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Políticas de alimentación y actividad física para la prevención de la obesidad infantil y enfermedades crónicas en América Latina Rafael Pérez-Escamilla, PhD Profesor de Salud Pública y Director, Programa de Salud Global Escuela de Salud Pública, Universidad de Yale, EUA rafael.perez-escamilla@ yale.edu twitter: @rperezescamilla 2
Declaración de Intereses: Trabajo financiado por el Centro Fogarty de los Institutos Nacionales de Salud de los EUA (NIH) No tengo ningún interés que declarar 3
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Obesity prevention policies case studies Excise taxes on sugar sweetened beverages and energy-dense foods (Mexico) Trans fatty acids removal from processed foods (Argentina) Front-of-package food label legislation (Chile and Ecuador) Ciclovías recreativas or open streets (Several LA Cities) 5
Methods Obesity prevention policies case studies Developed with an expert in the specific policy Policies selected based on level of implementation, visibility and potential impact to reduce childhood obesity Case studies coded to identify components that explained successful implementation and sustainability using the Complex Adaptive Health Systems framework (Paina & Peters 2012) Iterative consensus process among co-authors 6
Why taxes? Evidence informed policy e.g., tobacco experience Time bound congressional process for fiscal packages Public pays attention to taxes Fast implementation with short term results Evidence-based advocacy Lobbying; mass media campaigns Engagement from Ministry of Finances Political support SSB s Tax- Mexico Enabling factors 7 Key milestones 2013: Senate approval 2014: Tax implemented MX$1 per liter Non-alcoholic SSBs Findings MX$18 billion from SSB tax revenue in 2014 Soda price & consumption (INSP 2015) Policy Research INSP (SSB s price elasticity; SSB sobesity/diabetes models) Data driven policy statements INSP Academy of Medicine
Food Labeling & Advertising Law- Chile Why FL & advertising? Evidence informed policies FL use associated with improved dietary quality (Pérez-Escamilla) Marketing to children influences unhealthy food and beverage consumption in children (IOM) Key milestones 2007: First bill introduced 2012: Congress approves law 2015: Implementation policy developed 2016: Implementation starts Political champion Academic champion Civil society champion High level political support Enabling factors Compromise with food industry FOP label Infant formula marketing Junk food at universities 8
Trans Fatty Acids elimination- Argentina Why TFA elimination? Evidence informed Industrial TFA s cause CHD Industrial TFA s concentrate in processed foods Oils and fats produced by just a few companies in Argentina Technically feasible (international experience, e.g. Denmark) Academic champion (data) Government Food industry & distributors Universities & scientific societies 9 Key milestones 2004: Voluntary reduction 2006: Mandatory FL 2006: Multisectoral dialogue 2010: Targets and timeline set 2014: New regulation enforced 2015: Monitoring of regulation implementation by Argentina s FDA Enabling factors Predictive model of CHD savings as a result of policy implementation sensitivity analysis
Ciclovias Recreativas- Colombia Why ciclovias recreativas (CRs)? Evidence informed Sedentarism causes premature disability and death Car traffic/congestion causes pollution and high stress levels Builds social capital Technically feasible 350 CRs in the Americas 10 Key milestones 1970: First ciclovia in Bogota 2015: More than 100 km of car-free streets Sunday event: one million people Enabling factors Strong public support Cost-effectiveness studies Reaction to car-centered urban development LA and beyond Attractive to politicians Program process evaluations Mayor s Recommended PA program along the CR corridor
Cross-cutting Enabling Factors Champions Evidence based advocacy Political will & support Legislative process Intersectorial dialogue/coordination Strong representation from civil society Research & Evaluation (i.e. data) 11
Bradley, Curry, Pérez-Escamilla et al. (2012) 12
Source: Diaz del Castillo et al. (2013) How did this innovation spread happen? Evidence/know how + civil society + political will 13
Feedback loops occur when an output of a process within the system is fed back as an input into the same system. A central feature of al case-studies reviewed was the importance of overcoming or preventing onset of negative feedback loops or resistance with positive feedback loops or facilitators Examples: Mexico: media campaign orchestrated by El Poder del Consumidor to counteract soda companies scare tactics Mexico: INSP evidence-based policy briefs to counteract industry lobbying of legislators to reduce or repel the SSB s tax Chile: Reaching a compromise with food industry to be able to implement modified FL & marketing law Argentina: Multisectoral dialogue to understand different stakeholder s concerns to prevent negative feedback loops from slowing process 14
Emergent behavior refers to the spontaneous creation of order, which appears when smaller entities on their own jointly contribute to organized behaviors as a collective All four case studies are good examples of the CAS perfect storm that is needed to happen for obesity prevention/ reduction policies to be implemented successfully 15
Phase transitions occur when radical changes take place in the features of system parameters as they reach certain critical or tipping points Source: Diaz del Castillo et al. (2013) Scientific evidence and evaluation played an important role in achieving tipping points for policies' launch and sustain effective implementation. 16
Same policies may need very different strategies to get them of the ground and then my follow very different policy articulation and implementation patterns that are context specific (path dependence) Examples: FL legislation in Chile vs. Ecuador (Lutter) SSB s taxes in Mexico vs. Berkeley CA (Falbe et al. 2015) Ciclovias in Bogota vs. Mexico City Chile Ecuador 17
Conclusions Implementation of evidence-informed anti-obesity policies gaining momentum in Latin America Translating science into policy is a highly complex multi-directional non-linear process (Pratt et al. Environment & Behavior 2015) Need for multisectoral coordination of evidence-based policies that enable environments conducive to healthy lifestyles (change the default) CAS scaling up frameworks needed to objectively assess readiness for and progress with implementation of national evidence-informed anti-obesity policies Key goal: Shorten amount of time it takes for effective anti-obesity policy implementation to happen 18
From Chile to Canada and beyond! New regulations, which corporate interests delayed for almost a decade, require explicit labeling and limit the marketing of sugary foods to children. New York Times https://www.nytimes.com/2018/02/07/health/obesitychile-sugar-regulations.html 19
Gracias! twitter: @rperezescamilla 20