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World Health Organization and Physical Activity

Vuori, Ilkka MD, PhD

Progress in Preventive Medicine: March 2018 - Volume 3 - Issue 1 - p e0012
doi: 10.1097/pp9.0000000000000012
Original Research
Open

The World Health Organization (WHO) is a respected name as the global leader in the fight against critical health challenges such as malaria, tuberculosis, HIV, and noncommunicable diseases. Because of the great impact of WHO in influencing various health matters, there is wide interest and intensive effort to include new and important health issues in the working processes of WHO for acceptance to its agenda. One of these issues is promotion of physical activity to improve health. This article describes some key aspects of the structure and decision-making processes of WHO at mainly global level by examining the growth in the WHO’s emphasis on promoting physical activity over the last 5 decades. Initially, there was only weak and temporary interest in physical activity beginning in the 1960s, but currently, it is a topic that has warranted a comprehensive global action plan. The article comments on some of the key factors of this progress, including the increase during the 1980s and 1990s in the WHO’s emphasis on health promotion; the recognition of noncommunicable diseases as one of the main global health challenges in the 2000s; the widening of the understanding of the contents of and opportunities offered by physical activity for health; increased scientific evidence of the multiple benefits of physical activity to individual, population, community and environmental health, and persistent advocacy of a great number of leading researchers and established organizations around the world.

UKK Institute for Health Promotion Research, Tampere, Finland.

Published online 12 March 2018

Address reprint requests to Ilkka Vuori, MD, PhD, UKK Institute for Health Promotion Research, Jenseninkatu 19, 33610 Tampere, Finland. E-mail address: ilkka.vuori@uta.fi (Ilkka Vuori)

This is an open-access article distributed under the Creative Commons Attribution-NoDerivatives License 4.0 (CC BY-ND), which allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author.

The World Health Organization (WHO) is a large organization with complex structure, multiple functions, intricate working processes, and a staff of over 7,000 people. To understand the evolution of the focus on physical activity in the WHO, it is necessary to know the primary structure and decision-making processes of the WHO. These are thoroughly described on the web pages of the WHO,[1] but pertinent key aspects are described below.

The WHO is an organization in the United Nations’ system that directs and coordinates international health practice. WHO´s work is based on countries, and the organization has 194 Member States in 6 regions. This means that the primary work that is sanctioned and supported by the WHO and its regions is implemented primarily by member countries. WHO leads and supports the Member States and other partners in great part by producing health-related norms and recommendations, promoting collaboration, mobilizing partnerships, and galvanizing efforts of different stakeholders to respond to national, regional, and global health challenges.

WHO partners in a number of ways and levels with countries and the United Nations system. In order for WHO to acquire the expert knowledge, experience, and resources pertinent to various health-related issues, WHO engages with various nonstate experts and organizations to protect and promote public health. To strengthen these partnerships while at the same time protecting its work from potential risks and undue influence, WHO has adopted a framework of engagement with nonstate actors (FENSA). The framework sets out the rationale, principles, benefits and risks of engagement, and defines 4 groups of nonstate actors [nongovernmental organizations (NGOs), private sector entities, philanthropic foundations, and academic institutions and 5 types of interaction (participation, resources, evidence, advocacy, and technical collaboration)].

Currently, there are at least 4 organizations related to physical activity that partner officially with WHO: the Global Noncommunicable Disease Network (NCDnet), the EU Platform for Action on Diet, Physical Activity and Health (DPAS); the European Network for the Promotion of Health-Enhancing Physical Activity; and Pan-European Programme for Transport, Environment & Health. In addition, the WHO regions partner with a number of organizations.

In addition, the WHO uses the capacity of researchers and policy experts on advisory panels focused on specified topics. Currently, there are around 50 panels.

A third strategy for WHO to expand its capacity is its system of collaborating centers. These are institutions such as research institutes and parts of universities or academies, which are designated by the Director-General for specified tasks that support realization of the Organization’s programs. Currently, there are over 700 WHO collaborating centers in over 80 Member States. The first collaborating center working specifically on physical activity, designated in 1992, was the UKK Institute for Health Promotion Research in Tampere, Finland. There are, or have been 11 collaboration centers working at least partly on physical activity: 5 in Europe, 1 in the Americas, and 5 in the Western Pacific region.

