VOICE OF THE
WORKERS ISSUE 33 AUGUST 2014
Contents Dragging the Fat
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Promoting the Healthy Choice 03 Obesity kills millions and costs billions
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The Obesity Issue
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The Obesity Challenge Across Europe
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OBESITY THE POVERTY SYMPTOM Work is a human right. However, if we are to call ourselves a modern, European economy, we also need to talk about the right quality of work as a human right. This also equates with our general quality of life. We need to make sure that it is not only the supply of work that is important, but also the conditions that make workers better, productive and happier people. Naturally, workers’ personal health is paramount. This does not just include the provision of medical care when needed, but also disease prevention and the promotion of a healthy lifestyle. VOICE OF THE
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Unfortunately, many of us still take healthy lifestyles for granted. We all say that eating healthily, having plenty of exercise and a obtaining better work-life balance are important for our well-being; but our actions say otherwise. We seem to concentrate on the here and now aspects, rather than on future consequences. Unfortunately, many workers awaken to reality when illness and health troubles creep in. Most of us lead sedentary lifestyles. It starts from the home, and continues at the place of work. Many workers become quite literally couch potatoes,
EDITOR’S NOTE JOSEF VELLA walking only from bed to chair, to car seat, to office chair, back to car seat, to sofa and back to bed. The consequences on our health and sense of well-being are disastrous. We need to look forward and strive to change this culture. We need to work towards relinquishing being top of table when it comes to being overweight and obese. We have to start introducing best practice even at work, where more emphasis can be given to physical exercise and healthy eating. We need to encourage our restaurants to cut down on the generally high cost of a salad, and compensate by increasing the price of fatty foods. 1
EDITORIAL
Workers can introduce physical activity during lunch breaks, and encourage the use of stairs rather than lifts. Our canteens need to be encouraged to stock less of salty packets and fatty pastries, and offer more healthy and nutritious alternatives. We need to invest more in being creative in terms of making healthy food more attractive and accessible. What we sometimes overlook is the sheer cost of treating illnesses related to obesity, and the great
economic and social benefit of inducing the healthy lifestyle culture. The cost-benefit is heavily tipped towards the benefit. Yet, we are still a long way off.
advertising and the promotion of healthy eating habits and exercise, can go a long way in making this effort be more effective in the long run.
This effort needs to be urgent as well as holistic. We believe that there has to be a tripartite effort to tackle the serious issue of obesity in Malta. Government, employers, as well as unions, can work more together and move in the same direction. Better use of the media, including monitoring of
Celebrity chef Tom Colicchio once stated that “This is what people
don’t understand: obesity is a symptom of poverty.� Poverty is not just economic. It is also the absence of healthy lives. Measuring by this yardstick, Malta is in dire need to tackle this poverty issue. PICTURE STORY
Dragging the Fat Malta is chart-topping when it comes to obesity. Our small size, sedentary lifestyles, car culture and love of the wrong type of food, contribute to making us an obese nation and an obese workforce. This is having an adverse effect on our well-being, our productivity, our health, as well as on our pockets as a nation. Being successful in reversing this trend necessitates a culture change. If this culture change is not successful, Malta will pay a very high price individually, as well as collectively. The writing is on the wall. It takes all of us to succeed. VOICE OF THE
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INTERVIEW EDITORIAL
Promoting the Healthy Choice Interview with Dr Charmaine Gauci
DR GAUCI IS DIRECTOR, HEALTH PROMOTION AND DISEASE PREVENTION DIRECTORATE, AND CONSULTANT, PUBLIC HEALTH MEDICINE
