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Evaluation of the Norwegian Nutrition Policy with focus on the Action Plan on Nutrition (2007-2011)

The WHO Regional Office for Europe

The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves.

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Evaluation of the Norwegian Nutrition Policy with focus on the Action Plan on Nutrition (2007-2011)

World Health Organization Regional Office for EuropeScherfigsvej 8, DK-2100 Copenhagen Ø, Denmark

Tel.: +45 39 17 17 17. Fax: +45 39 17 18 18. E-mail: contact@euro.who.intWeb site: www.euro.who.int

Evaluation of the Norw

egian nutrition policy with a focus on the A

ction Plan on Nutrition 2007–2011

Evaluation of the Norwegian Nutrition Policy with focus on the Action Plan on Nutrition (2007-2011)Evaluation of the Norwegian nutrition policy with a focus on the Action Plan on Nutrition 2007–2011

World Health Organization Regional Office for EuropeUN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark

Tel.: +45 45 33 70 00. Fax: +45 33 70 01. Email: contact@euro.who.intWeb site: www.euro.who.int

Evaluation of the Norwegian nutrition policy with a focus on the Action Plan on Nutrition 2007–2011

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© World Health Organization 2013All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full.

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ABSTRACTThe WHO Regional Office for Europe conducted an evaluation of the Norwegian Action Plan on Nutrition (2007–2011) in 2012. The evaluation was commissioned by the Directorate of Health of the Norwegian Ministry of Health and Care Services under the terms of the framework agreement between the Regional Office and the Directorate of Health. The overall aim of the assignment was to provide an independent evaluation of the Action Plan on Nutrition and an assessment of the possible options for the future in terms of policy recommendations.

KeywordsDIETFOODHEALTH POLICYNUTRITION AND FOOD SAFETYNUTRITION POLICY SOCIOECONOMIC FACTORS

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Contents

Acknowledgements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

1.1 Why this evaluation and why now? . . . . . . . . . . . . . . . . . . . . . . . . . . .1

1.2 Nutrition and public health policy in Norway . . . . . . . . . . . . . . . . . . .1

1.3 Terms of reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

1.4 Process and conduct of the review . . . . . . . . . . . . . . . . . . . . . . . . . . .2

2. Nutrition in Norway: analysis of the situation . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

2.1 Nutrition policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

2.2 Broader policy context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

3. Evaluation of the implementation of the Action Plan. . . . . . . . . . . . . . . . . . . . . . .9

3.1 General comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

3.2 Evaluation of focus areas and measures in the Action Plan . . . . . . .13

3.3 Findings in relation to social inequalities in dietary intake . . . . . . . .21

4. Overall recommendations of the evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

4.1 General recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

4.2 Specific recommendations regarding the Action Plan . . . . . . . . . . . .25

4.3 Key priorities in nutrition policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27

5. Future policy priorities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

Annex 1 List of experts on the evaluation panel . . . . . . . . . . . . . . . . . . . . . . . . . .34

Annex 2 List of key informants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35

Annex 3 Internal government monitoring matrix . . . . . . . . . . . . . . . . . . . . . . . . . .37

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Acknowledgements

This report was commissioned by the Directorate of Health of the Norwegian Ministry of Health and Care Services. The WHO Regional Office for Europe would like to express its appreciation to the key national informants for the documentation and data they supplied relative to the objectives specified in the Norwegian Action Plan on Nutrition 2007–2011. Thanks are also due to the national and international experts on the evaluation panel for their valuable contribution to a consultative workshop with policy-makers and stakeholders, held in Oslo in April 2012, and to the preparation of this report. The Regional Office is most grateful to the Norwegian Directorate of Health for its support for the printing of this report.

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1. Introduction

1.1 Why this evaluation and why now?This report presents the findings of an evaluation of the Norwegian Action Plan on Nutrition 2007–2011. Recipe for a healthier diet (1) and recommendations for the future.

The evaluation was commissioned by the Directorate of Health of the Norwegian Ministry of Health and Care Services under the terms of the framework agreement between the WHO Regional Office for Europe and the Directorate of Health, and was carried out by the Nutrition, Physical Activity and Obesity Programme of the Regional Office. The overall aim of the assignment was to provide an independent evaluation of the Action Plan on Nutrition and an assessment of the possible options for the future in terms of policy recommendations. More specifically, the objectives of the evaluation were detailed in the terms of reference and mainly focused on:

• ananalysisoftheresultsofthepolicyandacomparisonwithitsobjectives;• anassessmentoftheefficiencyofthepolicyinmeetingtheseobjectives;• considerationofwhetherchangesareneededtothepolicyandsuggestionsforpossibleimprovementstothescope,

structureandworkingpractices,withdueconsiderationofdifferentpolicyoptions;and• recommendationsforthedesignoffuturepolicy.

This report details the work undertaken and the answers to the points set out in the terms of reference. The analysis is based on the stakeholder consultation process that took place in an intensive evaluation workshop in Norway in April 2012, including interviews with stakeholders and policy-makers and a review of the existing documents and data.

The evaluation was planned as a two-stage process: quantitative and qualitative. The first stage was to gather relevant and available documentation and data related to the objectives specified in the Action Plan (a quantitative internal evaluation was carried out by the Directorate of Health).

The second stage was a qualitative evaluation, whereby the Regional Office supported the Directorate of Health in setting up a group of national and international experts to conduct an intensive workshop in Oslo from 16 to 20 April 2012, with the aims of interviewing key informants (policy-makers and stakeholders), analysing the available data and discussing suggestions and inputs for the future. The members of the evaluation panel are listed in Annex 1 and the key informants in Annex 2. This report, which has been written by the Regional Office together with the external expert group, is an output of the consultation process and provides a summary evaluation for the Directorate of Health.

1.2 Nutrition and public health policy in NorwayThe Action Plan on Nutrition 2007–2011. Recipe for a healthier diet (1) set out the government’s measures to promote health and prevent disease through a healthier diet. The emphasis of the Plan was on helping to make it easier for individuals to make healthy choices, to facilitate good meals in kindergartens, schools and among the elderly, and to increase knowledge about food, diet and nutrition. The aim of the Plan was to improve public health through a healthy diet, with two main goals:

• tochangethedietinlinewiththerecommendationsofthehealthauthorities,and• toreducesocialinequalitiesindiet.

These two goals were translated into five main strategies:

• toimprovetheavailabilityofhealthyfoodproducts• toincreaseconsumers’knowledge• toimprovethequalificationsofkeypersonnel• todevelopalocalbasisofnutrition-relatedwork,and• tostrengthenthefocusonnutritioninthehealthcareservices.

The evaluation focused on the overall goals and measures proposed and taken forward with the Action Plan.

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1.3 Terms of referenceThe review panel agreed on the following terms of reference:

• to reviewprogress in the implementationof theActionPlanand toconsiderwhether implementation locallyandnationallyhadbeenappropriateandeffectiveinaddressingthePlan’sactionpoints;

• to review the impacts and outcomes of the implementation of the Plan, the extent to which the activitiesidentified had been fulfilled and the targets achieved, and whether the changes identified were attributable to thePlan;

• to identify futurechallenges,and to recommendstrategicareasofaction required tostrengthen thepolicygoalsof improving the national diet and counteracting obesity and noncommunicable diseases by means of reducing inequalities related to access to and choice of food and diet, as well as access to care in the field of nutrition-related diseases.

1.4 Process and conduct of the reviewAt the start of the evaluation process, in April 2012, the Regional Office organized a consultative workshop involving international and national experts who selectively interviewed people responsible for implementing policy and other relevant staff. Their approach was based on the methodology used for the evaluation of Australia’s National Mental Health Strategy (2), the methodology used for the Scottish Diet Action Plan review (1996–2005) (3) and other relevant country experiences in which the Regional Office was directly involved.

The review process aimed to detail what was proposed by the Action Plan and what had been achieved in terms of implementation, drawing from two main sources of evidence.

First, the Norwegian national dietary survey (4) (the Directorate of Health’s monitoring and surveillance system) provided the baseline for the quantitative review. In addition, an internal governmental monitoring process had been set up consisting of intersectoral meetings several times a year to follow up the implementation of the Action Plan through assessment of all 73 measures proposed in the Plan. This work was summarized in a matrix which was made available for the expert panel in preparation for the workshop (Annex 3).

Second, the workshop in Oslo involved a series of interviews conducted by the external expert group (working largely in pairs or threes) with policy-makers and stakeholders who had had responsibility for, or been involved in, the implementation of different initiatives on the ground or had worked in relevant areas. These informants were identified and invited by the Directorate of Health. Some interviews were in English, some were in Norwegian, some in a mixture of both languages with informal translation. Most were conducted face to face or by telephone. Most were recorded for back-up purposes.

2. Nutrition in Norway: analysis of the situation

2.1 Nutrition policy2.1.1 Overview of the Action Plan on Nutrition 2007–2011The Action Plan on Nutrition served as a policy framework for decision-makers, professionals, experts and others in the public and private sectors who play a role in the population’s diet. For good dietary habits to be achieved, many sectors need to work together. For this reason, 12 ministries collaborated in developing the Action Plan and taking forward intersectoral action during its implementation. The Plan contained 73 specific measures to promote health and prevent illness by changing eating habits in line with the nutrition recommendations of the health authorities. Reducing social inequalities in diet was one of the two overall goals. The measures emphasized contributions that made it easier for individuals to make healthier choices, to facilitate the provision of healthy meals in kindergartens, schools and among the elderly, and to increase people’s knowledge about food, diet and nutrition. The Action Plan, which ended in 2011, was a follow-up to the White Paper No. 16 (2002–2003). Recipe for a healthier Norway (5). It was also underpinned by WHO’s Global Strategy on Diet, Physical Activity and Health (2004) (6), the European Charter on Counteracting Obesity (7) and the WHO European Action Plan for Food and Nutrition Policy 2007–2012 (8).

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The Action Plan on Nutrition must also be viewed in connection with the Nordic Plan of Action for Better Health and Quality of Life through Diet and Physical Activity (9), adopted in July 2006, and the Action Plan on Physical Activity (2005–2009). Working together for physical activity (10). The launch of the Action Plan on Nutrition was followed by publication of the White paper No. 20 (2006–2007). National strategy to reduce social inequalities in health (11). There was a parallel working process between the Action Plan and the strategy to reduce social inequalities in health.

Section 2.1.2 below describes the historical perspective since 1963, as the Action Plan was built on several earlier political documents.

2.1.2 Overview of nutrition policy since 1975In the 1970s, Norway moved substantially to promote world food security. It expanded its emergency grain reserve and in 1975 joined the World Food Programme, increasing its commitment by 300% within five years. It also increased its official development assistance from 0.65% of gross national product in 1975 to 1.0% in 1985 (compared with the Netherlands and Sweden at about 0.88% and the United States at 0.22% in 1983).The food supply and nutrition policy objectives set in 1975 were changed slightly in 1993 (12). The goals of the Ministry of Agriculture remained self-sufficiency with respect to certain foods and, with due regard to the environment, the maintenance and promotion of agricultural development in outlying rural areas. Nutrition is not explicitly mentioned in reports on agriculture at ministerial level, although it was the Ministry of Agriculture that presented the first nutrition policy white paper in 1975 (13) which encouraged healthy dietary habits and proposed a nutrition and food policy in line with the recommendations of the World Food Conference (14). Parliament endorsed two new white papers in 1993, one on the new agricultural policy and the other on health policy. The latter emphasized disease prevention and health promotion, and had a separate section on nutrition policy objectives and instruments for action (15). The most important measures to influence the core diet in the last 50 years have included improvements in the content of fatty acids in margarine (1960–1980), reduction of the content of trans-fatty acids to a low level (1995–2005), maintenance of a high degree of grinding of sifted wheat flour (1960s), improvements in the baking quality of whole wheat (1980s), blending of overseas wheat with a high content of selenium into flour, introduction of low-fat milk (1984) and consultations with the food industry on the level of salt in food products (1980s).

Beyond the food available nationally and the kinds of food that consumers buy, national dietary patterns must be assessed by what people actually eat. Such information was sparse in Norway until the mid-1980s. In that decade, the health-related components of the nutrition policy were implemented most extensively through information and education, to a far more limited extent in its economic, community service and regulatory aspects, and least of all in the field of integration with relevant government processes. Other ambitions at the time were to influence the composition of core foods and use of fiscal measures, as well as to have dialogues with the food industry and the food service sector. A specific research programme was established where one of the purposes was to stimulate research on nutrition-related issues within a broader range of academic disciplines such as anthropology, sociology and economics. By all accounts, the pace of implementation was too slow to meet some of the prognoses for 1990 set in the white paper on nutrition from 1975–1976 (13).

In the 1990s, nutrition policy was administered intersectorally by linking it with policies that touched on health, agriculture, fisheries, consumer affairs, education and research. The government stressed the need for cooperation between these sectors in order to achieve the goals and objectives of the food and nutrition policy. Three organizations had a role in coordinating nutrition policy: (i) the Interministerial Council, which only existed for a few years; (ii) the NutritionCouncil, which together with the Interministerial Council came administratively under the then Ministry of Health and SocialAffairs;and(iii)theNorwegianFoodAuthority.Thelast-namedmergedin2004withotherinstitutionsandisnowcalled the Norwegian Food Safety Authority, with the task of enforcing food legislation emanating from the Ministry of Agriculture and Food, the Ministry of Fisheries and Coastal Affairs and the Ministry of Health and Social Affairs. The Authority coordinates all official control of foodstuffs, provides expertise and advice to municipal food control authorities, and gives information and advice to other relevant groups such as consumers and the food industry (12).

2.1.3 Overview of the Norwegian diet and diet-related problemsThe Action Plan contained defined general goals (Table 1) and quantitative goals (Tables 2 and 3) for dietary changes. Dietary trends before and during the period of the Plan are described with the latest available statistics and compared with targets. Food balance sheets go up to 2010, but for several of the other statistics the most recent data are from 2008 or 2009. Thus it has not been possible to describe the trends for the entire period of the Plan. In essence, trends before and after 2005 are compared.

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Table 1. General goals for the development of the Norwegian diet 2007–2011and trends in food supply 2000, 2005 and 2010

Dietary factor Goal 2000 2005 2010 Evaluation

Fat, E% 25–35 34 35 37 Negative trend Saturated fat, E% Approximately 10 15 15 16 Negative trend Trans fat, E% <1 <1 Goal reachedPolyunsaturated fat, E% 5–10 6 6 6 Within the targetProtein, E% 10–20 13 15 15 Within the targetCarbohydrates, E% 50–60 52 50 47 Below recommended levelSugar, E% < 10 17 15 13 Beneficial, target not reachedDietary fibre, g/day Approximately 30 24 24 27 Beneficial, target not reachedVegetables, kg/year Promote 59 62.6 72.6 Significant increase in 20 yearsFruit and berries, kg/year Promote 69.3 82.4 88 Significant increase in 10 yearsPotatoes, fresh, kg/year Promote 33 26.6 25.7 Significant decrease in 50 yearsPotato products, kg/year Decrease 27.3 33.5 31.4 Significant increase in 50 yearsWhole grain cereals Promote No dataFish and sea food, kg/year Promote 35 35.5 35.9 Little change in the last 10 yearsFatty meat products Decrease Meat contributed the same amount of fat in 2005 and 2010Meat, kg/year 63.9 71.3 73.8 Significant increaseFatty dairy products Decrease Dairy products accounted for less fat in 2010Whole milk, kg/year 30.3 31.2 19.7 Shift from fat to lean milkCheese, kg/year 14.5 17.0 17.9 Consumption of fatty cheese increasedCream, kg/year 6.8 7.3 7.3 Small changes Butter, kg/year Decrease 3.3 3.0 3.0 Small changes Margarine, kg/year Decrease 11.1 9.3 8.6 DecreasedShift to soft margarine Proportion of edible oils and light and edible oils margarine increasedSalt Decrease No dataSugar, kg/year Decrease 43.4 35.5 31 Significant decreaseSoft drinks with sugar, Decrease 90 60a 63 Decreased over time, but increased litre/year since 2007Sweets, kg/year Decrease 12.7 13.2 14.3 Increase over 50 yearsGood meal habits Promote Unclear due to lack of data

Note. Evaluation based on food supply statistics and household consumption surveys.a 2007, data missing for 2005–2006.

In the period 2005–2010, food supply statistics showed that the intake of dietary fat and saturated fat increased after having been relatively unchanged over the previous decade (Table 1).

The percentage of the population with an intake of saturated fatty acids above 10% of the total energy intake is now significantly high. Dietary content of saturated fat is now significantly higher than recommended. Dietary intake of protein, trans-fatty acids and polyunsaturated fatty acids has remained within the recommended limits during this period.

The importance of added sugars in the diet decreased after 2000 but is still greater than recommended. The average amount of fibre in the diet has increased but is still below the recommendations.

The consumption of vegetables, fruits and berries has increased over time and continued to increase in 2005–2010. During the period 2005–2009, the proportion of the population with an estimated daily intake of vegetables increased to about 20% and the proportion of people who eat fruit and berries daily increased to more than 20% (Table 2).

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Table 2. Quantitative goals for the development of the diet 2007–2011 and evaluation of trends

Goal 2001 2005 2009 Evaluationa (%) (%) (%)

20% change in the proportion of the population that eat or drink:vegetables daily,% Promote 39b 36 42 Increased to 17% 2005–2009fruit and berries daily,% Promote 43b 40 50 Increased to 25% 2005–2009fish for dinner 3 times/week,% Promote 23 22 22 Unchangedfish spread (mackerel in tomato sauce) >once a week,% Promote 17 20 26 Increased to 30% 2005–2009tap water daily,% Promote 73 83 87 Increased

Children and young people who eat or drink:sweets daily (aged 15 years),% Decrease 19 13 9 Decreased to 31% 2005–2009soft drinks and/or sugar-sweetened squash daily (aged 15 years),% Decrease 27 18 15 Decreased to 17% 2005–2009breakfast daily at home (aged 15–24 years),% Promote 56 55 58 Small changesugar intake above 10 E% Decrease Decreased for 2-year-olds from 11.7 E% to 6.7 E%saturated fat intake above 10 E% Decrease Decreased for 2-year-olds from 14.2 E% to 13 E%

a Evaluation based on data from Norkost 3 (4) and Currie C et al. (16).b 2003, data missing for 2001.

Table 3. Breastfeeding goals 2007–2011 and trends

Breastfeeding among infants Goal 1998–1999 2006–2007 Evaluationa

(%) (%) (%)

Exclusively breastfed at 4 months 44–70 44 46 Goal not reached Exclusively breastfed at 6 months 7–20 7 9 Goal not reached Breastfed at 12 months 36–50 36 46 Goal almost reached

a Evaluation based on data from Spedkost – 6 måneder (17).

The consumption of fresh potatoes fell and the consumption of processed potatoes rose significantly in the period 1970–2000 and there has been little change since. Grain consumption increased in the same period but has since fallen somewhat. It is uncertain whether the proportion of whole grain cereals has risen. Fish consumption has changed little over the past decade. The proportion of the population who said they ate fish for dinner three times a week changed little in 2001–2009, while the proportion who ate fish spreads (mackerel in tomato sauce) at least once a week increased by 30% in 2005–2009. The consumption of meat increased for a long time up to 2007, but fell slightly in both 2009 and 2010. Consumption of red meat was about the same level in 2010 as in 2005, while consumption of white meat increased significantly in the period 2005–2009. It is still uncertain whether the rising trend in meat consumption over a long time has stopped.

There has long been a shift from fat to lean types of milk, which continued in the period 2005–2010. Consumption of creamchangedlittleduringthisperiod;cheeseconsumption,ontheotherhand,hasbeenincreasingforalongtimeandcontinued to do so in this period.

The consumption of margarine, which had been falling for a long time, continued to decrease in the period 2005–2010, while butter consumption remained at about the same level. Sales of edible oils have increased over the last decade.

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The total consumption of sugar has decreased significantly over the last decade. Sales of chocolate and sweets, which increased significantly in the period 1970–2008, fell slightly in 2009 and 2010. Sales of soft drinks with added sugar decreased significantly in the period 1997–2004 and then increased slightly again in the period 2007–2010.

The Action Plan defined some dietary goals for children and young people (Table 2). Two cross-sectional studies were conducted,onein2001andonein2008,withtheaimofanalysingchangesin:children’smealpatterns;associationsbetweenmealpatternandgender,parentaleducationallevelandnumberofparentsinthehousehold;andassociationbetween intake of unhealthy snacks, meal pattern and the mentioned variables (18). The studies showed that there were no significant changes in children’s meal patterns from 2001 to 2008: in both years more than 90% of the participants reported that they had eaten breakfast the previous day, while approximately 95% had eaten lunch, 94% had eaten dinner, 82% had eaten supper and about 70% had eaten all four meals. The results also showed, however, that in spite of children having a stable meal pattern between 2000 and 2008, some did skip meals. The characteristics associated with skipping meals were living in a one-parent family, having parents with low education and being a boy (18). Simultaneously, in 2008 children reported a less frequent intake of fruit juice, lemonade and regular soft drinks, and a more frequent intake of diet soft drinks, than in 2001.

