Issue No. 10 [2011]
PAHO, Catalyst for Health in the Americas. Health: Our Most Basic Asset.
Jun 24, 2011
Nutrition, Obesity and Physical Activity in Maternal and Child Health
Nutrición, Obesidad y Actividad Física en la Salud Materna e Infantil

"Obesity is a disease in its own right, as well as a critical risk factor for other Non-Communicable Diseases (NCDs), which are the greatest cause of premature deaths and disabilities in the World. Its prevalence and incidence, at the global level and particularly in the Region of the Americas, show a sharp increase."

(Director, PAHO)

Washington, DC. 15 Jun 2011.
Opening Remarks. Plenary session. Regency Ballroom.

PAHO Director's presentation address two main topics as the "core" message, which are two critical elements that have a relevant impact in the way health systems and society effectively address the problem of nutrition, obesity and physical activity in maternal and child health.
  • Obesity is a problem in both, developed and developing countries, but specially in poor population.
  • The need for a renovated approach in Prevention.

"The Economist", Edition (13-19 Dec 2003).

"Worldwide obesity has more than doubled since 1980. In 2008, (20 and older population): 1.5 billion were overweight and 500 million Obese (60% women). In 2010, 43 million children were estimated to be overweight and/or obese and 92 million were at risk to become overweight. Trends are that the worldwide prevalence of overweight and/or obese has increased dramatically, from 4.2% in 1990 to 6.7 % in 2010 and is expected to reach 9.1% (60 million) in 2020.

In Latin America and the Caribbean (LAC) the prevalence of overweight and/or obese under 5 yr- is 6.9% (3.6 million). Caribbean: 6.9%; Central America: 7.2% ; South America 6.8%. "

  • Obesity is a problem in both, developed and developing countries, but specially in poor population.

By definition, obesity is an excess of body weight due to an excessive accumulation of fat, which results from a positive energy balance over a given period of time. The energy balance equation depends on two components: energy intake (Food) and energy expenditure (Physical Activity), the so-called "big two." Any factor that increases energy intake and/or decreases energy expenditure may lead to obesity.

There are multiple biological, environmental, economic and social factors that influence both components. Increases in obesity and other NCDs among the poor are not only due to a poor diet and insufficient physical activity, but also to a series of factors systematically associated with poverty. These adverse social and environmental factors generate early episodes of malnutrition (in the prenatal or in the early post-natal phase), which in turn lead to adaptative metabolic changes for increasing the capacity for survival...

Early malnutrition and the current epidemic of NCDs, including obesity, constitute a "continuum." They should not be regarded as opposites or as independent elements. These findings are supported by studies in the United Kingdom, the Scandinavian countries, and the Netherlands, as well as by a study of western Guatemala.

The new approach: Developing countries should also regard the prevention of malnutrition as a pillar in the prevention of obesity and other NCDs. This fundamental prevention, directed at the determinants of these diseases, should be provided throughout the life course, beginning with conception and the pre-gestational stage (Study cases of Peru, and Brazil).

  • The need for a renovated approach in Prevention.

The actions carried out so far to control obesity have not been successful, as it is expressed by the increase of the incidence and prevalence of obesity. The majority of interventions have been curative actions, and secondary and tertiary preventions, focus to the early and late stage of disease, respectively. On the other hand, primary prevention, based on Lalonde´s notion of "population at risk", has been a very useful tool to tackle the problem for a given population. It proposed that public health interventions should focus attention on that segment of population with the highest level of risk exposure as indicated by health risk behaviours, based on an analysis of the major causes of obesity and the underlying reasons for its occurrence...

Journal of Developmetnal Origins of Health and Disease. Cambridge University.

A limitation of the primary prevention of obesity is that it focuses mainly on behaviours such as physical activity and or diet with less attention to the social and environmental contexts that facilitate and sustain certain behaviours or detract from others. It becomes increasingly obvious that preventing obesity will require more much attention to factors operating at a higher level of organization. Furthermore, the behavioural factors associated to obesity cannot be fully understood in isolation of the social environment in which they are embedded.