Another strategy available for WHO to increase its capacity is through secondment assignment: temporary detachment of an individual from his or her regular workplace in an organization, for example, member state, research institute, or nongovernmental organization, to assignment with the WHO. The secondment is for specified expert tasks for a fixed period of time, under a tripartite agreement concluded by WHO, the releasing entity and the employee. Secondees return to the releasing entity at the end of their secondment. Although on secondment assignment, secondees are WHO staff members. All costs of the secondment position must be covered by the releasing entity.

WHO directs and coordinates international health efforts in several ways. It provides leadership on important health matters through partnerships with other organizations. Leadership priorities are defined in 6-year programs. Further, WHO shapes the research agenda related to health and stimulates the generation, translation, and dissemination of valuable knowledge. One of the key functions of WHO is to articulate ethical and evidence-based policy options related to health. Other functions of WHO include establishing norms and standards and promoting and monitoring their implementation, providing technical support, catalyzing change, building sustainable institutional capacity, monitoring the health situation, and assessing health trends.

There is a broad spectrum of issues and activities associated with the promotion of health, and WHO takes responsibility and action on many of them. This is clearly illustrated in the reports covering 10-year periods of WHO activities, for example, in the report “Ten years in public health 2007–2017.”[2] It is no wonder that WHO has found itself overcommitted and overextended. Even for mission critical tasks in the program of work, there has been only very limited access to human and other resources. This situation has led to an ongoing reform process aimed at establishing clear priorities, and better governance and management practices.

It is obvious that there is strong competition for prioritization among the many interests, ideas, agendas, and proposals from all over the world that are presented to the WHO. Much knowledge, discretion, diplomatic skills, influential relationships, networking, and perseverance is needed for success. To guarantee fair, equal, and transparent procedures, the WHO has adopted the FENSA mentioned above.

The supreme decision-making body for WHO is the World Health Assembly that consists of delegations from all Member States. The agenda for the Assembly is prepared by the Executive Board, which is composed of 34 members elected for 3-year terms. The members are technically qualified in the field of health. The main functions of the Board are to give effect to the decisions and policies of the World Health Assembly, to advise it and generally to facilitate its work. The functions and activities of WHO at the global and regional levels are proposed, handled, and decided by the World Health Assembly and the Executive Board.

The governance system of the WHO Regions corresponds to the main lines to that described above for the WHO as a whole. The Regions may have and also have their own priorities and programs according to their needs and resources.

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The functions of WHO related to physical activity

The main functions of WHO related to physical activity are listed below by decade. The list includes only functions that have had a global dimension and that have therefore been functions of the Headquarters in Geneva. Several functions have begun and developed, however, in the WHO regions.

1960s–1970s: Participation in and support of studies and projects related to the emerging serious health challenge, coronary heart disease, and its risk factors including physical inactivity, to assessment of physical activity and physical fitness, and to rehabilitation of patients with coronary heart disease.[3]

1980s: Health promotion developed into a major theme in WHO. The milestone was the approval of the Ottawa Charter[4] in 1986. Initially, the position of physical activity in health promotion was weak, but it grew gradually as a part of the development of the Active Living concept originated in Canada.

1990s: Establishment of the WHO Interdepartmental Committee on Physical Activity, Sports and Health in 1993, and designation of Collaborating Centers related to physical activity/sports in Australia, Finland, Great Britain, Hong Kong, Japan, and the United States. Joint statements were issued with the International Society and Federation of Cardiology on physical inactivity as a risk factor of coronary heart disease in 1993[5] and with the International Federation of Sports Medicine on the role of physical activity for health in 1994.[6] During this period, the Active Living concept developed into a global initiative.

2000s: The Global Strategy on DPAS[7] was developed and approved, and its implementation began in the member countries. The theme of the 2002 World Health Day was physical activity, and consequently the focus on physical activity lead to the annual Move for Health Day.[8] The WHO/United States Centers for Disease Control and Prevention consultation meeting on Physical Activity Policy Development produced a comprehensive physical activity policy framework[9] and other publications related to physical activity policy in the same issue of Public Health Reports.