To what extent is obesity a problem in Malta? The issue of overweight and obesity is a problem across all ages. Worldwide, at least 2.8 million people die each year as a result of being overweight or obese. More than half (52%) of the adult population in the European Union are overweight or obese. The prevalence of overweight and obesity among adults exceeds 50% in no less than 18Â of 27Â EU member states. The impact of obesity is very wide, both on the individual and also on the state. Obesity is a known risk factor for numerous health problems, including hypertension, high cholesterol, diabetes, cardiovascular diseases, respiratory problems (asthma), musculoskeletal diseases (arthritis) and some forms of cancer. Since obesity is associated with higher risks of chronic illnesses, it is linked to significant additional health care VOICE OF THE
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costs whereby it is estimated that around 7% of national health budgets across the EU are spent on diseases linked to obesity each year. How does obesity affect the lives of people at work? Obesity is associated with substantially increased rates of absenteeism from the place of work and reduced productivity while at work. It is noted from various studies that obese workers take more sick days, have longer duration of sick leaves and incur greater productivity losses than do non-obese workers. This Malta is with no exception facing this problem, with over 45% of children and 58% of adults being overweight or obese. The excess direct cost on the Maltese health service associated with overweight and obese individuals as compared with persons of normal weight is estimated to be nearly 20 million Euro per year (in
2008), accounting for 5.7% of total health expenditure. This estimate does not include expenses related to medication, surgery, ancillary services and loss of income. This amount increases to over 25 million Euro when private healthcare costs are included. What is being done to address this problem, and what do you suggest can be done at individual and at organisational levels, to control obesity, even during work? This issue has been of major concern and has led to the development of the Healthy Weight for Life strategy to be launched in 2012. This strategy identifies multi-sectoral areas for action which are effective and designed to lead to containment, halting and eventually reversal of the epidemic. This approach is crucial as changes need to be made to the living environment, which shift it from one that promotes weight 3
FEATURE STORY
gain (obesogenic) to one that promotes healthy choices and a healthy weight for all. The recommendations look into four main areas of action: 1. Promoting and supporting healthy eating 2. Promoting and supporting physical activity 3. Service delivery 4. Fiscal incentives In order to promote healthy eating, the following priority areas for action have been identified: • To improve the availability and uptake of a healthy diet by the Maltese population through healthy public policies across Government. • To work with stakeholders on consumer education about healthy eating and moderation as underlying principles of healthy eating. This is done through various initiatives in various settings including the community (outreaches, media, talks in various places), workplaces and schools. • To promote exclusive breast feeding for the first six months of life and to
continue breastfeeding in the first years of life. Various campaigns are done each year, communities and workplaces are encouraged to set up initiatives to promote, protect and support breastfeeding including breastfeeding rooms. This year we launched the national breast feeding policy for consultation. • To support pregnant women and new mothers to adopt healthy eating habits for themselves and their families through education and community initiatives. Educational opportunities across the lifespan are offered. • To support schools and families so that meals and snacks, including drinks, prepared for school aged children are nutritious and appetising, without being energy-dense and/or containing excess amounts of fats, trans-fatty acids, salt and sugar. • To regulate audiovisual advertising, such as advertising of unhealthy foods especially that directed at children. Currently adverts which are aired on TV are being
evaluated to develop a set of recommendations which will eventually be transposed in legislation to control such advertising. • To support schools to implement all the recommendations of the Healthy Eating Lifestyle Plan (HELP) document and to strengthen the Personal and Social Development (PSD) and Home Economics curricula as related to nutrition and healthy choices. • To set up a National Task Force led by the Ministry responsible for Health to develop action plans on the introduction of agreed mechanisms to reduce salt and sugar, limit saturated fat and eliminate transfat content in local food products. A national food consumption survey will be carried out which will inform on the food consumption patterns and hence guide to actions to be taken in respect of local reformulation and other actions. • To set up a Healthy Food Scheme using colour coding so that healthy food is easily identifiable.
