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ORDER OF THE GOVERNMENT OF THE REPUBLIC OF MOLDOVA

of September 8, 2014 No. 730

About approval of the National program in the field of food and food allowance for 2014-2020 and action plans on its implementation

(as amended on 05-09-2018)

Based on Articles 6, 7, 9 and 38 Laws No. 10-XVI of February 3, 2009 on the state supervision of public health (The official monitor of the Republic of Moldova, 2009, No. 67, the Art. 183), with subsequent changes and amendments, articles 9 and 18 of the Law No. 78-XV of March 18, 2004 on foodstuff (The official monitor of the Republic of Moldova, 2004, Art. No. 83-87, 431), with subsequent changes and amendments, and Resolutions of Parliament No. 82 of April 12, 2012 about approval of National strategy for prevention and control of noninfectious diseases for 2012-2020 (The official monitor of the Republic of Moldova, 2012, Art. No. 126-129, 412), and also for the purpose of protection of health of the population the Government DECIDES:

1. Approve:

The national program in the field of food and food allowance for 2014-2020, according to appendix No. 1;

The action plan for 2018-2020 on implementation of the National program in the field of food and food allowance for 2014-2020 according to appendix No. 2-1

The action plan for 2014-2016 on implementation of the National program in the field of food and food allowance for 2014-2020, according to appendix No. 2.

Staff of the Advisory board on coordinating of the National program in the field of food and food allowance for 2014-2020, according to appendix No. 3;

Regulations on the Advisory board on coordinating of the National program in the field of food and food allowance for 2014-2020, according to appendix No. 4.

2. Ceased to be valid according to the Order of the Government of the Republic of Moldova of 04.04.2018 No. 284

3. Determine that financing of the specified Program will be performed for the account and within the means which are annually approved in the national public budget and also from other sources, according to the current legislation.

4. To provide to the ministries and other central administrative authorities, within the conferred powers, accomplishment of this resolution and the actions included in action plans on program implementation, providing annually, till February 1, reports to the Ministry of Health, work and social protection which will generalize the acquired information and to send to the Government till March 1 the summary report on implementation of this Resolution.

5. Recommend to bodies of local public authority:

develop based on the National program in the field of food and food allowance for 2014-2016 and to approve in 2-month time from the date of publication of this resolution in the Official monitor of the Republic of Moldova territorial programs in the field of food and food allowance for 2014-2020;

consider annually implementation of territorial programs in the field of food and food allowance and to take measures for accomplishment of the provided tasks.

6. To impose control over the implementation of this resolution on the Ministry of Health, work and social protection.

Prime Minister

Iurie Leanca

Countersign:

Minister of Health, work and social protection

 

Andrey Saty

Minister of Agriculture, regional development and environment

Vasile Bumakov

minister of education

Maya Sandu

Minister of Finance

Anatol Arapu

Appendix No. 1

to the Order of the Government of the Republic of Moldova of September 8, 2014 No. 730

The national program in the field of food and food allowance for 2014-2020

I. Identification of problem

Section 1. International and national context

1. The burden of the diseases caused by bad food rather high also continues to grow. Rather small quantity of diseases is responsible for much high level of serious illnesses. Noninfectious diseases are connected with certain risk factors which make basis and give opportunity for general intervention: high arterial pressure, high level of cholesterol in blood, unhealthy food and lack of physical activity, consumption of tobacco and abuse of alcohol. Excessive consumption of the saturated fats and solid fats which are formed during chemical process of partial hydrogenation of liquid oils (further – transfats), sugars and salt, and low consumption of fruit and vegetables became major factors of risk for complication of the noninfectious diseases connected with food. Trans-fats increase the level of cholesterol of low density, reducing the level of cholesterol of high density and increasing thus risk of coronary diseases of heart, diabetes of the second type and the premature death rate provoked by these diseases.

2. Cardiovascular diseases (coronary heart disease and tserebrovaskulyarny diseases) are the leading cause of death. The food allowance and food are closely connected with these reasons of death rate. So, obesity increases risk of emergence of coronary heart disease, diabetes 2 types, some types of cancer, high consumption of salt/sodium increases risk for tserebrovaskulyarny diseases, and consumption of fruit and vegetables promotes the prevention of cancer diseases.

3. Bad food and food allowance affect not only on health, but also quality and life expectancy.

4. For elimination of the risk factors connected with the chronic diseases caused by food, the World assembly of health care accepted in May, 2004 "Global strategy in food allowance, physical activity and health". This Strategy emphasizes need of restriction of consumption of saturated fats, transfatty acids, salt and sugars, increases in consumption of fruit and vegetables and increase in level of physical activity.

5. In 2006 the European regional committee of the World Health Organization (further – WHO) adopted comprehensive strategy according to the prevention and control of noninfectious diseases at the 56th session (the Resolution of EUR/RC56/R 2). The specified resolution was the reply of WHO specific to the European region, to the Global strategy according to the prevention and control of noninfectious diseases accepted by the World assembly of health care in 2000.

