy Action 4.1 Strengthen policy frameworks, leadership and governance systems, at the national and subnational levels, to support implementation of actions aimed at increasing physical activity and reducing sedentary behaviours, including multisectoral engagement and coordination mechanisms; policy coherence across sectors; guidelines, recommendations and actions plans on physical activity and sedentary behaviour for all ages; and progress monitoring and evaluation to strengthen accountability. Baseline Available in 194 countries. Trend data available for youth and adults from 2013. For children under five years of age from 2019 when added as new question. Note Limitation: This analysis does not look into detail on recommended frequency, duration, type and intensity. Document analysis of submitted document is necessary for quality of guideline. St ra te gi c ob je ct iv e 4: A CT IV E SY ST EM S 24 Metric % of countries with national target(s) for physical activity. Definition The country has national target(s) for population level physical activity in one or more age groups or stated population groups. Data source WHO NCD CCS. Completed every two years by country representative. Questions NCD CCS Module II - 2 and 2a Q2. Is there a set of time-bound national targets for NCDs based on the 9 voluntary global targets from the WHO Global Monitoring Framework for NCDs? Yes No Don’t Know    If Yes: 2a) Is there a set of national indicators for these targets based on the indicators from the WHO Global Monitoring Framework for NCDs? Yes No Don’t Know    If Yes – document content analysis For these countries, secondary document analysis was undertaken to extract from provided link the physical activity target. Where present PA target extracted. Computation If PA target present = Yes If not, = No Baseline Available in 194 countries. Trend data on NCD targets available from 2013. Content analysis and data extraction of PA target available from 2019. Note - 4.1.4 National physical activity target. Policy Action 4.1 Strengthen policy frameworks, leadership and governance systems, at the national and subnational levels, to support implementation of actions aimed at increasing physical activity and reducing sedentary behaviours, including multisectoral engagement and coordination mechanisms; policy coherence across sectors; guidelines, recommendations and actions plans on physical activity and sedentary behaviour for all ages; and progress monitoring and evaluation to strengthen accountability. Metric % of countries with present and operational NCD multisectoral commission, agency or mechanism. Definition Country has a national multisectoral commission, agency or mechanism to oversee NCD or physical activity specific engagement, policy coherence and accountability of sectors beyond health. Data source WHO NCD CCS. Completed every two years by country representative. Questions NCD CCS Module I-Q4 and Q4a Q4. Is there a national multisectoral commission, agency or mechanism to oversee NCD engagement, policy coherence and accountability of sectors beyond health? Yes No Don’t Know    If No: go to MODULE II 4a) Indicate its stage: Operational   Under development   Not in effect   Don’t know Computation YES YES, and operational NO Baseline Available in 194 countries. Trend data available from 2013. NOTES Limitation: The question is within the context of national coordination and multi sector engagement in NCD management and prevention – it is not specific to physical activity. Secondary questions and submitted documentation provide details on membership and structure. 4.1.5 National coordination mechanism for NCD. Policy Action 4.1 Strengthen policy frameworks, leadership and governance systems, at the national and subnational levels, to support implementation of actions aimed at increasing physical activity and reducing sedentary behaviours, including multisectoral engagement and coordination mechanisms; policy coherence across sectors; guidelines, recommendations and actions plans on physical activity and sedentary behaviour for all ages; and progress monitoring and evaluation to strengthen accountability. St ra te gi c ob je ct iv e 4: A CT IV E SY ST EM S 25 Metrics % of countries with national surveillance on physical inactivity in children, adolescents and adults. Definition The country conducts national surveillance on levels of physical activity for: (i) children, (ii) adolescents, (ii) adults (≥ 18 years). Data source WHO NCD CCS. Completed every two years by country representative. Questions NCD CCS Module IIIB-Q4 Q4 Have population-based surveys of risk factors (physical inactivity) been conducted in your country for any of the following: Yes No Don’t Know    If Yes: 4c) Was there a survey on: Children Yes No Don’t Know Adolescents Yes No Don’t Know Adults Yes No Don’t Know Computation Yes if Q4 = yes No if Q4 = no or don’t know Computation for each age group Yes if Q4c(for age gp) = yes No if Q4c (for age gp) = no or don’t know 4.2.1 National surveillance on physical activity. Policy Action 4.2 Enhance data systems and capabilities at the national and, where appropriate, subnational level, to support: regular population surveillance of physical activity and sedentary behaviour, across all ages and multiple domains; development and testing of new digital technologies to strengthen surveillance systems; development of monitoring systems of wider sociocultural and environmental determinants of physical activity; and regular multisectoral monitoring and reporting on policy implementation to ensure accountability and inform policy and practice. Baseline Available in 194 countries. Trend data available for surveillance in youth and adults from 2013. NOTES - For further information, contact: Department of Health Promotion World Health Organization 20 avenue Appia 1211 Geneva 27 Switzerland Website: https://www.who.int/