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 2012
34.4% 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 21st 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
National Agreement for Nutritional
Health
Modification of the
environment
Change of conducts and
habits (healthy diet, physical
activity and plain water
drinking)
Objectives
1.
2.
3.
4.
5.
5.
6.
7.
8.
9.
Physical activity
Consumption of plain water
Diminish sugar and fats in drinks
Increase consumption of fruit, vegetables ,
whole grain cereals, legumes and fiber
Useful labeling and nutritional
alphabetization
Breastfeeding
Reduce sugar and other sweeteners in food
Diminish saturated and trans fats in processed food
Reduce portion sizes
Reduce use of salt
Intersectorial participation
Public sector
Private sector
Academia
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
What was achieved?
 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
In school setting
Guidelines on Nutritional Standards for Foods and Beverages
offered in Schools
Energy per portion <=
140 kcal
Total fats <=
≤ 40%
Stage I (School year 2010-2011).
Total of products: 1920
Energy per portion < = 130 kcal
Total fats <= ≤ 40%
Reduction of sugar, saturated
and trans fats, sodium and
fiber
Stage II (School year 2011-2012)
Total of products: 413
Energy per portion <= 130
kcal
Total fats <= ≤ 35%
More reduction of sugar,
saturated and trans fats,
sodium and fiber
Stage III (Starting from school
year 2012
Total of products: 336
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
• 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.
National Crusade
against Stunting –
Zero Hunger
AND
• Accessibility and availability of
nutritional products
• Elimination of malnutrition in
children
• Increase the purchase of products
from local producers
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
E-mail: ljubica.latinovic@salud.gob.mx