Primordial prevention is the avoidance of the emergence and establishment of the socio-economic and cultural patterns of living that contribute to an elevated risk of disease.

A life course approach to primordial prevention is crucial and consists in ensuring the conditions that promote optimal nutrition and care since conception and pre-gestational stages during pregnancy and infancy and throughout lifespan...

Summing-Up: There are 3 levels of interventions:
(a) General Population, acting upon the social determinants of health (primordial prevention) but giving special attention to vulnerable populations;
(b) Population at risks (primary prevention), in which the health sector is the main actor; and,
(c) The clinically obese, who requires a systematic secondary and tertiary prevention to reduce the risks and reduce premature deaths, co-morbidities, complications and to improve their quality of life.

Read more:
- Director's News & Releases

GHC. Global Health TV. Plenary Discussion:
- Nutrition, obesity and exercise in maternal and child health

PAHO Press Releases:
- Preventing obesity requires interventions throughout the life course and across sectors
- Enfoque para prevenir obesidad debe abarcar todo el curso de vida y ser multisectorial

- Pan American Conference on Obesity in Aruba Commits to Supporting Policies to Address the Problem

PAHO: taking concrete actions to address nutrition, obesity and physical activity in the Americas

Global Health TV Interviews PAHO Director

Mirta Roses Periago (Director, PAHO)
[Washington, DC. Global Health Council. 15 Jun 2011]
Global Health TV.

The Director of the Pan American Health Organization, Conference Co-Chair of the plenary session on Nutrition, Obesity and Physical Activity in Maternal and Child Health discusses with Global Health TV the link between obesity and poverty in the developing world.

- Interview by Global Health TV

"Adequate nutrition is a key determinant of health throughout the life-course beginning in the pre-natal phase, throughout childhood, adolescence, adulthood and in the later years of life." - stated Dr Roses.

Adequate nutrition plays a key role in improving maternal and child health

We know through scientific evidence that malnutrition or inadequate nutrition significantly affects maternal and child health. Adequate nutrition intake during pregnancy is essential to promote a variety of adaptative mechanisms for survival of the fetus. Thus, poor nutrition affects fetal development and early childhood development, and the magnitude of this impact depends on the extension (in time) of the severity of the nutritional imbalance. Stunting and poor growth are examples of the impact of inadequate nutrition on child health.

Malnutrition in childhood impairs normal growth and development, affecting a broad variety of human functions such as the capacity of learning, physical performance, and the physical work capacity.

Increasingly, obese children are being diagnosed with a range of health conditions previously seen almost exclusively among adults, including high cholesterol, high blood pressure, type 2 diabetes, sleep apnea and joint problems.

Malnutrition in early life also has an impact on one's health later in life. It is associated with premature death, infectious diseases, a higher risk of NCDs (particularly diabetes), reduced lifespan, functional impairments and poorer quality of life.

Thus, maternal and child health strategies need to include promotion of healthy eating and adequate nutrition throughout the lifecourse as integral public health interventions.

Read more:
- Director's News & Releases

GHC. Global Health TV.
- PAHO Director Interview by Global Health TV

A conversation with Dr. Mirta Roses Periago

Mirta Roses Periago (Director, PAHO)
[Washington, DC. 15 Jun 2011]
EVENT. Hampton Room

The accidental doctor

Dr. Mirta Roses is considered by many as the voice of public health in the Americas, but her path to PAHO was not as obvious as one might expect. In fact, she almost did not become a doctor.

Dr. Roses, who is currently serving her second term as PAHO director, gave some insight into her life and career at a session of the annual meeting of the Global Health Council on 15 June, during an informal chat with the council's president and CEO, Jeffrey Sturchio. Speaking about her choices when it came time to pick a specialization as a 16-year-old high school student, she said she faced a major dilemma because "I liked everything," including arts, literature, languages and science. But her best friend was going into medicine so she decided to follow.