The proportion of young people who said they drank soft drinks or ate sweets daily decreased significantly in the period 2001–2009 among both 15-year-olds and those aged 15–24 years. Dietary surveys show that the proportion of one-year-old children given sweet drinks fell from 64% to 20% between 1998 and 2006. The total intake of added sugars decreased from 10% to 4% of dietary energy among one-year-old children and from 12% to 7% of dietary energy among two-year-olds. During the same period the dietary content of saturated fat decreased among two-year-olds. There are no more recent surveys that might shed light on the dietary content of sugar and saturated fat among children and adolescents.

The Action Plan defined a separate objective to increase the proportion of adolescents who eat breakfast daily. Among schoolchildren aged 15 years, the proportion eating breakfast five days a week changed little among girls and decreased slightly among boys between 2001 and 2009. In the group aged 15–24 years, the proportion who said they ate breakfast at home daily or ate breakfast at school changed little in the same period. The proportion that only took drinks for breakfast or had failed to eat breakfast at least twice during the previous seven days decreased from 2003 to 2009. The proportion of infants who were exclusively breastfed at four and six months increased slightly from 1998 to 2006 but was far from the target for 2011 set in the Action Plan (Table 3). The proportion of infants breastfed at 12 months increased significantly from 1998 to 2006 and was close to the target in the Action Plan. There are no recent national data available on the proportion of infants who are breastfed.

A regional study using a relatively old dataset from participants in the adolescent part (Young-HUNT) of the Nord-Trøndelag Health Study during the period 1995–1997, numbering 8817 girls and boys aged 13–19 years (89% of all students in junior high schools and high schools in one county), found that higher levels of parental education, in particular the mother’s education, was associated with healthier dietary habits among adolescents (19).

During the period 2010–2011, an assessment was made of the diet of 862 men and 925 women aged 18–70 years. The method used was two randomly distributed 24-hour recalls and a food propensity questionnaire. This study, Norkost 3, was conducted by the Department of Nutrition, University of Oslo, in collaboration with the Directorate of Health and the Food Safety Authority (4).

The results showed a mean energy intake of 10.9 MJ per day for men and 8.0 MJ per day for women. The energy intake decreased with increasing age for both men and women. On average, protein, fat and carbohydrates contributed 18%, 34% and 43–44%, respectively, of the energy intake for both genders. Added sugar contributed 7% and both fibre and alcohol approximately 2% of the energy intake in both groups. The energy percentages consumed from saturated fat, monounsaturated fat and polyunsaturated fat were 13%, 12% and 6%, respectively, for both men and women. The energy percentage consumed from protein, fat, monounsaturated fat, polyunsaturated fat and trans fat were in accordance with the Norwegian nutrition recommendations. The dietary content of added sugar decreased substantially, but is still higher than recommended.

The energy percentage consumed from saturated fat was, however, above the recommended level, whereas the energy percentage consumed from carbohydrates was below. The main sources of fat were butter, margarine, oil and meat. Bread and sugar-sweetened squash and soft drinks were the most important sources of carbohydrates and added sugar

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in the diet. The survey demonstrated some social inequalities in food and nutrient intake. Participants with a higher education had a healthier diet than participants with a lower level of education, and non-smokers ate more fruit, berries and vegetables compared to daily smokers (4).

In 2010, there was an increase of three percentage points for third-graders (eight-year-olds) who were overweight or obese compared to 2008, on average from 16% to 19%. This was shown by figures from the Child Growth Study at the Norwegian Institute of Public Health (20). It is, however, too early to say whether this increase reflects a trend, but it is alarming and should be made a policy priority. The Child Growth Study is a nationwide study that started in 2008 to monitor growth trends among third-graders over time, and is the only study in Norway monitoring children’s height, weight and waist circumference. It was conducted for the second time in 2010, and the next measurements are scheduled for 2013 at the same schools. Almost 9 out of 10 pupils participated in the study in both 2008 and 2010. A total of 127 schools are taking part in this study, yielding data which are fed into the WHO Childhood Obesity Surveillance Initiative. The results show that 19% of girls were defined as overweight and 3% were obese (total 22%), while 12% of boys were defined as overweight and 5% were obese (total 17%) (20).

Weight increased in all adult age groups between the mid-1970s and 2000. The proportion of those overweight and obese varies from county to county. The average body mass index and proportion of those overweight and obese are lower in Oslo than in the four other counties (Oppland, Hedmark, Troms and Finnmark) where health studies have been carried out. People aged 40 years with a high education level are less obese than those with a lower level of education. In Oslo, the adult population tends to be heavier in eastern than in western districts, particularly the women. Among immigrants in Oslo the prevalence of overweight and obesity varies with ethnic background. The proportion of obesity in the immigrant population is highest among women from Turkey and lowest among men from Vietnam. Women from Pakistan and Sri Lanka have the highest waist/hip ratio, as shown in a study among 3000 immigrants from non-western countries.

In the last 20–40 years an increasing proportion of adults were found to be obese. Adult men have increased evenly in weight since the 1960s, while women have increased evenly in weight since 1985. The proportion of obese people rose from 9–10% in 1985 to 13–22% around 2000, according to figures from health studies of adults. Approximately 8–14% of the group aged 15–16 years are overweight or obese (21).

In the Directorate of Health’s study more boys than girls aged 15 years were obese. The Norwegian Institute of Public Health’s youth studies among 15–16-year-olds show the link between overweight and socioeconomic factors. Among immigrants aged 15–16 years in Oslo, the proportion of those overweight varies from 4% to 12%. The highest prevalence of overweight was among young immigrants from other western countries, eastern Europe and the middle east/north Africa, according to the youth part of the Oslo Health Study, which registered weight and height with the help of self-reported questionnaires (22).

2.1.4 Actors and stakeholders in nutrition As part of the development of the Action Plan, different stakeholders were invited to give their inputs in two public hearings. The interaction between the public sector, private sector and nongovernmental organizations provided a foundation for good programmes and measures. Experts, actors in the food industry and other private actors, nongovernmental organizations and trade unions, university colleges and county authorities showed great interest in the Action Plan and provided useful input. The dialogue was continued and the proposals, examples and experiences that have been accumulated by these actors during the implementation of the Action Plan have been taking into account during this evaluation.

2.2 Broader policy context 2.2.1 Public health policy contextNorway is a monarchy with a parliamentary form of government. There are three independent levels of government: the national government, the county councils and the municipal authorities. The state level is responsible for secondary care, which is delegated to four regional health authorities. The county authorities are responsible for, among other things, dental care, public health, secondary education, energy delivery and communication. The municipal authorities are responsible for health promotion, primary health care, care of the elderly, care of people with disabilities (including

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mental disabilities), kindergarten and primary school education, social work (child protection and social protection), water, local culture, local planning and infrastructure (23).

Life expectancy is among the highest in the world. Diseases of the circulatory system are the primary cause of mortality, with cancer the second largest cause of death.

The health care system is organized on three levels, national, regional and local. Overall responsibility for the health care sector rests at the national level with the Ministry of Health and Care Services, which is responsible for administering primary health care, specialized health care, public health, mental health, medical rehabilitation, dental services, pharmacies and pharmaceuticals, emergency planning and coordination, policies on molecular biology and biotechnology, and nutrition and food safety. The Ministry of Education and Research is responsible for planning and partially subsidizing the education of health personnel.

The Ministry of Health and Care Services has administrative responsibility for the following agencies: the Directorate of Health, the Norwegian Board of Health Supervision, the Institute of Public Health, the Medicines Agency and the Norwegian Scientific Committee for Food Safety. The Ministry of Agriculture and Food is responsible for the institutional management of the Food Safety Authority.

The Directorate of Health is the central administration for the government, with legal authority, in the field of health and social affairs. The Directorate contributes to the implementation of national health and social policy (for example, the Nutrition Action Plan), and serves as an advisory body to central authorities, municipalities, regional health authorities, voluntary organizations, the media and the public in general. An essential task for the Directorate is to develop and strengthen preventive work and to widen the availability of services in the field of health and social affairs (for instance, for nutrition).

The four regional health authorities have responsibility for specialist health care. They are financed by basic grants, earmarked funds and activity-based funding.

The local level is represented by 429 municipalities which have responsibility for primary health care, including nursing care. The aim of primary care is to improve the general health of the population and to treat diseases and deal with health problems that do not require hospitalization and a high level of specialized care. Each municipality decides how best to serve its population with primary care, which is for the most part publicly provided.

The main purpose of the Municipal Health Services Act (1982) (24) was to improve the coordination of the health and social services at local level, to strengthen those services in relation to institutional care and preventive care, and to pave the way for better allocation of health care personnel. The Act provides the municipalities with a tool to deliver comprehensive health services in a coordinated way. In 1988, it was expanded and county nursing homes were transferred to the municipalities.

The health care sector has undergone several important reforms in recent decades and nutrition is mentioned several times in the Public Health Act (2012) and the National health and care services plan (2011–2015) (25).

2.2.2 Policy context for social inequalitiesThe evaluation includes a specific commitment to assess the achievement of the second goal of the Action Plan – to reduce social inequalities in diet – both as a cross-cutting issue within the focus areas of nutrition and overall as a public health goal. It is, therefore, important to have an overview of the policy context and situation with regard to social inequalities when the Action Plan started.

In 2007, the National strategy to reduce social inequalities in health (2007–2017) was adopted by Parliament, with the primary objective to “reduce social inequalities by levelling up” (11). The strategy, together with two others approved by the government, forms part of Norway’s comprehensive policy to reduce social inequalities, promote inclusion and combat poverty. The other two reports/strategies are concerned with: (i) employment, welfare and inclusion, and (ii) early intervention for lifelong learning. The national strategy set out the guidelines for the government and ministries to reduce social inequalities in health over the decade in question, although its measures are largely linked to the follow-up from

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the other reports, for example, the Report on work, welfare and inclusion (26) and related action plans such as the Action Plan against Poverty (27).

The four priority areas are:

• toreducesocialinequalitiesthatcontributetoinequalitiesinhealth• toreducehealthinequalitiesinhealthbehaviouranduseofthehealthservices• tointroducetargetedinitiativestopromotesocialinclusion,and• todevelopknowledgeandcross-sectoraltools.

The national strategy emphasizes the development of public health policies that aim for a more equal distribution of the positive factors affecting health, with a balance across structural universal or selective measures to downstream universal or selective measures which seek to remedy or mediate the negative impacts of inequalities. Thus it is about making the existing universal system more responsive and effective with regard to equity.

The national strategy to tackle social inequalities was developed in response to evidence about systemic inequalities in health, as measured by large and growing differences in mortality among adults and at every stage of life. Education, income, childhood conditions and work and the working environment were identified as some of the most important mechanisms affecting the distribution of health in the population. In terms of nutrition, systematic inequalities in health behaviour and access to health services were identified as important contributors to, in particular, perpetuating or exacerbating inequalities in health.

An agreed conceptual framework is important for mapping the relationship between the broader social determinants of health and social inequalities in diet. As part of global work on social determinants and equity in relation to priority public health issues (such as harmful alcohol consumption, cardiovascular diseases and diabetes), inequalities in diet are seen as being the result of differential exposure (that is, limited disposable income for ensuring a healthy diet), differential vulnerability (poorer diet or less healthy food purchases due to limited income) and differential health outcomes (greater risk and/or greater obesity and overweight) (28). In terms of overall food availability and the changing exposure of different social groups to negative factors, however, it is also necessary to look outside the Action Plan on Nutrition to the wider policy context and interventions designed to ensure that everybody has at least a minimum wage (which in turn is found to be sufficient to meet minimal social and health needs), adequate social protection and/or lower rates of early school drop-out. More structural and upstream action to improve food availability and access may, however, sit at the level of socioeconomic context and position and changes to policies such as on taxation, subsidies and the pricing of healthy food. These always need to be considered in relation to levels of income as well as the costs of other necessities whose purchase may be prioritized over food (such as rent or fuel). The provision of education in nutrition and ensuring of healthy foods in kindergartens and schools are also examples of measures that are independent of socioeconomic status.

3. Evaluation of the implementation of the Action Plan

3.1 General commentsThe purpose of the evaluation was to review the national nutrition policy as well as progress and achievements in nutrition, with a focus on evaluating the Action Plan. The evaluation was based on: (i) the quantitative review which provided an update on current achievements in relation to the Norwegian diet, and (ii) the thematic matrix provided by ministries with regard to their tasks defined in the Action Plan (see Annex 3), together with (iii) the extensive evaluation week by the expert group that took place in Norway in April 2012.

3.1.1 Governance: implementation of the Action PlanThe Action Plan was developed and written with the purpose of gathering together existing and planned nutrition-related activities in the various ministries. The structure of the Plan, with 2 goals, 5 strategies, 10 focus areas and 73 measures, reflects the fact that it is as much a collection of activities in different sectors as it is a logical line between the different levels.

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The Action Plan was signed and involved activities by 12 different ministries. During the period of the Action Plan regular meetings took place between the ministries, although there was considerable variation in their involvement. The Ministry of Health and Care Services was involved in 59 of the 73 measures (Table 4) and was itself responsible for 33 of them. The Ministry of Education and Research, the Ministry of Fisheries and Coastal Affairs and the Ministry of Agriculture and Food were involved in 11–13 measures, while the other ministries were involved in 0–5 measures.

Table 4. Number of measures detailed in the Action Plan and assigned to different ministries

Ministry No. of measures

Health and Care Services 59Education and Research 13Fisheries and Coastal Affairs 11Agriculture and Food 11Labour and Social Inclusion 5Local Government and Regional Development 4Children and Equality 3Finance 3Environment 3Foreign Affairs 2Trade and Industry 1

The Ministry of Health and Care Services designated the Directorate of Health to be the secretariat for the Action Plan, with the overall responsibility for overseeing its implementation. Besides carrying out the tasks presented in the national budget, the Ministry of Health and Care Services each year writes a general allocation letter to the Directorate of Health, describing all the prioritized activities in different fields (such as nutrition).

The Directorate of Health and Social Affairs (since 2008, the Directorate of Health) was established in 2002. The Nutrition Council continued as an independent advisory board to the Directorate. In 2009, the Directorate was reorganized and the responsibility for nutrition was shared between three different public health departments with the aim of it being included in a broader public health perspective.

From the interviews with the various informants, it seemed that the implementation of the Action Plan went well, particularly during the period 2007–2009. Several informants reported, however, that after 2009 there appeared to be a loss of momentum. This appears to be validated by the fact that many activities, such as the development of national dietary guidelines, were undertaken initially. One reason for the perception of loss of momentum could be explained by the major reorganization of the Directorate of Health. Several informants indicated that this reorganization was not so much to facilitate better implementation of the Action Plan as to improve coordination with public health in general. The evaluation group did not evaluate or discuss the relevance of different models for organizing nutrition work.

3.1.2 Mechanism for monitoring implementationThe Action Plan did not detail a specific timeline or earmarked budget for each activity. For the indicators and targets related to each activity for monitoring and evaluation purposes, it was found that there was not enough information on socioeconomic status or ethnicity, age group, education or gender, or on other social determinants linked to health such as:overweightandobesity,dietaryintake(saturatedfatandtransfat,fruitandvegetables,fishandsalt);breastfeedingand complementary feeding; and the trends in prevalence/incidence of diabetes mellitus in, for example, women ofchildbearing age, or gestational weight gain or diabetes in pregnancy. The level of data disaggregation was, therefore, too weak to construct a health equity profile with regard to nutrition.

An association of the determinants of health with regard to dietary behaviour (such as dietary intake) and the outcome (prevalence of overweight/obesity, prevalence of diet-related noncommunicable diseases) is missing. Dietary surveys that have been conducted are in line with international standards but they could have been linked more strongly with the

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duration, timeline and priorities of the Action Plan, as a surveillance and monitoring system should feed directly into the policy priorities defined in national policy.

Some informants reported that they had learned some lessons during the implementation process but they were not aware of a structured reporting mechanism, although the county authorities have to report annually to the Directorate of Health about their activities as a result of the letters they receive each year regarding their planning and implementation. They felt that a structured reporting and monitoring mechanism could facilitate adjustments during the implementation phase. With regard to monitoring the implementation of the Action Plan, a more robust mechanism for accountability and reporting between sectors could strengthen collaboration and the exchange and/or dissemination of information between various national authorities and at county level, supported by an appropriate integrated information system and a surveillance system aligned with the policy priorities with defined roles for each actor and stakeholder during the implementation. Another way of improving the monitoring of nutrition-related activities could be to improve the reporting mechanisms on allocations to counties and the offices of the county governors.

The Dialogue Forum was mentioned as a reporting mechanism and was welcomed especially by the private sector, although a more structured mechanism was sought by many to encourage ownership by the different sectors.

The Action Plan was perceived as a supportive tool for the informants, both by the authorities and by health professionals, the private sector and civil society representatives. Most private stakeholders agreed that many of their initiatives did not come about as a direct result of the Action Plan, as many of them had developed their own plans following the endorsement of the WHO Global Strategy on Diet and Physical Activity in 2004 or even the long history of nutrition policy in Norway (as described above).

3.1.3 BudgetAs stated earlier, the Action Plan did not detail an earmarked budget for each of its activities. Such a budget is, however, important to facilitate their implementation. Earmarking the budget in the policy development phase will entail an assessment of the adequacy of the financial resources allocated to the policy for its implementation. If this shows that the financial resources are restricted, the activities can be adjusted. A key issue is the need to identify appropriate funding requirements for policy implementation in a detailed budget, together with a plan to manage the budget throughout this implementation, so as to support the optimization of resources for this purpose. Detailed and accurate expenditure reports are an essential tool for tracking the trends in expenditure that inform decision-making.

Several reasons were given for the non-availability of a detailed description of the budget allocation for the Action Plan, the main one being that the Plan included activities in various sectors which thus impinged on different budgets. It would be too simplistic to review the budget of the Ministry of Health and Care Services alone, as other ministries had designated roles and probably specific budget allocations for implementation of the Plan. For example, the Ministry of Education and Research is responsible for the free school fruit programme. Some informants stated that if funding for nutrition (linked directly with the Action Plan) had been earmarked, it would have been easier to take implementation forward. According to the Division of Public Health in the Directorate of Health, the resources spent on nutrition remained relatively constant during the period of the Action Plan.

3.1.4 CommunicationFrom reports by different informants, it became clear that the joint communication platform was much appreciated. Although this platform had developed several communication strategies during the period of the Action Plan, it was felt that a jointly defined media strategy for the Nutrition Council and the Directorate of Health would have been useful. This was considered particularly important, as the current issues with communication by all the commercial actors to the general public can cause misunderstanding and biased messages. It was also recognized that a communication strategy in support of the Action Plan aimed at all target groups and local actors was necessary and should be considered for future improvement.

In 2009, the Regional Office commissioned the report Health systems and health-related behaviour change: a review of primary and secondary evidence from the Centre for Public Health Excellence at the National Institute for Health and Clinical Excellence in the United Kingdom (29). This report aimed at identifying the characteristics of national, regional and local health systems and services that produce and support changes in behaviour. It presented a review of the role

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of policies and national programmes, including for the media (with evidence about mass media campaigns), as well as marketing tools. Mass media campaigns help to set the social context, establish health leadership and communicate health messages. There is evidence that such campaigns are not enough in themselves to promote changes in behaviour. If, however, they are developed in line with the policy or government programme being implemented, they can be effective in raising levels of awareness. With regard to nutrition, there is a body of evidence showing that promotional campaigns, including media interventions, can increase awareness of what constitutes a healthy diet, and may subsequently improve dietary intakes if they are reinforced by other measures that make healthier options more available (29).

The Directorate of Health has used campaigns together with other measures, but it was felt crucial to use a mix of communication tools and to ensure that the strategy is recognizable by means of an appropriate and consistent image, such as an attractive logo (linked to the Directorate of Health). This should be supported by a high quality web site which provides a clear point of contact for the general public.

Books, magazines and television programmes are an important source of information, and the active involvement of media providers may improve the effectiveness of the policy implementation. In 2011, the Directorate conducted a mass media campaign on keyhole labelling and collaborated with a smaller television channel (Utrop TV) on providing dietary inputs and recommendations to minority populations.

The Matportalen web site, which has been set up by the public authorities with information about food and health, was described by informants, specifically at local level, as a good source of information (30). It was renewed and relaunched in spring 2011. A total of approximately 220 articles/answers to frequently asked questions about nutrition were published during the period 2007–2011, an average of 44 published articles per year compared with only 10 per year in the period 2004–2006. The revised HelseNorge web site and the newly launched Helsedirektoratet web site (in December 2011) provide continuous updates of articles on nutrition targeted at health services and mediators (31,32).

