National Operational Action Plan for the Prevention and Control of Obesity in Children and Adolescents in Jamaica

Objectives

Jamaica’s National Operational Action Plan for the Prevention and Control of Obesity in Children and Adolescents, covering 2016 to 2020, operationalises obesity-prevention work within the National Strategic and Action Plan for the Prevention and Control of Non-communicable Diseases. It seeks to reduce childhood and adolescent obesity by 5% by 2020, alongside reductions in adolescent insufficient physical activity and childhood overweight.[1][2][3]The vision is for healthy Jamaican children and adolescents to live in healthy communities with the best possible quality of life; its mission is to create opportunities for healthy living through integrated whole-of-society action, supportive social and environmental policy, and systems that promote health across settings.[4]

• Apply a multisectoral, life-course and social-ecological approach to halt any rise in childhood and adolescent obesity and transform obesogenic environments into settings that support nutritious diets and physical activity.[5][6]
• Embed leadership and governance, Health in All Policies, integration with national development and economic planning, equity, gender equality, universal access and whole-of-society partnership.[4][2]
• Strengthen primary health care to provide family-oriented prevention, screening, education, treatment and referral for infants, children and adolescents at risk of, living with overweight, or living with obesity.[3][7]
• Protect, promote and support breastfeeding, including early initiation, exclusive breastfeeding for the first six completed months, Baby Friendly Hospital Initiative certification, regulation of breast-milk substitute marketing, and family and community support.[8][9][10][11]
• Improve school and community environments through healthier food provision, nutrition education, physical education, school wellness policy, school feeding standards, family participation and access to sport and physical activity.[11][12][13][14]
• Implement fiscal and regulatory measures to reduce consumption and marketing of sugar-sweetened beverages and energy-dense, nutrient-poor foods, increase informed healthy choices through front-of-package labelling and nutrition displays, and promote fresh fruit and vegetable consumption.[15][16][17][18]
• Establish surveillance, research and evaluation systems that provide timely data on obesity, undernutrition, risk factors and intervention performance for policy and planning.[19][20]

Implementation

Implementation is led by the Ministry of Health, supported by relevant public sectors and a broad network of education, health, local-government, civil-society, academic, private-sector and international partners.[2][21]The plan uses phased action over 2016 to 2020, distinguishing short-term actions over one to two years, medium-term actions over three years and long-term actions over five years; activities may be adjusted in response to available resources and evidence.[2]Its preparation included a multisectoral workshop, a writing group, stakeholder review and follow-up workshops, supported by collaboration between the Ministry of Health and the Pan American Health Organization/World Health Organization.[1][22]

• Coordinate policy across health, education, agriculture, finance, labour, local government, national security, trade, transport, planning, food production and marketing, recognising that diet and activity patterns are shaped by wider social and environmental conditions.[6][21]
• Deliver primary-care interventions by adapting treatment guidelines and referral protocols, training health workers, using World Health Organization age- and gender-specific growth references, auditing and supplying assessment equipment, developing communications, supporting families and communities, and reintroducing the Camp-4-the-Healthy-Way behaviour-modification concept.[21]
• Build breastfeeding support through a social-marketing campaign, curriculum revision, teacher and professional training, technical working groups, mother-friendly workplace and school arrangements, hospital infant and young child feeding committees, hospital self-appraisal and monitoring of breastfeeding substitutes.[8][9]
• Strengthen school delivery by revitalising the School Health Enhancement Committee, preparing policy and legislative submissions, training teachers and peer educators, educating parents and vendors, expanding physical education, implementing Health and Family Life Education, and linking school gardens and feeding programmes with local farmers.[11][12][13][23][14]
• Develop fiscal and food-environment policy through reviews of international practice, adaptation of the Pan American Health Organization and World Health Organization nutrient-profiling system, tax-economic analysis, stakeholder consultation, standards development, legislative proposals, enforcement strategies, sanctions and complaint-reporting mechanisms.[15][16][17]
• Promote physical activity through policy review, baseline research on green spaces and facilities, communications campaigns, safer and more supportive environments, clubs and other support systems, and collaborative programmes involving community-based and faith-based organisations.[18][24][25]
• Establish accountability through a Childhood Obesity Prevention Taskforce or Committee, a comprehensive monitoring and evaluation plan, standard reporting formats, trained monitoring teams, annual implementation reports and a mid-term evaluation.[2][19][26]
• Track key 2020 targets including family-oriented prevention in 90% of primary health-care facilities, breastfeeding messages reaching 80% of target groups, Baby Friendly Hospital Initiative certification in 50% of hospitals, full school implementation of Health and Family Life Education and physical education, community involvement in 50% of school wellness programmes, 60% of children and adolescents reporting moderate-to-high physical activity, and nutrition information displayed in 80% of food establishments.[7][8][9][2][14][18][24]
• Strengthen surveillance by harmonising surveys with international standards, incorporating World Health Organization growth standards into clinic reporting, developing child-data systems, training staff, auditing data quality, and establishing school reporting on overweight, obesity and undernutrition among children aged 6 to 17 years.[19][26][20]

