The Second WHO
European Action Plan for
Food and Nutrition Policy
2007-2012
Francesco Branca
Regional Adviser
Nutrition and Food Security
1 - Nutrition and Food
safety in Europe: double
burden
Source: WHO Regional Office for Europe, 2006.
Overweight in women (2000-2006)
≤25%
26-34.9%
35-44.9%
45-54.9%
55-64.9%
≥65%
No data
Measured
Source: WHO Global NCD InfoBase, 2005.
Overweight in women
projections for 2010
≤25%
26-34.9%
35-44.9%
45-54.9%
55-64.9%
≥65%
Prevalence of overweight and obesity in
children <11 years
21.4
21.9
21.7
19.5
18.0
14.8
16.6
17.0
15.5
14.8
14.7
16.0
12.6
9.8
4.9
11.7
11.3
9.9
12.3
10.5
7.5
6.9
8.3
6.3
4.4
4.0
3.6
4.2
6.7
11.4
4.4
5.7
20.0
15.2
22.5
4.0
3.0
4.5
2.0
7.0
19.1
19.9
16.7
13.7
13.3
15.8
11.5
16.0
12.9
14.3
14.0
15.0
8.7
9.1
6.9
10.5
10.3
7.4
18.9
10.3
10.3
5.8
4.6
6.6
7.0
5.5
3.0
4.1
3.0
3.9
4.0
4.9
7.6
11.2
2.4
3.9
5.4
5.9
17.0
10.1
40 30 20 10 0 10 20 30 40
Portugal, 2002-2003, 7-9
Spain, 1998-2000, 2-9
Italy: five villages in Milan province, 2000-2002, 6-11
Ireland, 2001-2002, 4-9
United Kingdom: three South Wales localities, 2001-2002, 5
Cyprus, 1999-2000, 6-9
Poland, 2000, 1-9
Germany: Zerbst, Hettstedt and Bitterfeld counties, 1998-1999, 5-10
Sweden, 2003, 8
Iceland, 2004, 9
Switzerland, 2002-2003, 6-9
Norway, 2000, 8-9
France, 2000, 7-9
Sweden, 2003, 4
Slovakia, 2001, 7-9
Italy: Perugia, Terni and Rieti provinces, 1993-2001, 3-9
Greece, 2003, 2-6
Netherlands, 2005, 2-9
Serbia and Montenegro: North Backa region, 1995-2002, 6-10
Cyprus, 2004, 2-6
Germany: Aachen city, 2001-2002, 5-6
(%)
FemmineMaschi
Pre-obesi, dati misurati
Obesi, dati misurati
Pre-obesi, dati riportati
Obesi, dati riportati
Soovrappeso, dati misurati
Trends of overweight among school children
in the WHO European Region
Source: WHO Regional Office for Europe, 2006.
0
5
10
15
20
25
30
35
40
1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005
Survey year
Prevalenceofoverweight(includingobesity)(%)
bothgenders
Denmark, 6-8 years
Denmark, 14-16 years
France, 5-12 years
France, 5-6 years
Germany, 5-10 years
Germany, 11-14 years
Germany, 5-6 years
Iceland, 9 years
Netherlands, 9 years
Spain, 6-7 years
Spain, 13-14 years
Sweden, 6-11 years
Sweden, 9-11 years
Switzerland, 6-12 years
UK, 5-10 years
UK, 4-11 years
UK, 11-12 years
Estimated economic costs of obesity
according to available studies
Double burden of child malnutrition
Source: Adapted from Cattaneo A et al. Child nutrition in CEE and CIS countries: report of a situation analysis. Geneva,
UNICEF, 2007.
0.0
5.0
10.0
15.0
20.0
25.0B
elarus
C
roatia
B
ulgaria
G
eorgia
TFYR
ofM
acedonia
Serbia
U
kraineK
yrgyzstan
A
rm
enia
B
osnia
and
H
erzegovinaK
azakhstan
R
ussian
FederationU
zbekistan
M
ontenegro
R
om
ania
A
lbaniaA
zerbaijanTajikistan
Percentage(%)
Underweight Overweight
Anaemia in Preschool Children
Normal (<5.0%)
Mild (5.0-19.9%)
Moderate (20.0-39.9%)
Severe (≥40.0%)
No data
Source: de Benoist B et al. Worldwide prevalence of anaemia 1993-2005: WHO Global Database on
Anaemia. Geneva, World Health Organization, 2007 (in press).
