Smorgasbord or symphony? Assessing public health nutrition policies across 30 European countries using a novel framework

Abstract

Background: 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 t inform future evidence-based diet strategies Methods: We created a public health nutrition policy database for 30 European countries . National nutrition policies wer classified and assigned using the marketing "4Ps" 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 Results: Product Voluntary reformulation of foods is widespread but has variable and often modest impact. Twelv 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 food and sugar-sweetened beverages. Finland, Hungary and Portugal also tax salty products Promotion Dialogue, recommendations, nutrition guidelines, labelling, information and education campaigns ar 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 an workplace canteens Interviewees generally considered mandatory reformulation more effective than voluntary, and regulation an fiscal interventions much more effective than information strategies, but also politically more challenging Conclusions: Public health nutrition policies in Europe appear diverse, dynamic, complex and bewildering. Th "4Ps" framework potentially offers a structured and comprehensive categorisation Encouragingly, the majority of European countries are engaged in activities intended to increase consumption o 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. Mor needs to be done across Europe to implement the most potentially powerful fiscal and regulatory nutrition policies.