Read more:
- A conversation with Dr. Mirta Roses Periago
- La médica accidental

Multisectoral Linkages in the Context of Addressing Noncommunicable and Chronic Diseases (NCDs)

Mirta Roses Periago (Director, PAHO)
[Washington, DC. 16 Jun 2011]
PANEL. Regency Ballroom

- Addressing the problem of chronic noncommunicable diseases requires action from multiple sectors
[PAHO Press Release]

"In the current Public Health arena, our great Challenges is to address Intersectoral Action with greater Effectiveness" - Dr Roses.

"… lack of health care is not the cause of the huge global burden of illness; waterborne diseases are not caused by lack of antibiotics but by dirty water, and by the political, social and economic forces that fail to make clean water available to all; heart disease is not caused by a lack of coronary care units but by the lives that people lead, which are shaped by the environments in which they live; obesity is not caused by moral failure on the part of the individuals but by the excess availability of high-fat and high-sugar foods. Therefore, the main action on social determinants of health must come from outside the health sector."

(WHO Commission on the
Social Determinants of Health, 2009)


Under this well understood principle, Dr Roses addressed three main issues:

  • The call to revisit the concept and practice of multisectoral approach is critical today in spite of many historical efforts.
  • The demands that intersectoral action poses on the functions of the Ministries of Health and implicitly, on the institutional arrangements required to discharge these functions.
  • The urban setting as a space of opportunity to address the determinants of non-communicable diseases (NCDs).

"Action beyond the health sector has been at the core of public health achievements. Effective actions on malaria, nutrition, and many other conditions depended on our ability to convey a clear message to others and bring them onboard to make them aware of their great contribution to health.

Globally, never in the history of Public Health has the burden of disease been dominated by NCDs and Injuries as it is now, addressing such burden of disease depends on our ability to mobilize other actions of the society for health. Take the greatest world burden: the management of non-communicable diseases, their causes, including the global shifting patterns of consumption, work, play, urbanization, lies outside the Health Sector, there is no other way to combat such diseases..."

PAHO Director calls for a greater coherence and innovative forms of governance to establish and achieve shared goals through integrated responses. Moreover, the magnitude of the current and future challenges calls for a whole of government approach to the issues, with increased accountability across government agencies but one that includes social actors in the prevention and control of NCD risks and the promotion of protective factors.

It is only through collaborative work that we can make upstream interventions that can actually modify the social determinants of health, and contribute to the creation and sustainability of environments conducive to stronger personal, family and community assets. This is our basic health promotion strategy.

Read more:
- Director's News & Releases

PAHO Press Releases:
- Addressing the problem of chronic noncommunicable diseases requires action from multiple sectors
- Enfrentar el problema de las enfermedades crónicas no transmisibles requiere la acción de múltiples sectores y no sólo la salud

- U.N. High-Level Meeting on Non-communicable Diseases (PAHO)

Bridging policy and practice: balancing high-level meetings and individual health needs

Mirta Roses Periago (Director, PAHO)
[Washington, DC. 17 Jun 2011]
Closing Remarks
Regency Ballroon

UN Meeting on Noncommunicable Diseases is the Next Challenge, Experts Agreed at Global Health Council Conference

Closing the 38th Annual Conference of the Global Health Council, Dr. Mirta Roses—co-chair of this year's event—analyzed and discussed the challenges that lie ahead. She and other experts agreed that the upcoming UN High Level Meeting on Noncommunicable Diseases presents an opportunity to raise awareness of this importance issue and to mobilize action to address it.

UN NCDs Summit is a crucial turning point in the world's awareness and commitment to confronting this epidemic and for achieving health for all.