Category of public health significance
2 – Some successes, but still
much to be done
The epidemic of obesity is
stopping in Sweden?
Göteborg : OW
decreased in girls
Stockholm : OW +
OB decreased in
girls and OB
decreased in boys
Karlstad, Umeå,
Västerås Ystad :
OB decreased in
boys and girls
0
5
10
15
20
25
OW+OB OB
2003
2004
2005
Source : Lissner et al., IJO 2007
Reduction of salt intake in Finland
Intake of saturated fatty acids is
higher than recommended
0
2
4
6
8
10
12
14
16
18
IsraelItaly
Portugal
SerbiaSpain
Croatia
Norw
ay
B
ulgaria
Poland
K
azakhstan
G
reece
G
eorgia
United
K
ingdom
Lithuania
Finland
G
erm
any
Hungary
Slovenia
Iceland
Denm
ark
Sw
eden
France
Belarus
B
elgium
A
ustria
%Energy
Supply of fruit and vegetables is below
the recommendations in many countries
>600g/person/day
<600g/person/day
Source: FAOSTAT 2003
3 - Evolution of the modern
food system
The modern food system
Globalisation of food trade
Longer and more centralised food
chain
Concentration of food retail
Urban food deserts
Increased consumption of industrially
processed foods
Increased consumption of foods out-of-
home
Agricultural policies
Trade and fiscal policies
Social policies
Urban planning policies
Consumer protection policies
Educational policies
Food production,
processing and retail
distribution
SUPPLY DEMAND
Individual
choices
Price
Availability
Quality
Safety
Knowledge,
attitudes,
practices
Income
Diet is influenced by features of
supply and demand
4 - Setting the policy scene : the
European Charter on counteracting
obesity and the policy response
Policy framework
Individuals alone are not responsible
- changing the social, economic and
physical environment
Responsibility of government across
sectors
Involvement of all stakeholders
Portfolio of interventions designed
to change the social, economic and
physical environment
Portfolio of policy tools (from
legislation to public/private
partnerships)
International coordination
Special focus on children and on
disadvantaged socioeconomic
population groups
Goal
2.2 Curbing the epidemic and reversing the
trend are the ultimate goal of action in the
Region. Visible progress, especially relating to
children and adolescents, should be achievable
in most countries in the next 4–5 years and it
should be possible to reverse the trend by
2015 at the latest.
International policy
developments referring to
the European Charter
EU Parliament Report on “Promoting healthy diets and
physical activity” (2006)
World Health Assembly (2007)
UN Standing Committee on Nutrition (2007)
FAO/WHO Codex Alimentarius Commission (2007)
EC White paper on Nutrition (2007)
EU Council conclusions on “Health promotion by means
of nutrition and physical activity” (2007)
Policy developments
in Member States
Development or revision of policy documents
• New policies
• Italy “Gaining health”
• Croatia “Action Plan for overweight and obesity prevention
and treatment 2007-2011”
• Norway “Nutrition Action Plan 2007-2011”
• Portugal “National Platform against obesity”
• Policy revisions : Germany, Switzerland, Sweden,
Russia, Estonia
• 7 planning to revise
Budget increase : 3 countries
Intersectoral process established : Croatia, Italy,
Hungary, Malta
Portugal
Primary prevention
Policy Measures and Regulations
• Food and nutrition recommendations
• Nutritional profiles of food
• Food in public institutions
• Labelling
• marketing
Care Provision Measures
Intersectorial Measures
• Healthy menus in restaurants
• Local councils
Measures in the remit of Communication/
Information/ Research/ Education and
Training
Secondary and Tertiary Prevention
.
