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Joint Research Centre
www.jrc.ec.europa.eu
Welcome by Ciarán NICHOLL
Public Health Policy Support Unit
WORKSHOP
The JRC in the European Commission
Commissioner
Máire Geoghegan-Quinn
Research, Innovation & Science
President
José Manuel Barroso
28 Commission Members
DG Research & Innovation (RTD) Director-General
Vladimír Šucha
Joint Research Centre
2 16 July 2014
EC-Joint Research Centre
EUROPEAN COMMISSION
DIRECTORATES GENERAL
DIRECTORATES INSTITUTES
UNITS SCIENTIFIC UNITS
European Reference
Laboratories, Centres & Bureaus
IRMM
ITU
IHCP
IES
IET
IPSC
IPTS ISM
HQ
JRC
3 16 July 2014
IRMM - Geel, Belgium
Institute for Reference Materials and Measurements
ITU - Karlsruhe, Germany Institute for Transuranium Elements
IET - Petten, The Netherlands and Ispra, Italy Institute for Energy and Transport
IPSC - Ispra, Italy Institute for the Protection and Security of the Citizen
IES - Ispra, Italy Institute for Environment and Sustainability
IHCP - Ispra, Italy Institute for Health and Consumer Protection
IPTS - Seville, Spain Institute for Prospective Technological Studies
EC-JRC: 7 Institutes in 5 EU Member States
4 16 July 2014
To provide customer-driven scientific and technical support for the conception, development, implementation and monitoring of EU policies. As a service of the European Commission, the JRC functions as a reference centre of science and technology for the Union. Close to the policy-making process, it serves the common interest of the Member States, while being independent of special interests, whether private or national.
The Mission of the Joint Research Centre
5 16 July 2014
Science for a healthier life
Institute for Health and Consumer Protection
Chemical Assessment and Testing
Systems
Toxicology Public Health Policy Support
Nano-Biosciences
Institute for Health and Consumer Protection Director: K. Maruszewski
Molecular Biology and Genomics
JRC - Institute for Health and Consumer Protection
M. P. Aguar Fernandez
C. Nicholl
J. Kreysa
M. Whelan
H. Stamm
Disclaimer: The contents of this presentation are the views of the author and do not necessarily represent an official position of the European Commission. © European Union, 2013
Healthcare Quality Breast Cancer Care – Quality
Assurance Scheme and Guidelines
Donata Lerda Healthcare Quality Team
Joint Research Centre
The European Commission’s
in-house science service
9
Background
In 2012, breast cancer continued
to be the cancer attributable for more
deaths among women in the European
Union, with a mortality rate of 22,4
(15,1 ÷ 29,5 per 100000 women) not
parallel to incidence.
Inequalities in outcomes are
unacceptable. Quality of care should
be aligned as regards essential
requirements.
Available at: EUCAN webpage.
Breast Cancer Care – Quality Assurance Scheme and Guidelines
Disclaimer: The contents of this presentation are the views of the author and do not necessarily represent an official position of the European Commission. © European Union, 2013
Cancer Registries
Joint Research Centre
The European Commission’s
in-house science service
Manola Bettio Cancer Information Team
11
Lomg-Term Strategic Dimension
European Cancer Information
Service (ECIS).
Laying the foundations for a
framework for interoperability
of all national/regional registries.
PARENT Joint Action (Registry
of registries).
Increasing collaboration with Eurostat.
Increasing collaboration with the INSPIRE framework – integration
of health data.
Rare Diseases Registries platform.
Rare Diseases Simona Martin Rare Diseases Team
13
Rare Diseases
Life-threatening or chronically debilitating diseases with low prevalence:
less than 5 per 10,000 persons (EU).
6,000-8,000 distinct rare diseases.
6%-8% of the EU population affected: 27-36 million people (EU).
Legal Framework
Communication from the Commission to the European Parliament, the
Council, the European Economic and Social Committee and the Committee
of the Regions on “Rare Diseases: Europe’s challenges” (2008).
Council Recommendation on an action in the field of rare diseases (2009).
Disclaimer: The contents of this presentation are the views of the author and do not necessarily represent an official position of the European Commission. © European Union, 2013
Joint Research Centre
The European Commission’s
in-house science service
Behavioural insights for healthy lifestyles
Behavioural Economics Team (BET)
Benedikt Herrmann Behavioural Economics Group Leader
15
On-going Projects
Disclaimer: The contents of this presentation are the views of the author and do not necessarily represent an official position of the European Commission. © European Union, 2013
Joint Research Centre
The European Commission’s
in-house science service
JRC Involvement in the implementation of the future
regulatory framework for Medical Devices Bo Larsen
Medical Devices Task Force
17
Short-Term Activities (2013-2014)
Analysis of incident reporting data for medical devices relevant for
the European market, and provide recommendations on effective
detection of signals and trends.
Participation in the Medical Devices Expert Group and sub-groups.
Contribute in projects of Clinical Investigations and Evaluation (CIE)
as well as of Compliance and Enforcement (COEN).
Disclaimer: The contents of this presentation are the views of the author and do not necessarily represent an official position of the European Commission. © European Union, 2013
Public Health Policy Support:
Nutrition Activities Sandra Caldeira Nutrition Group Leader
20
• DG SANCO and HLG for their great support
• 100% feedback rate from HLG!
• Michael Nelson (PHN Research) for SNIPE questionnaire and expert input
• WHO
• Our in-house Nutrition & Health team
With sincere thanks to:
Thank You for Your Attention
www.jrc.ec.europa.eu
© European Union, 2013 Disclaimer: The contents of this presentation are the views of the author and do not necessarily represent an official position of the European Commission.
Workshop School Food and Nutrition Policy in Europe:
policies, interventions and their impact
15-16 May 2014, European Commission Joint Research Centre (JRC), Ispra, Italy
(co-hosted with WHO-Europe and Public Health Nutrition Research UK)
EUROPEAN COMMISSION JOINT RESEARCH CENTRE
Institute for Health and Consumer Protection
I.2 Public Health Policy Support
Margherita Caroli MD PhD
Nutrition Unit
Department of Prevention
ASL Brindisi - Italy
Why should we promote healthy diet in children?
Health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest
possible level of health is a most important world-wide social goal whose realization requires the action of many other social and
economic sectors in addition to the health sector. Declaration of Alma-Ata Inter Conference on Primary Health Care, Alma-Ata,
USSR, 6-12 September 1978
Nutrition The process of providing or obtaining the food necessary for health and growth: Oxford dictionary
27.5 27.5
22.2 22.9 23.1 21.2
32.3
25.5
15.0
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
Children’s health status in Europe
Modified from Cattaneo, Monasta, Caroli et Al. Overweight and obesity in infants and pre-school children in the European Union: a review of existing data. Obes Rev 2010 11(5):389-98
% Prevalence of overweight (incl. obesity) in children 4-5 years of age
Prevalence of overweight (incl. obesity) (%), 2007-2008
0.0
10.0
20.0
30.0
40.0
50.0
Belgium
Bulgaria
Czech
Republic
Ireland
Italy
Latv
ia
Lithuania
Malta
Norway
Portugal
Slovenia
Sweden
Countries
Pre
va
len
ce
(%
)
6-year-olds 7-year-olds 8-year-olds 9-year-olds
46%
32%
38%
19%
Source: WHO Regional Office for Europe, . Estimate Is based on the 2007 WHO Growth Reference (>+1sd).
Children’s Health situation in Europe
The results of descriptive analysis show that the highest mean rate of child malnutrition was found in South Asia region (57 children per 100), while the smallest mean rate was found in Europe region (just 1 child per 100).
The Global Problems of Child Malnutrition and Mortality
in Different World Regions
Ashraf Ragab El-Ghannam
Journal of Health & Social Policy Vol 16, (4) 2003 p 1-26
Undernutrition
Health situation
Health situation
Both these figures are good example of how nutrition influences health in children
Overweight rate in Europe is much higher than malnutrition one
OW 19-46 % : UW 1%
The most urgent public health issue in paediatric age in Europe is overweight control
High risk of obesity persistence in adulthood (and consequently higher mortality)
35% of obese children at 6 years of age will be obese in adulthood
75% of obese adolescents at 12 years will be obese in adulthood
Weight excess in childhood
Risk of being overweight in adulthood
The Prince as child
The Prince
(Freedman 2005)
Elevated lipid concentrations and blood pressure Freedman et al.
Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. J Pediatr. 2007; 150(1):12-17.e2
Metabolic syndrome Bokor et al. Prevalence of metabolic syndrome in European obese
children I J Ped Ob. 2008; 3 (Suppl 2): 38
Gastroesophageal reflux disease Koebnick et al. Extreme childhood obesity is associated
with increased risk for gastroesophageal reflux disease in a large population-based study. Int J Pediatr Obes. 2011; 6(2-2):e257-63
Higher level of oxidative stress and inflammation Norris et al. Circulating
oxidized LDL and inflammation in extreme pediatric obesity. Obesity (Silver Spring) 2011; 19(7):1415-9
High cardiovascular risk Van Emmerik etal. High cardiovascular risk in severely obese
young children and adolescents. Arch Dis Child. 2012; 97(9):818-21
Severe obstructive sleep apnea Udomittipong et al. Severe obesity is a risk factor
for severe obstructive sleep apnea in obese children. J Med Assoc Thai. 2011; 94(11):1346-51
Dyspnea Scholtens et al. Overweight and changes in weight status during childhood in
relation to asthma symptoms at 8 years of age. J Allergy Clin Immunol. 2009; 123(6):1312-8,
Childhood obesity complications:
Children overweight or obese are, in adolescence and in adulthood, at greater risk of orthopaedic problems, low self-image, depression and impaired quality of life. They have an increased risk of being an obese adult, at which point CV disease, diabetes, certain forms of cancer, osteoarthritis, a reduced quality of life and premature death become health concerns. (Sassi 2010; Currie et al. 2012).
Evidence suggests that even if excess childhood weight is lost, adults who were obese children retain an increased risk of CV problems. Although dieting can combat obesity, children who diet are at a greater risk of putting on weight following periods of dieting. Eating disorders, symptoms of stress and postponed physical development can also be products of dieting. (WHO Europe, 2009).
To diet or not to diet: this is the question….
Yes, he is much better looking now, but he never
recovered from this …
Thus, preventing and not only treating is mandatory
Comparability of data limited because of:
use of different methods
(24-hour recalls or Food Frequency Questionnaires)
different years and periods of data collection
different age classifications.
Assessing children energy and nutrient intake in 16 European countries
Elmadfa I (ed): European Nutrition and Health Report 2009. Forum Nutr Basel, Karger, 2009;62:68–56
Intake of energy (MJ/die) in the European four regions
4-6 7-9 10-14
Regions Age groups North
South
Central and East
West
Elmadfa I (ed): European Nutrition and Health Report 2009. Forum Nutr Basel, Karger, 2009;62:68–56
Comparison among recommended and observed energy intake (min-max) in reviews published in 2004 and 2009 in the European
children
4 – 6 years 7 – 9 years 10 – 14 years
Recommended value*
M 5.7 – 6.1 F 5.2 – 5.6
M 7.1 – 7.7 F 6.5 – 7.1
M 9 – 11.6 F 8.4 – 10
2004** M 5.4 – 7.9 F 5.2 – 9.8
M 7.1 – 10.3 F 6.8– 9.8
M 7.9 – 15.3 F 6.9 – 11.1
2009*** M 6.1 – 7.4 F 5.9– 7.0
M 7.8 – 9.5 F 7.0 – 8.5
M 8.1 – 10.4 F 7.1 – 8.7
** Lambert J, Elmadfa I. et al. Dietary intake and nutritional status of children and adolescents in Europe . BrJ Nutr. 2004 92 Suppl 2, S147-S211
*Human energy requirements: Report of a Joint FAO/WHO/UNU Expert Consultation. 2004
***Elmadfa I (ed): European Nutrition and Health Report 2009. Forum Nutr Basel, Karger, 2009;62:68–56
Intake of protein (min-max) P%E in the European four regions
North
South
Central and East
West
Regions Age groups
4-6 7-9 10-14
Elmadfa I (ed): European Nutrition and Health Report 2009. Forum Nutr Basel, Karger, 2009;62:68–56
Comparison among recommended and observed protein intake (min-max) in reviews published in 2004 and 2009 in the European
children
* Lambert J, Agostoni C. et al. Dietary intake and nutritional status of children and adolescents in Europe . BrJ Nutr. 2004 92 Suppl 2, S147-S211
**Elmadfa I (ed): European Nutrition and Health Report 2009. Forum Nutr Basel, Karger, 2009;62:68–56
AGE %P/E 2004* %P/E 2009**
4-6 M 11,6-15,2 13-15,4
F 12,1-12,2 13,4-15
7-9 M 13,4-13,8 13,7-15,3
F 12,9-14,5 13,7-15,3
10-14 M 12,9-12,9 13,5-15,7
F 12,7-13,2 13,6-15,6
North
South
Central and East
West
4-6 7-9 10-14
Regions Age groups
Elmadfa I (ed): European Nutrition and Health Report 2009. Forum Nutr Basel, Karger, 2009;62:68–56
Carbohydrate (min-max) %E (sucrose) in the European 4 regions
Regions Age groups 4-6 7-9 10-14
North
South
Central and East
West
Elmadfa I (ed): European Nutrition and Health Report 2009. Forum Nutr Basel, Karger, 2009;62:68–56
Fat (min-max) %E; saturated fat %E in the European 4 regions
Regions Age groups 4-6 7-9 10-14
North
South
Central and East
West
Elmadfa I (ed): European Nutrition and Health Report 2009. Forum Nutr Basel, Karger, 2009;62:68–56
Dietary fibers g/day (min-max) in the European 4 regions
The South region shows a higher energy intake, protein, and fat intake (%E) and a lower carbohydrate intake (%E) compared to the other regions for 7- to 9-year-old children.
All other regions show otherwise comparable intake levels.
The South region shows less favorable macronutrient intake than the other three regions (in all the age groups).
Dietary fiber intake levels are far below the recommended level of 25 g/day in every region.
The South region tends to show in all age intervals the lowest share of saturated fatty acids (9.4–14.5%E).
Lowest intake of polyunsaturated fatty acids was observed in the North region (3.6%E).
Comparison of Regions
0
50
100
150
200
250
300
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
cit
ati
on
s
insulin resistance or type 2 diabetes
hypertension
steatosis or cirrhosis
Citation trends for paediatric obesity-linked co-morbidities
Overweight and obesity prevalence and estimated trend in European children and adolescents
2006-2010
Lobstein & Jackson-Leach Estimated burden of paediatric obesity and co-morbidities
in Europe. Part2. Number of children with indicators of obesity-related disease Int J
Pediatr Obes 2006. 1 (1):33-41
2006
Estimated number of EU children 5-18 yrs 71ml:
overweight 17ml
obese 5ml
1.2ml-1.7ml obese children with complications
Expected number of overweight children in 2010: 26million
% Number of children
EU
Imp. Gluc. Tolerance 8.4 420.000
Type 2 diabetes 0.5 27.000
Hypertension 22 1.110.000
Metabolic syndrome 24 1.200.000
Liver steatosis 28 1.420.000
Raised ALT 13 650.000
Dyslipidemia 20 1.120.000
Prevalence of co-morbidities of childhood obesity in Europe 2006
Lobstein & Jackson-Leach Estimated burden of paediatric obesity and
co-morbidities in Europe. Part2. Number of children with indicators of
obesity-related disease Int J Pediatr Obes 2006. 1 (1):33-41
How has evolved this estimation today?
EU information on health and nutrition habits of children and adolescents
EU has
Plenty of EU projects addressing these topics
Several different snapshots of eating behaviours and energy and nutrient in small samples of children/adolescents (some of them quite old (25-30 years old).
EU doesn’t have and needs
Children health and nutritional status data
Age disaggregated Sex disaggregated Foods intake (quality & quantity) Social determinants Cost of healthy nutrition Homogenously collected
What is around the obese child?
The economic crisis is increasing poverty, unemployment and stress, all of which are associated with worse health outcomes, yet public and private budgets are under great strain. The report highlights the marked slowdown (sometimes even reduction) in health spending over recent years in many countries, as part of broader efforts to reduce large budgetary deficits. If the report does not yet show any worsening health outcomes due to the crisis, there is no cause for complacency – it takes time for poor social conditions or poor quality care to take its toll from people’s health. Policy makers have often done what they could to ensure that access to high quality care remains the norm in Europe; whether this is enough to protect the health of the population will only become clear in years to come. Yves Leterme Paola Testori Coggi OECD Health at a Glance: Europe 2012, OECD Publishing. http://dx.doi.org/10.1787/9789264183896-en
Health is an invisible value which becomes visible only when is lost
Margherita Caroli, her own home, many years ago
School and Nutrition
in WHO European
Region
Dr Joao Breda PhD, MPH, MBA Programme Manager Nutrition, Physical Activity
and Obesity
Ispra, 15&16 May 2014
School food and nutrition
• Problem?!