Monitoring & Evaluation

The plan establishes surveillance, research and evaluation as a dedicated line of action, supported by a comprehensive monitoring and evaluation system intended to assess progress towards targets, identify strengths and gaps, and generate timely data for policy and planning.[2][19]Monitoring is to cover all action areas and be supported by a Childhood Obesity Prevention Taskforce or Committee, an evaluation plan, a standard reporting format, a trained monitoring and evaluation team, a mid-term evaluation, and annual implementation reports disseminated during 2016 to 2020.[2][19][26]

• Track primary healthcare implementation through indicators including screening, education, treatment and referral in 70% of facilities; family-oriented obesity-prevention activities in 90% of primary healthcare facilities; family and community support programmes in 20% of vulnerable districts; and service access indicators, including a 30% target for adolescents aged 10 to 19 years in the supplied table.[2][3][21][7]
• Monitor breastfeeding interventions through the proportion of target groups hearing breastfeeding-benefit messages, targeted at 80%, and the proportion of hospitals certified under the Baby Friendly Hospital Initiative, targeted at 50%.[8][9]Monitor implementation through campaign evaluation, hospital self-appraisal, monitoring of breast-milk substitutes, publication of certified hospitals, and monitoring of reports on breast-milk substitute marketing legislation.[8][9][10]
• Assess school health and wellness measures through full implementation of Health and Family Life Education and physical education, approval and implementation of the School Feeding Policy in all schools, implementation of school-feeding standards, and active community involvement in 50% of school wellness programmes.[2][12][13][23][14]Develop school-feeding reporting systems, conduct periodic inspections, and require nutrition personnel to report on school programmes.[13][23][14]
• Measure food-policy implementation through enacted fiscal and marketing legislation, enforcement strategies, changes in the retail prices of sugar-sweetened beverages attributable to taxation, restrictions on marketing unhealthy foods and non-alcoholic beverages to children, and front-of-package nutrition labelling.[15][16][17]Monitor labelling separately for imported and locally produced relevant processed foods, with a stated target of 100% in each category.[17]Support enforcement through compliance-monitoring systems, sanctions and complaint-reporting arrangements.[16][17]
• Track physical activity and nutrition-information outcomes through a target for 60% of children and adolescents to report moderate-to-high physical activity and a target for 80% of food establishments to display nutrition information.[18][24]Monitor compliance with food-labelling and nutrition-display requirements through surveys and trained enforcement teams.[18]
• Strengthen data quality by harmonising routine surveys with international standards, incorporating World Health Organization growth standards into the Monthly Clinic Summary Report, reporting growth-monitoring data from public health centres, and undertaking periodic audits of data quality and practice conformity.[19][26]Develop surveillance for children aged 6 to 17 years using standardised school data-capture tools, staff training in data collection and management, routine data-source identification, fact sheets and reports.[26][20]
• Use available evidence from the Jamaica Health and Lifestyle Survey, World Health Organization estimates, youth surveys, the Global School-based Student Health Survey, Health Promoting Schools Survey and other routine surveillance activities.[6][27][4]Reported measures include body mass index, overweight and obesity prevalence, physical activity, dietary practices and child nutrition indicators.[6][27]

The supplied material does not fully specify indicator definitions, data frequency, reporting recipients, evaluation methodology or accountability procedures for every action area, although it identifies responsible institutions, timelines and a range of implementation indicators.[4][15][18][20]

Costing & Financing

No costed implementation plan, Jamaican budget, expenditure allocation, quantified funding gap, financing source, resource-mobilisation mechanism or economic assumption is provided in the supplied sections.[2][12][13][25][20]Implementation may be adjusted periodically according to available resources and evidence, but no quantified resource assessment is included.[2]

• Recognise obesity as a prospective economic and health-system concern because associated complications may affect national productivity and generate treatment costs.[1][28]The source notes that obesity accounts for 2% to 7% of health costs in some developed countries, without providing a comparable estimate for Jamaica.[28]
• Identify physical, human and financial resources for implementing the school health and wellness policy across all schools during 2016 to 2020, without specifying amounts or funding sources.[12]
• Use fiscal-policy analysis as part of planned taxation measures on sugar-sweetened beverages and energy-dense, nutrient-poor foods, including a tax-economic evaluation of proposed measures.[16][29]
• Note external support for upgrading health centres through the European Union-funded Programme for the Reduction of Maternal and Child Mortality, although the amount and financing period are not specified.[30]
• Address resource constraints affecting implementation, including inadequate nutritional-assessment equipment in primary care, limited health-data reporting by private providers, limited research funding, disrepair of community sports facilities, and costs that may constrain sports participation.[30][31]

The material refers to potentially cost-effective policy options, including taxation, healthier-food pricing strategies, school feeding and agricultural subsidies, but does not estimate their costs, savings, revenues or distributional effects.[6]