Lloyd-Williams Ffion, Bromley Helen, Orton Lois, Hawkes Corinna, Taylor-Robinson David, O'Flaherty Martin, McGill Rory, Anwar Elspeth, Hyseni Lirije, Moonan May, Rayner Mike, Capewell Simon
Department of Public Health & Policy, Institute of Psychology, Health & SocietyUniversity of Liverpool, Whelan Building, Quadrangle, L69 3GB Liverpool, Merseyside, UK.
BMC Public Health. 2014 Nov 21;14:1195. doi: 10.1186/1471-2458-14-1195.
Countries across Europe have introduced a wide variety of policies to improve nutrition. However, the sheer diversity of interventions represents a potentially bewildering smorgasbord. We aimed to map existing public health nutrition policies, and examine their perceived effectiveness, in order to inform future evidence-based diet strategies.
We created a public health nutrition policy database for 30 European countries. National nutrition policies were classified and assigned using the marketing "4 Ps" approach Product (reformulation, elimination, new healthier products); Price (taxes, subsidies); Promotion (advertising, food labelling, health education) and Place (schools, workplaces, etc.). We interviewed 71 senior policy-makers, public health nutrition policy experts and academics from 14 of the 30 countries, eliciting their views on diverse current and possible nutrition strategies.
Product Voluntary reformulation of foods is widespread but has variable and often modest impact. Twelve countries regulate maximum salt content in specific foods. Denmark, Austria, Iceland and Switzerland have effective trans fats bans. Price EU School Fruit Scheme subsidies are almost universal, but with variable implementation.Taxes are uncommon. However, Finland, France, Hungary and Latvia have implemented 'sugar taxes' on sugary foods and sugar-sweetened beverages. Finland, Hungary and Portugal also tax salty products. Promotion Dialogue, recommendations, nutrition guidelines, labelling, information and education campaigns are widespread. Restrictions on marketing to children are widespread but mostly voluntary. Place Interventions reducing the availability of unhealthy foods were most commonly found in schools and workplace canteens. Interviewees generally considered mandatory reformulation more effective than voluntary, and regulation and fiscal interventions much more effective than information strategies, but also politically more challenging.
Public health nutrition policies in Europe appear diverse, dynamic, complex and bewildering. The "4 Ps" framework potentially offers a structured and comprehensive categorisation. Encouragingly, the majority of European countries are engaged in activities intended to increase consumption of healthy food and decrease the intake of "junk" food and sugary drinks. Leading countries include Finland, Norway, Iceland, Denmark, Hungary, Portugal and perhaps the UK. However, all countries fall short of optimal activities. More needs to be done across Europe to implement the most potentially powerful fiscal and regulatory nutrition policies.
欧洲各国已出台各式各样的政策来改善营养状况。然而，干预措施的多样性之广，犹如一桌令人眼花缭乱的自助餐。我们旨在梳理现有的公共卫生营养政策，并考察其实际效果，以便为未来基于证据的饮食策略提供参考。
我们为30个欧洲国家创建了一个公共卫生营养政策数据库。国家营养政策采用市场营销的“4P”方法进行分类和赋值，即产品（重新配方、淘汰、推出更健康的新产品）；价格（税收、补贴）；促销（广告、食品标签、健康教育）和场所（学校、工作场所等）。我们采访了来自30个国家中14个国家的71位高级政策制定者、公共卫生营养政策专家和学者，了解他们对当前各种营养策略以及可能的营养策略的看法。
产品 食品自愿重新配方的情况很普遍，但影响各异且往往有限。12个国家对特定食品的最高盐含量进行监管。丹麦、奥地利、冰岛和瑞士实施了有效的反式脂肪禁令。价格 欧盟学校水果计划补贴几乎普及，但实施情况各不相同。税收并不常见。不过，芬兰、法国、匈牙利和拉脱维亚已对含糖食品和含糖饮料征收“糖税”。芬兰、匈牙利和葡萄牙还对咸味产品征税。促销 对话、建议、营养指南、标签、信息和教育活动很普遍。对儿童营销的限制很普遍，但大多是自愿性的。场所 减少不健康食品供应的干预措施最常见于学校和工作场所食堂。受访者普遍认为强制性重新配方比自愿性更有效，监管和财政干预比信息策略更有效，但在政治上也更具挑战性。
欧洲的公共卫生营养政策似乎多样、动态、复杂且令人困惑。“4P”框架可能提供一种结构化且全面的分类方式。令人鼓舞的是，大多数欧洲国家都在开展旨在增加健康食品消费、减少“垃圾”食品和含糖饮料摄入量的活动。领先的国家包括芬兰、挪威、冰岛、丹麦、匈牙利、葡萄牙，或许还有英国。然而，所有国家都未达到最佳行动水平。欧洲各地需要采取更多行动来实施最具潜在效力的财政和监管营养政策。