• Mandate
• Nutritional status surveillance – global and regional
• Evidence generation and evaluation
• Guidelines and recommendations
• Marketing HFSS
• A setting ideal to prevent food insecurity and
micronutrient deficiencies
Prevalence of overweight (BMI-for-age +1SD)
among European adolescents (11, 13 and 15 years old boys and girls) in 2002
Source: HBSC Survey 2002. Data for 32 Member States
of the WHO European Region in 2002
15%≤ BMI-for-age <20%
10%≤ BMI-for-age <15%
BMI-for-age >10%
BMI-for-age ≥20%
No information
Prevalence of overweight (BMI -for-age +1SD)
among European adolescents (11, 13 and 15 years old boys and girls) in 2006
Source: HBSC Survey 2006. Data for 32 Member
States of the WHO European Region in 2006
15%≤ BMI-for-age <20%
10%≤ BMI-for-age <15%
BMI-for-age >10%
BMI-for-age ≥20%
Prevalence of overweight (BMI -for-age +1SD)
among European adolescents (11, 13 and 15 years old boys and girls) in 2010
Source: HBSC Survey 2010. Data for 32 Member
States of the WHO European Region in 2010
15%≤ BMI-for-age <20%
10%≤ BMI-for-age <15%
BMI-for-age >10%
BMI-for-age ≥20%
Nutrition, PA and Obesity
International highlights from the HBSC 2009/2010
International Report
Health behaviors: all worsen Overweight and obesity: all increase Breakfast: decreases in both boys and girls Fruit: decreases in both boys and girls Physical activity: decreases in both boys and girls
How can we support national efforts? WHO provides upstream policy advice to set national targets
6 global targets for nutrition to be attained by 2025
-40% 40% reduction in number of children
under-5 who are stunted
-30% 30% reduction in low birth weight
≥ 50% Increase the rate of
exclusive breastfeeding in the first six months to
at least 50%
-50% 50% reduction of anaemia in women reproductive age
0% No increase in childhood
overweight
<5% Reduce and
maintain childhood
wasting to less than 5%
Global Action Plan and
Global Monitoring Framework
Health 2020 Strategic objectives
1. Improving health for all and reducing health inequalities
2. Improving leadership and participatory governance for health
Priority areas
Adolescents - overweight (including obesity)
prevalence in youth according to “sub-region”
14.1
20.2
11.5
15.5 14.7
21.3
15.6 16.2
15.3
22.5
18.5 17.3
0
5
10
15
20
25
30
Western Europe Southern Europe Eastern Europe Northern Europe
%
2002
2006
2010
Sharper increase
Overweight prevalence distribution according to geographical region in 32 countries within WHO
European Region, considering both boys and girls with 11, 13, 15 (Source: HBSC) – unpublished,
please do not quote
Obesity and inequalities
Existing Pan-European Surveillance Systems:
1) WHO-COSI
2) Healthy Behaviour in School-aged Children
(HBSC)
3) EU Menu
4) EHIS (European Health Information System)
5) EHES (European
6) DHS & MICS
Evidence and guidance
Overview Surveillances systems WHO
European Region EU Member States
Po
lic
y
Ac
tio
ns
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Measures to affect food prices
Labelling - signposting
Reformulation - less sugar and salt
Promote Active Travel for school-children
Marketing HFSS foods to children - restrictions
Salt reduction initiatives
School Fruit Scheme (SFS) or similar
Programs in schools (inc. vending machines)
Baby Friendly Hospital Initiative
Physical Activity Policy incl. Guidelines
Breastfeeding promotion and protection policies
Food Based Dietary Guidelines
Labelling - nutritional information
No Action Partially implemented Fully implemented
Moving forward toward protecting
children from obesity and NCDs
• Monitoring and surveillance
• Sustainability and enlargement;
• School food and nutrition programmes;
• Vulnerable groups
• Local action;
• Marketing food to children - NP;
• Prices policies
• Reformulation
• Early nutrition and life-course
• Health sector response
Health and Consumers
EU actions on Nutrition and Physical activity
Nutrition in schools Presentation at JRC School Food Policy Workshop
Philippe Roux
Head of Unit 'Health Determinants'
Directorate-General for Health and Consumers
European Commission
15 May 2014
1
Health and Consumers
1. EU policy framework
• Europe 2020: A European Strategy for Smart, Sustainable and Inclusive Growth
• Investing in Health
• Strategy for Europe on Nutrition, Overweight and Obesity-related Health issues
2
Health and Consumers
Europe 2020: A European Strategy for Smart, Sustainable and Inclusive Growth
Action on health is needed to achieve: - sustainable and efficient health systems - Contribute to increased employment – by reducing premature death and disability amongst working age population -Reduce health inequalities 3
Health and Consumers
Investing in Health Commission Staff Working Document (February 2013)
As part of the "Social Investment Package" Investment in health is: - investing in sustainable health systems – cost effective spending, structural reforms and sound innovation - investing in people's health as a human capital – contributes to economic growth - Investing in reducing health inequalities
4
Health and Consumers
The Strategy for Europe on Nutrition, Overweight and Obesity-related Health issues (2007)
5
European Commission
Member States
Private/public Stakeholders
WHO
High Level Group on Nutrition and Physical Activity
EU Platform for Action on Diet, Physical Activity and Health
Nutrition and Physical Activity in all policies
EC Programmes/fundings (Health programme, Research programme)
Monitoring system and evidence base
External Evaluation of the Strategy: - Efficiency proved - Need to boost the work
Health and Consumers
Priority areas of the Strategy
6
• better informed consumers • making the healthy option available • encouraging physical activity • develop the evidence base to support policy
making • develop monitoring systems Children are a priority group in the Strategy Reducing inequalities is a horizontal concern
Health and Consumers
Evaluation report
Supports continuation of the Strategy, High Level Group and Stakeholder Platform
Continued coordination at the EU level by the Commission is needed
EU Platform to monitor efficacy and impact
Further focus on:
• physical activity
• lower socio-economic groups
7
Health and Consumers
2. Implementation of the Strategy
• EU Platform for Action on Diet, Physical Activity and Health
• High Level Group on Nutrition and Physical Activity
• Action Plan on Childhood Obesity
• Cooperation with Joint Research Centre
8
Health and Consumers
The EU Platform for Action on Diet, Physical Activity and Health
9
• Since 2005 a multi-stakeholder and voluntary approach • 33 EU Platform members:
• Industry • Public Health NGOs • Health Professionals • Consumer Groups
• More than 300 commitments
• Members are responsible for the monitoring and
reporting on their commitments
Health and Consumers
Fields of action
10
137 active Platform commitments:
• Consumer information, including labelling
• Education, including lifestyle modification
• Physical activity promotion
• Marketing and advertising
• Composition of foods (reformulation)
• Advocacy and information exchange
27 active commitments dealing with healthy diets and physical activity of school children.
http://ec.europa.eu/health/nutrition_physical_activity/platform/platform_db_en.htm
Health and Consumers
Example of Platform commitment - 1
11
• Name: Eat like a Champ
• Platform member: Danone (FoodDrinkEurope)
• Time of action: 2010 – 2017
• Target audience: Children and adolescents
• Geographical coverage: United Kingdom
• Description: a 6 week nutrition education programme taught in year 5 classes (9-10 year olds) in the UK. The lessons are developed with the British Nutrition Foundation. It aims at helping the government tackle the growing issue of poor nutrition and sedentary lifestyle amongst children and parents
Health and Consumers
Example of Platform commitment - 2
12
• Name: Smart Choice
• Platform member: Mars (FoodDrinkEurope)
• Time of action: 2007-2015
• Target audience: Educators
• Geographical coverage: Belgium
• Description: Run mainly in secondary schools and targets students between 12 and 18 years of age. The objective of the programme is to continue strengthening efforts in education by supporting schools to encourage responsible snacking, promoting appropriate vending practices with the ultimate goal of promoting a healthy lifestyle.