The authorities are respected and trusted by the general public. The National Nutrition Survey indicated in 2011 that three out of four people (74%) have very great confidence in dietary advice from the Directorate of Health. The following agencies provided material for the web site: the Norwegian Food Safety Authority, the Directorate of Health, the National Institute of Public Health, the Scientific Committee for Food Safety, the National Veterinary Institute, the Bioforsk Norwegian Radiation Protection Authority and the National Institute of Nutrition and Seafood Research.

As far as a communication strategy for minorities is concerned, the Directorate of Health organized a workshop on diet and minorities in May 2011, with participants from different immigrant communities. The outcomes consisted of a set of concrete ideas to be developed in dialogue with various minority groups. An example was cooperation with the largest immigrant newspaper about a television programme featuring a local merchant cooking in consultation with a nutritionist, both of whom had immigrant backgrounds.

3.1.5 Norwegian Nutrition CouncilThe Norwegian Nutrition Council was established in 1946. After various changes in its administration over the years, in 2002 its staff became employees of the Directorate of Health and Social Affairs. The Council continued to exist as a professional, scientific and independent advisory board to, in particular, the health authorities. During the period of the Action Plan the Council consisted of 11 members who met, on average, four times a year. The Directorate served as the secretariat for the Council.

During the period of the Plan, the Nutrition Council was responsible for a systematic review of the literature. This resulted in the report Dietary advice for promoting public health and preventing chronic diseases (33), which provided an overview for the health authorities of the updated national dietary guidelines and thus served as the basis for the national dietary recommendations.

The external expert group heard from several current and former members of the Council. Many of them had strong opinions about the Council, although some held a nostalgic view. Some felt that the Council should be replaced and its functions taken over by the Directorate of Health. Others believed that the Council needed an even more independent role, reflecting its role as an independent body under the Ministry of Health and Care Services.

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As a result of these interviews, the expert group identified several issues needing some reflection with regard to the future role of the Nutrition Council. These included: where the Council should be anchored organizationally (in the Directorate of Health or in the Ministry of Health and Care Services), the background of and criteria for selecting Council members, the mandate, the need for the Council to be kept updated, the provision of input by the Council on national and Nordic nutrition recommendations and the Council’s role in communication.

3.2 Evaluation of focus areas and measures in the Action PlanThe Action Plan had 10 focus areas with 73 detailed measures and 5 main strategies to achieve them.

The five main strategies were:

• toimprovetheavailabilityofhealthyfoodproducts• toincreaseconsumers’knowledge• toimprovethequalificationsofkeypersonnel• toensurethelocalbasisofnutrition-relatedwork• tostrengthenthefocusonnutritioninthehealthcareservices.

The expert group was asked to evaluate whether these five strategies had been achieved through the implementation of the proposed measures associated with the strategies. A preparatory meeting between the experts and members of the Directorate of Health and the Ministry of Health and Care Services took place in April 2012 in the Regional Office in Copenhagen. This meeting defined and prioritized the focus for the evaluation of the first four strategies, as described below.

3.2.1 Availability of healthy food products and improvement of consumers’ knowledge The Action Plan mentioned a number of measures that could improve the availability of healthy food products and discouragetheavailabilityofunhealthyfoodproducts.Theseincluded:thedevelopmentandreformulationofproducts;theestablishmentofaforumfordialogue;increasedaccesstohealthyfoods(suchasvegetablesandfruitfromprimaryproducers);increasedavailabilityofseafoodthroughstrengthenedcollaborationbetweenthegovernmentandtheprivatesector (fishing industry and retail); the provision of healthy ready-to-eat meals from fast food and kiosk outlets; theintroductionof taxationon, forexample,non-alcoholicbeverages; support foreconomic incentives; the regulationoffoodmarketingthroughthelabellingoffoodandsymbolsandhealthclaims;andvariousaccessissues,includingproductplacement and display.

In addition, the Action Plan aimed to improve public knowledge about nutrition through information, communication and educational approaches reaching all subgroups in the population, including new methods and channels of communication. Measures included: todevelopacomprehensiveplan for informationandcommunicationonnutrition; to reviewandspecify theofficialdietaryguidelines; tocampaign for thepromotionoffishconsumption; topublishabasiccookerybook;tocontinuetodeveloptheMatportalenwebsite;toawardanutritionprize;andtoestablishadialogueforumforinformation and communication.

The overall evaluation aims of the external expert group regarding these two strategies were to discover:

• goodexamplesofimprovedavailabilityofhealthyfoodproductsthroughouttheperiodoftheActionPlanandimportantfactorsforsuccess;

• goodexamplesofmeasuresthathavebeenabletoincreaseconsumers’knowledgeaboutnutrition;• examplesof importantbarriers in thewayof improving theavailability of healthy foodproductsand consumers’

competenceregardingnutritionanddiet;• thepotentialforimprovingtheavailabilityofhealthyfoodproductsandconsumers’competenceregardingnutrition.

Good examples of improved availability of healthy food products throughout the period of the Action Plan and important factors for success

The keyhole labelling system, which was introduced as a joint Nordic health labelling initiative in June 2009, was mentioned as a key tool in improving efforts to develop and reformulate products in some specific food groups (34).

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Three consumer-oriented mass media campaigns were carried out during the period 2009–2011 to inform the population about the keyhole labelling system. A home page was created, along with materials for consumers (folders in 12 languages) and for the food industry and education sectors. In just two years, the keyhole logo has become the best known and most used logo in the grocery trade. By December 2011, approximately 1500 keyhole-labelled products were available, in addition to fruits, vegetables, berries and fresh fish that could also be labelled with the logo.

A population survey in January 2012 of awareness and knowledge about the keyhole among consumers aged over 18 yearsshowedcontinuedpositiveprogress:98%kneworhadheardaboutthelogo;85%knewthatthelogorepresentedahealthierchoice;manyknewthatthelogorepresentedlessfat,sugarandsaltandmoredietaryfibre;60%trustedthescheme;and50%thoughtthatitmadeiteasiertochoosehealthierfoods.

The private sector has also been involved in other initiatives for better food labelling, such as the bread scale (four categories based on the whole grain and whole grain flour content), improved declaration of the content of food and the introduction of guideline daily amounts. Independent of the Action Plan, the food industry has also developed and increased the number of healthier products available. But there is more to be done, for example developing new keyhole products and making bulk products (such as cheese) healthier. In addition, work is going on to develop a national salt reduction strategy, including a dialogue with food producers with the aim of reducing the amount of salt in their products.

The free distribution of fruit in schools, giving access to healthy foods such as vegetables and fruit from primary producers in lower secondary schools (grades 8–10) and combined primary and lower secondary schools (grades 1–10), was mentioned as a good example of improved availability of healthy food products, and suggestions were made as to how this could become universal for all schoolchildren in grades 1–10. In 2007, the Ministry of Health and Care Services and the Ministry of Education and Research jointly decided to make free fruit and vegetables available to all pupils in lower secondary schools, thus increasing the availability of healthy food in schools. At 57% of the primary schools, pupils can subscribe to a subsidized fruit and vegetables scheme but in 2011 only 18% of the pupils at these schools did so. Informants also suggested that consideration should be given to the economic incentive of removing the value added tax from sales of fruit and vegetables.

In conclusion, there appear to be examples of success regarding the increased availability of and access to healthy food. Little progress has, however, been made regarding action on securing healthy ready-to-eat meals from fast food and kiosk outlets, except perhaps for a few initiatives developed for people such as long-distance lorry drivers.

Good examples of measures that have been able to increase consumers’ knowledge about nutrition

During the period of the Action Plan, dialogue forums were used to communicate and consult with stakeholders. There were two forums: one at national level between the authorities, nongovernmental organizations and relevant private actors, and the other for cooperation between the food industry, the authorities, researchers and consumers.

It was seen as important for nutrition-related programmes to facilitate opportunities for information exchange, expert discussion, consensus on challenges and effective measures, and coordination of measures and various subsidization schemes. Nongovernmental organizations, the agricultural sector information offices and the Norwegian Seafood Export Council actively provided information, courses, dietary advice and educational programmes devoted to diet and health. Many of these organizations were committed to work with schools and kindergartens. There was a need for greater clarity in regional and local public health efforts as regards certain aspects of partnering with private sector actors over issues such as commercial interests and advertising.

Informants also considered it important to maintain a forum in which the authorities, the food industry, researchers and consumers met to discuss topical issues concerning food, nutrition and health. The main objective of the forum was to achieve a common platform and understanding of the efforts to achieve a healthier diet in the population. A seminar was organized annually with the food industry and consumer organizations to discuss trends, disseminate new knowledge and exchange information. Approximately 40–50 participants attended the meetings and different themes were discussed at each meeting. Positive feedback was received from the participants in 2012 with regard to these hearings.

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These dialogue forums were referred to many times by informants, especially those from the private sector. The food industry’s information offices continued to carry out information campaigns and other communication activities during the period of the Action Plan.

The results of the interviews showed that all informants thought these forums were important in improving collaboration with the Ministry of Health and Care Services and the Directorate of Health. All private sector informants agreed that they should be continued and could be even more useful if smaller and more frequent meetings were held on specific topics and based more on a real dialogue. This could help to strengthen synergies between different initiatives at different levels.

As a direct communication tool to increase knowledge and skills for consumers, the Cookbook for all was published in September 2007 (35). The book was given free to all pupils in lower secondary schools and to student teachers. Municipalities could buy the book at cost of production for training purposes (for example, language courses for immigrants or Good Food courses). The book was updated with the keyhole labelling scheme and new dietary advice and was made available in bookshops for the general public. It was mentioned by the informants as a success story for staff working in schools. In 2008, it received a prize for the most beautiful book used in primary and secondary education. The recipes and cooking tips in the book are based on the national dietary guidelines. Table 5 presents an overview of the number of books printed and distributed free to pupils, sold to municipalities at cost of production and sold in bookshops during the period 2007–2011.

Table 5. Cookbook for all: numbers distributed or sold 2007–2011

Distributed or sold 2007 2008 2009 2010 2011 Total

To pupils, free 73 413 76 850 76 729 77 142 74 493 378 627To municipalities, at cost of production 5 470 4 060 6 520 5 360 5 800 27 210Through bookshops, at normal cost 8 381 337 2 031 1 445 949 13 143

An expert group appointed by the Nutrition Council to update the current dietary advice went through all the relevant available research literature as the basis for their report Dietary advice to promote public health and prevent chronic diseases (33). This report, which was developed using a robust systematic review methodology, is available online and will be translated into English. Its launch in January 2011 gave rise to a broad debate and wide media coverage, as well as considerable international interest and recognition. Informants mentioned the book as a good source for increasing competence in nutrition. The Directorate of Health has translated the scientific dietary recommendations into more accessible information using brochures, posters, online articles and lectures which have been disseminated to the county authorities, clinics, doctors’ surgeries and other mediators. However, since the book was published it appears that not enough tools have been developed to make the information accessible to the general population. For example, no food models such as food pyramids or a food plate or other pictorial aids appear to have been developed to aid the widespread dissemination and uptake of the guidelines (36). The health authorities have apparently chosen not to develop this kind of model.

Another tool to communicate good dietary practices, particularly targeting children, was the fish project Fiskesprell. This was considered a good initiative for kindergartens to increase the availability of seafood through collaboration between the government and the private sector (fishing industry and retail). The aim of the project was to increase knowledge among kindergarten staff regarding the nutritional benefits of fish and other seafood. It also aimed to develop children’s cooking skills by encouraging them to help with preparing the fish, and make them more positive towards eating fish by enjoying the experience of a good taste. As part of the Action Plan, the Fiskesprell project was offered to all the counties from autumn 2008, based in the Partnership for Public Health. Several informants raised the question of financing during their interviews with the expert panel: two of the counties had decided not to participate, giving budgetary concerns as the reason. This was not, however, an issue for other counties which had found the necessary funds.

A survey carried out to assess meals, physical activity and environmental health in kindergartens in the spring of 2011 showed that 37% of the administrators (n=1375) and 29% of the head teachers (n=1100) responded that at least one

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member of their staff had participated in a Fiskesprell course.1 Among the head teachers who reported participation, 48% said that knowledge and experience from the course had been used to a large, or very large, extent. The survey also showed that among the kindergartens in which staff had participated, a higher proportion served fish or fish products as part of the warm meal at least once a month or more often, as compared with kindergartens that had not participated or where participation was not known.

The Directorate of Health carried out several communication activities during the period of the Action Plan to improve consumers’ awareness and the consumption of healthier products. These activities include the above-mentioned mass media campaigns, collaboration with the Norwegian magazine Se og Hør [See and Hear] (with approximately one million weekly readers) in the form of a 14-page report on healthy eating and recipes involving celebrities, and a workshop with participants from different immigrant groups with the purpose of identifying specific ideas for communicating advice to such groups.

Although an evaluation of the impact of these initiatives is not available, some of the successful initiatives show that progress has been made towards increasing knowledge about and competence in nutrition among consumers. It is, however, difficult to infer causality between increased consumer awareness and the Action Plan. This can only be verified by carrying out specific consumer research, including among different subgroups of consumers.

Examples of important barriers to improving the availability of healthy food products and consumers’ competence regarding nutrition and diet

Economic determinants such as the price of food and the cost of an affordable healthy food basket are key factors in improving the availability of healthy food products, as shown in the WHO publication The challenge of obesity in the WHO European Region and the strategies for response (37). From interviews with the expert panel, it appears that the authorities have not developed an example of a minimum healthy food basket or what this would cost in, for example, urban as opposed to rural areas. The National Institute for Consumer Research has, however, developed a reference budget that includes a food basket in line with the dietary recommendations (38). This was first developed in 1987 and revised in 2003 and 2007. For example, women aged 18–30 years would receive 9.4 MJ/day (protein 18 E%, fat 33 E%, carbohydrates 49 E%) which would cost approximately NKr 1835 per month. It has also been calculated that a food basket for a diet aimed at people with hypercholesterolemia (fat 25 E%, saturated fat 7 E%, carbohydrates 55%, protein 20 E%) would cost 40% more (NKr 2569 per month).

Certain products eligible to meet the keyhole criteria may cost more than the usual alternatives owing to the greater expense of producing some of the healthier varieties of these products, although some keyhole-labelled products, such as milk, yoghurt and skyr (a form of strained yoghurt), may cost the same. Added costs may create a barrier to easier availability, particularly for those on low incomes. There is a need for more information as to which groups in the population buy the keyhole-branded products. A consumers study or market surveys already available could provide a more detailed picture of consumers’ behaviour, particularly if stratified by income groups.

Further, the overwhelming attention and focus in the media on diets from various self-designated experts can create confusion and pose a particular challenge to promulgating the official dietary guidelines.

Price policies and regulations such as taxation (on, for example, non-alcoholic beverages), economic incentives and food marketing regulations are difficult to implement owing to the natural conflict of interest between different stakeholders and the political difficulties of adopting and implementing them. Informants from the private sector recognized that the authorities believe that voluntary marketing regulations are not working, so the industry is anticipating mandatory regulations from the state. While the food industry is not enthusiastic, it seems to accept that regulations are inevitable. For many years, the health authorities have been proposing the use of price policies. Some reports and papers concerning taxation have been published (by, for example, the Norwegian Agricultural Economics Research Institute) and constitute a basis for the implementation of such initiatives. The strengthening of the regulatory framework to achieve healthier diets, particularly for children, seems to be coming about with the proposal on the regulation of marketing of food to children, which is currently under public discussion.

1 Participation in the course during 2010/2011: 4565 kindergarten staff (from 1991 kindergartens) and 401 others. During 2009/2010, 912 student teachers and 616 preschool teachers participated.

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Potential for improving the availability of healthy food products and consumers’ competence regarding nutrition: multisectoral collaboration

Norway has participated in an international dialogue, through the WHO Action Network on Marketing Food and Beverages to Children, with other organizations and countries that had the same agenda or wished to have an exchange about the measures related to regulation of food marketing proposed in the Action Plan. Through its chairmanship of this Network, Norway has been instrumental in exchanging information with other Member States and facilitating implementation of policies with regard to the marketing of food and beverages to children. Norway has also participated in the EU High Level Group on Nutrition and Physical Activity and the European Food Safety Authority meetings. In addition, the Nordic Council of Ministers is an important forum for dialogue between the Nordic countries. The evaluation process showed that in Norway, more collaboration at national level between different authorities would help to ensure that each sector develops a sense of ownership for the implementation of the Action Plan.

3.2.2 Competence in nutrition – key personnelMeasures related to improving and securing nutrition-related knowledge, skills and competence in various key health professional groups are linked to improving work in this area aimed at the prevention and early identification of overweight and obesity and other nutrition-related noncommunicable diseases, as well as improving awareness at the local level and in primary health care. Improving competence is also linked to the integration of nutrition in the curricula for professional training and education.

The overall evaluation aims of the external expert group in assessing competence in nutrition efforts at local level were to discover:

• good examples of measures to increase nutrition competence among key health personnel and other relevantoccupationalgroups;

• goodexamplesofadequatestandardsandroutinesfornutritioninthehealthcaresector;• examplesof barriers in thewayof improving competence innutritionand for establishingadequate routines for

nutritioninthehealthcaresector;• thepotentialforimprovingcompetenceinnutritionandforestablishingadequateroutinesfornutritioninthehealth

care sector.

Good examples of measures to increase nutrition competence among key health personnel and other relevant occupational groups

Informants involved with clinical nutrition presented evidence that a well-established nutritional structure in a hospital went together with better nutritional care. A well-defined structure in a hospital was defined as the presence of a multidisciplinary nutrition team, a resource person in the area of nutrition, guidelines for identifying patients at risk of under-nutrition, assignment of responsibilities, and education for nursing staff.

Good examples of adequate standards and routines for nutrition in the health care sector

In 2006, the Norwegian Society of Clinical Nutrition and Metabolism asked the authorities for guidelines for the prevention and treatment of under-nutrition. This resulted in the publication of guidelines in 2009 (39). Although there is no regulatory framework requiring the full implementation of all action points in the guidelines, it has been suggested that audits of the implementation of the guidelines carried out by health authorities could improve practice in the Norwegian context.

The Directorate of Health is responsible for providing guidelines to the various medical disciplines. These are included in the annual letter from the Ministry of Health and Care Services to the regional health authorities, which forms a central management tool in the hospital sector. The regional health authorities are responsible for the implementation of these guidelines. Since 2009, the Directorate of Health has instructed the regional health authorities to ensure that: (i) nutrition isincludedinoverallspecialisthealthcareservices;(ii)hospitalshaveroutinesandthecompetencetointegratenutritionintomedicaltreatment;and(iii)hospitalscansupportthemunicipalitiesonnutrition-relatedissues.

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Examples of barriers in the way of improving competence in nutrition and for establishing adequate routines for nutrition in the health care sector

A national survey of food and diet among leaders and health personnel in nursing homes was published in 2008 by Østfold University College (40). This study showed that only 16% had written procedures to be used in the assessment of patients’ nutritional status. There was, however, no national survey of nutritional status in nursing and care services. In 2010, a nationwide audit run by the Norwegian Board of Health Supervision identified major deficiencies in the daily work to prevent and treat malnutrition in older people who received health and social services (41). There is still a significant need for improvement in the health care services with regard to the formal procedures for assessing nutritional status, night fasting, and knowledge about nutrition and about the daily practice of prevention, identification and treatment of malnutrition.

It seems that more work is needed to integrate greater attention to nutritional issues in the education and training curricula of health professionals and other related actors. University courses on human nutrition and clinical nutrition are well standardized, but colleges and other institutions offering training up to bachelor level do not have a standard core curriculum. Key issues for improvement are the lack of targeted nutritional education in training courses for health care professionals and issues regarding the number of nutritionists being trained. The differences in academic knowledge and skills between professional groups such as dieticians, nutritionists, clinical nutritionists and public health nutritionists are unclear in terms of their training and certification.

There are not many opportunities for individual consultations about nutrition, and in primary care they seem to be carried out predominantly by a handful of self-employed nutritionists working in the private sector. They are thus far too expensive for people on low incomes.

There do not seem to be sufficient data to provide a picture of the dietary behaviour of certain population groups coherent enough to be used by health professionals for response to and in dialogue with vulnerable groups such as pregnant women and infants. Neonatal records, for example, could be included more often in routine data collection. Data on antenatal health care (for example, maternal weight, height and weight gain) could be collected to ensure that this group is covered. This could also allow sufficient disaggregation to provide useful data on inequalities and other issues, such as infant feeding (including breastfeeding and complementary feeding) and monitoring tools for the diet and growth of children aged 0–5 years.