During her speech, PAHO Director highlights the importance of the UN High-level meeting on NCDs, which will lead to a series of political commitments from Heads of State, in the form of an action oriented outcome document. This will place NCD prevention and control on the global development and economic agendas. And overall, we can expect that the UN High-level meeting on NCDs, will lead to:

  • Greater awareness among world leaders of the social and economic development implications of NCDs, particularly for the poor.
  • Inclusion of NCDs as a development priority of the UN agenda since it is impacting already the growth potential of developing countries.
  • A changed perception that NCDs are much more than a health problem and therefore warrant responses by all sectors, beyond the health sector.
  • Increased commitment by international organizations for financial and technical support to countries, acknowledging the urgency of having NCDs included as part of their agendas.

PAHO, as the WHO regional office of the Americas, is committed to follow up on the decisions, which will emerge from the UN HLM on NCDs. We will continue working with our constituents, namely the Ministers of Health in the Americas and partners, to catalyze and support the translation of the UN outcome document to policy and practice. First, and foremost, we will continue to advocate for NCDs, with policy makers and leaders and working with our civil society networks such as the Healthy Caribbean Coalition and the Healthy Latin America Coalition. We will host a ""Wellness Week' initiative at the time of the UN HLM in New York City and other cities, as a public awareness and advocacy effort to call attention to health and wellbeing and to celebrate, on an annual basis, NCD prevention and control.

Our priority will be to focus on prevention of risk factors and the ''policy wins'', such as implementing the Framework Convention on Tobacco Control; giving special attention to childhood obesity; supporting regulations and restrictions for alcohol and marketing foods to children. We are actively using new social media opportunities to engage the public and raise awareness about NCD prevention and control, and I'm happy to say that our PAHO facebook page on NCDs has already established thousands of users.

Primary health care is a main priority, and we will continue to work with Member States on models of health care for NCDs that are more people-centered, comprehensive and integrated through the development of Integrated Health Service Delivery Networks based on a strong Primary Health Care foundation.

Given that no one organization can do it alone, PAHO will be working through an innovative partnership platform which we have established with public-private partners, named the Forum for Action on Chronic Diseases. An emphasis in its first year will be on having mass media campaigns to promote health and wellbeing in the Americas.

In the days leading up to, and following the UN HLM, it will be important for all of us to catalyze the momentum across all sectors. I hope all of you members of the Global Health Council community can take part in making the UN HLM on NCD a crucial turning point in the world's awareness and commitment to confronting this epidemic and for achieving health for all. - Dr Roses concluded.

Read more:
- Director's News & Releases

PAHO Press Releases:
- UN Meeting on Noncommunicable Diseases is the Next Challenge, Experts Agreed at Global Health Council Conference
- Reunión de la ONU sobre enfermedades no transmisibles es el próximo desafío, coinciden los expertos en el Consejo Mundial de la Salud

- U.N. High-Level Meeting on Non-communicable Diseases (PAHO)

Global Health Council (GHC)
Annual Conference 2011

Consejo Global de Salud 2011

Washington, DC. 13-17 Jun 2011.


Tuesday, 14 Jun 2011

- Addressing the policy implications of drug resistance
- Marcos Espinal, (NCD, PAHO)
Stop TB Partnership
Executive Room. (3:30 - 5:00 pm)
- Regional NCD assessments: LAC, Europe and Eurasia
- Silvana Luciani (NCD, PAHO)
Situation Analysis of Cancer in Latin America and the Caribbean
Executive Room. (5:15 - 6:15 pm)
- Health in the 'green' economy: leveraging big gains for chronic disease prevention at no cost to health systems
- Luiz A. C. Galvao (SDE, PAHO)
Congressional Room. (7:00 pm - 9:00 pm)

Wednesday, June 15

- The importance of nutrition, obesity and physical activity in maternal and child health
- Mirta Roses Periago (Director, PAHO)

Plenary session. Regency Ballroom. 8:30 - 10:00 am
- A conversation with Dr. Mirta Roses Periago
- Mirta Roses Periago (Director, PAHO)

Hampton Room. (5:15 - 6:15 pm)