Health and Consumers
The High Level Group for Nutrition and Physical Activity
13
• Representatives from 28 EU Member States, 2 EFTA countries (Norway, Switzerland) and WHO
• Seeks European solutions to obesity-
related health issues
• Encourages governments to share policy ideas and practice.
Health and Consumers
Nutrient framework - 1
High Level Group agreed in 2011 on an EU Framework on Selected Nutrients (energy, total fat, saturated fat, trans fat, added sugars, portion sizes and consumption of specific foods)
First salt, now saturated fat
Action on fat followed success on salt. Work is ongoing on an Annex with benchmarks to reduce saturated fat (5% until 2016 and an additional 5% by 2020)
In 2014 and beyond, the efforts on saturated fat reduction will target school meals, ready meals, dairy, meat products, fats oils and margarines (mapping of school meals by the JRC)
14
Health and Consumers
Nutrient framework - 2
Under the EU Action Plan on Childhood Obesity, further discussions on saturated fat reduction strategies will soon begin with the dairy and meat products stakeholders
Energy intake, added sugars and total fat to follow
In the future, additional annexes should be added to the Framework
15
Health and Consumers
• Following the discussions with the Informal Health Council in Dublin in March 2013 on childhood obesity, the High Level Group for Nutrition and Physical Activity was mandated to develop an action plan targeting childhood obesity.
• The Action Plan will play a key role in implementation of the 2007 Strategy for Europe on Nutrition, Overweight and Obesity-Related Health Issues. It will bridge between the current and the next Commission and European Parliament. And it will help to gain momentum for nutrition and physical activity, keeping it high on the agenda.
16
Action Plan on Childhood Obesity - 1
Health and Consumers
• At the last High Level Group meeting on 24 February 2014 in Athens, the Action Plan received the agreement of MS.
• The Action Plan was communicated at the Greek Presidency Conference on “Nutrition and Physical Activity from childhood to old age: challenges and opportunities”, which took place on 25-26 February 2014, also in Athens.
• The Action Plan is a voluntary High Level Group initiative and not a Commission document.
17
Action Plan on Childhood Obesity - 2
Health and Consumers
• Eight areas for action:
• - Support a healthy start in life
• - Promote healthier environments, especially in schools and pre-schools
• - Make the healthy option the easier option
• - Restrict marketing and advertising to children
• - Inform and empower families
• - Encourage physical activity
• - Monitor and evaluate
• - Increase research
18
Action Plan on Childhood Obesity - 3
Health and Consumers
Joint Research Centre
• Supports the EU Platform and High Level Group with research updates on nutrition, obesity and physical activity
• Guidelines on school meals mapping
• Partner in EXPO Milan 2015
• Competences and cooperation on health
Institute for Health and Consumer Protection (cancer, rare diseases; lifestyle; environmental and behavioural)
Institute for Prospective Technological Studies (forecasting)
19
Health and Consumers
3. Additional work at EU level
• EU-wide School Fruit and Vegetables and School Milk Schemes
• Pilot projects
• EC co-funding programmes
20
Health and Consumers
• The EU-wide School Fruit and Vegetables and School Milk Schemes contribute to establishing healthier eating habits among school children. The Commission adopted a new proposal (COM
(2014) 32 from 30 January 2014) to strengthen the educational dimension of these schemes and increase their effectiveness.
• The current School Fruit Scheme can already support initiatives for educating children about agriculture, healthy eating habits and environmental matters related to fruits and vegetables including food waste (These measures will be eligible for EU aid as of 2014/2015 school
year).
• http://ec.europa.eu/agriculture/sfs/index_en.htm
• http://ec.europa.eu/agriculture/milk/school-milk-scheme/index_en.htm
21
Wider School Scheme
Health and Consumers
• Pilot projects supported by the European Parliament that focus on local communities:
• The Commission has launched three pilot projects:
• - two projects aim to increase consumption of fresh fruits and vegetables in communities where the household income is below 50% of the EU average. Children are one of the target groups;
• - one project aims to promote healthy diets among children, pregnant women and elderly.
•
• SANCO/2011/C4/01
• SANCO/2012/C4/02
• SANCO/2013/C4/02
22
Pilot projects
Health and Consumers
• The Commission has programmes in place that could fund project or research proposals on healthy lifestyles:
• - the new Health Programme (2014-2020) will have a budget of € 449.394 million over seven years (2014 to 2020).
• http://ec.europa.eu/health/programme/policy/index_en.htm
• - the Horizon 2020 Framework Programme for Research and Innovation (2014-2020).
• COM(2011) 809 final, 30.11.2011
•
23
EU co-funding
Health and Consumers
School Feeding Policy Environment: cross country
review
Samrat Singh Research Associate
RESEARCH FRAMEWORK
• 18 country review of school feeding policy/legal frameworks (PCD-WFP)
• Ongoing technical assistance in Ghana, Nigeria, Kenya and Mali
POLICY ENVIRONMENT
REGULATORY SYSTEM
• Defined by set of legislative and executive
instruments
• Articulates ‘rights’, sets out objectives and
establishes the institutions/processes
BENEFITS OF A COMPREHENSIVE REGULATORY SYSTEM • Defined and secure budgetary allocation
• Longitudinal sustainability
• Multi-agency harmonization
• Efficiency and Transparency
• Sectoral/policy convergence
• Institutional foundation
KEY ISSUES AND FINDINGS
Issue 1: LEGISLATIVE FRAMEWORK
Primary legislation, secondary legislation and process
Findings:
• Highly variable
• No + correlation b/w right to food & legislative
engagement
• Well established frameworks policy linkages
CROSS COUNTRY COMPARISON OF LEVEL OF LEGISLATION AND THE REGULATORY APPROACH
Issue 2: DEFINING OBJECTIVES
Clearly defined objectives, policy coherence
Findings:
• Nutrition & Education
• Farm linkages
• Gender equity
Issue 3: DECENTRALIZATION
Devolution in governance/ management, conformity with
local laws, difference b/w devolution-power & functions.
Findings:
• Most countries decentralized management
• Brazil, England, Scotland, India- substantial
• Ecuador - centralized
• Nigeria - outside state apparatus
• Ethiopia, Malawi - well developed decentralized governance
Issue 4: FARM LINKAGES
Local procurement, agricultural production, defining ‘local’,
supply chain implications.
Findings:
• Chile/Bangladesh - modality constraints
• Specific mandate & mechanism - Brazil, US, Ecuador,
Tanzania
• England/ Scotland – encouraged - constrained by EU law
• Mali, Ghana - included in objectives
• Well-developed procurement law better linkages
CROSS COUNTRY COMPARISON OF PROCUREMENT GUIDELINES AND FARM LINKAGES
Advanced
Med-Adv
Medium
Low-Med
Low
Nil-Low
Nil
PROCURMENT GUIDELINES
FARM LINKAGES
CH BR EC
RSA US
EN
BR
PN
CH
IN
CH
KN
CH SC
CH
NG
CH MA
BD
CH
JD
Issue 5: TARGETING
Defined in legislation/policy, principles/mechanisms, review.
Findings:
• Universality access/availability
• Brazil – Rights-based social inclusion, RSA – Needs-based
• Rights based (Brazil)/needs-based(RSA)/non-constitutional
entitlement-based (England)
ILLUSTRATION:NIGERIA
• 20 states 2 states
• Universal Basic Education Act (2004) provides for school lunch limited impact
• Development of state level policy & legislation (framework/detailed) (Osun state)
• Federal guidelines/platform for harmonization and cross learning
An initiative by DG SANCO and the JRC
https://ec.europa.eu/jrc/
School food policies across the EU28 plus Norway and Switzerland
Disclaimer: This presentation and its contents do not constitute an official position of the European Commission or any of its services. Neither the European Commission nor any person acting on behalf of the Commission is responsible for the use which might be made of this presentation or its contents
Therese Kardakis, Michael Nelson, Jan Wollgast, Sandra Caldeira
Stefan Storcksdieck genannt Bonsmann, PhD
Background
• Both national and international strategy papers and policies highlight school setting as important for children to develop healthy diet and lifestyle habits
• European overview of school food policies would help researchers and policymakers alike in their respective work
Objective
• Describe current landscape of school food policies across EU28 plus Norway and Switzerland
Background and Objective
• Identify most recent national policy documents in relation to standards or guidelines for provision of food in (primary and secondary) schools • WHO NOPA, ministerial websites, original papers and reports • Support from HLG members, national dietitians
• Systematically describe the content of the respective policy
• Based on SNIPE* questionnaire (developed by PHN Research) • Subset of mainly nutrition-related questions
• Analyse resulting matrix for key commonalities and differences
between countries to possibly collate core elements characteristic of solid school food policy for Europe
Methodology
*SNIPE = School Nutrition Index of Programme Effectiveness
• Mandatory school food standards in 18 out of 34 policies
Mandatory vs voluntary policies
voluntary
mandatory
Which ministries are responsible?
n=34
3%
97% 94% 88%
65%
53% 50%
0%
20%
40%
60%
80%
100%
What are the major policy objectives?
n=34
Evaluation criteria? Which ones?
