The targets have a political dimension to all of them and there were important omissions. Diet is a major determinant of cardiovascular disease and fatty acid composition—saturated, monounsaturated and polyunsaturated—was not addressed. Nor were trans fatty acids which are widely used by the food industry in processed foods such as margarines. A substantial reduction in saturated fat consumption, and the elimination of trans fatty acids in all food production, could have a major impact on reducing the incidence of cardiovascular disease. Substitution of saturated fats in part with polyunsaturated fatty acids, both n-6 fatty acids which mainly come from plant foods and n-3 fatty acids coming mainly from fish oils, will further reduce cardiovascular disease. The current recommendations of professional bodies are to reduce saturated fat to <10 % of total energy intake and to substitute polyunsaturated fatty acids. Trans fatty acids should be eliminated from the human diet. The omission of fats from the lifestyle targets was political because it will impact directly on the business of major food manufacturers but this does not preclude national action. Several countries have already banned the use of trans fatty acids in all manufactured foods although this product continues to be widely used around the world. Other important aspects of the diet were also omitted from the targets. Sugars in the form of simple carbohydrates, widely used in sweetened soft drinks and other foods are a major source of calories in the diet and regular consumption is associated with the development of obesity and type 2 diabetes. Sweetened soft drinks have no nutritional value and therefore have no part in a healthy diet which should encompass a wide variety of wholegrain products, fresh fruit and vegetables. The combination of unhealthy eating and physical inactivity is driving the epidemic of obesity and, as a consequence, type 2 diabetes. To halt the rise in obesity and diabetes is not sufficient as a target because in some western populations a majority of the adult population are already overweight. To halt a further rise is important but this adverse trend needs to be reversed. This requires action at a population level on adopting healthy eating and becoming more physically active at the same time. To achieve the recommendation that all adults should spend 2.5–5.0 h a week on physical activity, or aerobic exercise training of at least moderate intensity, or 1–2.5 h per week on vigorous intense exercise, requires radical changes in the built environment in order to facilitate such activity in everyday life. Lifestyle also impacts directly on blood pressure, lipids and glucose and although there is a target for blood pressure, and one for diabetes, there is no target for cholesterol. Low density lipoprotein cholesterol (LDL-C) is a major risk factor for CVD, just like blood pressure and glucose, and high density lipoprotein cholesterol (HDL-C) is protective. The concentrations of both LDL-C and HDL-C are influenced by lifestyle, both diet and physical activity, and a target for LDL-C would also have been appropriate.

At the 66th World Health Assembly in May 2013 the WHO Global Action Plan for the Prevention and Control of Non-communicable Diseases 2013–2020 was endorsed [7] (Table 2). The vision is a world free of the avoidable burden of noncommunicable diseases.

The goal is “To reduce the preventable and avoidable burden of morbidity, mortality and disability due to noncommunicable diseases by means of multisectoral collaboration and cooperation at national, regional and global levels, so that populations reach the highest attainable standards of health and productivity at every age and those diseases are no longer a barrier to well–being or socioeconomic development.”