6. In 2010 the World assembly of health care accepted number of recommendations concerning marketing of foodstuff and soft drinks for children, supported later by the framework implementation of this number of recommendations.

7. In 2006 at the European ministerial conference on fight against obesity at children which took place in Istanbul the European charter on fight against obesity at children by means of which state members undertook to make active efforts on fight against obesity and to place obesity as burden for public health at higher level in the political agenda was accepted. The charter determined number of the purposes, the principles and base of actions, having demanded adoption of programs for the purpose of transformation of obligations of the Charter to specific actions and mechanisms of monitoring.

8. In 2007 the European action plan in the field of food and food allowance for 2007-2012 was adopted at the 57th session of Regional committee (The resolution of EUR/RC/57/R 4) and the wide range of actions for improvement of food and safety of food implemented with the participation of large number of government sectors and also with attraction of public and private sectors which also urged state members to develop, implement and manage politicians in the field of food and food allowance is established.

9. The first World ministerial conference on problem of healthy lifestyle and control of noninfectious diseases which took place in April, 2011 adopted the Moscow declaration approved further by the World assembly of health care by means of the resolution WHA64.11. This meeting took into account number of "bestbuys", including the recommended actions concerning consumption of salt and transfats, restriction of impact for children of advertizing of foodstuff with the high content of saturated fats, sugars and salts. After this event in September, 2011 the meeting of high level of the United Nations on noninfectious diseases at which the political declaration of the Meeting of high level of the General Assembly on the prevention and control of noninfectious diseases subsequently approved at the 66th session of the World assembly of health care was adopted took place.

10. In 2011 the European regional committee of WHO accepted the Action plan on implementation of the European strategy according to the prevention and control of noninfectious diseases for 2012-2020 (the Resolution of EUR/RC61/R 3). Three of five priority interventions are directed to "promotion of healthy consumption by means of tax and marketing the politician", "removals of transfats from foodstuff (and their replacement with polynonsaturated fats)" and "decrease in consumption of salt".

11. In September, 2012 the European regional committee of WHO, adopted new framework European policy of health at the 62nd session – Health-2020. Health-2020 is intended to support actions in the government and society on considerable improvement of health and wellbeing of the population, reducing inequality in the field of health, to strengthening of public health and providing with the health care systems concentrated on people, which are universal fair, steady and high-quality.

12. In July, 2013 at the Vienna ministerial conference Ministers of Health of the countries of the European region of WHO adopted the Vienna Declaration about food allowance and noninfectious diseases in the context of policy Health-2020. The declaration contains 5 priority fields of actions:

1) creation of the healthy food circle and promotion of physical activity among all national groups;

2) assistance to use of healthy food during life, especially in the most vulnerable national groups;

3) strengthening of potential of health care systems on strengthening of health and provision of services concerning noninfectious diseases;

4) support of implementation of supervision, monitoring, assessment and studying of the status of food allowance and behavior of the population concerning food;

5) strengthening of administration of alliances and network and granting of power to administration of community for participation in activities for strengthening of health and prevention of diseases.

13. The European commission accepted in 2007 the White book concerning the European strategy in food allowance, supervision, excess weight and the related aspects of food of COM(2007) 279. Aim the White book – to establish the integrated approach at the European Union level promoting decrease in diseases because of bad food, excess weight and obesity. Basis of strategy initiatives of the Commission, the Platform of the European Union for actions in the field of food, physical activity and the Green book "Constitute promotion of healthy food and physical activity: The European measurement according to the prevention of excess weight, obesity and chronic diseases".

14. The European action plan on strengthening of services and potential of public health is created by key poles of first-priority regional policies, Health of 2020.

15. For acceleration of progress of rather double burden of improper feeding of the politician on food shall provide management of this process as it is described in the key purposes of Health-2020 of WHO. Following the recommendations about management provided in the framework European policy of WHO Zdorovye-2020, of person, the making decisions and the interested key persons shall mobilize political commitment on decrease in double burden of improper feeding and promote intersectoral cooperation between national and local institutions, between experts, civil society and private sector.

16. Adequate inside - and intersectoral coordination is important for providing the multisectoral answer to improper feeding. Now, the coordination mechanism which mentions challenges in the field of food, no and coordination is inadequate and inefficient.

Section 2. National context

17. The Republic of Moldova faces double burden of improper feeding. On the one hand, it is insufficiency of food and deficit in food allowance that is characteristic of developing countries, on the other hand, the excessive body weight and obesity that is inherent for developed countries. Low growth because of chronic insufficiency of energy is characteristic of 6% of children under 5 years, and the fifth part of children has anemia (the Multicluster research, the Republic of Moldova, 2015). One third of women of childbearing age and more than 40% of expectant mothers have anemia. For the purpose of decrease in deficit of micronutrients the Government claimed and implements national programs for decrease and liquidation of shortcomings of this sort.