* 59% (=19) specify outcome measures
56%
35% 29%
24%
15%
0%
20%
40%
60%
80%
100%
Food provisionat school
Take up ofschool meals
Nutrition ofchildren
Foodconsumption at
school
Financialviability of
services
n=34*
Food-based standards (n=34) For lunch For other mealtimes
Drinks limited to specific types 82% 82%
F&V provision 79% 68%
Fresh drinking water 79% 68%
Soft drinks restricted 71% 65%
Sweet treats restricted 68% 79%
Frequency of serving dairy 65% n/a
(Deep-)fried/processed products restricted 65% 65%
Salt provision restricted 65% 53%
Frequency of serving non-meat/non-dairy protein 59% n/a
Frequency of serving (oily) fish 59% n/a
Crisps/savoury snacks restricted 59% 74%
Frequency of serving (red) meat 53% n/a
Starchy food cooked in fat/oil restricted 53% 53%
Nutrient-based standards (n=34) For lunch For other mealtimes
Energy 65% 44%
Fat 59% 44%
Protein 50% 26%
Total carbohydrates 47% 32%
Iron 44% 24%
Calcium 44% 26%
Vitamin C 44% 29%
Fibre 44% 24%
Sugars 41% 35%
Sodium 41% 24%
Folate 38% 29%
Saturated fat 38% 26%
Zinc 32% 21%
Vitamin A 32% 21%
• 65% (22/34) request training requirements for catering staff • 21% (7/34) others recommend qualified staff/formal training
• 26% (9/34) specify marketing restrictions for high-sugar
foods and drinks as well as snacks high in fat/salt • Another 50% (17/34) restrict marketing in some other way
• 68% (23/34) mandate food and nutrition as part of national
curriculum
• 82% (28/34) also give guidance on food provision in pre-schools
Other findings
• All 30 countries (EU28 plus Norway and Switzerland) have school food policy in place
• Almost even split between voluntary guidelines and obligatory standards
• Countries differ in history and extent of providing food at school
• Our descriptive map of European school food policies can help policymakers facilitate exchange of experiences and support researchers in assessing impact on public health
• Information could be turned into an online database to be updated regularly and linked with existing information platforms
Take home messages
Public Health Policy Support: Nutrition
• visit us @ http://ihcp.jrc.ec.europa.eu/our_activities/public-health/nutrition • read our newsletter Nutrition Research Highlights • follow us on twitter @IHCPNutritionEU
Workshop “School Food and Nutrition Policy in Europe” Joint Research Centre, European Commission Pedro Graça [email protected]
Focus on Food Security/Reducing micronutrients deficiency through School Nutrition
ISPRA, May 15th 2014
)
The concept of Food Security
“The access to sufficient, safe and nutritious food to maintain a healthy and active life”
World Food Summit, 1996
means…. “Education/Knowledge” and “Food Availability”
Curriculum (Students)
Food Services (Environment)
• Disciplines
• Other areas
• Bar
• Canteen
• Other areas
Nutrition Intervention in Schools
(Education and Food Provision)
Model used for interventions in schools
Rui Matias Lima, 2014
45,259,5
69,3
87,2 94 98 97
0
20
40
60
80
100
%
year
1999
year
2000
year
2001
year
2007
year
2008
year
2009
year
2010
Nutrition Education - Schools initiative
% of schools with Nutrition Education voluntary projects in
(1999-2010) Portugal
Rui Matias Lima
Circular nº 11/DGIDC/2007 – Schools Bar
Circular nº 14/DGIDC/2007 – Schools canteen (Iodine salt in 2014)
Decreto-Lei nº 55/2009 de 2 de Março
Despachos anuais sobre Acção Social Escolar (Despacho n.º 14368-
A/2010, de 14 de Setembro)
http://www.dgidc.min-edu.pt/educacaosaude/index.php?s=directorio&pid=1
Portuguese Food School Services Regulation
System of Planning and Evaluation of School Meals
SPARE – Menu planning
SPARE – Food policy evaluation
SPARE – Reports
Nutritional
adequacy
Menus
Quality
Global
Hygiene,
Sanitary and
Environment
http://www.fcna.up.pt/SPAREbase
(InfoFamília, DGS 2014)
Fo
od
In
se
cu
rity
in
Po
rtu
gal
What changes after 2011 ?
(InfoFamília, DGS 2014) Fo
od
In
se
cu
rity
co
ex
ists
wit
h
ob
es
ity i
n P
ort
ug
al
Food Insecurity (all levels)
Severe Food Insecurity
Moderate and Severe Food Insecurity
The characteristics of the study population (n=1098)
Health inequalities in energy balance-related behaviours among schoolchildren across in Europe: Baseline results of the EPHE project
(Mantziki K et al, 2014)
Country Fruit
(times/wk)
Cooked vegetables (times/wk)
Salad/Raw vegetables (times/wk)
Water (times/d)
Fruit juices (ml)
Soft drinks (ml)
TV watching
(h/d)
Computer playing (h/d)
Sleep duration
(h/d)
Belgium - - - - - - *** ** -
Bulgaria - - - - * - - *** -
France - - - * † * ** - -
Greece - - * - - - ** - -
Portugal *** *** ** - - * ** * **
Romania * * - - * *** *** - -
The Netherlands
*** - - - * - * - ***
*,**,***: Result statistically significant at the 5% , 1%, 0% level, respectively. †:Result marginally significant at the 5% level. ^:The differences in the indicated energy balance-related behaviours are reported for weekdays only.
Health inequalities in energy balance-related behaviours among schoolchildren across in Europe: Baseline results of the EPHE project
Levels of significance of differences in energy-balance related behaviours between low and high educational level of the mother per country
(Mantziki K et al, 2014)
FOOD INSECURITY
Welfare State expenses on health
and social care
Work capacity Poverty and
Social Inequalities
Chronic Diseases
FOOD INSECURITY
Demographic and technical changes
(Ageing Population)
Economic Crisis
Ratio between the non-healthy and healthy population (chronic
diseases)
Ratio between the non-working and working population
Welfare State expenses on health and social care
Poverty and Social Inequalities
Cycle
betw
ee
n p
ove
rty,
foo
d
inse
cu
rity
an
d N
CD
s…
is
co
min
g t
o s
ch
oo
l
(Gregório MJ, Graça P, Nogueira PJ, 2014)
Draft FNAP 2014-2020 version 1.1. 09/03/2013
1 of 36
WHO European Region
Food and Nutrition Action Plan
2014 – 2020
WHO European Region Food and Nutrition Action Plan 2014-2020
WHO Europe´s policy framework
Food and Nutrition
Curriculum (Education)
Food Services (Environment)
• Disciplines
• Other areas
• Bar
• Canteen
• Other areas
Nutrition Intervention in Schools
Can we keep the traditional model ?
How to Promote Food Security in the age of
austerity
New questions
New and non traditional food
insecure students
Teachers and school staff less rewarded and
more insecure in job/less time to
nutrition in school/less involvement/more
functions
Food services paid by municipalities each
with specific economic capacities and
investments/less and more dispersed control
School canteens and food services provided
by outsourced companies
Food companies start to provide food and nutrition education materials in terms of their Social Responsibility
The importance of local government participation with improved capacity to evaluate food insecurity
Create strong networks between local food producers and schools
Improve the nutritional quality of food assistance programs
Integrate traditional diets as a sustainable and healthy diet pattern in school curriculum and canteens
Improve school staff workforce capacity to be involved in solutions
Lo
okin
g f
or
po
ten
tia
l are
as o
f
inte
rven
tio
n i
n P
ort
ug
al
The School Food Plan
JRC School Food and Nutrition Policy in Europe
15th May 2014
Background to The School Food Plan • July 2012, independent reviewers Henry Dimbleby and John Vincent
charged with answering two questions: 1. How do we get our children eating well in school?