The excess direct cost on the Maltese health service associated with overweight and obese individuals as compared with persons of normal weight is estimated to be nearly 20 million Euro per year (in 2008), accounting for 5.7% of total health expenditure
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FEATURE STORY
In order to promote physical activity, the following priority areas for action have been identified: • To increase physical activity through healthy public policies, so that the living environment is one that promotes healthy choices. • To implement the recommendation of three hours of physical activity weekly for all schoolchildren. Schools are being lobbied to increase the levels of physical activity. As from this upcoming scholastic year, all form 1 children will have 3 lessons of PE per week. Collaboration with schools is being sought to find ways how to further increase the levels of PE in schools at all levels. • To encourage children and parents to use a screen time log, reduce the number of hours of watching television, use of computer/video games to a maximum of two hours per day for children, and to encourage sit down meals as family time as opposed to TV dinners, whenever possible. Various camapiagns and intiatives carried out to promote more physical activity and less sedentary time. • To support Local Councils to increase the opportunities available for physical activity, including the use of legislation and enforcement to improve safety on the roads, availability of open spaces and increase walkability in built-up areas.
initiatives are proposed: • To increase and improve weight management and physical activity classes for adults. These classes are offered free of charge to all people who are overweight or obese. • To set up community initiatives such as cookery clubs and community gardens, focusing especially on lower socioeconomic groups and older persons. Cookery classes were piloted with a group of lower socioeconomic class • To increase and improve parentcraft and breastfeeding classes. • To provide training and guidelines to health professionals in primary care in order to improve the delivery of holistic advice and management on all issues related to nutrition, physical activity and weight management and ensure that it contains the same key messages. • To work with stakeholders to develop a national curriculum and certification for facilitators of weight management programmes. • To set up multi-disciplinary clinics for the management of excess weight in adults and children.
Possible economic measures which may act as motivators to healthy lifestyle choices are discussed. Feasibility studies on the introduction of sin taxes as well as incentives and subsidies for increased accessibility and affordability of healthy food are proposed. The actions taken are developed through a settings approach whereby focus is done in schools, the community and workplaces. There are a range of possible actions in the workplace. Some initiatives include programmes to incentivize weight loss and the maintenance of recommended body weight, encourage exercise, and promote healthy diets. All this should be supported by an enabling workplace environment whereby access to healthy food and exercise is available. The vision for actions related to obesity is to have a society where healthy lifestyles related to diet and physical activity become the norm and where healthy choices are easy and accessible to all, so as to prevent disease and prolong disability free years of life.
In order to support people with overweight and obesity, it is recommended to re orient the public health services to increase the importance of health promotion and disease prevention. The following VOICE OF THE
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MEUSAC
Obesity kills millions and costs billions The last three decades have seen the levels of overweight and obesity in the EU population rise dramatically, particularly among children. According to the results of the European Health Interview Survey published by Eurostat in 2011, the share of obesity in the population of the EU Member States varied between 8% in Romania to 24% in the United Kingdom, with Malta faring second on the higher end of the scale with 21%. Since 2002, the EU Council repeatedly called the European Commission and the Member States to develop actions in the fields of nutrition and physical activity. Eventually, in 2005, the EU Platform for action on diet, physical activity and health was set up to specifically address the health problems associated with
overweight and obesity across Europe. The Commission ‘Strategy for Europe on Nutrition, Overweight and Obesity-related health issues’, published in 2007, focused on integrated action to reduce the risks associated with poor nutrition and limited physical activity, while addressing inequalities across the Member States. It called for the integration of policies across the board - from food to consumer, sport, education and transport. Since the adoption of the White Paper, a High Level Group on Nutrition and Physical Activity has been set up to strengthen the role of governments in seeking European solutions to obesityrelated health issues through the sharing of knowledge and good practices in key fields such
as product reformulation and the re-designing of the physical environment. The latest initiative of the Group consists of an Action Plan on Childhood Obesity. Through its Public Health Programme, in place since 2008, the EU funds several initiatives on nutrition and physical activity. For the period 2014-2020, the Programme has a total budget of almost €450 million. On a national level, the Healthy Weight for Life Strategy for 20122020 was launched to address the trend towards increasing obesity and overweight in the Maltese population. The strategy aims towards a society in which healthy lifestyles become the norm and healthy choices are easy and accessible to all, so as to prevent disease and premature deaths.