2010s: The WHO issued Global Recommendations on Physical Activity for health in 2010.[10] In 2011, the United Nations General Assembly held a high-level meeting and adopted a far-reaching Resolution, Political Declaration on the Prevention and Control of Non-communicable Diseases” document A/66/L.1).[11] Consequently, in 2013 the World Health Assembly approved the Global NCD Action Plan for the Prevention and Control of NCDs 2013–2020.[12] In the Declaration and in the Action Plan physical inactivity was included as 1 of the major risk factors of NCDs. In 2017, the draft of the WHO Global Action Plan on Physical Activity[13] was drafted and opened for large process of commentary with the aim that in May 2018 the final draft will be considered by the Member States in the World Health Assembly.

In the following section, key aspects of the major WHO activities listed above are more thoroughly described and addressed from a perspective focused on physical activity.

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The WHO global initiative on active living

Considerable interest of WHO on physical activity aroused with the development of the health promotion concept, first in the European region in the 1980s and later on a global scale. Physical activity was seen by the WHO as 1 area of health promotion, a component of “Active Living.” A draft program on Active Living, “Physical Activity for Health” was written in the Division of Health Promotion, Education and Communication of WHO.[14]

The draft was evaluated and approved by a group of international experts at the Informal Meeting on Active Living in Geneva in 1997. The participants of the meeting recognized the added value in creating a partnership-based WHO Initiative on Active Living/Physical Activity for Health. The meeting resulted in a recommendation for the formation of a Consultative Group on Active Living, which would collaborate with WHO and support its actions. These were based on 5 objectives: to strengthen worldwide advocacy on physical activity for health; to provide support for the development of national policies, strategies, and programs; to help promote community programs and capacity building; to develop local, national, regional, and international support networks; and to foster the dissemination of current knowledge related to active living, and supporting the development of new knowledge.

The goal statement of the initiative reflected well the ideas of health promotion by focusing particularly on a new, large understanding of health and physical activity; public health and population health perspective; the social and mental health gains of physical activity in addition to its well-known biological benefits; higher level of integration of physical activity into everyday life leading to greater and better perception of its value and to increased opportunities for physical activity in both developed and developing countries; creation of supportive environments, particularly by establishing and/or strengthening links with professional and social organizations and groups; and creating new and/or strengthening existing partnerships, and enhancing intersectoral actions and sustainable advocacy initiatives.

The meeting also identified a set of priorities and possible actions including, for example, need for strong message from WHO, policy commitment at all levels of governance, working with “settings for health” (particularly healthy schools, healthy cities, and healthy villages), and working together with the Active Aging activities as part of the WHO Program of Ageing and Health. This program published the Heidelberg Guidelines for Promoting Physical Activity Among Older Persons in 1996 and organized a global walking event, Global Embrace, in connection with the World Health Day 1999 and the International Year of Older Persons.

In the latter part of 1997 ambitious but feasible strategies and activities were planned in the meetings of the National Policy Group hosted by Finland and of the International Consultative group held in Geneva. The Active Living Initiative was presented in the fourth International Conference on Health Promotion in Jakarta, Indonesia, as 1 of the 10 priority health promotion areas and most important future challenges. An important outcome was that sedentary behavior was included in the Conference Declaration as 1 of the demographic trends that threaten the health and well-being of hundreds of million people worldwide.

In 1998, the Workshop on International Standardization of Physical Activity Assessment for Public Health Purposes organized by WHO and United States Centers for Disease Control and Prevention in Geneva led to the development of the International Physical Activity Questionnaire.[15] The meeting on Promoting Active Living in and through Schools hosted by Denmark produced a policy statement and guidelines for action, and the meeting of the Active Living National Policy Network hosted by Canada produced a document on the purpose, goals, objectives, strategies, and guidelines for action for the network. In addition to the major activities, physical activity for health and the Active Living Initiative were advocated in a number of major conferences and other events, and some materials were produced.