• What more needs to be done to make tasty, nutritious food available to all school children?
• How do we excite children about food so that they want to eat it?
2. What role should cooking and food play more broadly in schools, to enrich children’s home lives and leave a legacy for later life?
• Ate in over 60 schools, hosted 7 regional events around the country
• Supported by an Expert Panel
Why Good Food Matters
Behaviour & Culture
Health
Attainment
The School Food Plan • Published on 12th July 2013 by the Secretary of State for Education
• Sets out 16 clear actions to improve health and attainment by driving change around food culture, including:
– Food education and cooking compulsory in the new curriculum
– £17.4m seed funding from DfE to establish breakfast clubs and increase take-up of school meals
– Introduction of new school food standards
The School Food Plan
• Positivity and Consensus
• Economics of School Food – Increasing take-up as the means and the end
• Sharing What Works Well – Every school is different, no single best practice
Three Principles
1. The Head teacher leads the change
1. Food as part of a whole school approach
1. Seeing through the eyes of the child
Key Updates • Universal Infant Free School Meals
• Cooking and Food Education compulsory up to the age of 14 in the new National Curriculum
• Ofsted inspection guidance includes the dining environment
• Revised School Food Standards
• DfE contracts of school support - over £17 million total
September 2014
A GOLDEN OPPORTUNITY
1. Universal infant free school meals
2. Cooking and food education in the curriculum
3. Revised food based Standards for all schools
Universal Free School Meals Revenue Funding
• £2.30 per meal taken
• Over £1bn committed in the budget for next two years
Capital Funding
• £150m – allocated based on pupil numbers to Local Authorities and the Academies Capital Maintenance Fund
Full details available in the DfE advice document https://www.gov.uk/government/publications/universal-infant-free-school-meals
Universal Free School Meals
Available at www.schoolfoodplan.com/uifsm :
• Universal infant free school meals toolkit
• Checklist for head teachers
• Links to DfE advice document
• Links to direct implementation support service
What Works Well
• Online platform for schools to Share What Works Well
SFP Actions Actions for Government
1. Cooking in the Curriculum
2. Food-based Standards
3. Increase Take-up
4. Establish Breakfast Clubs
5. London Flagship Boroughs
6. DfE Research
7. Train Head Teachers
8. Public Health England
9. Ofsted Guidance
10. DfE Measurement 5 KPIs
Actions for School Food Plan
11. Share What Works Well
12. Improve School Food Image
13/14 Build Workforce Skills
15/16 Support Small Schools
17. Universal Free School Meals
Cooking in the Curriculum • Practical cooking and food education are now compulsory for
Key Stages 1 to 3 in the new National Curriculum (effective from September 2014)
• As part of the School Food Plan, the Times Educational Supplement is helping develop a dedicated online platform for sharing what works well for food in schools, to be hosted at www.schoolfoodplan.com
Revised Food-based Standards
• Standards Panel drafted and tested new food-based standards, September to December 2013
• New standards will be available by September 2014, in force for early 2015
DfE Tenders
• Lot 1: £9.6m to support school readiness for universal infant free school meals
• Lot 2: £4.8m to increase school food take up in junior and secondary schools where take up is low
• Lot 2: £3m to establish school breakfast clubs
DfE has now awarded these contracts. More details available at www.schoolfoodplan.com
Ofsted Inspection Guidance As of September 2013:
• Inspectors should consider the food on offer at the school and atmosphere of the school canteen. They should
– Consider how lunchtime and the dining space contribute to good behaviour and the culture in the school, including by spending time in the lunch hall, and
– Ask school leaders how they help to ensure a healthy lifestyle for their children and, specifically, whether their dietary needs have been considered.
Train Head Teachers
The National College for Teaching and Leadership (NCTL) has developed content on food and nutrition to include in three of its compulsory essential modules within its leadership curriculum, including the National Professional Qualification for Headteachers.
London Flagships • GLA will establish 2 London Flagship Boroughs, to
demonstrate transformational impact on health and attainment by improving food across the whole environment, using schools as a catalyst to drive this change.
• Selection process will begin in March 2014
Find out more at: www.schoolfoodplan.com/london-flagships
Or email [email protected]
London Flagships
Indicative timeline – dates subject to change
Public Health England As part of the School Food Plan, PHE will:
• Share evidence on public health actions that are effective in tackling childhood obesity, relating to school food
• Advise Health & Wellbeing Boards and authorities on the most effective approaches within schools to improve children’s diets
• Work with the School Food Plan to create podcasts that share what works well in schools
• Use its social marketing expertise through Change4Life to communicate with children, young people and families around school food
Public Health England
Share What Works Well
Workforce Development • Led by LACA, this public-private alliance will develop a more
structured approach to training and qualifications for school caterers, including professional standards
Find out more at www.schoolfoodplan.com/workforce
Small Schools Taskforce A cross-sector collaboration of caterers, kitchen designers and manufacturers, working together to support small schools, will:
• Compile information on small school meals services around the country
• Run pilot to explore two solutions for small schools
• Publish findings in an open access report
Follow progress at www.schoolfoodplan.com/small-schools
Any queries, just email: [email protected]
Jan Jansen MSc MPH
CBO as WHO Collaborating Centre for School Health
Promotion
1
SHE Network – Who are we?
• 43 member countries: EU and EECA
• National coordinators and SHE Research Group
• Since 1992
• Support: WHO Euro, Council of Europe and EC
• Focus: making Health Promoting Schools an integral part of policy development in education and health sector
2
20 March 2014 3 SHE introduction
Mission: Every child and young person in Europe has the right, and should have the opportunity, to be educated in a health promoting school.
4
Whole school approach:
• Healthy school policies
• Physical school environment
• Social school environment
• Health skills and action competencies
• Community links
• Health services
5
New model for health promoting schools Whole school – whole community – whole child
A collaborative approach to Learning and Health
http://ascd.org (formerly the Association for Supervision and Curriculum Development)
6
What SHE does:
1. Share good practice
2. Identify areas for research
3. Maintain and expand SHE network
4. Ongoing technical support
5. Collaboration between health and education sectors
6. Support school health services and HPS
7
Trends and topics SHE 2013-2016
1. Tackling the health divide
2. Investing in making people healthier, empowering citizens
3. Tackling Europe’s major diseases
4. Creating healthy environments
5. Promoting and adopting ‘health in all policies’
8
SHE factsheet 1
State of the art:
Health promoting schools in Europe
9
Some Findings - 2013
• 34.000 schools in Europe are HPS • Some countries 100% schools
• Others range 2 – 10 %
• Strong commitment to HPS • National strategy
• Increasing number of HPS
• Networking
• Monitoring and evaluation
10
Popular health topics in schools:
• Sports/physical activity (96%)
• Healthy eating (92%)
• Drugs/smoking/alcohol (92%)
• Mental health (80%)
• Safety (77%)
• Environment/ Hygiene ( both 65%)
• Sexual health/ Violence in schools ( both 62%)
11
SHE factsheet 2
Evidence for effective action
(incl. background
document)
12
Evidence of whole school approach:
• The way the school is managed
• The experiences students have in taking responsibility for shaping change
• The way teachers relate to and treat students
• How school engages with its local community (including parents) .....