MEUSAC 280 Republic Street, Valletta VLT 1112 Tel: +356 2200 3315 • Fax: +356 2200 3329 • Email: info.meusac@gov.mt www.meusac.gov.mt VOICE OF THE
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MCESD
The Obesity Issue Obesity is caused by excessive consumption of food when compared to an individual’s energy requirements. Obesity is regarded as a public health challenge for our country. Statistics reveal that in 2010 obesity caused more than 3 million deaths in Europe. Obesity leads to various social and economic problems which do not affect solely the individual concerned but society at large. Obese individuals might not be physically and mentally able to work and socialise with others and this might also lead to social exclusion amongst other problems. The major problem is that obesity affects individuals of all ages. Prevention of childhood obesity needs to be a European
and global priority since obese children are more likely to face heart and other chronic diseases as they grow older. Overweight children are more likely to have to face social problems. Further emphasis needs to be made on healthy eating especially with young children so that future generations are healthier. Hence the need to start with an educational campaign from an early age. Incentives for healthy eating at work and school need to be a priority. Extensive and further research is to be carried out so that the problem is understood and policies and actions are made accordingly. Prevention is essential in any future national policy on obesity.
Healthy eating and physical activity should be promoted as the only way to live. Policy makers and stakeholders need to act collectively to be effective. Furthermore they should lead by example as Ms. Madi Sharma, an EESC member, did. She was working on bringing about a collective effort at EESC level on obesity. The initiative was entitled “We have to stop the blame game and start working together”. She stated that the EESC should be in the frontline of the fight against obesity. Whilst she was working on this initative the EESC member herself lost 10 kilos so as to further encourage individuals with the obesity problem.1
1 Source: www.eesc.europa.eu MCESD 280/3, Republic Street, Valletta, VLT1112 Tel: (+356) 2200 3300 www.mcesd.org.mt VOICE OF THE
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CONFEDERAZIONE ITALIANA AGRICOLTORI
The Obesity Challenge Across Europe “Eat well – feel good”: Commission proposes to combine and reinforce existing school milk and school fruit schemes In January 2014 the European Commission published a proposal bringing together two currently separate school schemes, the School Fruit Scheme and the School Milk Scheme, under a joint framework. In a context of declining consumption among children for these products, the aim is to address poor nutrition more effectively, to reinforce the educational elements of the programmes and to contribute to fight against obesity. With the slogan “Eat well - feel good”, this enhanced scheme from farm to school will put greater focus on educational measures to improve children’s awareness of healthy eating habits, the range of farm produce available, as well as sustainability, environmental and food waste issues. www.youtube.com/watch?v=593vv4eanKM
EU Action Plan on Childhood Obesity 2014-2020 The European Commission has drafted in February- March an Action Plan to against Childhood Obesity in order to contribute to halting the rise in overweight and obesity in children and young people (0-18 years) by 2020. To achieve this goal, the active participation of a wide range of stakeholders is necessary. The Action Plan specifies a set of operational objectives that have been designed to guide the actions of stakeholders across eight priority areas. The actions were proposed by a number of Member States and provide a basis for countries to develop policy on tackling childhood obesity. The Full text of the document is available here: http://goo.gl/zaOChD Obesity Perception and policy Multi-country review and survey of policymakers 2014 Over the last few decades, rates of obesity have been rapidly rising, first across the developed world and, more recently, in developing countries. The health impacts can be myriad and serious, and the implications for individuals and for governments – including increasing health-care costs and falling economic output – are clear. Policymakers will be faced with the financial consequences of obesity – and they are well placed to take action to control the epidemic and its health repercussions. The European Association for the Study of Obesity (EASO), with C3 Collaborating for Health, commissioned a survey of policymakers’ attitudes towards and knowledge of obesity issues. It built on a successful survey of policymakers carried out in three countries in 2013 (England, Spain and the United States), extending it to a further eight (Brazil, Bulgaria, Canada, Denmark, France, Germany, Italy and Mexico). More information about the study are available here: http://goo.gl/uOXRRw
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TOOLS
VIDEO AND CAMPAIGN
Obesity is not just a national issue; it is also a European one. The Brussels Office of the Confederazione Italiana Agricoltori has compiled some initiatives taken at European level, including audio-visual campaigns and Policy information documents.
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