During the next 2 years, the functions of the Active Living Initiative decreased gradually. The main reasons were lack of clear directions, support, and resources for the Initiative in WHO due to the lengthy period of temporary directorship of the Division of Health Promotion, Education and Communication after the resignation of the Director of the Division, and the change of focus of the activities of the newly organized unit, Social Change and Mental Health Cluster and the Department of Noncommunicable Disease Prevention and Health Promotion within it. The activities of the Active Living Initiative described above, the results of these activities as well the experience gained through the Initiative until the first part of 1999 is well summarized by Mr. Hamadi Benaziza, a health education specialist with long career in the service of WHO, in the document The WHO Global initiative on Active Living. Progress and Challenges.[16]

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Comment on the physical activity–related activities of WHO in the 1990s

Although the most productive life course of the Active Living Initiative remained short, it increased remarkably understanding and acceptance of physical activity for health and its promotion within and widely outside WHO. The initiative enlarged the view on the role and potential of physical activity as a societal factor, formulated and documented a wide array of necessary policies, strategies and actions for promoting physical activity for health. Further, the initiative led to the development of some permanent products such as the International Physical Activity Questionnaire, introduced physical activity as a function of some settings approaches promoted by WHO, and presented physical activity for health to a great number of former and new audiences. The work of the initiative also gave valuable experiences of the opportunities and challenges of physical activity promotion at various levels from local to global, led to contacts and networking of leading researchers and promoters of physical activity for health around the globe, and to a great number of contacts to influential professional and civic organizations. Much of what has been presented in the documents of the Active Living Initiative has been of use in later plans and strategies developed within and outside WHO as well as in realized programs and projects aiming at increasing physical activity for health at various levels.

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Global strategy on diet, physical activity, and health[7]

The next major phase in the activities of WHO related to physical activity was the development of the Global Strategy on DPAS. The starting point for this work was the resolution approved by the World Health Assembly in 2000 on WHO Global Strategy for Prevention and Control of Noncommunicable Diseases. This strategy emphasized integrated prevention of noncommunicable diseases by targeting 4 main risk factors: tobacco, unhealthy diet, physical inactivity, and harmful use of alcohol. An important document was also a report by WHO/Food and Agriculture Organization of the United Nations, which pointed out the risk to health caused by obesity and overnutrition, and their global role in causing ill-health.[17] Especially the draft of this document handled physical activity as a side-issue, but in the consultation process, this bias was partly corrected.

In 2001, the World Health Assembly included health promotion as a topic on its agenda. Health promotion was identified as a fundamental goal for public health. Several countries stressed the importance of healthy lifestyles and asked WHO to develop a global strategy for diet and physical activity to complement the work that is going on for tobacco control.

In 2002, the World Health Assembly mandated that WHO should formulate a Global Strategy on Diet, Physical Activity, and Health. One of the main grounds was the World Health Report 2002.[18] It presented alarming figures: mortality, morbidity, and disability attributed to the major noncommunicable diseases currently account for approximately 60% of all deaths and 43% of the global burden of disease, and are expected to rise to 73% of all deaths and 60% of the global burden of disease by 2020. A profound shift in the major causes of death and disease has already occurred in developed countries and is under way in many developing countries. The disease burden attributable to noncommunicable disease is already greatest and continues to grow in the developing countries.

The data of the World Health Report 2002 indicated also that the most important risk factors of noncommunicable diseases include high blood pressure, high concentrations of cholesterol, inadequate intake of fruits and vegetables, overweight and obesity, physical inactivity, and tobacco use. Five of these risk factors are closely related to diet and physical activity. Unhealthy diets and physical inactivity are thus among the leading causes of the major noncommunicable diseases. It was seen that there is unique opportunity to formulate and implement an effective strategy for substantially reducing deaths and disease worldwide by improving diet and promoting physical activity.

The development and approval of the Global Strategy was a multistage process including several rounds of consultations with stakeholders, Member States, United Nations agencies, civil society organizations, private sector, and with the public. From the beginning, physical activity was in a side role compared with diet regarding the basic documents and the number of experts used. The efforts to improve the position of physical activity in developing the strategy are described in detail by Bauman and Craig.[19]

The overall goal of the Global Strategy is to promote and protect health through healthy eating and physical activity by guiding the development of an enabling environment for sustainable actions at individual, community, national, and global levels.