Potential for improvement with regard to education and training

Only broad and inclusive multisectoral planning at the national level, including ensuring an appropriate geographical distribution, will allow for effective coordination in scaling up the numbers of students and aligning professional education in nutrition with national nutritional needs.

Overarching reforms must be undertaken at all levels in interventions aimed at increasing the number of health professionals. Evidence demonstrates that simply increasing the student quota is not enough to address the shortage of health professionals. Although it is important to increase the number of graduates, this must be done in tandem with interventions targeted at multiple levels (42). Educational institutions need to increase their capacity and reform their recruitment practices, teaching methods and curricula in order to improve the quality and social accountability of graduates. Country-led efforts should be linked to international activities as a way of building on lessons learned and successful examples of implementation. The inclusion of nutrition training in the curricula for undergraduate and continuing education, especially for nurses and medical doctors, would probably significantly increase the capacity of the health system to respond to nutrition-related health problems. There also appears to be a need for mapping current nutritional competence among the health personnel in nursing care.

Self-perceived skills in nutritional knowledge among Scandinavian doctors and nurses have shown that insufficient knowledge is the main barrier to good nutritional management in various clinical settings in Norway (43). This lack of knowledge is evident in three main areas relating to good clinical nutrition practice: screening of patients on admission, assessment of undernourished patients and initiation of nutrition treatment.

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Key areas that could be addressed to increase competence in nutrition include:

• theauthorizedscopesofpracticeforvariouscategoriesofnutritionist;• preserviceeducationtiedtohealthneeds(addingasocialinequalitiescomponenttonutritioneducation);• in-servicetraining(suchasdistanceorblended2learning);• thecapacityoftraininginstitutions;• performancemanagement(appraisal,supervision,productivity);• trainingofcommunityhealthworkers(in,forexample,centresforlearningandcoping)andeducationalproviders(in

kindergartens,andprimary-andsecondary-schoolteachers);• identificationandselectionofandsupportforchampionsandadvocatesinthehealthworkforce;• leadershipdevelopmentformanagersintheareaofnutritionatalllevels.

3.2.3 Nutrition efforts at local levelThis area includes nutrition-related work at county and municipal level, including measures in schools and kindergartens. The Action Plan aimed to establish a stronger basis for nutrition and dietary work at local level through ensuring local bases for policy and making public health efforts more systematic. Locally-based nutrition-related work also involves the promotion of healthy eating habits among children and young people in schools and preschools, since the responsibility for these activities is largely devolved to the local level.

Following the increased emphasis on municipalities’ responsibilities for health promotion and disease prevention under the new Public Health Act (44), which was developed after the end of the Action Plan, greater attention will be given to this area in national public health activities.

The overall evaluation aims of the external expert group in assessing nutrition efforts at local level were to discover:

• goodexamplesoflocally-basednutrition-relatedworkthroughouttheperiodoftheActionPlanandimportantfactorsforsuccess;

• examplesofbarrierstolocally-basednutrition-relatedwork;• thepotentialforimprovement.

Good examples of locally-based nutrition-related work throughout the period of the Action Plan and important factors for success

A new section on planning in the Planning and Building Act (45) came into force on 1 July 2009. This incorporated public health considerations: according to § 3–1 of the Act on duties and considerations in planning, plans should “promote population health and counteract social inequalities in health, as well as help to prevent crime”.

The new Public Health Act of 2012 included provisions whereby the promotion of public health became a statutory responsibility for counties. In 2006, the Health in Master Plans project was initiated by the Directorate of Health, with the aim of improving the integration of public health considerations into the social components of municipal plans. By 2010, all the 30 project municipalities had developed Health in Master Plans, and the experiences from this project played an important role in the development of the 2010 and 2012 Public Health Acts. The development work for the Health in Master Plans project, with an emphasis on nutrition, was initiated in four pilot municipalities in three counties. All these took steps to ensure that there was a political and organizational basis for nutrition-related work in their areas. Examples of action included the adoption of nutrition programmes into the plan for a safe and healthy childhood and inclusion of the Good Food training course in municipal and financial planning. In 2010, an evaluation of the Health in Master Plans project referred to a survey conducted in all municipalities of their public health activities and how the work was organized during the second year of the Action Plan (2008). The results showed that at the time, only a quarter of the municipalities reported that nutrition-related work was an integral thematic area in their municipal plans. Some activities relatedtotheActionPlanwerefoundtobetakingplaceinseveralcountiesandmunicipalities;othersinonlyoneortwo counties. Some activities were widespread partly because they were the result of national regulations (such as free fruit and vegetable distribution in schools) or because the programmes were linked to national action supported by the

2 Education that combines face-to-face classroom methods with computer-mediated activities.

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government and/or a commercial body. Even so, it seemed that the Action Plan was a driver for intersectoral collaboration at the local level.

Other initiatives or activities seemed to arise because of the creativity or engagement of one or two key individuals in a position to initiate nutrition activities who had drawn on the Action Plan as a key tool to enable them to carry out their plans (for example, running a healthy living centre or a school food programme, or projects initiated at county level by a public health adviser). All those interviewed who worked at the local level displayed great enthusiasm for the Action Plan (and for being interviewed about it – all were very keen to engage with the evaluation) and specifically for its physical manifestation as a written document that they could present and use in negotiation and advocacy. All those interviewed wanted the Action Plan to be revised and the possibilities it offered to be strengthened and continued: none wanted it to stop. It was, however, clear that at local level nutritional work was often driven by one or more local activists. In other words, local nutrition activities appear to need a local champion, which at the same time make them vulnerable because of their dependence on key individuals. Little evidence was found that nutrition activities had been started or continued simply because the Action Plan had stated that this should happen. There needed to be someone with the skills, interest and initiative. With some notable exceptions, informants working in nutrition said that they had felt that their status was not high, and that the Action Plan had helped to raise their status and make their knowledge and skills more visible and valued.

Particular barriers were also encountered in the education sector at local level through a lack of tools, expertise or financial resources. The expert group repeatedly heard that there was a lack of teaching staff with appropriate training in nutrition and food, insufficient nutrition-related content in the curriculum and not enough good, healthy food options in schools. All those interviewed said it was important that all those involved in teaching and in the school food environment should work together to promote and enable good understanding and practice related to healthy food.

The Action Plan was used to enable local professionals to advocate the monitoring of food and meals provided in kindergartens so as to ensure that they complied with regulations referring to the guidelines for food and meals in kindergartens (46) (revised as a result of the Action Plan). The informants were also clear that if the guidelines had been stronger in their wording, by stating, for example, that food served in schools “must” instead of “should” be based on the guidelines, greater compliance could be achieved at local level.

Other informants, who were not working directly in nutrition but, for instance, on child poverty, said that the Action Plan had enabled them to include nutrition in their work programmes where previously this might not have been accepted either by their line managers or those with whom they were working. These more unexpected spin-offs included examples such as the Living Healthily courses for unemployed people, as well as the inclusion of ways to bring about and manage healthy food and living among new immigrants in the New in Norway programme.

The informants highlighted the importance of a formal national policy document that works as a tool to drive action at local level.

Action Plan generated/strengthened success stories

From 2009 to 2012, the Ministry of Education and Research carried out a project (Helhetlig Skoledag [Comprehensive School Day]) testing various models in schools aimed at improving the coherence between school and the before- and after-school programmes. Components of the programme included food in school, physical activity, help with homework and various cultural activities. Provision of breakfast was one of several models for school food tested in a project coordinated by the Directorate of Education. One of the informants interviewed had experience of breakfast provision, while other schools tested lunch schemes although these were not discussed during the evaluation. The provision of breakfast at primary schools was reported as being a successful example of a project looking at options for food provision in the school setting, especially where teachers identified the children who needed it most (such as those who came without eating first, or who brought unhealthy food). One school described making a contract agreement with the parents that the children would eat it, thus engaging them too.

The findings from the Health Behaviour in School-Aged Children (HBSC) study (16) indicated that young people who are overweight are more likely to skip breakfast, are less physically active and watch more television. Eating breakfast

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regularly is associated with higher intakes of micronutrients, a better diet that includes fruit and vegetables and less frequent use of soft drinks. Body mass index and the prevalence of overweight are, in general, lower in young people who eat breakfast, which is also advocated as a way of improving cognitive function and academic performance. Eating breakfast daily is less common among girls and in families with lower socioeconomic status and decreases with age. The latest data from the HBSC 2009/2010 study (16) show that this is also the case among Norwegian girls. In Norway, 76% of girls and 79% of boys aged 11 years reported that they ate breakfast every school day, which is higher than the HBSC average of 71% but lowest among the Nordic countries (Sweden 86%, Denmark 82%, Iceland 81%, Finland 79%).

The informants indicated why they regarded school breakfasts as a success (even though very few schools offer breakfast): the children could eat together, with adults (teachers) who knew them in a different way to their parents, sometimes in classrooms so that they were in small groups. The teachers said that children were calmer and studied better when they had breakfast at school. However, in the political debate concerning the provision of breakfast and lunch in schools, breakfast is currently considered a family responsibility. Those working in education (teachers and trainers) or nutrition promotion at county or municipal levels, as well as those leading national civil society alliances, all expressed a wish to see meals provided in schools, in accordance with national guidelines, rather than food brought from home. A 2006 report mapping the situation and modelling five options for the costs of and potential for providing lunch in schools noted that, owing to the principle of free education in Norway, it would be very difficult to implement a lunch model based on out-of-pocket payments (47).

Potential for improvement

Public procurement guidelines are needed to ensure that food provided in school settings, as well as in other public institutions such as care homes and hospitals, is in line with the Norwegian food-based dietary guidelines (48).

3.3 Findings in relation to social inequalities in dietary intakeSocial inequalities in health persist in Norway. Examples of health problems that are unevenly distributed in the population are cardiovascular diseases, overweight and obesity and type 2 diabetes. These conditions are linked to lifestyle and behavioural factors such as diet, physical activity, harmful use of alcohol and tobacco use. There is consequently much to indicate that social differences in lifestyle are a contributory factor in social inequalities in health.

The overall evaluation aims of the external expert group in relation to social inequalities in dietary intake were to discover:

• examplesintheActionPlanofstructuralmeasuresthathaveparticularlyfocusedonreducingsocialinequalitiesindiet;

• examplesofimportantbarrierstoreducingsocialinequalityinnutritionanddiet;• thepotentialforimprovement.

3.3.1 What the available data showIn terms of trends in social inequalities in diet, the available disaggregated data for adults were limited to sex and age cross-linked with level of education (basic compared to university).

Among schoolchildren there does seem to have been a levelling-up of the social gradient in the consumption of fruit in the period 2005–2009 when cross-linked with their parents’ socioeconomic status. Among girls, the greatest increase was in families with a middle socioeconomic status (approximately 12%), whereas among boys the greatest increase was in those from families with a lower socioeconomic status (approximately 19%, compared to 11% for those with a middle socioeconomic status and 9% for those with the highest socioeconomic status). There are, however, limited data regarding food availability and more upstream social determinants that affect health behaviour, such as food choices and dietary intake.

3.3.2 Findings from interviews with key informants and related documentationIn sections 3.1–3.3, informants mentioned both universal and selective interventions, largely at the upstream/structural and midstream/risk reduction levels, that can be understood as contributing to a reduction in social inequalities in diet. These included the following measures.

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• Thefreefruitschemeandotherprojectshavebeenintroducedinschoolstoincreasetheavailabilityofhealthyfoodin school settings.

• Thekeyholelabellinginitiativehasbeenintroduced,includingpre-testingwithawiderangeofstakeholderstoseehow they responded to the key messages as well as annual follow-up surveys which include information about level of income, education and number of children living at home. The 2012 survey included a question on ethnicity derived from the Statistics Norway surveys.

• Theproposedregulationson restricting themarketingofunhealthy foods tochildrenandyoungpeoplewill,asauniversal measure, have a potential impact on social inequalities in diet by reaching all children without regard to their socioeconomic background.

• Healthylivingcentres,particularlytheGoodFoodlowthresholddiet-relatedschemeandtheActiveintheDaytimeproject, have a selective focus on the level of risk reduction and/or effect mediation. A report from Modum municipality showed that approximately 60% of those attending the centres were unemployed or outside the labour market, which is consistent with figures from 2010. Specific projects (particularly those with ethnic minorities and/or migrants) included Romsås in Motion (which was in place before the Action Plan commenced), the cohort study of pregnant women looking at ethnic diversity in response to the huge prevalence of gestational diabetes in ethnic communities, and the materials about nutrition and diabetes produced by the Diabetes Association of Norway using fruit, vegetables and foods consumed by different ethnic groups to communicate messages about healthy eating.

• Targetedcommunicationinitiativeshavebeenundertaken,includingthetranslationofkeynutritioninformationintoseveral languages (the keyhole labelling brochure was translated into 14 languages) and/or the use of oral as well as print media. Key examples include the workshop on diet and minorities, the 2008 nutrition prize focusing on promoting healthy diets among immigrants and cooperation with the largest immigrant newspaper about nutrition.

There is enough information to show that in principle there seems to be a good balance between social reform, risk reduction and mediation at universal and selective levels. More information is, however, needed to say with certainty whether the balance between upstream, midstream and downstream universal and selective interventions is right and/or whether it is making a contribution to tackling social inequalities in diet. There has been a strong emphasis on the implementation of upstream/structural interventions that are largely universal in focus. From the interviews with key informants, it does, however, seem that the balance and coordination across each category (that is, improvements in making universal interventions more responsive to the specific needs of some population groups, such as ethnic minorities) could be strengthened.

Some initiatives could be improved. For example, some key informants called for the free fruit scheme to be available in all schools instead of only some, “to move from being halfway there to being universal in coverage”. The scheme was intended to be universal, but implementation seems to have been selective. In a research project offering free fruit in schools, the impact on health inequalities was measured using data disaggregated by sex and parents’ education. The offer of free fruit and vegetables at school increased fruit intake among pupils aged 10–12 years between 2001 and 2008, but vegetable intake did not increase significantly. The effect was the same for boys and girls, and for children of parents with higher or lower education. The programme clearly had an effect both on boys and on children of parents without a higher education. Related to this, some of the key informants, particularly those who worked with ethnic groups or on selective initiatives, indicated that there needed to be greater mainstreaming of inequalities-sensitive practice and/or systematization of initiatives, as there are many different specific and short-term projects. Some of the key informants indicated the need for increased, or more sustained, funding to enable longer-term action and impact, noting that funding is critical to avoid workers “burning out”. Nearly all those working with ethnic groups noted the need for greater integration and linkage of inequalities-sensitive practice into the mainstream and universal system.

The keyhole labelling initiative is being monitored in different social groups by level of education, marketing legislation and targeted materials. This monitoring exercise seems to be promising in terms of the potential health impact of tackling social inequalities in diet.

In contrast, most of the key informants working with people who have lower levels of income and/or education and/or belong to ethnic minorities, considered that there needs to be more deliberate and focused action to close gaps in diet and/or in social inequalities that affect food choices.

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The universal services are seen as fundamental to such action but some extra effort is required to make them responsive. One informant noted that most immigrants have no idea how to use the health services – understanding what is available, why it is important to use them and so on. On the other hand, immigrants have been identified as using services four times as much as native Norwegians, although this also relates to the responsiveness and quality of the system. Such frequent use is often the result of problems with communication, such as the unavailability of a translator or the complexity of symptoms and/or co-morbidities.

The feedback from informants was that good intentions (as reflected in the second main goal of the Action Plan) are not in question, but there seems to be a challenge in putting them into practice in terms of understanding what needs to be done differently, doing it systematically and following up to see if there has been a reduction in social inequalities as a result. Those working in the field of social inequalities do not necessarily see some of the key changes needed to make a difference, or whether any changes that have been made appear to be closing the gaps. This last issue may also be linked to whether programmes are being evaluated for their impact on inequalities and/or whether the right data are available to make such an assessment.

Some projects and initiatives do focus on social inequalities in diet (in relation to socioeconomic characteristics such as level of education, ethnicity and minority), although some of the key informants indicated that these are not necessarily systematic, coordinated or documented, nor monitored for distribution of impact or effect.

An important consideration is the need to build up the competences of public health and clinical professionals who work with migrants and different ethnic groups rather than focusing on culture. This needs to be done through elements in undergraduate, postgraduate and continuing professional education courses.

Settings-based approaches, which are largely at the midstream and risk reduction level, are considered important in tackling social inequalities in diet. They include health centres, health visitors, kindergartens (particularly because they are cost-effective and have a wide reach), school health services and healthy living centres.

The evaluation of interventions with the purpose of assessing the distribution of impact, change and/or outcomes seems to be a challenge as regards the impact of interventions on social inequalities, and also in the more systematic use of disaggregated data on socioeconomic status and ethnicity. This is particularly the case with data for monitoring the impact of various initiatives on different ethnic or minority groups as part of an overall mainstream and regular monitoring effort.

There seem to be better data on different socioeconomic groups than on minority groups or by ethnicity. Data on ethnic minority groups seem to be strong from the early part of this century, when some major studies provided the basis for the Oslo Immigrant Health Profile. It is not clear what other national data are available or being collected. There is a need to collect data on migrants and ethnic minority groups throughout the country.

Examples of barriers to reducing inequalities in nutrition and diet

The question of attribution is a challenge. Nutrition is part of a broader effort to strengthen public health overall, and the Action Plan was introduced at the same time as a whole-government approach to tackling social inequalities. The linkages and connections need to be analysed, to see what other macro-level policies in relation to, among other areas, education and social protection that were put in place in the period 2007–2012 may also have contributed to a levelling-up of inequalities across different social groups.

Potential for improvement

Table 6 provides an overview of examples of social reform identified during the interviews and in a review of key documents that have either had a particular focus on reducing social inequalities in diet and/or generally or that aimed to create a more enabling environment for supporting positive health behaviour.

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Universal

Selective

Marketing legislation.

Keyhole labelling system for food.

Fiskesprell in kindergartens.

Free fruit in schools programme. Legislation for the policy has to be in place but it is delivered using a settings-based approach. This is categorized as universal (as with Fiskesprell) because it is available to all children in the relevant school settings but not selective in its focus from an inequalities perspective.

Reduction in costs to families associated with secondary education (such as paper and books) by gradually providing this equipment free, and efforts to increase attendance in secondary schools, with the aim of creating equal opportunities in later life.

Action to reduce the upper limit on kindergarten fees by 18% in 2006 and introduction of pilot projects allowing attendance at kindergarten free at specified times during the week for children living in multiethnic or disadvantaged areas.

Testing of keyhole labelling with selected groups (those with low levels of education or low language skills, migrant and ethnic groups) so that a structural measure is responsive to all groups.

Changes to primary care practice among general practitioners regarding nutrition and lifestyle advice. For example, enabling doctors to charge an hourly rate for situations where they are giving lifestyle advice (such as on diet), particularly for people with type 2 diabetes or high blood pressure not being treated with medicine.

Antenatal cohort study among women from ethnic minorities to generate information in relation to gestational diabetes and including a targeted post-natal physical activity and weight loss initiative.

Health information and education campaigns such as a cookbook and school health promotion activities.

Targeted communication initiatives, including translation of key nutrition information into several languages (the keyhole labelling brochure was translated into 14 languages) and/or use of both oral and print media.

Tailored health information for different ethnic and/or minority groups such as that produced by the Diabetes Association.

Healthy living centres, particularly the Bra Mat low threshold diet-related scheme and Active in the Daytime in Oslo and Nordland county. These programmes are aimed at people who are unemployed, on sick leave and/or from different ethnic minorities.

Table 6. Examples of social reform focusing on reducing social inequalities in diet and/or generally or aiming to support positive health behaviour

Measure Social reform Risk reduction Effect mediation (upstream or structural) (midstream) (downstream)

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These interviews and documents indicated that monitoring of whether these interventions are making a difference to social inequalities in diet remains a challenge. Key issues include the following.

• Thecollection,measurementandmonitoringofsex-andage-disaggregateddata,cross-linkedwithtwoorthreekeyand agreed socioeconomic determinants as well as ethnicity, need to be strengthened and perhaps a minimum set of equity criteria developed.

• Someofthoseadministeringandimplementingtheuniversalmeasures,particularlyatthesocialreformlevel,needto recognize that equity issues should be considered as part of the regular monitoring and assessment of effective programme implementation. This is linked to the first issue, and it became apparent in discussions about health services at all levels, both general and nutrition-related. There seems to be an implicit assumption that if a service or intervention is intended to be universally available, then it is actually universally available and accessible in practice. This assumption needs to be tested as part of good practice in ensuring that universal and/or effective coverage is actually happening.

• Cananydifferences (suchaschanges in ratesorprevalence)beattributed to the intervention (social reform, riskreduction, effect mediation) and whether it is universal or selective? The further downstream and more selective an intervention, the easier it is to measure and assess attribution.