Platform
against
obesity
Norway
Diet Action Plan
by 12 Ministries (2007 – 2011)
Aim: better population health through
better nutrition
Goal1: Change population diet
according to national
recommendations
Goal 2: reduce social inequalities in
diet
Priorities:
+ Fruit, Vegetables, Whole grain, Fish
- Saturated fatty acids and transfatty
acids
- Energy-dense nutrient poor foods
Main strategies for
diet improvement
1. Improved availability of healthy food and
hinder access to unhealthy food/drinks
2. Increased knowledge in all parts of the
population
3. Building competence and awareness
among stakeholders and key groups
4. Stronger local basis for action through
partnership and integrated public health
approaches
5. Strengthening nutrition in prevention and
treatment within the health and care
system
Physical Activity Action Plan
by 8 Ministries 2005-2009
Aim: Better health in the
population through increased
physical activity
• Goal 1: Increase the share of
children and young people who
are moderately physically active
for at least 60 minutes every day
• Goal 2: Increase the share of
adults and elderly who are
moderately physically active for
at least 30 minutes every day
HEALTH EDUCATION,
PROMOTION OF HEALTHY
FOOD
AND HEALTY LIFE-STYLES
IMPLEMENTATION OF NEW
PROJECTS AND INITIATIVES
♦“Whole school approach to healthy eating”
♦“Nutrition-friendly schools initiative”
♦ Updating of nutritional standards and norms
for menu planning in kindergartens, schools,
students canteens, retirement homes, hospitals
♦ Updating of dietary guidelines
♦ Regulations concerning vending machines
(kindergartens,schools,sport facilities,hospitals
♦ Obesity prevention(counceling for children,youth)
♦ Physical activity promotion
GOOD PRACTICE EXAMPLES
“Health promoting schools”
“Eco kindergartens and schools”
“School gardens”
“Healthy cities”
“Healthy counties”
Monitoring of
nutritional status
Croatia
United Kingdom
The Obesity National Support Team (NST)
Provide support for organisations in local areas at the
highest risk of not making progress on delivering the
obesity target
Produce recommendations for action to improve local
practice
Provide generic advice and guidance to all areas in
England including the development of:
• toolkits and models to support improving delivery of PSA targets
• key public health deliverables and contributions to national,
regional and local conferences and learning events
For local governments
Municipalities and districts
France
A federative logo
Standard reference document for voluntary
charters of commitments to nutritional
improvement
For producers, agro-industries, distributors, caterers,
firms, professional or cross-professional organisations
To give a frame for voluntary commitments proposal
made by food sector operators, to be validated by public
authorities
Based on the objectives, the food guidelines and
principles of the PNNS
At least 2/3 of the turn over/volume or promotional
expenses of the Firm must be involved
For a prof or cross prof organisation, 2/3 of its membres
or 2/3 of the national turn over they represent must be
concerned
Information initiatives
France : public campaign and media
adverts
The Netherlands : web-based
information tool promoting a healthy
lifestyle for pregnant women
Malta : national anitobesity campaign
with a particular focus on childhood
obesity
Bulgaria : national week on
counteracting obesity
The nutrition guides of the PNNS
Septembre 2002 Septembre 2004
4,5 millions d’exemplaires 700 000 exemplaires
Septembre 2005
900 000 exemplaires
Septembre 2004
1,5 millions d’ exemplaires
Pour tous Pour tous Parents enfants 0-18
ans
Adolescents
2007
Femmes enceintes
Septembre 2003
Pregnant and
breastfeeding
women
And their specific issues for professionals
France – Media adverts
Public Health Law (august 2004) : article 29
Advertisements and measures promoting drinks
(except water, tea, coffee and fruit juices)or
manufactured foods must add a health information.
Advertisers may depart from that obligation by paying
1,5% of the cost of the promotion to INPES
Decree of February 27 2007
For sentences :
A common first part : « For your Health
– Eat at least five fruits and vegetables a day »
– Take regular physical exercise »
– Avoid eating too much fat, sugar and salt »
– Avoid snacking between meals »
For children ads, use the « tu » and change « for your
health » by « for healthy growth » or « In order to be
fit »
The Netherlands
Healthy lifestyle for pregnant women
5 - Operationalising policy :
the Second Action Plan for Food
and Nutrition Policy
What is new in the Food and
Nutrition Action Plan 2007 ?