The 4 main objectives of the Global Strategy are to reduce risk factors that stem from unhealthy diets and physical inactivity; to increase awareness and understanding of the influences of diet and physical activity on health; to develop, strengthen, and implement policies and action plans to improve diets and increase physical activity that are sustainable, comprehensive, and actively engage all sectors; and to monitor scientific data and key influences on diet and physical activity, to support research in a broad spectrum of relevant areas, including evaluation of interventions, and to strengthen the human resources needed in this domain to enhance and sustain health.

The strategies that will be used need to be evidence-based, comprehensive, multisectoral, multidisciplinary and participatory, and the strategies need to recognize the complex interactions between personal choices, social norms, and economic and environmental factors. The strategies have to include a life-course perspective, and they should be part of broader, comprehensive, and coordinated public health efforts. A number of issues need to be addressed simultaneously. Regarding physical activity, issues include requirements for physical activity in working, home and school life, increasing urbanization, and various aspects of city planning, transportation, safety, and access to physical activity during leisure. Priority should be given to activities that have a positive impact on the poorest population groups and communities. Evaluation, monitoring, and surveillance are essential components of such actions. National strategies and action plans should be culturally appropriate and sensitive to differences in physical activity and diet patterns according to sex, culture, and age.

The Strategy defines the responsibilities of various partners in its implementation. The main responsibility to implement the Strategy is on the Member States, and a great number of issues and tasks for the Member States is listed. According to the scope of this article, the responsibilities of WHO are described in more detail. WHO has to provide the leadership, evidence-based recommendations, and advocacy for international action. WHO has to support Member States in several areas including facilitation the framing, strengthening and updating of regional and national policies on diet and physical activity, in provision of guidance on the formulation of guidelines, norms and standards, in identifying and disseminating information on evidence-based interventions, policies and structures that are effective, and in using standardized surveillance methods and rapid assessment tools to measure changes in distribution of risk, and to assess the current situation, trends, and the impact of interventions.

In the follow-up and future development of the Global Strategy, the tasks of WHO include reporting on progress made in implementing the Global Strategy and in implementing national strategies, including information of patterns and trends of dietary habits and physical activity, evaluation of the effectiveness of policies and programs used, and constraints or barriers encountered in implementation of the Strategy and the measures taken to overcome them.

Further, WHO will work at global and regional levels to set up a monitoring system and to design indicators for dietary habits and patterns of physical activity.

In 2006, WHO published a document, Global Strategy on Diet, Physical Activity and Health: A framework to monitor and evaluate implementation.[20] The goals of the document are to provide an approach to measure the implementation of WHO Global Strategy on DPAS at country level, and to assist Member States to identify specific indicators to measure the implementation of DPAS at country level. The proposed framework and indicators aim to assist ministries of health, other government offices and agencies, as well as other stakeholders to monitor the progress of their activities in the area of promoting a healthy diet and physical activity. The document suggests a great number of indicators in a series of tables according to DPAS recommendations. This article is a valuable source of ideas, suggestions, and information not only for those monitoring the implementation of DPAS but for all those who are interested in or working on promoting healthy nutrition and physical activity for health.

WHO has supported implementation of the Global Strategy also by publishing a number of documents, for example, fact sheets and A Guide for Population-Based Approaches to Increasing Levels of Physical Activity[21] and Interventions on Diet and Physical Activity: What Works: Summary Report.[22] A background document Evidence Tables contains the information that resulted from a comprehensive review of literature. It can be accessed at www.who.int/dietphysicalactivity/what works.

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Move for health day and initiative

WHO had chosen physical activity as the theme of World Health Day 2002. The main event was the annual Agita Sao Paulo walk. Director General of WHO attended the event on invitation by the organizers. Altogether, 1987 events in 148 countries on 5 continents were organized. The messages of the Day were translated in 63 languages.

The success of the Day impressed not only the Director General but also the delegates of the World Health Assembly 2002, and it unanimously adopted a resolution[7] that committed all member states to celebrate the “Move for Health Day” each year to promote physical activity as an essential strategy for health and well-being. The same resolution also called for the development of a Global Strategy on DPAS for prevention and control of chronic noncommunicable diseases.