• Istherateofchangefasterinmoredisadvantagedgroups?Thatisoneoftheideasbehindlevelling-upacrossthesocialgradient so as to improve health faster among the population groups considered to have poorer health outcomes. There is not enough information to answer this question, nor is there a quantitative target that would enable measurement of whether the hoped-for change is being realized. Change does, however, seem to be in the right direction in some instances: for example, more schoolchildren are consuming fruit, berries and vegetables at least once a day.

4. Overall recommendations of the evaluation

4.1 General recommendationsThe Norwegian nutrition policy has increased knowledge on nutrition and health in the population. The main changes in the diet have been as seen in other WHO European Member States: a reduction in the consumption of fat (mainly saturated fat) and an increase in the consumption of vegetables, fruit and cereals. Diet and meal patterns are changing rapidly, especially among the younger generation, and public health campaigns are losing ground to aggressive marketing of foods high in fat, sugar and salt. Even though heart disease has almost halved during the past three decades, the proportion of adult obesity in Norway is now as high as in the rest of Scandinavia: about 10%.

There are several challenges as well as positive trends in the current developments in diet. The content of saturated fat is now significantly higher than recommended. The consumption of added sugars has decreased since 2000 but is still higher than recommended. The content of dietary fibre has increased but is still lower than recommended. On the positive side, the dietary content of protein, trans fat and polyunsaturated fat has remained at the recommended level during the period of the Action Plan. Furthermore, the consumption of vegetables, fruit and berries has increased over time, including during the period 2005–2010. Current dietary habits must be seen not only in relation to the period of the Action Plan but also to work over several decades.

4.2 Specific recommendations regarding the Action PlanThe authorities, health professionals, private sector and civil society alike perceived the Action Plan with enthusiasm as a supportive tool at local level for initiating and implementing nutrition-related activities. In particular, local professionals used it to advocate the monitoring of food and meals provided in kindergartens for compliance with regulations referring to the Directorate of Health’s guidelines for kindergartens, which were revised as a result of the Plan.

The allocation of measures between the various ministries showed that the Plan was primarily rooted in the context of health. There are many good reasons why this is the case, but it could also be a challenge with regard to distributing ownership and commitments to the other ministries involved. Ideally, sectors other than health should see how health-related work contributes to achieving their objectives.

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There were, however, no clear timeline, budgets, earmarked funding or targets/milestones for the different measures in the Plan. Furthermore, the preciseness of the language describing the different measures varied from the specific, for example: “1.4 Publish a basic cookery book for everyday use in the population” to the vaguer “4.8 Encourage school owners to strengthen food and meal programmes in before- and after-school programmes for schoolchildren”. The content of the measures also differs between those that were a continuation of previous activities, such as “7.5 Continue nutrition and diet initiatives together with physical activity and anti-tobacco programmes as a priority focus in partnerships for public health”, and others that were new activities, for example: “1.3 Implement a campaign to promote consumption of fish and other seafood”.

There is a need to strengthen the steering mechanism with regard to funding and financing mechanisms.

4.2.1 Core activitiesAccording to the findings from interviews and other available material, many activities should be considered for continued support. The observations of the expert group are based on the experience of the people, institutions and health professionals involved and the likelihood of positive effects. These activities include the following:

• the distribution of free school fruit in lower secondary schools (grades 8–10) and combined primary and lower secondaryschools(grades1–10),whichshouldbeextendedtoincludeprimaryschools;

• thecommonNordickeyhole labelling system, mentioned by various informants as one of the supportive tools for the ActionPlan;

• the Fiskesprell fish project, implemented by most counties in kindergartens to improve the nutrition skills andcompetence of kindergarten staff, which had positive effects on kindergarten children in terms of preparation skills and taste preferences with regard to the consumption of fish.

Communication. The Dialogue Forum was acknowledged by all informants as an important step towards improving collaboration with the Ministry of Health and Care Services and, especially, the private sector. All private sector informants agreed that the Forum should continue, and that it could be even more useful if smaller and more frequent meetings were held on specific topics and based more closely on a real dialogue. Other measures such as the development of the Matportalen, Helsedirektoratet and HelseNorge web sites and the publication of the Cookbook for all, were also popular.

Targeted communication initiatives, including the translation of key nutrition information into several languages and/or the use of oral as well as print media, should be continued. Key examples include the workshop on diet and minorities, the 2008 nutrition prize focused on promoting healthy diets among immigrants, and cooperation with the largest immigrant newspaper about nutrition.

Activities at local level. In the education sector, barriers were encountered in the form of a lack of available tools, expertise or financial resources. It was repeatedly reported that there is a need for more teaching staff to receive appropriate training about food and nutrition, the nutrition content in the curriculum could be improved, and the provision of good, healthy food options in schools could be scaled up. Examples of nutrition programmes being adopted into the plan for a safe and healthy childhood and the incorporation of the Good Food training course into municipal and financial planning should be repeated more widely.

Key personnel and competence in nutrition. The range of domestic approaches that should be implemented or proposed to address the projected shortage of nutritionists, especially in primary health care, could include both short- and longer-term initiatives, legislative as well as programme development activities, and national as well as municipal or local efforts. It was considered essential that those involved should represent a broad range of stakeholders.

Focus on social inequalities in diet. Although the Action Plan has two overarching policy priorities (social inequalities and cross-cutting issues), informants felt that it was unclear how these priorities should be translated into action. This led to the recommendation that policy action needs to be strengthened and reoriented from mainly universal coverage towards a focus on the specific needs of low income groups and ethnic minorities.

Many of the other measures, such as the above-mentioned Good Food low threshold diet-related scheme at healthy living centres, Fiskesprell in kindergartens, the free fruit scheme at schools and the keyhole labelling system, are important and relevant measures for reducing inequalities in health.

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4.2.2 Monitoring challengesThere appeared to be several challenges associated with the monitoring of nutrition-related issues, including a lack of disaggregated data and of specific consumer investigations into changes in consumers’ knowledge and into the status of nutrition in nursing and care services. There were also insufficient data to provide a coherent picture of dietary behaviour among certain population groups that could be used by health professionals to respond to and in dialogue with vulnerable groups such as pregnant women and infants. For example, neonatal records could be included more frequently in routine data collection. Data on antenatal health care (such as maternal weight, height and weight gain) could be collected to ensure that this group is covered and to allow for sufficient disaggregation so as to provide useful data on inequalities and other issues, such as infant feeding. In terms of trends in social inequalities in diet, the available disaggregated data for adults were limited to sex and age cross-linked with level of education (basic compared to university).

4.3 Key priorities in nutrition policy The Action Plan should be seen as an example of good practice in the application of the WHO Health 2020 policy framework. The implementation of the Action Plan does, however, require a whole-government and whole-society approach, and the emphasis on decentralization is creating some difficulties for the implementation of action plans at local level. While the question of local autonomy is important in addressing multilevel governance, it is recognized that empowerment and ownership both top-down and bottom-up may improve implementation.

In future policy-making related to nutrition, such as a new action plan, consideration should be given to the number of action points, targets for action points and milestones, a time-line for implementation, a detailed budget and a more structured reporting mechanism.

There is room for improvement with regard to ownership by the various ministries involved. One suggestion is to establish a steering group for the Action Plan. The role and responsibility of the Nutrition Council should also be clarified. The Directorate of Health is a key leader for public health policy at both national and European levels, so re-investment in it would be crucial. As an example, the nutrition surveillance system allows for the monitoring of key challenges with regard to nutrition. These priorities, for example the focus on vulnerable groups in data collection, need to be followed up closely to ensure that they are indeed integrated within the nutrition surveillance system.

4.3.1 Increasing nutrition competence among consumersIt is important to garner more information about consumer behaviour and the role of incentives. For example, research would be useful to validate how well the keyhole labelling system is able to affect various determinants of behaviour.

The Directorate of Health could consider incentives for local policy-makers and organizations working with low opportunity and/or ethnic and cultural minorities to encourage a balanced diet among social risk groups. An example might be a booklet for local authorities offering examples of good practice in providing healthy nutrition in low opportunity groups. The Directorate of Health could encourage this approach by rewarding good practice by local authorities.

Further development of work on communication could include the production of pictorial aids, such as food pyramids or food plates, for dissemination in support of the national guidelines. Training sessions for media professionals working regularly with nutrition could also be considered.

More emphasis should be given to making healthier ready-to-eat meals available from fast food and kiosk outlets.

4.3.2 Visibility of nutrition activities at local levelThe Action Plan was used by various actors at local levels, working in different contexts to achieve a number of outcomes. This applied both to the written document, which could be used in negotiation with other local partners, and to its existence as legislation enabling it to be used for advocacy and in education. As stated above, the Action Plan was an important policy instrument at local level as wherever it needed implementation, it was crucial to train key staff to increase their competence in nutrition.

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There might be potential in increasing the number of individual nutrition consultations in primary care and making them available in institutions. The healthy living centres could be one arena, but other parts of the health system could also provide this service.

Healthy living centres, particularly the Good Food low threshold diet-related scheme and the Active in the Daytime project, have a selective focus on the level of risk reduction and/or effect mediation. A report from Modum municipality showed that approximately 60% of those attending the centres were unemployed or outside the labour market, which is consistent with figures from 2010.

There were also examples of specific projects, particularly with ethnic minorities and/or migrants, such as Romsås in Motion (which was in place before the Action Plan commenced), or the cohort study of pregnant women being undertaken to look at ethnic diversity and in response to the huge prevalence of gestational diabetes. The Diabetes Association of Norway has done important work in producing materials about nutrition and diabetes, using fruit, vegetables and foods consumed by different ethnic groups to communicate messages about healthy eating.

The continuous implementation of projects such as these should be considered to ensure the sustainability and visibility of nutrition activities at local level.

4.3.3 Increasing nutrition competence – health professionalsThere is a need for improvement in the health care services with regard to formal written procedures for assessing nutritional status, night fasting, and knowledge about nutrition and about daily practice in preventing, identifying and treating malnutrition.

Nutrition-related work should be well-integrated in institutions at local level to ensure that the skills and status of practitioners are more visible and valued, and to reduce the dependence on non-expert nutrition enthusiasts, which to some extent appears to be the case today.

There is a lack of targeted nutritional education in training courses for health care professionals.

More emphasis needs to be placed on building up the competences of public health and clinical professionals working with migrants and various ethnic groups and less on the present focus on culture. This needs to be done as part of undergraduate, postgraduate and continuing professional education courses.

Only broad and inclusive multisectoral planning at the national level, including ensuring an appropriate geographical distribution, will allow for effective coordination in scaling up the numbers of students and aligning professional education in nutrition with national nutritional needs.

Competence regarding nutrition should be built up among schoolteachers through appropriate training in nutrition and food. In addition, the nutrition content in curricula needs to be looked into, as well as the provision of good, healthy food options in schools.

4.3.4 Strengthening action on social inequalities in dietThe following are recommendations in relation to both universal and selective interventions that could be extended and or enhanced to make a greater impact on social inequalities in diet.

The overarching recommendation is that disaggregated data (at least sex and age) cross-linked to at least two or three socioeconomic determinants (level of education, income, occupational status, ethnicity, etc.) should be collected more systematically and routine analysis undertaken. Rather than seeking to have a massive data set for a possible new nutrition action plan, it could be useful to develop a minimum indicator set (no more than three to five indicators) for making assessments.

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Further recommendations include the following.

• Thefruitschemeshouldbeexpandedtomakeituniversalandavailableinallschools.

Rationale/evidence is found in work by Bere et al. (49) about the impact on health behaviour and parents not being willing to take up the subsidized scheme, together with evidence about early child development showing that increased exposure in kindergartens and primary schools should mean that good eating habits are developed earlier, are more entrenched and are better for learning.

• Work should be undertaken on costing a healthy food basket to identify the relative costs for all groups in thepopulation of a diet that is in accordance with the recommended guidelines.

Rationale/evidence: other interventions are important, particularly in relation to the effective adoption of healthy behaviour. If it costs too much to eat healthily out of a lower family income, there will be less change and potentially widening social inequalities with the higher income groups who can afford the cost.

• Existing structural measures should continue to be implemented, including keyhole labelling and price policies(including taxes and subsidies) as well as other types of incentive.

Rationale/evidence: such measures seem to be having the desired effect but more evidence is needed about the impact of taxes on unhealthy foods and the lowering or removal of taxes on healthier foods as well as about other incentives and measures affecting price. This is important from a social inequalities perspective and relates to being able to afford to live in a healthy way and to the healthy food basket (50).

• Aninventoryofnutritionprojectsand/orinitiatives(currentandpastfiveyears)shouldbedevelopedfocusingonsocialinequalities and specific groups in the population defined by socioeconomic status, place of residence, ethnicity, etc.

Rationale/evidence: it would be useful to get an overview of the nutrition initiatives that could be classified as aiming to reduce social inequalities in diet. This could be used to find out whether more selective initiatives are needed for action on social inequalities in diet and nutrition, and whether more effort needs to be put into capturing the learning from these initiatives in guidance and integrating it into mainstream practice and universal services for nutrition and diet. Such an overview should also enable peer learning and exchange between different stakeholders looking to do similar work. Examples of similar inventories or catalogues are A better life for children and adolescents through diet and exercise. Nordic catalogue of initiatives and best practice for improved health and quality of life via diet and physical activity (51).

• Anequity-focusedassessmentshouldbeundertakenoftheclinicalandpublichealthnutritionservicesofferedaspartof the health system (at all levels) to identify whether there are gaps in relation to specific groups in the population, including those with lower levels of education, migrants and ethnic minority groups.

Rationale/evidence: it was not clear from interviews with the key informants or from the available information whether there is a focus on social inequalities in the nutrition services at the downstream/individual intervention level. The obligation to provide equal health services to all, regardless of gender, economic circumstances, etc., is set out to some extent directly in the health laws as well as in the general duty of the equal carrying out of public service in the anti-discrimination legislation. According to the Patients’ Rights Act, patients can complain to the supervision authorities, who work independently of political management dealing with complaints from the public and carrying out systematic surveys of the health services.

• Anagreedsetofminimumcriteriashouldbedevelopedforevaluatingthesocialinequalitiesimpactofinterventionsimplemented in the existing Action Plan and a possible new nutrition action plan.

Rationale/evidence: there is already a good set of data in the system and the generation of infinite data collection or a call for a whole new set is not desirable.

• Asystemorprocessshouldbeputinplacetoensurethecollectionofrelevantdisaggregateddata(socioeconomicstatus, ethnicity, etc.). A minimum set can be collected and accessed and used for monitoring and evaluation.

Rationale/evidence: from interviews with the key informants it is clear that a better use of existing data could help.

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There seems to be a need for a greater mainstreaming of inequalities-sensitive practice and/or systematization of initiatives in view of the many specific and short-term projects.

The proposed regulations restricting the marketing of unhealthy foods aimed at children and young people could have an impact on social inequalities in diet by reducing the likelihood of some groups of children and young people being more exposed, because of their socioeconomic background, to such marketing and therefore more differentially vulnerable.

5. Future policy priorities

Several issues relating to monitoring should be considered. The current surveillance system does not allow for stratified distribution between different social groups. In addition to the need for disaggregated data on diet, further consideration should be given to monitoring and assessing the distribution of impact, change and outcome of the various measures (such as keyhole-labelled products, communication efforts and fruit and vegetable schemes in schools) for the social groups differentiated by socioeconomic status.

Regular consumer studies would provide a more detailed picture of consumers’ behaviour, including whether the keyhole labelling system reaches all levels of the population.

There is also a need for an analysis of the linkages and connections with other macro-level policies in relation to education, social protection and so on, and how they influence inequalities between different social groups.

Initiatives and projects aimed at reducing social inequalities in nutrition and diet should have a particular focus on monitoring and documenting the distribution of impacts and effects.

Monitoring that measures process indicators should be carried out at district as well as provincial, national, regional and global levels. Apart from ensuring that activities are being implemented in the agreed manner, it allows decision-makers to stay aware of all the problems and constraints that may slow down progress and provides them with the information they may need to refine their planning.

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Annex 1LIST OF EXPERTS ON THE EVALUATION PANEL

WHO Regional Office for EuropeCaroline Bollars, Technical Officer, Nutrition, Physical Activity and Obesity Programme, Division of Noncommunicable Diseases and Life-Course

João Breda, Programme Manager, Nutrition, Physical Activity and Obesity Programme, Division of Noncommunicable Diseases and Life-Course

Sarah Simpson, Project Manager, European Office for Investment for Health and Development

Rodrigo Rodriguez-Fernandez, Nutrition, Physical Activity and Obesity Programme, Division of Noncommunicable Diseases and Life-Course

International and national expertsElizabeth Dowler, University of Warwick, Coventry, United Kingdom

Charli Eriksson, Örebro University, Örebro, Sweden

Hanna Hånes, Norwegian Institute of Public Health, Oslo, Norway

Aileen Robertson, Metropolitan University College, Copenhagen, Denmark

Gun Roos, National Institute for Consumer Research, Oslo, Norway

Harry Rutter, London School of Hygiene and Tropical Medicine, London, United Kingdom

Grethe S Tell, Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway

Dag Thelle, Research Centre for Epidemiology, University of Oslo, Oslo, Norway

Suvi Virtanen, National Institute for Health and Welfare, Helsinki, Finland and University of Tampere, Tampere, Finland

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Annex 2LIST OF KEY INFORMANTS

Heidi Aagaard, Nurse and lecturer, nursing and care sector

Anne Kathrine Owren Aarum, Senior adviser, Directorate of Health

Tore Angelsen, Project leader, Information Office for Fruit and Vegetables

Helga Arianson, County Medical Officer, Hordaland County Governor’s office

Jon Olav Aspås, Director-General, Department of Public Health, Ministry of Health and Care Services

Pernille Baardseth, Technological nutritionist, Norwegian Institute of Food, Fisheries and Aquaculture Research, Nofima AS

Sissel Lyberg Beckman, Head, Department of Public Health, Ministry of Health and Care Services

Knut Berdal, Senior adviser, Ministry of Agriculture and Food

Elling Bere, Professor, University of Agder

Ingunn Bergstad, Head, Nutrition and Dietetics Section, Oslo University Hospital

Bodil Blaker, Senior adviser, Department of Public Health, Ministry of Health and Care Services

Rune Blomhoff, Professor, University of Oslo, Member of Nutrition Council

Geir Sverre Braut, Deputy Director-General, Norwegian Board of Health Supervision

Magritt Brustad, Professor, Centre for Sami Health Research, University of Tromsø

Kristi Wettre Brønner, Clinical nutritionist/dietitian, Network of Nutritionists in Food Industry

Annechen Bahr Bugge, Researcher, National Institute for Consumer Research

Vibeke Bugge, Nutritionist, Information Office for Eggs and Meat

Anne Bærug, Head, Norwegian Resource Centre for Breastfeeding

Lisbeth Dahl, Researcher, National Institute of Nutrition and Seafood Research

Jorunn Vormedal Dalen, Academic Director, Food and Environment, Confederation of Norwegian Enterprise, Food and Agriculture

Cathrine Dammen, Head, Specialist Health Care Department, Ministry of Health and Care Services

Astri Grydeland Ersvik, Nurse, Norwegian Nurses Association and Association for Public Health Nurses/Health Visitors

Øyvind Gievær, Senior adviser, Directorate of Health

Elin Glomnes, Leader, Norwegian Association for Nutritionists

Anne Hafstad, Head, Healthy Public Policies Department, Directorate of Health

Rut Harildstad, Senior adviser, Ministry of Fisheries and Coastal Affairs

Helge Hasselgård, Managing Director, Grocery Manufacturers of Norway

Brita Haugum, Leader, Dietitians’ Association

Paal Haavorsen, Academic Director, Rehabilitation Enterprises Union

Ida Berg Hauge, Director, Information Office for Dairy Products

Maren Hegna, Senior adviser, Ministry of Education and Research

Tore Henriksen, Professor, University of Tromsø

Aase-Berit Hoffart, Adviser, Secretariat of the Parents’ Association for Children in Preschool, also representing the Parents’ Association for Schoolchildren

Steinar Høie, Head, Food Policy, NHO Mat og Drikke [NHO Food and Drink]

Gunstein Instefjord, Academic Director, Food and Trade, Consumer Council

Øyvind Irtun, Professor, Norwegian Society of Clinical Nutrition and Metabolism

Inger-Lise Fevang Jensen, Association for Teachers of Food and Health in Schools

Anne Karen Jenum, Researcher and general practitioner, University of Oslo

Geir Mo Johansen, Senior adviser, Ministry of Finance

Lars Johansson, Senior adviser, Directorate of Health

Jorunn Killingstad, Leader, Healthy Life Central (Frisklivsentral)

Knut-Inge Klepp, Acting Deputy Director-General of Health, Directorate of Health

Kathrine Kleveland, Leader of the Board, Farming Women’s Association (NorgesBygdekvinnelag)

