Translating public - private sector partnership in action for overweight and obesity prevention Mexico´s experience Workshop on Scaling up meaningful and successful industry engagement through convergent innovation PACO III, Aruba June 6, 2013

Background Obesity is one of the major public health challenges of the XXI Century From 1980 to this day, the prevalence in Mexico has tripled, and continues to grow at an alarming rate, especially among children. Obesity is the risk factor No. 1 for diabetes – 6.4 million Mexicans live with diabetes

Overweight and obesity prevalence according to age group 2 to 5 years old: slight increase from 7.8% in 1988 to 9.7% in % of children 5 to 11 years old are overweight and obese (19.8% overweight and 14.6% obese) 35% of adolescents, age 12 to 19, present overweight and obesity In adults, 73% of women and 69.4% of men are overweight and/ or obese Source: ENSANUT 2012

Strategic plan for healthy weight Source: Kickbush I., Healthy Societies: Addressing 21 st Century Health Challenges, 2008

What do we conclude from this? Both government and society must act to combat the epidemic of obesity The severity of the problem calls for the participation of different government sectors, civil society, private sector and individuals. National Agreement for Nutritional Health Strategy to Control Overweight and Obesity

Modification of the environment Change of conducts and habits (healthy diet, physical activity and plain water drinking) National Agreement for Nutritional Health

Objectives 1.Physical activity 2.Consumption of plain water 3.Diminish sugar and fats in drinks 4.Increase consumption of fruit, vegetables, whole grain cereals, legumes and fiber 5.Useful labeling and nutritional alphabetization 5.Breastfeeding 6.Reduce sugar and other sweeteners in food 7.Diminish saturated and trans fats in processed food 8.Reduce portion sizes 9.Reduce use of salt

Intersectorial participation Public sector Private sectorAcademia Levels of government

Dynamics of joint work Work with four most important chambers – to get them all engaged as one stakeholder; agreements to be respected by all members Workshops organized by Ministry of Health on technical level to define goals, actions and metrics Working groups organized depending on the specific topic for example: reduction of salt, elimination of saturated and trans fats, labeling, etc. and timeframe to meet the goal

Working groups rules In order to avoid rotation, it was agreed to have the same representative at all the meetings The discussion and arguments must be evidence based. All information on the topics discusses is strictly confidential. Agreements from each session were not reviewed or discussed again. The written report has been done at every session and signed by all attendees. At the end of the workshop, the report of most relevant conclusions and agreements was elaborated and communicated to all stakeholders.

Problems on the way…. For private sector to accept and agree that the main goal of collaboration is the health of the population and what actions need to be done to achieve it Technical discussions on definitions, nutritional criteria and concepts Obesity as individual responsibility and not multifactorial problem. It took lot of time and effort to overcome that barrier. Some issues on advertising of food and beverages to children, specially on regulation of the incentives and gifts that come with products Accountability and transparence of the actions

Food and beverages industry commitments Reformulate some of the products, innovate and elaborate new ones with less sugar, salt and fat Reduce portion sizes of their products Eliminate trans fats from all processed food products Adopt voluntary regulatory measures in marketing of food and non alcoholic beverages to children (Code PABI) Provide simplified and more understandable front labeling of their products in order to promote health literacy and informed decision making Promote healthy lifestyles, physical activity and healthy nutrition in every setting

 About 1750 new or reformulated processed food and beverages products in their content of calories, sugar, saturated and trans fats as well as sodium. Incorporation of whole grain, fiber, etc.  Higher availability of half skimmed and skimmed milk.  More understandable and easier to read front labeling “Look and choose”  Marketing campaigns on healthy life styles and physical activity promotion  Complete elimination of trans fats from processed foods.  Agreement to diminish salt in bread and bread products What was achieved?

Stage I (School year ). Total of products: 1920 Stage II (School year ) Total of products: 413 Stage III (Starting from school year 2012 Total of products: 336 Energy per portion <= 140 kcal Total fats <= ≤ 40% Energy per portion < = 130 kcal Total fats <= ≤ 40% Reduction of sugar, saturated and trans fats, sodium and fiber Energy per portion <= 130 kcal Total fats <= ≤ 35% More reduction of sugar, saturated and trans fats, sodium and fiber In school setting Guidelines on Nutritional Standards for Foods and Beverages offered in Schools

Lessons learnt Public private partnership is possible BUT: Health sector needs to safeguard its integrity and leadership during all the process It is important to develop clear guidelines and “rules of the game” during the negotiation and specific actions implementation Both partners should adopt constant clear and transparent accountability process Have strong agreement on shared responsibility of both sectors Develop and agree upon evaluation measures, and reporting

New challenges National Strategy for Prevention and Control of Overweight and Diabetes AND To ban products that “do not contribute to the nutrition of the school population”. To regulate traffic light color coding front labeling To ban the advertising of food and non alcoholic beverages that do not fulfill the established nutritional criteria Fiscal aspects to impulse dispositions for elaboration and distribution of food and beverages with low content of fats, sugars and sodium. Accessibility and availability of nutritional products Elimination of malnutrition in children Increase the purchase of products from local producers National Crusade against Stunting – Zero Hunger

WHO position on work with private sector “…But the industries that contribute to the rise of NCDs do (have front groups and lobbies). When public health policies cross purposes with vested economic interests, we will face opposition, well-orchestrated opposition, and very well-funded opposition. WHO will never be on speaking terms with the tobacco industry. At the same time, I do not exclude cooperation with other industries that have a role to play in reducing the risks for NCDs.” Address to the Sixty-sixth World Health Assembly, May 2013 Dr Margaret Chan, Director-General of the World Health Organization

Questions remain… Is it ethical for health sector to work with alcoholic beverages industry? What about infant formula industry? How do we overcome the conflict of interest working on obesity/ overweight strategy as well as on hunger elimination?

Ljubica Latinovic MD, MHA Deputy Director of Healthy Environments General Directorate of Health Promotion Ministry of Health, Mexico