In the launch of the first Move for Health Day 2003 in Sao Paulo, the Director General of WHO emphasized that this event is to be seen as part of a larger “Move for Health” Initiative linked to the ongoing process to promote sustained population participation in physical activity in the context of an integrated approach to the prevention of noncommunicable diseases, health promotion, and socio-economic development. The Move for Health Initiative is driven by countries. In its implementation, WHO has an important role in supporting and coordinating it. Also, other major international organizations including concerned United Nations Agencies, International Olympic Committee, other sports organizations, NGOs, professional societies, relevant local leaders, development agencies, the media, consumer groups, and private sector have roles and are invited to collaborate with and support the Move for Health Day and Initiative. Successful events are results of wide collaboration as convincingly demonstrated in the organization of the Agita Sao Paulo Walking Parades.[23]

In the Move for Health Initiative, WHO encourages a wide range of activities, from formulating local and national policies and strategic plans to increase population participation in physical activity and sports for all to rising public awareness about priority issues related to health and development. Move for Health activities can include, for example, organizing walking, cycling and leisure sport campaigns, promotion streets free from cars, and development of parks and open spaces where people can practice enjoyable physical activities. Local Move for Health activities give possibilities to bring up and demonstrate the large spectrum of physical activities and their potential for a multitude of biological, psychological, and social benefits at individual, family, community, and environmental level.

Currently, the number of registered Move for Health Day events is around 3,000, most of them in South American countries. The number of events has increased with time. In reality, the number of events is much larger than shown above, because on most continents in most countries only a fraction of the events is registered.

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Comment on WHO activities related to physical activity in the 2000s

During this decade, physical activity gained a steady position among the activities of WHO, and it was accepted as a health topic of the organization. The main reason for this improved status is obvious: continuously increasing scientific evidence showed convincingly the great potential of feasible physical activity for prevention of the major noncommunicable diseases. This “slow-motion disaster” for public health as well as overweight and obesity were not just problems of the developed countries, but they were rapidly growing also in the developing countries. This information was communicated effectively to the decision makers outside and within WHO, for example, via the World Health Report 2002[18] and the related Global Burden of Disease publications. Thus, for the first time, physical activity was seen by this influential organization as one means to combat hazardous global health problems. Further, the Move for Health Day in 2003 and annually since then with thousands of events around the world, well-prepared advocacy materials and wide media coverage gave physical activity positive visibility as an acceptable, accessible, affordable, and even enjoyable health measure for large populations in all parts of the world. Physical activity being a comprehensible, feasible, safe, low-cost, and commercially and politically unusually neutral means among the risk factors of noncommunicable diseases and obesity facilitated its acceptance among most professionals and stakeholders in preventive medicine, public health, and related areas. Further, the commonalities of physical activity and healthy diet regarding their effects and promotion integrated physical activity to a larger and more traditional framework of disease prevention and health promotion. These features of physical activity made it acceptable also for policy and decision makers representing different political and commercial views and opinions.

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Global recommendations on physical activity for health[10]

A global expert meeting in 2008 in Mexico concluded that there was the need and enough evidence for WHO to develop global recommendations on physical activity for health. The recommendations were developed through several phases and approved by the WHO Guideline Review Committee in 2010. The focus of the Global Recommendations on Physical Activity for Health is primary prevention of NCDs through physical activity at the population level. The primary target audience for the recommendations is policy-makers at the national level. The recommendations address 3 age groups: 5–17 years old, 18–64 years old, and 65 years old and above. A section focusing on each age group includes a narrative summary of scientific evidence, the current physical activity recommendations, and the interpretation of and justification for the recommendations made.

A section of the document deals with issues how to use the recommendations, for example, their adaptation at national level and in low- and middle-income countries, what supporting policies are needed, a list of possible physical activity promoting interventions, strategies for communicating the recommendations at national level, and monitoring and evaluation of the promotion measures.

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The WHO global action plan for the prevention and control of noncommunicable diseases 2013–2020[12]

This action plan was developed as a response to the United Nations Political Declaration on Prevention and Control of NCDs, endorsed by Heads of State and Government in 2011 (resolution A/RES/66/2). To facilitate realization of the commitments of the Heads of States to establish and strengthen multisectoral national policies and plans for the prevention and control of NCDs, the World Health Assembly 2013 endorsed the WHO Global Action Plan for the Prevention and Control of NCDs 2013–2020. The Global Action Plan provides Member States, international partners, and WHO with a road map and menu of policy options which, when implemented collectively, will contribute a 25% relative reduction in premature mortality from NCDs by 2025 and to progress on 8 other global NCD targets.