Gunn Harriet Knutsen, Adviser, Health and Quality, Norwegian Seafood Federation

Berit Koen, Public health adviser, Municipality of Volda

Bernadette Kumar, Director, Norwegian Centre for Minority Health Research

Geir Kvam, Secretary, Norwegian Transport Workers’ Union

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Karen Lassen, Lecturer, Vestfold University College

Jorunn Lervik, Public health adviser, County Governor’s Office of Sør-Trøndelag

Fedon Lindberg, Head, Dr Lindberg’s Clinic

Kaja Lund-Iversen, Nutritionist, Kostforum

Tove Løken, Senior adviser, Department of Specialist Health Care, Ministry of Health and Care Services

Haakon Meyer, Professor, Head of Nutrition Council, National Institute of Public Health and University of Oslo

Mette Helvik Morken, Associate Professor, University of Bergen

Kari Hege Mortensen, Public health adviser (clinical nutritionist), County authorities of Nordland

Mari Nes, Head of Department, Norwegian Research Council

Joachim Nilsen, Senior adviser, Department of Public Health, Ministry of Health and Care Services

Torunn Nordbø, Director, Information Office for Bread and Grains

Kaare R Norum, Professor Emeritus, Former Head of Nutrition Council, University of Oslo

Berit Nygaard, Special adviser, Norwegian Research Council

Trond Nygard, Senior adviser, Department of Specialist Health Care, Ministry of Health and Care Services

Arne Oshaug, Associate Professor, Oslo and Akershus University College

Manuela Osmundsen, Head of Department, Akershus University Hospital

Irene Teigen Paulsen, Nutritionist, Inter-municipal Environmental Health

Guttorm Rebnes, Director, Information Office for Fruit and Vegetables

Arnhild Haga Rimestad, Senior adviser, Ministry of Health and Care Services

Gro Samdal, Head, Learning and Coping Centre

Unni Silkoset, Senior adviser, Norwegian Agency for Development Cooperation

Vigdis Britt Skulberg, Clinical nutritionist, Health and Welfare Administration, Municipality of Oslo

Merethe Steen, Head, Consumer Interests Section, Norwegian Food Safety Authority

Eli Strande, Senior adviser, Department of Public Health, Ministry of Health and Care Services

Janne Strømme, Clinical nutritionist, private clinic

Birger Svihus, Professor, Norwegian University of Life Sciences

Britt Sørø, Leader, Institutional Catering, Norwegian Association for Nutrition and Dietetics

Lasse Tenden, Head of analyses, Confederation of Norwegian Enterprise, Food Service

Kjersti Toppe, Member of Parliament, First Vice-Chairperson, Standing Committee on Health and Care Services

Tone Torgersen, Senior adviser, Directorate of Health

Elisabeth Varland, Senior adviser, Ministry of Children, Equality and Social Inclusion

Jorunn Borge Westhrin, Nutritionist, Public health adviser, County authorities, Telemark County

37

Ann

ex 3

INTE

RNA

L G

OVE

RNM

ENT

MO

NIT

ORI

NG

MAT

RIX

1. C

omm

unic

atio

n ab

out f

ood

and

diet

Goal

s: S

treng

then

kno

wle

dge

abou

t foo

d an

d di

et a

nd s

kills

in p

repa

ratio

n of

hea

lthy

food

in a

ll po

pula

tion

grou

ps

Enco

urag

e en

joym

ent o

f foo

d an

d m

otiv

ate

heal

thy

chan

ges

in d

iet

Ad

apt p

ublic

info

rmat

ion

and

com

mun

icat

ion

to m

inor

ity la

ngua

ge a

nd a

t-ris

k gr

oups

1.1

Deve

lop

and

impl

emen

t a

com

preh

ensi

ve p

lan

for i

nfor

mat

ion

and

com

mun

icat

ion

activ

ities

in

the

nutri

tion

area

Heal

th &

Car

e Se

rvic

es;

Agric

ultu

re

&F

ood;

Fi

sher

ies

&

Coas

talA

ffairs

;Ch

ildre

n,

Equa

lity

& S

ocia

l In

clus

ion;

Ed

ucat

ion

&

Rese

arch

A co

mpr

ehen

sive

pla

n w

as d

evel

oped

, but

a la

ck o

f fun

ding

fo

r the

spe

cifie

d ac

tiviti

es m

eant

that

sub

-pla

ns a

nd a

co

mm

unic

atio

n pl

atfo

rm fo

r the

affe

cted

par

ties

wer

e de

velo

ped

and

impl

emen

ted

inst

ead.

Man

y m

easu

res

in th

e Ac

tion

Plan

al

so in

clud

e co

mm

unic

atio

n, a

nd th

ese

activ

ities

are

pre

sent

ed

as p

art o

f tho

se m

easu

res.

The

Dire

ctor

ate

of H

ealth

has

de

velo

ped

com

mun

icat

ion

stra

tegi

es a

nd p

lans

for d

ieta

ry

advi

ce (s

ee 1

.2) a

nd th

e ke

yhol

e la

belli

ng s

yste

m (s

ee 2

.9) a

nd

used

focu

s gr

oups

in th

e de

sign

of c

omm

unic

atio

ns a

ctiv

ities

.

In th

e su

mm

er o

f 201

1 th

e ex

pert

grou

p w

orke

d ed

itoria

lly w

ith

the

popu

lar

mag

azin

e Se

og

Hør

(1 m

illio

n re

ader

s a

wee

k),

prod

ucin

g 14

dou

ble-

side

d re

ports

with

tip

s fo

r he

alth

y ea

ting

and

reci

pes.

Nor

way

’s “c

ooke

ry m

um”,

Ingr

id E

spel

id H

ovig

, and

tw

o ot

her c

eleb

ritie

s (o

ne w

ith a

n im

mig

rant

bac

kgro

und)

gav

e th

eir s

uppo

rt.

In M

ay 2

011,

a w

orks

hop

was

hel

d on

die

t and

min

oriti

es w

ith

parti

cipa

nts

from

diff

eren

t im

mig

rant

com

mun

ities

. Thi

s yi

elde

d m

any

idea

s to

be

deve

lope

d in

dia

logu

e w

ith m

inor

ity g

roup

s,

for e

xam

ple,

coo

pera

tion

with

the

larg

est i

mm

igra

nt n

ewsp

aper

Parti

cipa

ting

min

istri

es h

ave

shar

ed

resp

onsi

bilit

y fo

r im

plem

entin

g th

e co

mm

unic

atio

n pl

atfo

rm.

The

Dire

ctor

ate

of H

ealth

gav

e th

e hi

ghes

t pr

iorit

y to

impl

emen

tatio

n of

the

keyh

ole

labe

lling

sch

eme

and

new

die

tary

adv

ice

(see

1.2

and

2.9

). M

any

proj

ects

hav

e be

en

publ

ishe

d on

the

web

.

The

Med

ia P

rofil

e An

alys

is (R

etrie

ver)

cove

ring

nutri

tion

show

s th

e fo

llow

ing

num

bers

of h

its:

2009

:10

911;

201

0:2

332

4;2

011

(up

to4

Jul

y):

22 4

17.

The

Min

istry

of A

gric

ultu

re &

Foo

d pu

blis

hes

food

and

die

t inf

orm

atio

n on

its

web

site

link

ed

to k

eyho

le la

belli

ng, d

ieta

ry a

dvic

e, e

tc.

The

Dire

ctor

ate

of H

ealth

con

tinuo

usly

upd

ates

nu

tritio

nal a

rticl

es o

n th

e He

lsed

irekt

orat

et,

Mat

porta

len

and

Hels

eNor

ge w

eb s

ites.

The

re

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

38

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

wer

e 56

arti

cles

on

the

Hels

edire

ktor

atet

web

si

tein

200

3–20

06;5

6in

200

7;4

9in

200

8;3

0in

200

9 an

d 30

in 2

010.

The

Hel

sedi

rekt

orat

et

web

site

was

rela

unch

ed in

Dec

embe

r 201

1 ta

rget

ed a

t hea

lth s

ervi

ces

and

med

iato

rs (s

ee

1.2

and

2.9)

.

The

med

ia h

ave

focu

sed

stro

ngly

on

low

ca

rboh

ydra

te/h

igh

fat d

iets

sin

ce th

e su

mm

er

of 2

011.

The

con

tinui

ng d

ebat

e on

the

mer

its

of s

uch

diet

s is

cha

lleng

ing

due

to th

e va

riety

of

opi

nion

on

low

car

bohy

drat

es/h

igh

fats

as

oppo

sed

to n

orm

al d

iets

.

In F

ebru

ary

2012

, the

Dire

ctor

ate

of H

ealth

in

vite

d se

lect

ed e

xecu

tives

, exp

erts

and

pr

ofes

sion

als

to d

iscu

ss a

nd h

elp

with

die

tary

ad

vice

in fu

ture

. A s

emin

ar o

n di

etar

y ad

vice

fo

r jou

rnal

ists

and

wor

ksho

ps w

ill b

e or

gani

zed

with

thes

e pe

ople

and

with

crit

ics

of d

ieta

ry

advi

ce.

abou

t a T

V pr

ogra

mm

e w

here

the

loca

l mer

chan

ts c

ook

in

cons

ulta

tion

with

a n

utrit

ioni

st, a

ll w

ith im

mig

rant

bac

kgro

unds

.

The

Min

istry

of A

gric

ultu

re &

Foo

d m

arke

d W

orld

Bre

ad D

ay, t

he

Wee

k of

Tast

e, G

ane

Fart

[Pal

ate

Ride

– a

pla

y on

the

wor

d fo

r sl

eigh

-ride

] (a

com

petit

ion

to fi

nd th

e be

st re

stau

rant

focu

sing

on

loca

l foo

d tra

ditio

ns),

the

Year

of t

he P

otat

o an

d ot

her m

edia

in

itiat

ives

. The

Dire

ctor

ate

of H

ealth

par

ticip

ated

in 2

008

in

the

six-

prog

ram

me

TV s

erie

s Ly

st &

last

[Ple

asur

e an

d bu

rden

], fo

cusi

ng o

n nu

tritio

n- a

nd d

iet-r

elat

ed to

pics

.

Sinc

e 20

10, t

he N

orw

egia

n Se

afoo

d Co

unci

l has

incr

easi

ngly

fo

cuse

d on

the

dom

estic

mar

ket.

For t

he fi

rst t

ime

it ha

s ru

n co

mm

erci

als

for s

alm

on o

n TV

.

A w

orki

ng g

roup

app

oint

ed b

y th

e N

atio

nal

Nut

ritio

n Co

unci

l w

ent t

hrou

gh a

ll th

e re

leva

nt a

vaila

ble

rese

arch

lite

ratu

re a

s th

e ba

sis f

or th

e re

port

Diet

ary a

dvic

e fo

r pro

mot

ing

publ

ic h

ealth

and

pr

even

ting

chro

nic

dise

ases

. The

repo

rt ha

s a

thor

ough

sci

entifi

c ba

sis.

It w

as d

evel

oped

thro

ugh

an o

pen

and

trans

pare

nt p

roce

ss

and

netw

ork c

onsu

ltatio

n an

d w

as la

unch

ed a

t a la

rge

mee

ting

in

Janu

ary

2011

.

The

Dire

ctor

ate

of H

ealth

pub

licize

d th

e sp

ecifi

c di

etar

y re

com

men

datio

ns fr

om th

e re

port

in b

roch

ures

, pos

ters

, on

line

artic

les

and

lect

ures

so

as to

dis

sem

inat

e ad

vice

and

in

form

atio

n to

cou

nty

auth

oriti

es, c

linic

s, d

octo

rs’ s

urge

ries

and

othe

r med

iato

rs. T

he la

unch

of t

he re

port

and

diet

ary

guid

elin

es

crea

ted

a br

oad

deba

te a

nd w

ide

med

ia c

over

age.

The

repo

rt al

so d

rew

bro

ad in

tern

atio

nal a

ttent

ion

and

reco

gniti

on.

Heal

th &

Car

e Se

rvic

es1.

2 Co

mm

unic

ate

offic

ial

diet

ary

guid

elin

es in

spe

cific

te

rms

39

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

The

food

indu

stry

’s in

form

atio

n of

fices

offe

r ge

neric

info

rmat

ion

and

wer

e bu

sy w

ith

com

mun

icat

ions

act

iviti

es d

urin

g th

e pe

riod

of

the

Plan

.

The

Min

istry

of A

gric

ultu

re &

Foo

d pa

rtici

pate

d in

the

deba

te, p

artic

ular

ly in

rela

tion

to a

dvic

e re

leva

nt to

agr

icul

tura

l and

food

pol

icy,

with

fe

atur

e ar

ticle

s am

ong

othe

r thi

ngs.

The

M

inis

try o

f Fin

ance

sup

porte

d th

e M

eetE

at

conf

eren

ce in

201

1. T

he g

oal o

f thi

s co

nfer

ence

w

as to

impr

ove

the

dial

ogue

bet

wee

n th

e hu

man

and

vet

erin

ary

med

icin

e an

d fo

od

tech

nolo

gica

l env

ironm

ents

on

diet

and

nu

tritio

n.

The

proj

ect w

as e

valu

ated

thor

ough

ly in

201

2.

Kind

erga

rten

staf

f hav

e be

en a

sked

to e

valu

ate

the

proj

ect a

long

the

way

and

an

eval

uatio

n su

rvey

is s

ent t

o al

l par

ticip

atin

g lo

wer

se

cond

ary

scho

ols.

In a

map

ping

of m

eals

, phy

sica

l act

ivity

and

en

viro

nmen

tal h

ealth

in k

inde

rgar

tens

in s

prin

g 20

11, 3

7% o

f the

adm

inis

trato

rs (n

=137

5) a

nd

29%

of t

he h

ead

teac

hers

(n=1

100)

resp

onde

d th

at a

t lea

st o

ne m

embe

r of s

taff

in th

eir

kind

erga

rten

had

parti

cipa

ted

in a

Fis

kesp

rell

cour

se.

Com

mun

icat

ion

of d

ieta

ry a

dvic

e ha

s be

en c

lose

ly li

nked

to th

e ke

yhol

e la

belli

ng s

chem

e, w

ith th

e m

ain

focu

s on

the

sche

me.

An

unp

ublis

hed

popu

latio

n su

rvey

in J

anua

ry 2

012

show

ed th

at

cons

umer

s kn

ow w

hat i

s go

od fo

r hea

lth in

line

with

die

tary

re

com

men

datio

ns, b

ut th

ey d

o no

t kno

w th

at th

ese

are

the

gove

rnm

ent’s

reco

mm

enda

tions

.

A N

orst

at s

urve

y in

201

1 sh

owed

that

thre

e ou

t of f

our p

eopl

e (7

4%) h

ave

“ver

y gr

eat c

onfid

ence

” in

the

Dire

ctor

ate

of H

ealth

’s di

etar

y ad

vice

.

The

Fisk

espr

ell p

roje

ct w

as s

tarte

d in

aut

umn

2008

, with

the

goal

of i

ncre

asin

g aw

aren

ess

of th

e nu

tritio

nal b

enefi

ts o

f fis

h an

d ot

her s

eafo

od a

nd g

ivin

g yo

ung

peop

le g

ood

tast

e ex

perie

nces

. Thr

ough

the

proj

ect,

staf

f in

kind

erga

rtens

and

sc

hool

s ar

e gi

ven

advi

ce o

n ho

w to

pre

pare

and

pre

sent

se

afoo

d, a

ll w

ith a

you

thfu

l tw

ist.

Fiske

spre

ll is

a co

llabo

rativ

e pr

ojec

t bet

wee

n th

e M

inist

ries o

f Fis

herie

s & C

oast

al A

ffairs

and

Hea

lth &

Car

e Se

rvice

s and

the

Seaf

ood

Coun

cil, w

hich

toge

ther

fund

it w

ith co

ntrib

utio

ns fr

om

the

fish

sale

s org

aniza

tions

. The

Dire

ctor

ate

of H

ealth

and

the

Natio

nal I

nstit

ute

of N

utrit

ion

and

Seaf

ood

Rese

arch

are

par

tner

s in

the

proj

ect.

Fish

erie

s &

Co

asta

lAffa

irs;

Heal

th &

Car

e Se

rvic

es

1.3

Carry

out

a c

ampa

ign

to

prom

ote

the

cons

umpt

ion

of

fish

and

othe

r sea

food

40

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

Amon

g th

e he

ad te

ache

rs w

ho re

porte

d pa

rtici

patio

n, 4

8% s

aid

that

kno

wle

dge

and

expe

rienc

es fr

om th

e co

urse

had

bee

n us

ed to

a

larg

e, o

r ver

y la

rge,

ext

ent.

The

surv

ey a

lso

show

ed th

at a

mon

g th

e ki

nder

garte

ns w

here

sta

ff ha

d pa

rtici

pate

d in

a c

ours

e, a

hig

her p

ropo

rtion

ser

ved

fish

or fi

sh p

rodu

cts

as p

art o

f the

war

m m

eal

once

a m

onth

or m

ore

ofte

n, c

ompa

red

with

ki

nder

garte

ns th

at h

ad n

ot p

artic

ipat

ed o

r w

here

par

ticip

atio

n w

as n

ot k

now

n.

The

proj

ect b

uild

s on

pos

itive

exp

erie

nce

with

an

earli

er, s

imila

r pr

ojec

t fun

ded

by th

e Se

afoo

d Co

unci

l. Un

der t

he A

ctio

n Pl

an,

the

coun

ties

wer

e in

vite

d to

par

ticip

ate

in th

e Fi

skes

prel

l pro

ject

fro

m a

utum

n 20

08, b

asin

g it

in th

e Pa

rtner

ship

for P

ublic

Hea

lth.

As th

e pr

ojec

t is

rela

ted

to p

ublic

hea

lth e

fforts

in e

ach

coun

ty,

its b

asis

and

long

-term

per

spec

tive

are

ensu

red.

All c

ount

ies

parti

cipa

ting

in th

e pr

ojec

t rec

eive

fina

ncia

l sup

port

to o

rgan

ize c

ours

es fo

r sta

ff in

prim

ary

scho

ols,

afte

r-sch

ools

an

d ki

nder

garte

ns, n

urse

s an

d pa

rent

s. T

he D

irect

orat

e of

Hea

lth

anno

unce

s th

e fu

ndin

g fo

r the

cou

ntie

s ea

ch y

ear.

Parti

cipa

tion

in F

iske

spre

ll co

urse

s:45

65 k

inde

rgar

ten

staf

f (19

91 k

inde

rgar

tens

) dur

ing

2010

/201

1,

and

912

stud

ent t

each

ers

+ 61

6 pr

e-sc

hool

teac

hers

dur

ing

2009

/201

0.

Fina

ncia

l sup

port

to b

uy fr

esh

prod

uce

and

mat

eria

l giv

en to

:29

40 s

choo

ls w

ith 2

23 4

69 lo

wer

sec

onda

ry s

choo

l pup

ils (s

ince

20

08);

1480

sch

ools

with

48

507

prim

ary

scho

ol p

upils

dur

ing

2009

/201

0.

Regi

ster

ed fo

r the

sch

ool y

ear 2

010/

2011

:12

31k

inde

rgar

ten

staf

f(55

7ki

nder

garte

ns);

543

stud

ent t

each

ers

+ 37

7 pr

e-sc

hool

teac

hers

+ 7

0 st

uden

ts in

pu

blic

hea

lth;

682

33lo

wer

sec

onda

rys

choo

lpup

ils(f

rom

900

sch

ools

);31

733

prim

ary

scho

ol p

upils

(fro

m 9

70 s

choo

ls).

41

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

The

prec

urso

r of t

his

book

was

pos

itive

ly

eval

uate

d an

d is

use

d by

pup

ils e

ven

afte

r the

y ha

ve le

ft sc

hool

.

In 2

008,

the

book

rece

ived

a p

rize

for t

he m

ost

beau

tiful

boo

k us

ed in

prim

ary

and

seco

ndar

y ed

ucat

ion.

The

Food

Saf

ety

Auth

ority

is a

nat

iona

l bod

y, w

hose

aim

is to

ens

ure

that

food

and

drin

king

-w

ater

are

as

safe

and

hea

lthy

as p

ossi

ble

for

cons

umer

s.

The

Cook

book

for a

ll w

as p

ublis

hed

in S

epte

mbe

r 200

7. It

is

give

n fre

e to

all

pupi

ls in

low

er s

econ

dary

sch

ools

and

to s

tude

nt

teac

hers

. Mun

icip

aliti

es c

an b

uy it

at p

rodu

ctio

n co

st fo

r tra

inin

g pu

rpos

es (l

angu

age,

Goo

d Fo

od c

ours

es, e

tc.).

The

boo

k is

upd

ated

w

ith th

e ke

yhol

e la

belli

ng a

nd n

ew d

ieta

ry a

dvic

e. It

can

als

o be

bo

ught

in b

ooks

hops

.