Common goals
25 priority actions
to influence supply
of food and
consumers’
behaviours
Built on good
practice in
Member States
Portfolio approach
– some well
established and
FOOD AND NUTRITION
ACTION PLANS IN THE WHO
EUROPEAN REGION
0%
20%
40%
60%
80%
100%
1994/95 1998/99 2005
Yes No
Goals
Nutrition : saturated fat, trans fatty acids,
free sugars, fruit and vegetables, salt
Food safety :risk based and tailored
(salmonella, campylobacter, brucellosis)
Food security : reduce hunger (MDG)
Nutrition goals
• <10% of daily energy intake from saturated fat
• <1% of daily energy intake from trans fatty
acids;
• <10% of daily energy intake from free sugars;
• > 400g fruits and vegetables a day;
• <5 g a day of salt
• infants should be exclusively breastfed for the
first six months of life and breastfeeding should
be continued until at least 12 months
2007
Oct Nov Jun Sep
MemberStatesConsultation,Copenhagen
MinisterialConference,Istanbul
Counterpartsmeeting,Paris
2 Written
consultations
57thRegionalCommittee,Belgrade
Outline 2 drafts Final draft20062005
Comments of
drafting group
The development of the Action Plan
ACTION AREAS
1. Supporting a healthy start
2. Ensuring safe, healthy and
sustainable food supply
3. Providing comprehensive
information and education
to consumers
4. Implementing integrated actions
5. Strengthening nutrition and
food safety in the health sector
6. Monitoring and evaluation
HEALTH
CHALLENGES
Diet related
noncommunicable
diseases
Obesity in children
and adolescents
Micronutrient
deficiencies
Foodborne
diseases
Challenges and action areas
Action area 1
Supporting a healthy start
1. Promote maternal nutrition
and safe dietary habits
2. Protect, promote and support
breastfeeding and timely,
adequate and safe
complementary feeding of
infants and young children
3. Promote the development of
school and pre-school
nutrition and food safety
policies
Action area 2
Ensuring safe, healthy
and sustainable food supply
1. Improve the availability
of fruit and vegetables
2. Promote the
reformulation of
mainstream food
products
3. Improve food supply and
food safety in public
institutions
4. Explore the use of
economic tools (taxes,
subsidies)
Action area 2
Ensuring safe, healthy
and sustainable food supply
5. Ensure that the commercial offer of
food products is aligned to foodbased
dietary guidelines
6. Explore the use of economic tools
(taxes, subsidies)
7. Establish targeted programmes for
the protection of vulnerable groups
8. Establish intersectoral food safety
systems with a farm to fork approach
Action area 3
Providing comprehensive
information and education to
consumers
1. Food-based dietary
guidelines and food
safety guidelines,
complemented by
physical activity
guidelines
2. Public campaigns
aimed at informing
consumers
3. Appropriate
marketing practices
4. Adequate labelling of
Action area 4
Integrated actions to address
related determinants
1. Increase opportunities
to perform physical
activity
2. Reduce the
consumption of
alcohol
3. Ensure the provision
of safe drinking water
4. Reduce environmental
contamination of th
food chain
Action area 5
Strengthening nutrition and food safety
in the health sector
1. Engage primary
care staff in nutrition
assessment and in
the provision of diet,
food safety and
physical activity
counselling
2. Improve the
standards of service
delivery for the
prevention,
diagnosis and
treatment of nutrition
related diseases
Action area 6
Monitoring and evaluation
1. Establish national and
international surveillance systems
on nutritional status and food
consumption
2. Establish monitoring and
surveillance systems for microbial
and chemical hazards in the food
chain and foodborne diseases
3. Evaluate the impact of
programmes and policies
4. Improve public and private
research establishments to better
understand the role of nutrition,
food safety and lifestyle factors in
disease development and
prevention
The Regional Committee […]
URGES Member States
• to develop, implement, and reinforce comprehensive,
integrated and intersectoral food and nutrition policies;
• implement the commitments outlined in the Charter
• define national goals and priority actions in line with the
ones defined in the 2nd European Action Plan for Food
and Nutrition Policy
REQUESTS the Regional Director to take
necessary steps to ensure that food and nutrition
policy development are fully supported in the
Regional Office
Resolution
EUR/RC57/Conf.Doc./4
Actors and roles
Economic operators
Civil society and
professional networks
International actors
Governments
Stewardship and leadership
