Identifying the most effective and cost effective public health nutrition policy options for CVD prevention

February 28th 2014


This report presents the findings of EuroHeart II Work Package 5, where the specific objective was “Identifying the most effective and cost-effective CVD prevention policies”. The project started in August 2011 and ended in February 2013. This work package was conducted in co-ordination with Work Package 4 (on reporting and analysing of data on CVD), and helped determine different policy scenarios for the work conducted in Work Package 6 on predicting future CVD trends under different policy scenarios in the EU.

Work Package 5 aimed to acquire comprehensive and comparable information on current public health nutrition policies, plans and actions that would impact on cardiovascular health and CVD prevention, and also to test the hypothesis “The countries with the largest number of established, effective CVD prevention policies have achieved the biggest reductions in population smoking, blood pressure and cholesterol levels”.

The specific objective was addressed through a number of projects:

  • updating previous literature reviews of nutrition policy interventions, focussing on peer reviewed and grey literature up to February 2013;
  • creating a database to summarise food policies in 30 countries across Europe;
  • interviewing policy-makers and thought-leaders from 14 diverse countries to elicit their views on a wide range of possible strategies and policy options;
  • categorising public health nutrition policies using a novel framework; and
  • analysing and modelling recent data to explicitly test the hypothesis.

Rapid scoping reviews of the effectiveness of population-wide nutrition policy interventions were conducted. The literature was assessed and categorised using the “4Ps” framework: Price, Product, Promotion and Place. The studies were synthesised as narrative reviews. Individual reviews were produced for salt; fats (trans fats, saturated fats and total fats); fruit and vegetables; and generic healthy eating initiatives.

A database was created to summarise public health nutrition policy for 30 European countries (EU 27 plus Iceland, Norway and Switzerland). Using the “4Ps” conceptual framework, textual data regarding nutrition policies and actions for each country were catalogued. Policy-makers and thought-leaders in 14 diverse European countries gave their views of different policy options for public health nutrition (in Belgium, Czech Republic, Estonia, Finland, Germany, Greece, Iceland, Ireland, Italy, Malta, Poland, Portugal, Slovenia and England).

This report provides an overview of public health nutrition policies in 30 European countries. It then presents a deeper analysis of nutrition policy actions relating to cardiovascular disease prevention in 14 of those European countries. Information was gathered through country visits and interviews with a diverse range of national experts and stakeholders.

Population-wide policy actions to promote a healthy diet potentially offer large benefits in terms of reducing the CVD burden. However, not all interventions are equally effective. The evidence suggests that the largest effects could be achieved by “upstream” comprehensive, multi-level interventions, (for instance targeted at decreasing salt and trans fats, or increasing fruit and vegetable consumption). Mandatory approaches generally appear more powerful than voluntary approaches for tobacco control, alcohol control, and dietary reductions in salt or trans fats. Effective population-wide interventions appear to be consistently cost saving (NICE 2010).

This project is not without its limitations. This analysis provides a potentially useful description of activities up to February 2013. However, we also recognise that developments are on-going and our data are inevitably a “snapshot”. We therefore plan future work to identify and evaluate population-based policy actions carried out in the WHO European Region. The policy actions identified will then provide an evidence base on which to develop, pilot and validate a nutrition policy assessment tool.

Public health nutrition policies represent a complex, dynamic and rapidly changing environment. It is therefore very encouraging to observe that the majority of European countries are engaged in activities to improve public health nutrition. However, many European countries fall short of optimal activities. Furthermore, the promotion, implementation and evaluation of effective policies remain patchy and variable, from non-existent to extensive. Within the EuroHeart II work package 5, Finland, Iceland, Portugal and perhaps England demonstrate notable progress. France and Hungary also demonstrate progress.

The full report can be downloaded via this link.