In th

e co

okbo

ok, d

ieta

ry a

dvic

e fro

m th

e Di

rect

orat

e of

Hea

lth is

tra

nsla

ted

into

reci

pes

and

prac

tical

coo

king

.

Cook

book

for a

ll: n

umbe

rs d

istri

bute

d or

sol

d 20

07–2

011

Distr

ibut

ed

2007

20

08

2009

20

10

2011

To

tal

or so

ldTo

pupil

s,

free

73 41

3 76

850

76 72

9 77

142

74 49

3 37

8 627

To m

unici

- pa

lities

, at

cost

of

produ

ction

5 4

70

4 060

6 5

20

5 360

5 8

00

27 21

0Th

rough

book

- sh

ops,

at

norm

al co

st 8 3

81

337

2 031

1 4

45

949

13 14

3

Mat

porta

len

is a

web

site

with

info

rmat

ion

abou

t foo

d an

d he

alth

fro

m p

ublic

aut

horit

ies.

The

follo

win

g fo

od a

dmin

istra

tion

agen

cies

prov

ide

mat

eria

l for

the

web

site

: Foo

d Sa

fety

Aut

horit

y, Di

rect

orat

e of

Hea

lth, N

atio

nal I

nstit

ute

of P

ublic

Hea

lth, S

cient

ific C

omm

ittee

fo

r Foo

d Sa

fety,

Nat

iona

l Vet

erin

ary I

nstit

ute,

Nor

weg

ian

Radi

atio

n Pr

otec

tion

Auth

ority

, Nat

iona

l Ins

titut

e of

Nut

ritio

n an

d Se

afoo

d Re

sear

ch a

nd g

over

nmen

t foo

d au

thor

ities

in o

ther

coun

tries

. The

M

atpo

rtale

n w

eb si

te w

as re

laun

ched

in sp

ring

2011

.

Heal

th &

Car

e Se

rvic

es

Heal

th &

Car

e Se

rvic

es;

Agric

ultu

re &

Fo

od;F

ishe

ries

& C

oast

al

Affa

irs

1.4

Publ

ish

a ba

sic

cook

ery

book

for e

very

day

use

1.5

Furth

er d

evel

op th

e M

atpo

rtale

n w

eb s

ite w

ith

resp

ect t

o nu

tritio

n an

d di

et

42

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

The

prize

cre

ates

a g

ood

oppo

rtuni

ty to

hi

ghlig

ht im

porta

nt n

utrit

ion

wor

k. It

was

no

t aw

arde

d in

200

9 du

e to

sca

rce

hum

an

reso

urce

s.

The

Nat

iona

l Nut

ritio

n Co

unci

l is

behi

nd th

e aw

ard,

whi

ch w

as fi

rst a

war

ded

in 1

984.

Othe

r im

porta

nt a

rena

s fo

r int

erac

tion

are

thro

ugh

proj

ects

, con

fere

nces

, mee

tings

, etc

.

Kost

For

um is

a c

onsu

ltativ

e bo

dy c

onsi

stin

g of

the

Nat

iona

l Ass

ocia

tion

of P

ublic

Hea

lth,

The

Nor

weg

ian

Canc

er S

ocie

ty, T

he N

orw

egia

n He

art a

nd L

ung

Patie

nt O

rgan

izatio

n, T

he

Nor

weg

ian

Diab

etes

Ass

ocia

tion

and

the

Nor

weg

ian

Asth

ma

and

Alle

rgy

Asso

ciat

ion.

Ko

stfo

rum

is w

orki

ng to

mak

e it

easi

er fo

r ad

ults

and

chi

ldre

n to

mak

e he

alth

y fo

od

choi

ces.

The

Dire

ctor

ate

of H

ealth

and

the

A to

tal o

f app

roxi

mat

ely

220

artic

les/

answ

ers

to fr

eque

ntly

as

ked

ques

tions

abo

ut n

utrit

ion

wer

e pu

blis

hed

durin

g th

e pe

riod

of th

e Pl

an, a

n av

erag

e of

44

artic

les

a ye

ar, a

s ag

ains

t ap

prox

imat

ely

10 a

yea

r for

200

4–20

06.

The

prize

is a

war

ded,

afte

r the

ann

ounc

emen

t of t

he c

hose

n su

bjec

t, by

the

Dire

ctor

ate

of H

ealth

in c

oope

ratio

n w

ith th

e N

atio

nal N

utrit

ion

Coun

cil.

It w

as a

war

ded

in 2

007,

200

8, 2

010

and

2011

and

attr

acte

d po

sitiv

e pr

ess

cove

rage

. Ann

ual i

ssue

s fo

r the

aw

ards

wer

e:

2007

: pro

mot

ing

heal

thy

diet

s an

d a

heal

thy

envi

ronm

ent f

or

child

ren

and

youn

g pe

ople

loca

lly, n

atio

nally

and

inte

rnat

iona

lly20

08: p

rom

otin

g he

alth

y di

ets

amon

g im

mig

rant

s20

10: b

ette

r foo

d fo

r the

sic

k an

d el

derly

2011

: loc

al n

utrit

ion

– a

heal

thy

diet

for c

hild

ren

and

youn

g pe

ople

.

The

purp

ose

is to

gat

her p

artic

ipan

ts to

exc

hang

e in

form

atio

n,

disc

uss

subj

ects

, cha

lleng

es a

nd e

ffect

ive

mea

sure

s, a

nd

poss

ibly

coo

rdin

ate

mea

sure

s. F

orum

s w

ere

held

in a

utum

n 20

08 o

n th

e th

eme

Low

Thr

esho

ld S

ervi

ces

on D

iet,

and

in 2

010

on th

e th

eme

Plan

of A

ctio

n fo

r Nut

ritio

n: th

e fin

al s

tage

, new

gu

idel

ines

, loc

al n

utrit

ion

prog

ram

mes

, etc

.

Heal

th &

Car

e Se

rvic

es

Heal

th &

Car

e Se

rvic

es;

Agric

ultu

re

&F

ood;

Fi

sher

ies

&

Coas

talA

ffairs

;Ch

ildre

n,

Equa

lity

& S

ocia

l In

clus

ion;

Ed

ucat

ion

&

Rese

arch

1.6

Awar

d of

the

Nut

ritio

n Pr

ize

1.7

Esta

blis

h a

foru

m fo

r di

alog

ue a

t nat

iona

l lev

el

betw

een

auth

oriti

es,

nong

over

nmen

tal

orga

niza

tions

and

rele

vant

pr

ivat

e ac

tors

43

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

agric

ultu

ral a

nd s

eafo

od in

form

atio

n of

fices

are

ob

serv

ers.

The

Min

istry

of A

gric

ultu

re &

Foo

d w

as p

rese

nt

as a

n ob

serv

er in

201

0, a

nd th

ere

was

goo

d fe

edba

ck o

n th

e co

nten

t and

form

.

Nofi

ma

is E

urop

e’s la

rges

t ins

titut

e fo

r app

lied

rese

arch

in th

e fie

lds

of fi

sher

ies,

aqu

acul

ture

an

d fo

od.

In 2

011,

the

Nat

iona

l Nut

ritio

n Co

unci

l su

bmitt

ed a

stra

tegy

pro

posa

l for

redu

cing

sa

lt in

take

in th

e po

pula

tion,

the

key

elem

ents

be

ing

nego

tiatio

ns w

ith th

e fo

od in

dust

ry

to re

duce

sal

t in

thei

r pro

duct

s, c

ombi

ned

with

info

rmat

ion

to c

onsu

mer

s. T

he M

inis

try

of H

ealth

& C

are

Serv

ices

has

ask

ed th

e Di

rect

orat

e of

Hea

lth to

pre

pare

an

actio

n pl

an

for r

educ

ing

salt

inta

ke in

the

popu

latio

n ba

sed

on th

e Co

unci

l’s s

trate

gy.

See

also

sec

tions

2.9

and

9.2

.

Initi

ativ

es to

ok p

lace

in v

ario

us s

ecto

rs.

In 2

009,

the

Min

istry

of F

ishe

ries

& C

oast

al A

ffairs

set

up

the

Mar

ine

Wea

lth C

reat

ion

Prog

ram

me:

Bus

ines

s Co

oper

atio

n fo

r Gr

eate

r Adj

ustm

ent o

f the

Val

ue C

hain

s to

the

Mar

ket.

In 2

006,

a n

orth

Nor

weg

ian

pilo

t pro

ject

con

duct

ed b

y th

e Fo

unda

tion

Nor

weg

ian

Food

Cul

ture

was

set

up

to p

rom

ote

and

impr

ove

the

use

of lo

cal f

ood

in re

stau

rant

s. It

was

inte

nded

to

spre

ad th

e ex

perie

nce

gain

ed fr

om th

e pr

ojec

t.

Reci

rcul

atio

n an

d Ut

iliza

tion

of O

rgan

ic B

y-pr

oduc

ts (R

UBIN

) fu

nds

proj

ects

to in

crea

se th

e ut

iliza

tion

of p

rodu

cts

from

fis

herie

s an

d aq

uacu

lture

as

ingr

edie

nts

in c

onsu

mer

pro

duct

s (fe

ed, f

ood,

hea

lth fo

od).

Agric

ultu

re &

Fo

od;F

ishe

ries

& C

oast

al

Affa

irs

2.1

Enco

urag

e th

e de

velo

pmen

t of h

ealth

y fo

od

prod

ucts

and

mea

ls

2. H

ealth

y fo

od in

a d

iver

se m

arke

tGo

als:

Mak

e it

easi

er fo

r con

sum

ers

to c

hoos

e fo

ods

with

goo

d nu

tritio

nal c

ompo

sitio

n in

ord

er to

put

toge

ther

a h

ealth

y di

et

Impr

ove

acce

ss to

and

pro

mot

ion

of h

ealth

y fo

od p

rodu

cts

Re

duce

the

prom

otio

n of

food

s th

at c

ontri

bute

to a

n un

heal

thy

diet

, esp

ecia

lly a

mon

g ch

ildre

n an

d yo

unge

r peo

ple

44

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

Parti

cipa

nts

in th

e fo

rum

als

o m

eet t

hrou

gh

coop

erat

ive

proj

ects

suc

h as

the

desi

gn a

nd

impl

emen

tatio

n of

the

keyh

ole

labe

lling

sy

stem

, mar

ketin

g, e

tc.

The

Min

istri

es o

f Fis

herie

s &

Coa

stal

Affa

irs a

nd A

gric

ultu

re &

Fo

od h

ave

been

giv

en s

uppo

rt fo

r a n

atio

nal c

entre

for f

ood

with

14

food

-rela

ted

busi

ness

es o

utsi

de S

tava

nger

.

The

Nor

weg

ian

food

indu

stry

is in

volv

ed in

the

Euro

pean

Te

chno

logy

Pla

tform

Foo

d fo

r Life

. The

Res

earc

h Co

unci

l’s F

ood

Prog

ram

me

is in

crea

sing

ly fo

cusi

ng o

n th

e de

velo

pmen

t of

heal

thy

and

safe

food

s.

The

Nor

weg

ian

Inst

itute

of F

ood,

Fis

hery

and

Aqu

acul

ture

(N

ofim

a) is

wor

king

on

new

rese

arch

on

heal

thy

ingr

edie

nts

and

mea

ls.

The

purp

ose

of th

e di

alog

ue fo

rum

was

to c

reat

e a

com

mon

pl

atfo

rm a

nd u

nder

stan

ding

for p

rom

otio

n of

a h

ealth

ier d

iet.

The

foru

m w

as e

stab

lishe

d as

a p

erm

anen

t ser

ies

of m

eetin

gs

durin

g th

e pe

riod

of th

e Pl

an a

nd c

ontin

ued

up to

201

2. T

here

ha

s be

en p

ositi

ve fe

edba

ck. A

ppro

xim

atel

y 40

–50

parti

cipa

nts

met

eac

h tim

e. T

he th

emes

hav

e be

en a

s fo

llow

s:

2007

:exp

ecta

tions

,for

ma

ndc

onte

nto

fthe

foru

m;

2008

: bre

ad, l

abel

ling,

com

mun

icat

ion

and

expe

rtise

in fo

od a

nd

nutri

tion;

2008

: sep

arat

e ad

ditio

nal m

eetin

gs o

n he

alth

ier f

oods

in th

e fa

st

food

mar

ketw

iths

elec

ted

parti

cipa

nts;

2009

: adv

ertis

ing

in s

choo

ls, s

alt,

palm

oil,

etc

.20

10: s

tatu

s an

d ch

alle

nges

with

rega

rd to

food

and

hea

lth in

ge

nera

land

info

llow

ing

upth

eAc

tion

Plan

die

tin

parti

cula

r;th

eke

yhol

ela

belli

ngs

yste

min

the

fast

food

and

cat

erin

gm

arke

t;20

11: n

ew p

olic

y do

cum

ents

, ref

orm

of c

oord

inat

ion,

de

velo

pmen

t in

the

diet

, pla

ns, s

umm

ary

dial

ogue

are

na.

Heal

th &

Car

e Se

rvic

es;

Agric

ultu

re

&F

ood;

Fi

sher

ies

&

Coas

talA

ffairs

;Ch

ildre

n,

Equa

lity

&

Soci

al In

clus

ion

2.2

Esta

blis

h a

dial

ogue

foru

m

for c

oope

ratio

n be

twee

n th

e fo

od in

dust

ry, a

utho

ritie

s,

rese

arch

ers

and

cons

umer

s

45

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

The

repo

rt to

par

liam

ent A

gric

ultu

re a

nd

food

pol

icy.

Wel

com

e to

the

tabl

e si

gnal

s an

in

crea

sed

focu

s on

frui

ts a

nd v

eget

able

s.

In 2

007,

the

Min

istry

of A

gric

ultu

re &

Foo

d al

loca

ted

fund

s to

lo

cal a

nd re

gion

al in

itiat

ives

thro

ugh

the

coun

ties.

Ever

y ye

ar th

e N

orw

egia

n Fa

rmer

s’ U

nion

and

the

Nor

weg

ian

Farm

ers

and

Smal

lhol

ders

Uni

on n

egot

iate

with

the

stat

e on

the

fram

ewor

k co

nditi

ons

for a

gric

ultu

re. I

n 20

08, t

he M

inis

tries

of

Hea

lth a

nd A

gric

ultu

re &

Foo

d ha

d a

mee

ting

in a

dvan

ce o

f th

ese

year

ly n

egot

iatio

ns.

The

Geitm

yra

food

cul

ture

cen

tre fo

r chi

ldre

n ha

s be

en s

et u

p in

Osl

o w

ith fu

nds

from

the

Min

istry

of A

gric

ultu

re &

Foo

d to

pr

omot

e kn

owle

dge

and

use

of fr

uit a

nd v

eget

able

s, a

mon

g ot

her t

hing

s. In

201

2, e

duca

tiona

l mat

eria

ls a

nd p

rogr

amm

es

wer

e de

velo

ped.

The

Min

istri

es o

f Fis

herie

s &

Coa

stal

Affa

irs

and

Educ

atio

n &

Res

earc

h al

so s

uppo

rt th

e ce

ntre

.

Frui

ts a

nd v

eget

able

s al

so h

ave

thei

r pla

ce in

the

Nor

dic

Coun

cil

of M

inis

ters

’ pro

gram

me

New

Nor

dic

Food

II (2

010–

2014

). Th

e vi

sion

is th

at th

e N

ordi

c cu

isin

e w

ill in

spire

enj

oym

ent,

inno

vatio

n, ta

ste

and

dive

rsity

, bot

h at

hom

e an

d ab

road

.

See

also

4.3

.

On 1

Jan

uary

201

0, a

regu

latio

n w

as in

trodu

ced

requ

iring

the

labe

lling

of fi

sh p

rodu

cts

with

con

sum

er in

form

atio

n (s

uch

as

for f

resh

fish

, the

cat

ch a

nd/o

r sla

ught

er d

ate)

. Wor

k ha

s be

en

star

ted

to d

eter

min

e th

e ap

prop

riate

met

hod

for a

sses

sing

the

qual

ity o

f fre

sh fi

sh, a

nd to

dec

ide

a st

anda

rd fo

r lab

ellin

g fis

h bo

xes

and

palle

ts s

o as

to im

prov

e lo

gist

ics

and

the

flow

of

info

rmat

ion.

Agric

ultu

re &

Fo

od

Fish

erie

s &

Co

asta

l Affa

irs

2.3

Prom

ote

the

cons

umpt

ion

of fr

uit a

nd v

eget

able

s by

st

imul

atin

g be

tter a

cces

s to

hi

gh-q

ualit

y pr

oduc

ts fr

om

prim

ary

prod

ucer

s

2.4

Stre

ngth

en c

olla

bora

tion

betw

een

the

auth

oriti

es,

fishe

ries

indu

stry

and

reta

ilers

to

incr

ease

the

avai

labi

lity

of

good

qua

lity

fish

and

seaf

ood

46

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

Any

intro

duct

ion

of a

key

hole

-labe

lled

prod

uct

in th

e ki

osk,

pet

rol s

tatio

n an

d se

rvic

e m

arke

t an

d ot

her f

ood

serv

ice

indu

stry

pre

mis

es o

r re

stau

rant

s is

com

plex

. Som

e of

thes

e pr

oduc

ts

(read

y pa

cked

) are

sui

tabl

e fo

r thi

s m

arke

t.

Sinc

e 20

08, t

he tr

ansp

ort c

ompa

ny D

HL h

as

been

col

labo

ratin

g w

ith n

utrit

ion

stud

ents

an

d Ev

eryd

ay C

ook

to p

ublis

h an

ove

rvie

w o

f nu

tritio

n-ra

ted

food

ser

vice

s an

d re

stau

rant

s al

ong

the

mai

n tru

nk ro

ads.

The

proj

ect N

ordi

c Yo

ung

Heal

th 2

009–

2010

fo

cuse

d on

you

ng c

onsu

mer

s an

d th

e fa

st fo

od

sect

or. T

he N

atio

nal I

nstit

ute

for C

onsu

mer

Re

sear

ch, N

ofim

a an

d ot

her N

ordi

c re

sear

ch

inst

itutio

ns c

oope

rate

d in

the

proj

ect.

Mai

n re

sults

: the

obs

tacl

es to

hea

lthy

choi

ces

are

said

to b

e st

ruct

ural

bar

riers

, the

eas

e of

ac

cess

ing

unhe

alth

y ra

ther

than

hea

lthy

food

, an

d ag

gres

sive

mar

ketin

g w

ith u

nhea

lthy

food

s de

liber

atel

y pl

aced

with

in e

asy

reac

h. M

any

of th

e re

spon

dent

s w

ere

open

to h

ealth

ier

alte

rnat

ives

.

To b

e co

nsid

ered

in re

latio

n to

mea

sure

s in

sec

tion

2.2.

The

Nat

iona

l Ins

titut

e fo

r Con

sum

er R

esea

rch

repo

rt Fo

od o

n th

e go

– o

ppor

tuni

ties

and

limita

tions

for n

ew a

nd h

ealth

ier e

atin

g co

ncep

ts in

the

fast

food

mar

ket,

2007

was

sup

porte

d fin

anci

ally

by

the

Dire

ctor

ate

of H

ealth

.

Ther

e ha

s be

en e

xten

sive

inte

ract

ion

with

indu

stry

and

the

auth

oriti

es in

Den

mar

k an

d Sw

eden

on

keyh

ole

labe

lling

in

gene

ral,

and

conc

erni

ng th

e ki

osk,

pet

rol s

tatio

n an

d se

rvic

e m

arke

t.

Wor

k is

in p

rogr

ess

on a

repo

rt by

the

Food

Saf

ety

Auth

ority

an

d th

e Di

rect

orat

e of

Hea

lth w

ith s

ugge

stio

ns fo

r fur

ther

wor

k on

the

keyh

ole

labe

lling

sys

tem

in th

e ki

osk,

pet

rol s

tatio

n an

d se

rvic

e m

arke

t.

The

Wee

k of

Tast

e ha

s be

en h

eld

annu

ally

sin

ce 2

005

to

incr

ease

aw

aren

ess

of th

e qu

ality

and

joy

of fo

od, w

ith a

focu

s on

bas

ic fl

avou

rs. T

he M

inis

tries

of A

gric

ultu

re &

Foo

d an

d Fi

sher

ies

& C

oast

al A

ffairs

coo

pera

te w

ith th

e in

form

atio

n of

fices

for a

gric

ultu

re a

nd s

eafo

od, N

ofim

a an

d th

e N

orw

egia

n N

atio

nal A

ssoc

iatio

n of

Che

fs. I

n 20

11, 2

6 ca

fete

rias

parti

cipa

ted.

