Public health nutrition actions across 14 EU countries: a qualitative study to elicit the views of policy makers and thought leaders

• Published in: The Lancet (British edition) Vol. 382; no. S3; p. S63
• Main Authors: Lloyd-Williams, Ffion, Dr, Bromley, Helen, PhD, Orton, Lois, PhD, Hawkes, Corinna, PhD, Taylor-Robinson, David, MD, O'Flaherty, Martin, MD, Moonan, May, MD, Rayner, Mike, PhD, Capewell, Simon, Prof
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 29.11.2013; Elsevier Limited
• Subjects: beverages; cardiovascular diseases; computer software; death; European Union; experts; food policy; guidelines; health foods; heart; Internal Medicine; Internet; interviews; laws and regulations; nutrition policy; public health; Qualitative research; researchers; stakeholders; sugars; vegetable consumption; World Health Organization; United Kingdom; Hungary; Norway; Portugal; Iceland; Finland; ANE, Atlantic, Iceland; Europe; British Isles
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(13)62488-5

Abstract Background Cardiovascular disease (CVD) is the main cause of death in Europe. EuroHeart II is a research programme led by the European Heart Network and European Society of Cardiology to address the burden of CVD in Europe and to determine interventions for prevention of avoidable deaths and disability. One aspect identifies the most effective public health nutrition policies, to inform future evidence-based strategies to promote cardiovascular health. Methods We mapped national nutrition policies across 30 European countries, then contacted and recruited potential participants in 14 of those countries. Participants were identified through various sources; for example, the European Heart Network, via national Heart Foundations, via published work, the internet, and the snowballing technique. Before interview, participants were emailed information about the project, the interview questions (developed and piloted with senior stakeholders in the UK), and a summary of public health nutrition policies in their country. Policy makers, academics, and other public health nutrition experts at the national level shared their views on a range of possible approaches to public health nutrition strategies, covering the entire policy spectrum. The interviews were done in English, either by person, telephone, or Skype. The interviews typically lasted 45–60 min. The interview questions were open ended and used as a topic guide. This structure enabled the interviews to be led by the interviewees, not the interviewers. Also, the interviews were flexible with no maximum time limit. Interviews were transcribed and entered into NVivo software. The Framework approach was used to analyse transcripts. Cross checking of coding and interpretation of data was done by three researchers from the research team. Findings We did 70 interviews in 14 countries across Europe. The interviews enabled more up-to-date and accurate information than was provided on websites or in reports. Responses revealed important differences between official lists of food policies and their actual implementation on the ground. European countries are at very different stages of addressing public health nutrition issues. Most are promoting dialogue, recommendations, and guidelines (often regarded as an early part of the policy process). Voluntary reformulation of foods is also common, especially for salt, sugar, and total fat. Legislation, regulation, or fiscal interventions targeting salt, sugar, fat, or fruit and vegetable consumption are still uncommon. Many interviewees expressed a preference for regulation and fiscal interventions and generally believed that they were more effective than voluntary measures and information-based interventions, albeit politically more challenging. Conversely, information-based interventions were often seen as being more politically feasible than regulation and fiscal measures. Interpretation Public health nutrition policies in Europe represent a complex, dynamic, and rapidly changing arena. Encouragingly, most countries are engaged in activities intended to increase consumption of health food and decrease the intake of junk food and sugary drinks. Exemplar countries showing notable progress might include Finland, Norway, Iceland, Hungary, the UK, and Portugal. However, most countries fall well short of optimum activities. Implementation of potentially powerful nutrition policies remains frustratingly patchy across Europe. This study provides only a snapshot of activities up until 2012; developments are ongoing, and data may not be complete and will require regular updating. We propose future work to identify and assess population-based policy actions across the WHO European Region to expand and refine the evidence base. This information could support development of a nutrition policy assessment method for each country to use to promote—and implement—healthier food strategies. Funding European Union Health Programme.