In addition to the Global Action Plan, the World Health Assembly agreed in 2013 on a set of global voluntary targets, which include a 25% reduction of premature mortality from NCDS, and a 10% reduction in the prevalence of insufficient physical activity by 2025.

The WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020 focuses on cardiovascular diseases, cancer, chronic respiratory diseases and diabetes, and on 4 shared behavioral risk factors—tobacco use, unhealthy diet, physical inactivity, and harmful use of alcohol.

The following section reviews the Action Plan primarily from the perspective of physical activity promotion.

The Action Plan presents several policy options available to member states for promoting physical activity. These options are intended to advance the implementation of the Global Strategy on DPAS and other relevant strategies, and to promote the ancillary benefits from increasing population levels of physical activity, such as improved educational achievement and social and mental health benefits, together with cleaner air, reduced traffic, less congestion, and the links to healthy child development and sustainable development. The primary aim of the Action Plan is to achieve the following voluntary global targets: a 10% relative reduction in the prevalence of insufficient physical activity, to halt the rise in diabetes and obesity, and to achieve a 25% relative reduction in the prevalence of hypertension.

The proposed policy options include adoption and implementation of national guidelines on physical activity for health; development of partnerships and engagement of all stakeholders to implement actions aimed at increasing physical activity across all ages; development of policy measures to promote physical activity through activities of daily living, including “active transport” (walking and cycling), recreation, and leisure and sport; creation and preservation of built and natural environments that support physical activity, with a particular focus on providing infrastructure to support “active transport,” active recreation and play, and participation in sports; conducting evidence-based public campaigns and social marketing initiatives to inform and motivate people about the benefits of physical activity. Appendix 3 of the Global Action Plan contains a wide menu of evidence-based policy options for the member countries, as well as tools available to WHO for achieving the Plan’s targets.

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Development of a draft global action plan to promote physical activity[13]

The WHO Executive Board has requested that the Director-General develop a draft Global Action Plan to promote physical activity. Development of the Action Plan by the Secretariat in WHO consists of several phases. In January 2018, Member States considered the draft of the Global Action Plan at the meeting of the WHO Executive Board, and in May 2018 Member States will consider the final draft in the World Health Assembly.

A number of arguments have been presented in support of the formulation of the Global Action Plan to Promote Physical Activity. Many of them are shown below in abbreviated form.

Physical inactivity is 1 of the leading behavioral risk factors for the major causes of NCDs and for other health-related problems. However, inactivity is common and it is on the rise in many countries. In 2013, the World Health Assembly set a global voluntary target for a 10% reduction in physical inactivity by 2025. However, progress toward achieving this target has been slow. In 2015, NCDs were responsible for over 15 million premature deaths with 85% of these occurring in developing countries. Most of these 15 million premature deaths from NCDs could have been prevented or delayed if decisive policy actions were taken to address the 4 main risk factors of physical inactivity, unhealthy diet, harmful use of alcohol and tobacco use, and to empower individual, families, and communities to act.

The 2030 Agenda for Sustainable Development Goals (SDGs) and the commitment made by world leaders to develop ambitious national SDG responses provides a golden opportunity to refocus, renew, and combine collective efforts to promote physical activity. The new global action plan provides opportunities for urgent prioritization and scaling of efforts to implement effective actions to increase the physical activity-based contribution to improvements in health and wellbeing and support of specific SDGs. The Action Plan will leverage the contributions of all relevant sectors, in particular, environment, education, health, sports, and technology to accelerate progress in achieving the global voluntary NCD targets set by the World Health Assembly for 2025 and the SDG targets set for 2030. Policies addressing the SDG goals can provide important opportunities for health-related groups and other sectors to engage, and to link policies and to prioritize investments in more considered and potentially more synergistic ways.