National policies and programmes
Local policies and programmes
Monitoring
Advocacy
Guidelines
Culture change
Quality and safety
Availability
Information
Coordinating action
Good practice
Technical support
Multisectoral
mechanisms
Review of policies
and action plans
Prioritising
and adapting
Dialogue
and partnerships
Allocating tasks
and resources
Monitoring
implementation
Steps for implementation
Policy implementation
WHO’s role in ensuring
implementation
Advocacy
Building partnerships
SMARTen and operationalise actions
Guiding international action and ensuring
critical mass in actions
Surveillance and policy analysis
Good practices in programmes and
policies
Building partnerships
European Commission
UN organisations
Ngo networks and alliances
The private sector : setting
operational goals
Action tools
Nutrition friendly school initiative
Nutrition profiles for use in labelling,
marketing, economic tools and food
procurements
Food procurements in public
institutions
Labelling recommendations
Good practices in programmes and
policies
Cost effectiveness tool
Action networks
Concept:
Joining an action network involves making a commitment to
take relevant action, participate in the initiatives necessary
for implementation throughout the Region and share
experience. Action networks would provide the for a for the
exchange of good practice, as well as coalitions to foster
greater political commitment
What is needed:
• Action listed in the Action Plan
• Government commitment in a sufficient number of
countries
• Experience in some countries
• Leading country
• Workplan
Action network on marketing foods and
non alcoholic beverages to children
Norway, Belgium, Bulgaria, Denmark, Finland, Portugal,
Slovenia, Spain and the United Kingdom
Objectives:
• constitute a coalition of committed countries who can demonstrate
specific and effective actions to protect children against marketing
pressure
• discuss and share experiences in order to identify best practices in
monitoring the exposure of children to food and beverage marketing
• discuss alternative approaches to regulation: statutory regulation,
self-regulation and co-regulation
• develop content and principles which may contribute to international
recommendations on the regulation of food and beverage marketing
• establish working groups that can look further into various topics
and share their expertise and recommendations with the other
countries in the network
• prepare reports to various international meetings such as to the
World Health Assembly
Action network on salt reduction
led by UK (involving Russian
Federation, Finland, Serbia, Ireland,
Bulgaria, Belgium, Portugal, Spain,
France, Slovenia)
Objectives:
• exchange experience and good practice
• develop common tools (salt targets,
monitoring system, communication with the
public/stakeholders, technology and
processing developments)
Childhood Obesity
Surveillance Initiative
Portugal, Belgium, Bulgaria, Cyprus, Czech,
Hungary, Ireland, Italy, Latvia, Lithuania, Malta,
Norway, Portugal, Slovenia, Sweden, UK
Semi-longitudinal design with repeated crosssectional
samples
Primary schools
One or more of the following age groups: 6.0-6.9;
7.0-7.9; 8.0-8.9 or 9.0-9.9 years
Nationally representative sample
Cluster sampling of schools or classes
Per age group: ≈2800 children
Possible new Action Networks
Hospital Nutrition
Nutrition Friendly Schools
Nutrition and physical activity
promotion in Primary Health Care
Food procurements in public
institutions
Surveillance and policy
analysis project
Nutritional status, diet and physical
activity
National nutrition policies and physical
activity promotion policies
Actions to implement the policies
(government programmes and initiatives,
public-private partnerships, legislation in
the different areas of action) – DPAS
indicators’ framework
Project and initiatives in different settings
Status of implementation of key
commitments
Conclusions
Where we are:
• Policy framework ok
• Priority list – provisionally ok
• Critical mass of action - no
We need:
• Advocacy on the policy solutions (content,
method and quantity)
• Demonstrate successful policies – the
Swedish example
• Economic cost scenarios for public and
private sector
Thank you
More information
Nutrition and Food Security
http://www.euro.who.int/Nutrition
Obesity http://www.euro.who.int/obesity
Database on nutrition policy and obesity
http://data.euro.who.int/nutrition/
WHO/Europe, Transport and health website
http:// www.euro.who.int/Transport
HEPA Europe http:// www.euro.who.int/hepa