Thursday, June 16

- Multisectoral linkages in the context of addressing noncommunicable and chronic diseases
- Mirta Roses Periago (Director, PAHO)

Regency Ballroom. (8:30 - 10:00 am)
- Leveraging wireless technologies to improve health information flows
- Marcelo D'Agostino (KMC, PAHO)

Empire Room. (3:45 - 4:45 pm)

Friday, June 17, 2011

- Policy track: the road to the High Level Meeting on NCDs
- James Hospedales (NCD, PAHO)

Palladian Room11:00 am - 12:30 pm
- Bridging policy and practice: balancing high-level meetings and individual health needs
- Mirta Roses Periago (Director, PAHO)

Closing Remarks. Regency Ballroom. (12:45 - 2:15 pm)


PAHO at the Global Health Council Gallery

(Photo © PAHO/WHO Photography. David Spitz)

- PAHO's Gallery
- PAHO Director's Gallery


Global Health Council
Annual Conference 2011

- (GHC) Annual Conference on Global Health
- Global Health TV: Interviews, Conferences
- Annual Awards Presented by the GHC

The Global Health Council is the world's largest membership alliance dedicated to saving lives by improving health throughout the world.
PAHO Latest Events
148th Session of the Executive Committee of PAHO/WHO

Washington DC. 20-24 Jun 2011.

PAHO's Executive Committee Reviews Public Health Priorities for the Americas

(Photo © PAHO/WHO - Photography)

The 148th session of the Executive Committee of the Pan American Health Organization (PAHO/WHO) at the headquarters of the Regional Office for the Americas of the World Health Organization (PAHO/WHO) reviews and discuss several initiatives that will be endorsed in September by all of the Ministers of Health of the Americas at the annual meeting of the Directing Council.

During this session PAHO discussed important health strategies, plans and resolutions to improve public health in the Region. Public health strategies in which PAHO plays a leadership role along with the countries' Ministries of Health to improve the health of the people of the Americas among others important technical, administrative and financial matters aiming to strength the Organization performance.

Key health issues:

  • Strategy and Plan of Action on Urban Health;
  • Strategy and Plan of Action on Climate Change
  • Plan of Action on Road Safety
  • Plan of Action to Reduce the Harmful Use of Alcohol
  • Plan of Action on Psychoactive Substance Use and Public Health
  • Strategy and Plan of Action on Epilepsy
  • Strategy and Plan of Action for Malaria
  • Plan of Action to Accelerate the Reduction of Maternal Mortality and Severe Maternal Morbidity
  • Strategy and Plan of Action on eHealth
  • Progress Reports on Technical Matters: Immunization; Public Health, Innovation, and Intellectual Property; WHO Framework Convention on Tobacco Control; Implementation of the International Health Regulations (2005); Millennium Development Goals in the Region of the Americas; Pan American Centers

More information about the sessions, strategies, resolutions and main documents:
- PAHO Governing Bodies »

- Click to see our gallery
(Photo © PAHO/WHO - Photography)

PAHO Executive Committee is made up of nine Member States elected by the Conference or Directing Council to serve for alternate three-year periods. The Committee, which meets twice a year, acts as a working group for the Conference or the Directing Council. The Director of the Bureau can convene special meetings of the Committee either on his/her own initiative or in response to a request by at least three Member Governments. The Committee has an auxiliary Advisory body, which is the Subcommittee on Program, Budget, and Administration.


PAHO Briefing Session to OAS Permanent Council
DIRECTOR's Briefing
to the OAS Permanent Council

Briefing session on PAHO’s Executive Committee Meeting to the Ambassadors to the Organization of American States (OAS) and other PAHO Members States. Dr. Mirta Roses, director of the Pan American Sanitary Bureau (PASB) presents currently health, administrative, financial and technical issues under discussion for the next session of the Executive Committee, as the Health Specialized Agency of the Inter-American System.

- PAHO Director briefing presentation to OAS Ambassador Permanent Council [PPT] »

- See on SlideShare »


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