Builds health protective factors and reduces risk-taking behaviour
13
SHE online school manual
How to become a health promoting schools
in 5 steps
14
Health promoting schools give:
• Better learning achievements
• Higher job satisfaction
• Better care for pupils
• Better school atmosphere
• Higher efficiency at school-level
• Better image of school
15
HEPS: Healthy eating and physical activity in schools
EU funded project
HEPS offers
• A new comprehensive approach
• Aimed at the prevention of overweight through schools
• Based on the Health Promoting School Approach
HEPS Schoolkit (1)
• Guidelines – National level
– Guidelines on promoting
HE & PA
• Advocacy Guide – national level
– 5 step advocacy process
– Examples and arguments
HEPS Schoolkit (2)
• Tool for Schools – School level
– How to develop a policy
– Rapid assessment tool
• Inventory Tool – National/regional level
– Step-by-step approach
– Quality checklist
• Teacher Training Resource – National/regional level
HEPCOM is supported by the EU’s Health programme (2008-2013),
The views expressed are purely the authors' own and do not reflect the views of the European Commission
Hepcom
The Learning Platform for Preventing Childhood Obesity in Europe
P R O M OT I N G H EA LT H Y E AT I N G A N D P H YS I C A L A C T I V I T Y I N LO C A L
C O M M U N I T I E S
Obesity highlights at European level …
of children and adolescents are overweight,
And of these are obese
The challenge
Over of children who are overweight before
puberty will be overweight in early adulthood
20%
60% 1/3
children in the EU are considered overweight or obese,
with the numbers growing by per year
22M 400.000
Source: WHO and European Commission
EU FUNDED PROJECT LIFE
1st Release web learning platform
Pilot phase with local Communities
Final version of the platform
Running platform with an increasing number of health promotion tools
HEPCOM LEARNING PLATFORM DEVELOPMENT
AFTER THE END OF THE
PROJECT
Starting
page:
HEPCOM PROJECT IN NUMBERS
Contact:
Jan Jansen: [email protected]
Goof Buijs: [email protected]
Silvia de Ruiter: [email protected]
SHE website: www.schoolsforhealth.eu
CBO website: www.cbo.nl
25
Thank you for your attention
Workshop "School Food and Nutrition Policy in Europe:
policies, interventions and their impact Mikkelsen BE,
15-16 May 2014, European Commission Joint Research Centre (JRC), Ispra, Italy (co-hosted with WHO-Europe and Public Health Nutrition Research UK)
Take European SMP diversity
into account
Example: SE & FI Example: Kindergarten, DK Example: Schools, DK
Institution with meals for all
Institution with no meals for all
Institution with meals for some
Collective Semi-Collective Non-Collective
Two doors of the school
Teaching & learning
Food & Meals
SHE HPS
WSA FoodScape Approach
Curricular approaches Health, education & food
Children Eating & learning
The meal
Teacher Teaching & pedagogy
Cateringstaff Food & Cooking
The school foodscape approach
Kapitel 6, Mad og måltider i børneinstitutioner, Sanne Sansolios og Bent Egberg Mikkelsen http://munks.gyldendal-uddannelse.dk/Books/Ernæring_og_sundhed/9788762811683
Local community
School Foodscapes Assessment Tool (S-FAT)
New arrivals
• 75 % community aid for F&V
• 50 % community aid for AM’s
Accompanying measures The following costs, which shall be directly linked to the
School Fruit Scheme, are eligible for the Union aid:
• costs associated with the implementation of agriculture and food-related measures, such as costs of organising tasting classes, setting up and maintenance of gardening sessions, organisation of farm visits and similar;
• costs related to the measures aimed at educating children about agriculture, healthy eating habits and environmental matters related to the production, distribution and consumption of fruit and vegetable products;
• costs associated with the implementation of other measures that are carried out in order to support the distribution of products and that are line with the objectives of the School Fruit Scheme.
Teachers are role models
• Rollemodels are important for change of behviour and preferences (Wardle et al., 2003) (Wardle & Cooke, 2008)
• Acceptance of new foods depandant on sociale factors, including teachers and peers (Birch, 1980).
• Vicarious learning – the fact that children learn from adults through observation and interaction (Bandura, 1962) is a potential powerful role in the creation of food literacy among preschool aged children
The kinder garten garden
From planting to harvest
Evidence & monitoring develop methdologies for measurement of
• Methdologies for measurement of
• Intake
• Uptake
• Cost effectiveness
• Feasability
• Appreciation
• Data’n devices
School Outreach community links
www.sol-bornholm.dk
Use whats already there
• COST.EU
• JPI
• ERA
• Joint Actions
• EU SFS (SFVS) DG Agri
• SMS DG Agri
• Erasmus+/Comenius
• H2020
Conclusions
• Who: EU/JRC, WHO; EU Sanco, EU agri
• Methdologies, monitoring, intake, cost effectiveness, data’n devices
• WSA dula tracks
• SMS SMP SFS (SFVF)
• Communities, partnerships
• Accomp measures/HOFA’s hands-on-food-activity
Actions/Next stops
• Summerschool ”European summer school on food & nuttriton strategies at school”
• COST action
• More meeting opportunities: London, Ispra, next stop ??
• Methodology development/common protocols?
COSI – WHO
Childhood Obesity
Surveillance Initiative
Dr Joao Breda PhD, MPH, MBA Programme Manager Nutrition, Physical Activity
and Obesity
Ispra, 15&16 May 2014
WHO European
Childhood Obesity
Surveillance Initiative
Pan-European
surveillance systems and
research infrastructures
Existing Pan-European Surveillance Systems:
1) WHO-COSI
2) Healthy Behaviour in School-aged Children
(HBSC)
3) EU Menu
4) EHIS (European Health Information System)
5) EHES (European
6) DHS & MICS
WHO European Childhood Obesity
Surveillance Initiative
(WHO-COSI)
• Aim: to measure routinely trends in overweight and obesity in primary
school children (6-9 years), in order to understand the progress of the
epidemic in this population group and to permit inter-country
comparisons within the European Region.
• Coordinator: Dr. João Breda - WHO Regional Office for Europe
• Funding: WHO, EU – DGSANCO & local resources
• Governance:
International level: WHO develops the protocols and manages the
international coordination of the surveillance initiative and
facilitates investigators’ meetings.
Country level: Each country is responsible for its national data
collection and identifies the institute to be responsible for overall
national coordination.
WHO-COSI
• Past waves:
1st round: school year 2007/2008
Participating countries: Belgium (Flemish region), Bulgaria,
Cyprus, Czech Republic, Ireland, Italy, Latvia, Lithuania,
Malta, Norway, Portugal, Slovenia and Sweden
2nd round: school year 2009/2010
Participating countries: those participating in the first
round (excepting Bulgaria and Sweden) + Greece, Hungary,
Spain and the former Yugoslav Republic of Macedonia
3rd round: school year 2012/2013
Participating countries: those participating in the second
round + Albania, Republic of Moldova, Romania and Turkey
• Next waves: school year 2015/2016
WHO-COSI
1. Albania 2. Belgium 3. Bulgaria 4. Cyprus 5. Czech Republic 6. Greece 7. Hungary 8. Ireland 9. Italy 10. Latvia 11. Lithuania 12. Malta 13. Norway Discussions ongoing with: Denmark, France, UK and Croatia
WHO-COSI - 25 Participating countries &:
14. Portugal 15. Republic of Moldova 16. Romania 17. Slovenia 18. Spain 19. Sweden 20. Turkey 21. FYRM 22. Poland (new) 23. Kazakhstan (new) 24. Austria (new) 25. UZB (new – tbc)
WHO-COSI
• Age group: 6, 7, 8 and/or 9-year-old children (countries could
choose for one or more of these four age groups)
• Sample size: 2800 children per age group (6.0–6.9; 7.0–7.9; 8.0–
8.9; 9.0–9.9)
• Core measurements:
Child: body weight and body height
School: frequency of physical education lessons, availability
of school playgrounds, possibility of obtaining a number of
listed foods and drinks on the school premises, existence of
school initiatives organized to promote a healthy lifestyle
WHO-COSI
• Optional measurements:
Child: Waist and hip circumferences
Associated co-morbidities
Dietary intake patterns: food frequency, breakfast, breastfeeding
Physical activity/inactivity patterns: transport to school, membership of sport
or dancing club, frequency of in free time playing outside, doing homework or
reading a book, using a computer for playing games, watching television (incl.
videos), usual amount of sleep each day.
Family: Morbidity
Socioeconomic status
School: Availability of safe school routes
School bus transport
Nutrition education included in the school curriculum
School meals
Vending machines
Availability of fruit/vegetable/milk schemes
WHO-COSI
Results (12 countries)
• Overweight including obesity 18%-57% (boys)
& 18%-50% (girls);
• Obesity 6-31% in boys and 5-21% in girls;
• Southern European countries with highest
prevalences;
• Highest significant decrease found in
countries with high BMI and highest increase
in countries with lower mean BMI.