The proposed Global Action Plan builds on previous NCD strategies and plans endorsed by the World Health Assembly. Further, the Plan has strategic links with other priority agendas of WHO including road safety, public health and environment, housing and sustainable urban development, mental health, healthy aging, women’s, children’s and adolescents’ health, disability, and nutrition. Some of the actions within these strategies and plans would deliver directly, or facilitate indirectly, improved opportunities for the population to be more active. Conversely, actions set out in the Global Action Plan on physical activity could work reciprocally to support the “linked” strategies mentioned above. Harnessing these synergies and building coherence between different but related policy agendas are critical for maximizing the opportunities for joint action and efficient use of limited resources.

The vision of the Action Plan is a world where all countries provide enabling environments and opportunities for all citizens to be physically active. Through these activities, the Plan would enhance the social, cultural, and economic development and wellbeing of nations.

The main goal of the Action Plan is that 100 million people are more active by 2030.

The Action Plan is built on four strategic objectives:

Creating active society aims to create societies with positive attitudes and values toward everyone being active through increasing community-wide knowledge of the multiple benefits of physical activity and the multiple pathways to being physically active.

Creating active environments aims to create environments that promote and safeguard the rights of people of all ages and abilities to equitable access to safe places and spaces in their cities and communities to be physically active.

Creating active lives aims to increase provision and access to opportunities and programs that support people of all ages, abilities, and diverse identities in multiple settings, to be physically active in their community.

Creating active systems aims to provide the leadership and systems necessary for governance, coordination, and joint action at national and subnational levels including data systems for surveillance, monitoring and accountability, research and development to build capacity, and strategies to mobilize resources and implement actions to increase participation in physical activities.

For each of these strategic objectives, the draft suggests indicators of success and actions for Member States, for the WHO secretariat, and for national and international partners.

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Comment on WHO activities related to physical activity in the 2010s

Physical activity promotion has been a consistent component of the working agenda of WHO during the 2010s as a strategy for the prevention of noncommunicable diseases and reducing the incidence of obesity. The most visible activities related to physical activity promotion in the 21st century, publication of the Global Recommendations on Physical Activity for Health and the initiation of the development of a Global Action Plan to Promote Physical Activity, occurred at the beginning and at the end of the first decade. A critical step in promoting the importance of physical activity was the inclusion of physical inactivity as 1 of the main risk factors of NCDs in the United Nations Political Declaration on Prevention and Control of NCDs, and consequently among the voluntary targets of the WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020. The decision of the WHO Executive Board to request the development of a Global Action Plan that is focused solely on physical activity promotion can be considered as a conclusive sign of worldwide recognition for the direct and indirect individual, societal and environmental benefits of physical activity, and of the value of the policies, strategies, and actions in its promotion. The contents of the draft Action Plan are likely to meet the requests and expectations of the policy and decision makers working for physical activity promotion from local to global levels because the recommended policies demonstrate well the multiple connections of physical activity with important current and future societal challenges, and the vast potential for wide-spectrum physical activity promotion in addressing these challenges.

Finally, the evolution of the role of physical activity within WHO from slight, temporary interest in the 1960s and 1970s to an important part of global strategies and actions, and finally to a self-standing entity of planned future actions has not happened spontaneously. On the contrary, decisive roles in this development have been played by a great number of eminent researchers, advocates, and promoters of physical activity outside and within WHO. Likewise, there has been a critical role of several strong organizations with a clear vision on the importance of and opportunities for physical activity promotion. Their persistent work has influenced policymakers and experts at various levels, as well as the staff of WHO to take positions and actions that have gradually opened the way to acknowledging the importance of physical activity, and to actions leading to WHO-supported increases in physical activity promotion among member countries. The development of these collaborative activities is analogous to how a ship uses evolving knowledge and information—adjusting its course to stay on safe water while moving forward toward its destination.

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Disclosure

The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by Progress in Preventive Medicine at the discretion of the Editor-in-Chief.

Abbreviations and Acronyms

DPAS = = Global Strategy on Diet, Physical Activity, and Health

EU = = European Union

FENSA = = Framework on Engagement with Nonstate Actors

HIV = = immunodeficiency virus

NCD = = noncommunicable disease

NGO = = nongovernmental organization

SGD = = sustainable development goal

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Keywords:

health promotion; physical activity; World Health Organization; WHO

Copyright © 2018 The Author(s). Published by Wolters Kluwer on behalf of the European Society of Preventive Medicine.