17-1. Every third child in the Republic of Moldova suffers from deficit of iodine. Women of childbearing age, the feeding women and children are the most susceptible groups concerning deficit of iodine. Since 1998 the Government of the Republic of Moldova realized three consecutive national programs directed to liquidation and the prevention of iodine-deficiency violations by means of iodination of the salt intended for consumption by the person. Though some achievements in the prevention of iodine-deficiency violations by means of salt iodination were registered, the purpose on steady liquidation of these violations shall be supported and reached. Deficit of iodine is determined by the low level of content of iodine in the environment and therefore, for prevention of iodine-deficiency violations it is necessary to carry out the additional measures connected with permanent iodination of the population. In 2014 WHO confirmed that all food salt, held for use in farms and in the food industry, shall be enriched with iodine as the strategy of safe and effective prevention and control of iodine-deficiency violations among the population which is persistently recommended to state members for the purpose of implementation and steady maintenance of intervention.

18. About two thirds of foreign healthy population are aged more senior than 40 years have the increased values of blood pressure and content of cholesterol. Food and bad food allowance, and also the related risk factors became the reason of annual loss of 50% of healthy years of life at women and 35% - at men.

19. Improper feeding and low level of physical activity are the main of four origins of such noninfectious diseases as cardiovascular diseases, the increased arterial pressure, diabetes of the second type, stroke, some types of cancer, musculoskeletal diseases and some mental violations. In the long term growth of incidence of noninfectious diseases will make negative impact on expectancy of life and will reduce duration and quality of life. More than 80% of the cases of death rate which are annually registered in the Republic of Moldova are caused by noninfectious diseases. Cardiovascular diseases are the reason of 55-57% of annually registered death rate cases, cancer diseases – about 14%, diseases of digestive tract – about 10% of cases of death rate.

20. The specific weight of the feeding by exclusively breast milk up to 6 months which is the important determining factor of the state of health at adult age decreased and makes only 37% in 2012 in comparison with 46% in 2005. Strengthening of actions for implementation of initiative "Hospital – the child's friend", complete implementation of requirements of the International code for marketing of substitutes of maternal milk, increase in level of awareness of importance of breastfeeding by health workers, promotion of breastfeeding by means of communication campaigns will promote increase in ratio of the children who are only on breastfeeding up to 6 months and also breastfeeding duration.

21. Only half of children under 7 years consumes daily milk and 62% consume daily fruit and vegetables (2009), with considerable difference between the city and rural zone and level of the income of family. Fruit and vegetables are available to the majority of the population only during season. The consumer price index on fruit grew to % 747,1 in 2009 in comparison with 1999.

22. There are no data based on which it would be possible to estimate nature of adequacy of consumption of foodstuff concerning all most important nutrients, including energies. The data concerning providing with foodstuff per capita according to statistical data of the Organization for agricultural industry and food of the United Nations (FAOSTAT), show that the energy consumption per capita during 1992 - 2010 varied between 3200 and 2600 kcal/days and tends to growth. Such consumption exceeds estimative need of consumption. The food allowance became more various, the proportion of grain decreases. Providing food with primary groups, such as fruit and vegetables, meat and offal, milk and dairy products low in comparison with the neighboring Romania and Ukraine.

The data concerning consumption calculated based on available food are important for tracing of tendencies in time. Data of rather current consumption of foodstuff individually and national groups which are absent at the national level now are necessary for concept of adequacy of food allowance. Even if cards of food balances can specify availability of macronutrients and micronutrients at the national level, distribution of these nutrients in the country and between national groups often is unequal as a result of insufficiency of food, on the one hand, and obesity – on the other hand.

23. The estimative energy consumption, coming from fats, in families with children fluctuates between 32% and 33% (2006-2010) with tendency to growth, exceeding the limit which is most recommended to WHO in 30%. The specific weight of energy from simple carbohydrates makes 12% (FAOSTAT 2005-2007), also exceeding the limit (10%) which is most recommended to WHO.

24. Saturated fats and transfats which have more expressed atherosclerotic properties are widely used in the food industry.

25. The current legislation on labeling does not provide obligatory informing the consumer concerning content of salt, sugar, saturated fats and transfats in foodstuff.

26. Promotion of healthy food is not priority. Actions for informing the population of rather healthy food are carried out chaotically. Food is not obligatory component of the training program in educational institutions.

27. Though there are separate elements of supervision of the status of food, it is not sufficient. It is necessary to install functional and steady system of supervision, monitoring and assessment in the field of healthy food, the status of food and the determining determinants, and also their tendencies in time and space. The national researches including indicators of the status of food depend on external donations, are not planned and do not include all necessary indicators, and the existing indicators cannot be rather broken for the solution of the questions connected with inequality.

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