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Findings on school
food environments
from the WHO
Europe COSI
Initiative
Jo Jewell WHO Regional Office for Europe School Food and Nutrition Policy in Europe, Joint Research Centre Ispra, 15-16 May 2014
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Outline of presentation
i. Brief background of COSI
ii. The need for a cross-national surveillance
initiative in childhood obesity
iii. Recent expansion of COSI & inclusion of
school food environments
iv. Findings and conclusions
v. Next steps
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11042014
• Only around 25% of
Member States had
validated national
prevalence data on
overweight or obesity
in primary school
children
• Huge variation
within and between
member states in
data collection and
analysis
• Gap of data on
children between 6-9
years-old
Background of COSI
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European Charter & Vienna Declaration
“A process needs to be put together to develop internationally comparable core indicators for inclusion in national health surveillance systems ”
“… Visible progress, especially relating to children and adolescents, should be achievable… and it should be possible to reverse the trend by 2015…”
“…consolidating, fine-tuning
and scaling up existing
national and international
monitoring and
surveillance systems”
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11042014
Aims and objectives of COSI
• To implement a harmonized system across the WHO European Region
• To measure trends in overweight and obesity in primary school children
Why?
– to fill the current gap in available cross-national comparable data on primary-school children aged 6-9 year-olds
– to map and identify trends over time, allowing benchmarking
– to inform evaluation and review of the policy response
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11042014
Key elements
• Common protocol
– Collection procedures and measurements
– Same age groups in each country
• Nationally-representative samples
• Data stratifiable according to country data needs (e.g. by level of urbanisation; geographic location)
• Some countries collect optional data on parental SES and school food and physical activity environment characteristics
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Expansions of COSI
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Source: COSI Round 2 2009/2010
A north- south gradient of overweight %
Obese a
nd o
verw
eig
ht
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11042014
School environments
Rationale for inclusion:
• Individual energy intake and expenditure are affected by a wide range of environmental influences, including the school environment:
– Useful to obtain data and categorise schools according to their food and physical activity environments, using standardised criteria, in order to provide and overview of situation and inform policy development
– Also useful to look at levels of overweight and obesity at school level and compare against school environment characteristics, in context of evaluation of school-based standards and interventions
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School environments – cont’d
• Developed an index of 18 school environmental characteristics (indicators)
– Nutrition-related aspects covered include availability of fresh fruit and vegetables, drinking water, sugar-sweetened beverages and sweet or salted snacks.
– Physical activity-related aspects include provision of physical education lessons (more than 60 mins per week) and availability of recreation areas on school premises
• A scoring system was then devised awarding either 1 or 0 points to a school for each indicator, which allowed a composite score
• Schools in 11 of the countries participating in COSI provided information for COSI Rounds 1 & 2
COSI
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School environments – nutrition score
• Not all schools provided information for all nutrition characteristics in the index
– If countries provided information on 12 of the 16 characteristics they were incorporated into the analysis
• A relative school nutrition environment score based on all available data was calculated for each school by dividing the total attained positive points by the maximum number of positive points a school could attain (range: 1216)
• In addition, a relative school nutrition environment score was also calculated for each school for five selected nutrition-related characteristics - fruit, milk, SSBs, sweet and salty snacks.
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School nutrition environments –findings
• A large variability in relative school nutrition environment scores was found across countries
• Two clusters of countries identified:
– Low-score cluster (Bulgaria, Czech Republic, Greece, Hungary, Ireland and Portugal) graded less than half of the 16 included characteristics as positive
– High-score countries (Latvia, Lithuania, Norway, Slovenia and Sweden) judged more than half of the characteristics as positive
• BUT high variability in scores between schools within the same country, with both high- and low-score schools identified in Bulgaria, Czech Republic, Greece and Lithuania
COSI
11042014
School nutrition environments –findings
• Portugal moved up to the high-score cluster from Round 1 to Round 2, while all other countries remained in the same cluster
• There was a statistically significant difference in mean scores in the Czech Republic, Portugal and Slovenia between the two rounds
• HOWEVER, at this stage, we could not demonstrate an association between the school nutrition environment score and the school BMI score, not even in Portugal where a significant improvement for both. Probably this had to due with the short time span of two years
COSI
11042014
School nutrition environments –findings
Categories of schools based on the relative school nutrition environment score
(‘all available items’)* in COSI Round 2 (2009/2010), by country (%)
COSI
11042014
School nutrition environments –findings
Categories of schools based on the relative school nutrition environment score
(‘selected items’)* in COSI Round 2 (2009/2010), by country (%)
COSI
11042014
Conclusions
• Some countries appear to have more supportive school nutrition environments than others
• The lower school nutrition environment scores might relate to the absence or inadequate implementation of national policies
• Most countries with low scores also host schools with supportive school environment policies
– uniform school policies to improve school nutrition environment may not developed or implemented to same degree throughout a country.
• May always be difficult to identify an association with BMI (as many other factors at play), but over time a relationship may emerge
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Next steps of COSI
• The fourth round of COSI is currently planned to
take place in 2015/2016
• To have more member states participating and
completing more data
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The Vienna Declaration on Nutrition and
Noncommunicable Diseases in the
Context of 2020
“Development of a new food and
nutrition action plan 2015-2020”
“Monitoring and surveillance of
population’s nutrition status”
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11042014
Thank you for your attention
• For further information:
– http://www.euro.who.int/en/what-we-do/health-
topics/disease-
prevention/nutrition/activities/monitoring-and-
surveillance
– http://www.euro.who.int/en/what-we-do/health-
topics/disease-prevention/nutrition/policy
SNIPE: School Nutrition Index
of Programme Effectiveness - Modelling the index Tim Marsh May 2014
Thanks to Michael Nelson
Public Health Nutrition Research
Micro-Simulation
•Is a computer model of a specified population (1993-2050)
•A series of individuals (typically several million) are simulated and monitored throughout their lives
•The population of individuals accurately reflects known age profiles, birth, death and health statistics (where those are known) and is capable of making projections into the future
•Obesity distributions among population determined by predictions and specified scenarios
•The model specifically targets the relationship between individuals’ evolving body mass indices, and the incidence of disease
•The model can simulate and compare the impact of various public health interventions
Long term impact of child obesity intervention
Hollingworth, W, Hawkins, J, Lawlor, D, Brown, M, Marsh, T & Kipping, R 2012, ‘Economic evaluation of lifestyle interventions to treat overweight or obesity in children’. International Journal of Obesity., pp. 1 - 8
Effect of school competitive food policies on adolescent overweight trends, weight-related disease and medical costs in three US States Laura Bonhard
Table [X] Cumulative Costs and Cost Savings for 1% and 5% BMI Reduction
Cumulative Costs 2010-2070 in USD
Cost: No Change
in Population BMI Cost: 1% BMI
Reduction Percentage
savings* Cost: 5% BMI
Reduction Percentage
Savings*
Maine $ 520,435,000 $ 490,909,000 4.82% $ 480,017,000 8.43%
Kentucky $ 467,923,000 $ 434,467,000 6.4% $ 413,190,000 10.5%
Montana $ 426,494,000 $ 391,816,000 8.13% $ 370,264,000 13.18% *Percentage of savings relative to the cost with no change
Inspiration from Tobacco Control
Expert groups to develop a scale of effectiveness
Joossens L, Raw M, The Tobacco Control Scale. A new scale to measure country activity, Tobacco Control, 2006; 15, 247-53
School Nutrition Index of Programme Effectiveness (SNIPE) The six domains
•School food policy and key objectives:
Implementation:
Monitoring: including inspection, compliance with standards or guidance (whether compulsory or voluntary), evidence of utility
Finances
Outcome and impact measures
Social protection and sustainability
Possible implementation measures to score? Policy Max Score
Leadership and governance (national, regional, local) ?
Implementation modality (roles of government and private sector, distribution of resources, compulsory vs. voluntary standards
?
Local school-food related policies
?
Meals and food offered, take up, coverage, availability, accessibility (e.g. free or subsidized meals)
?
Costs, payment, and subsidies
?
Nutritional objectives (including standards and quality)
?
Practical guidelines for catering providers, schools, parents, etc ?
Possible implementation measures to score?
Policy Max Score
Recipes
?
Kitchen and dining environment and management (e.g. equipment and staffing levels, infrastructure, queuing, cashless systems, service style (cash cafeteria, family)
?
Training (catering and teaching staff)
?
Marketing
?
Parental and community engagement
?
Integration with curriculum, physical education, cookery
?
An additional step? Re weight the policy due to effectiveness of its intervention
Possible outcome measure?
• Nutritional status and growth
• Nutrition-related health e.g. dental, obesity, Chd in different time scales short
to long term
• Educational variables, including attainment, attendance, absenteeism,
behaviour, etc.
• Community and agricultural outcomes