The

exci

se d

uty

on n

on-a

lcoh

olic

bev

erag

es w

as a

ltere

d in

200

6/20

07. S

ince

1 J

anua

ry 2

007

the

tax

has

appl

ied

to

swee

tene

d dr

inks

. Bev

erag

es w

ithou

t add

ed s

ugar

or s

wee

tene

r (s

uch

as p

ure

wat

er o

r jui

ce) a

re e

xem

pt. I

n 20

08, t

he ta

x w

as

incr

ease

d by

app

roxi

mat

ely

60%

in re

al te

rms.

Sub

sequ

ently

the

tax

has

been

adj

uste

d fo

r gen

eral

infla

tion.

Heal

th &

Car

e Se

rvic

es;

Agric

ultu

re &

Fo

od

Fina

nce;

He

alth

& C

are

Serv

ices

2.5

Surv

ey a

nd fo

llow

up

read

y-m

ade

food

and

mea

ls

from

rest

aura

nts

and

the

conv

enie

nce

stor

e m

arke

t

2.6

Rest

ruct

urin

g of

the

tax

on

non-

alco

holic

bev

erag

es

47

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

2.7

Stud

y th

e po

ssib

ilitie

s of

us

ing

econ

omic

ince

ntiv

es to

pr

omot

e a

heal

thy

diet

2.8

Wor

k to

impr

ove

the

labe

lling

of f

ood

prod

ucts

, in

clud

ing

bette

r nut

rient

de

clar

atio

ns

2.9

Aim

to in

trodu

ce s

ymbo

l la

belli

ng to

mak

e it

easi

er to

pu

t tog

ethe

r a h

ealth

ier d

iet

Heal

th &

Car

e Se

rvic

es;

Fina

nce

Heal

th &

Car

e Se

rvic

es

Heal

th &

Car

e Se

rvic

es;

Child

ren,

Eq

ualit

y &

Soc

ial

The

cons

umer

pric

e in

dex

for s

oft d

rinks

incr

ease

d fro

m N

Kr 1

30

in 2

008

to N

Kr 1

66 in

Feb

ruar

y 20

12.

Sale

s of s

oft d

rinks

cont

aini

ng a

dded

suga

r in

2007

wer

e 60

litre

s pe

r cap

ita p

er y

ear.

In 2

011

they

wer

e 61

litre

s pe

r cap

ita p

er

year

. The

re h

as b

een

a sm

all d

ecre

ase

in s

oda

with

arti

ficia

l sw

eete

ners

(200

7: 4

4 lit

res

per c

apita

per

yea

r, 20

11: 3

9 lit

res

per c

apita

per

yea

r) an

d bo

ttled

wat

er (2

007:

24

litre

s pe

r cap

ita

per y

ear,

2011

: 17

litre

s pe

r cap

ita p

er y

ear).

The

Exci

se C

omm

ittee

sub

mitt

ed a

repo

rt in

200

7 m

ainl

y fo

cusi

ng o

n ho

w to

use

exc

ise

dutie

s to

tax

prod

ucts

con

tain

ing

suga

r/sw

eete

ners

. A n

ew ta

x w

ould

rais

e se

vera

l que

stio

ns

need

ing

furth

er c

onsi

dera

tion.

The

Min

istry

of H

ealth

& C

are

Serv

ices

con

tinue

d th

is w

ork,

in c

onsu

ltatio

n w

ith th

e M

inis

try

of F

inan

ce, i

n 20

12.

At th

e Eu

rope

an le

vel,

the

Nor

weg

ian

gove

rnm

ent w

orke

d to

in

fluen

ce E

U Re

gula

tion

No.

116

9/20

11 o

n th

e pr

ovis

ion

of

food

info

rmat

ion

to c

onsu

mer

s. T

he R

egul

atio

n in

trodu

ced

new

ru

les

on m

anda

tory

dec

lara

tion

of n

utrit

ion,

incl

udin

g en

ergy

, sa

tura

ted

fat,

suga

r and

sal

t. Th

e de

clar

atio

n ca

n ta

ke th

e fo

rm

of g

raph

ics

or s

ymbo

ls. O

n th

e gl

obal

leve

l, N

orw

ay h

as w

orke

d to

influ

ence

Cod

ex s

tand

ards

on

food

labe

lling

to in

clud

e ad

ded

suga

rs.

The

keyh

ole

labe

lling

sys

tem

was

intro

duce

d in

Jun

e 20

09 a

s a

join

t Nor

dic

syst

em fo

r hea

lth la

belli

ng o

f foo

d pr

oduc

ts. I

t is

a br

oad-

base

d pr

oces

s en

com

pass

ing

indu

stry

, con

sum

ers,

etc

.

To b

e fo

llow

ed u

p by

the

Dire

ctor

ate

of H

ealth

an

d in

tern

atio

nally

.

Initi

ativ

es ta

ken

by re

taile

rs a

nd

nong

over

nmen

tal o

rgan

izatio

ns to

the

Min

iste

r of

Hea

lth a

ccel

erat

ed th

e pr

oces

s th

at le

d to

th

e de

cisi

on. N

ordi

c co

oper

atio

n on

the

revi

sion

of

the

crite

ria s

tarte

d in

the

autu

mn

of 2

011.

48

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

Mor

e kn

owle

dge

is n

eede

d ab

out t

he b

rand

an

d a

broa

der s

elec

tion

of p

rodu

cts.

Nor

dic

coop

erat

ion

is c

ontin

uing

. See

als

o se

ctio

n 2.

5.

Thre

e co

nsum

er-o

rient

ed m

ass

med

ia c

ampa

igns

wer

e ru

n du

ring

the

perio

d 20

09–2

011.

A h

ome

page

was

cre

ated

and

m

ater

ials

dev

elop

ed fo

r con

sum

ers

(fold

ers

in 1

2 la

ngua

ges)

, th

e fo

od in

dust

ry a

nd th

e ed

ucat

ion

sect

or. A

nnua

l sur

veys

of

cons

umer

aw

aren

ess,

kno

wle

dge

and

attit

udes

to th

e br

and

sinc

e be

fore

it w

as la

unch

ed a

s w

ell a

s m

arke

t ana

lyse

s w

ere

unde

rtake

n in

200

9, 2

010,

201

1 an

d Ja

nuar

y 20

12.

In A

ugus

t 201

1, T

NS

Gallu

p fo

und

that

in ju

st tw

o ye

ars,

the

keyh

ole

has

beco

me

the

best

kno

wn

and

mos

t use

d br

and

in th

e gr

ocer

y tra

de. A

pop

ulat

ion

surv

ey o

n aw

aren

ess

and

know

ledg

e of

the

keyh

ole

sym

bol a

mon

g al

l con

sum

ers

aged

ove

r 18

year

s (in

Jan

uary

201

2) s

how

ed c

ontin

ued

posi

tive

prog

ress

: 98%

kn

ew o

r had

hea

rd o

f the

bra

nd, a

nd 8

5% k

new

that

the

labe

l re

pres

ente

d a

heal

thie

r cho

ice.

Man

y al

so k

new

that

the

mar

k re

pres

ente

d le

ss fa

t, su

gar a

nd s

alt a

nd m

ore

diet

ary

fibre

. The

la

belli

ng s

yste

m w

as tr

uste

d by

6 o

ut o

f 10

peop

le a

nd 5

0%

thou

ght t

he b

rand

mad

e it

easi

er to

mak

e he

alth

ier c

hoic

es.

As a

resu

lt of

a g

ood

dial

ogue

with

sup

plie

rs a

nd tr

ader

s on

th

e im

plem

enta

tion

of th

e sc

hem

e, in

dust

ry a

nd re

taile

rs h

ave

cont

ribut

ed s

igni

fican

tly to

mar

ketin

g. C

omm

unic

atio

n is

link

ed

to d

ieta

ry a

dvic

e.

A N

ordi

c in

spec

tion

cam

paig

n in

201

1 sh

owed

that

the

keyh

ole

labe

l is

used

pro

perly

.

Appr

oxim

atel

y 55

0 ke

yhol

e-la

belle

d pr

oduc

ts (o

ther

than

frui

t or

vege

tabl

es) w

ere

on s

ale

in 2

010,

and

abo

ut 1

500

in D

ecem

ber

2011

.

Incl

usio

n;

Agric

ultu

re &

Fo

od;F

ishe

ries

& C

oast

al

Affa

irs

49

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

2.10

Fol

low

up

and

cont

inue

to

dev

elop

rule

s fo

r the

use

of

nut

ritio

n an

d he

alth

cla

ims,

fo

rtific

atio

n of

food

s an

d fo

od

supp

lem

ents

2.11

Con

side

r int

rodu

ctio

n of

rest

rictio

ns o

n ad

verti

sing

of

unh

ealth

y fo

od a

imed

at

child

ren

and

youn

g pe

ople

Heal

th &

Car

e Se

rvic

es

Heal

th &

Car

e Se

rvic

es

The

EU C

omm

issi

on’s

wor

k on

dev

elop

ing

nutri

tion

profi

les

has

com

e to

a s

top.

In m

eetin

gs b

etw

een

(am

ong

othe

rs)

the

Nor

weg

ian

Min

iste

r of H

ealth

and

the

Euro

pean

Hea

lth

Com

mis

sion

er, t

he N

orw

egia

n Go

vern

men

t has

trie

d to

con

vinc

e th

e Co

mm

issi

on to

rest

art t

his

wor

k.

The

Nor

weg

ian

food

and

bev

erag

e in

dust

ry a

dopt

ed v

olun

tary

gu

idel

ines

for t

he m

arke

ting

of fo

ods

and

beve

rage

s to

chi

ldre

n in

200

7.

As a

follo

w-u

p of

the

Actio

n Pl

an, t

he N

atio

nal H

ealth

Car

e Pl

an

(201

1–20

15) a

nd W

HO’s

reco

mm

enda

tions

on

the

mar

ketin

g of

unh

ealth

y fo

ods

to c

hild

ren,

the

Min

istri

es o

f Hea

lth a

nd

Child

ren,

Equ

ality

& S

ocia

l Inc

lusi

on h

ave

esta

blis

hed

a w

orki

ng g

roup

to c

onsi

der t

he p

ossi

ble

intro

duct

ion

of n

ew

rest

rictio

ns o

n th

e m

arke

ting

of fo

od a

nd d

rink

to c

hild

ren

and

youn

g pe

ople

, inc

ludi

ng w

heth

er th

ere

is a

nee

d fo

r spe

cific

ne

w le

gal m

easu

res.

The

wor

k in

volv

es a

des

crip

tion

of th

e ex

tent

of m

arke

ting

of u

nhea

lthy

food

s to

you

ng p

eopl

e an

d th

e de

velo

pmen

t of a

mod

el fo

r nut

ritio

n pr

ofilin

g.

In 2

007,

Nor

way

was

the

initi

ator

and

driv

ing

forc

e fo

r WHO

to

pre

pare

reco

mm

enda

tions

on

the

mar

ketin

g of

food

and

be

vera

ges

to c

hild

ren.

The

se re

com

men

datio

ns w

ere

adop

ted

by a

reso

lutio

n pr

opos

ed b

y N

orw

ay, w

ith th

e su

ppor

t of m

any

coun

tries

, at t

he W

orld

Hea

lth A

ssem

bly

in M

ay 2

010.

In 2

008,

the

Euro

pean

net

wor

k on

redu

cing

the

mar

ketin

g of

un

heal

thy

food

s an

d be

vera

ges

tow

ards

chi

ldre

n w

as s

et u

p.

Thes

e co

untri

es a

re w

orki

ng to

geth

er to

pro

tect

chi

ldre

n’s h

ealth

by

redu

cing

the

mar

ketin

g of

nut

rient

-poo

r and

ene

rgy-

dens

e

The

regu

latio

ns a

re b

eing

impl

emen

ted

acco

rdin

g to

pla

n. W

ork

on th

e nu

tritio

n pr

ofile

s is

aw

aite

d in

the

EU.

Asse

ssm

ent w

ork

was

com

plet

ed in

201

2.

The

netw

ork

will

run

thro

ugh

2012

, with

the

poss

ibili

ty o

f an

exte

nsio

n.

The

netw

ork

has

cont

ribut

ed w

ith k

now

ledg

e an

d ex

perie

nce

to s

uppo

rt ef

forts

to d

evel

op

the

WHO

reco

mm

enda

tions

on

the

mar

ketin

g of

food

and

bev

erag

es to

chi

ldre

n, a

nd h

as

deve

lope

d a

code

as

an e

xam

ple

of h

ow s

uch

mar

ketin

g ca

n be

regu

late

d. T

he n

etw

ork

is a

lso

wor

king

to d

evel

op a

pro

toco

l for

m

onito

ring

the

mar

ketin

g of

food

to c

hild

ren.

50

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

See

2.5.

A si

mpl

e qu

estio

nnai

re d

istri

bute

d in

200

6 re

sulte

d in

few

but

pos

itive

ans

wer

s to

the

new

slet

ter.

The

broc

hure

s Fo

od fo

r inf

ants

and

How

to

brea

stfe

ed y

our b

aby

will

be

com

plet

ely

revi

sed

whe

n ne

w re

com

men

datio

ns o

n in

fant

nut

ritio

n ar

e pu

blis

hed.

food

s an

d be

vera

ges

to c

hild

ren.

Cur

rent

ly, 2

0 W

HO E

urop

ean

Mem

ber S

tate

s ar

e m

embe

rs. N

orw

ay (t

hrou

gh th

e Di

rect

orat

e of

Hea

lth) c

hairs

and

is th

e se

cret

aria

t for

the

netw

ork,

whi

ch is

a

colla

bora

tive

activ

ity w

ith th

e Re

gion

al O

ffice

. See

als

o 10

.1.

Not

initi

ated

.

The

Dire

ctor

ate

of H

ealth

dis

tribu

tes

annu

ally

60

000

copi

es

of th

e br

ochu

res

Food

for i

nfan

ts a

nd H

ow to

bre

astfe

ed y

our

baby

. The

se b

roch

ures

are

revi

sed

whe

n ne

eded

, mos

t rec

ently

in

201

1. A

new

slet

ter w

as re

gula

rly d

istri

bute

d to

chi

ld h

ealth

ce

ntre

s in

the

perio

d 20

07–2

010.

A ne

w w

eb s

ite fo

r pre

gnan

t wom

en (e

ncou

ragi

ng a

hea

lthy

lifes

tyle

) was

laun

ched

in 2

010.

Heal

th &

Car

e Se

rvic

es;

Child

ren,

Eq

ualit

y &

So

cial

Incl

usio

n

Heal

th &

Car

e Se

rvic

es

2.12

Dra

w u

p a

sum

mar

y of

kn

owle

dge

abou

t pro

duct

di

spla

y an

d ch

oice

of f

oods

at

vario

us ty

pes

of s

ales

out

let

3.1

Offe

r upd

ated

info

rmat

ion

mat

eria

l on

brea

stfe

edin

g,

infa

nt a

nd y

oung

chi

ld

nutri

tion

3. N

utri

tion

in th

e ea

rly

stag

es o

f life

Goal

s: m

prov

e di

etar

y gu

idan

ce fo

r wom

en o

f chi

ldbe

arin

g ag

e an

d pr

egna

nt w

omen

Fa

cilit

ate

excl

usiv

e br

east

feed

ing

for a

hig

her p

erce

ntag

e of

infa

nts

for t

he fi

rst s

ix m

onth

s of

life

and

con

tinue

d br

east

feed

ing

until

at l

east

12

mon

ths

Fa

cilit

ate

a go

od d

iet f

or in

fant

s an

d yo

ung

child

ren

St

reng

then

gui

danc

e on

bre

astfe

edin

g, d

iet,

food

and

mea

ls fo

r par

ents

of i

nfan

ts a

nd y

oung

chi

ldre

n

Cont

ribut

e to

ens

urin

g th

at m

arke

ting

of b

reas

t-milk

sub

stitu

tes

is s

trict

ly in

line

with

inte

rnat

iona

l rec

omm

enda

tions

Em

phas

ize e

fforts

tow

ards

wom

en a

nd c

hild

ren

with

a n

on-w

este

rn b

ackg

roun

d

51

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

3.2

Cont

inue

and

furth

er

deve

lop

the

Baby

-Frie

ndly

In

itiat

ive

in N

orw

ay

3.3

Faci

litat

e th

e in

corp

orat

ion

of th

e en

tire

WHO

Cod

e of

Mar

ketin

g of

Br

east

-milk

Sub

stitu

tes

into

N

orw

egia

n le

gisl

atio

n an

d en

sure

com

plia

nce

with

the

Code

3.4

Mai

ntai

n es

tabl

ishe

d m

ater

nity

leav

e sc

hem

es

for w

omen

, and

con

side

r th

e po

ssib

ility

of p

aid

brea

stfe

edin

g br

eaks

so

that

al

l wom

en w

ho w

ish

to m

ay

brea

stfe

ed in

acc

orda

nce

with

the

heal

th a

utho

ritie

s’

Heal

th &

Car

e Se

rvic

es

Heal

th &

Car

e Se

rvic

es

Labo

ur;

Child

ren,

Eq

ualit

y &

Soc

ial

Incl

usio

na

Artic

les

abou

t inf

ant a

nd y

oung

chi

ld n

utrit

ion

are

cont

inuo

usly

de

velo

ped

and

upda

ted

on th

e Di

rect

orat

e of

Hea

lth,

Mat

porta

len

and

Hels

eNor

ge w

eb s

ites.

Cour

ses

wer

e ar

rang

ed fo

r nur

ses

wor

king

in c

hild

hea

lth

cent

res

and

mid

wiv

es in

all

coun

ties

from

aut

umn

2007

to

sprin

g 20

09 b

y th

e Re

sour

ce C

entre

for B

reas

tfeed

ing

and

the

Dire

ctor

ate

of H

ealth

, in

colla

bora

tion

with

the

Nor

weg

ian

Nur

ses

Orga

niza

tion.

The

mai

n su

bjec

t was

an

actio

n pl

an fo

r a

bette

r die

t, w

ith e

mph

asis

on

guid

elin

es fo

r ski

lled

nurs

ing

clin

ics.

Nat

iona

l gui

delin

es fo

r per

inat

al c

are

are

bein

g de

velo

ped

by

the

Dire

ctor

ate

of H

ealth

.

The

gove

rnm

ent i

s co

nsid

erin

g of

ferin

g pa

id b

reas

tfeed

ing

brea

ks fo

r bre

astfe

edin

g w

omen

. It i

s no

t cle

ar w

hen

this

will

be

deci

ded.

The

Min

istri

es o

f Lab

our,

Heal

th &

Car

e Se

rvic

es a

nd C

hild

ren,

Eq

ualit

y &

Soc

ial I

nclu

sion

hav

e es

tabl

ishe

d an

inte

rnal

wor

k gr

oup

cons

ider

ing

brea

stfe

edin

g br

eaks

and

dis

tribu

tion

of

pare

ntin

g le

ave

betw

een

the

pare

nts.

Follo

w-u

p an

d ev

alua

tion

is d

one

thro

ugh

a co

ntin

uing

rand

omize

d co

ntro

lled

stud

y.

By th

e en

d of

201

1, 1

09 o

ut o

f 430

m

unic

ipal

ities

had

intro

duce

d th

e pr

ojec

t Am

mek

yndi

ge H

else

stas

jone

r (ce

rtific

atio

n of

br

east

feed

ing

prac

tices

at c

hild

hea

lth c

entre

s)

and

15 m

unic

ipal

ities

or u

rban

dis

trict

s ha

d be

en a

ppro

ved.

It is

som

ewha

t unc

lear

.

52

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

In 2

007,

the

Food

Saf

ety

Auth

ority

and

the

Dire

ctor

ate

of H

ealth

pub

lishe

d th

e re

port

Deve

lopm

ent i

n th

e ba

by fo

od m

arke

t – s

tatu

s fo

r 200

7.

In 2

007

and

2008

, the

Foo

d Sa

fety

Aut

horit

y pu

blis

hed

Parts

I an

d II

of th

e re

port

Anal

yses

of

nut

rient

s in

bab

y fo

od p

rodu

cts

2006

/200

8.

In 2

011,

the

Dire

ctor

ate

of H

ealth

est

ablis

hed

a w

orki

ng g

roup

to

revi

se th

e re

com

men

datio

ns o

n in

fant

nut

ritio

n. T

his

is a

co

mpr

ehen

sive

task

. It i

s pl

anne

d to

com

plet

e ne

w g

uide

lines

fo

r inf

ant n

utrit

ion

in 2

013.

As s

oon

as th

ese

guid

elin

es a

re fi

nish

ed, g

uide

lines

for t

he

nutri

tion

of p

rem

atur

e ba

bies

will

be

star

ted.

A ne

w b

roch

ure

abou

t nut

ritio

n an

d ph

ysic

al a

ctiv

ity in

pr

egna

ncy

was

pub

lishe

d in

200

9. T

he D

irect

orat

e of

Hea

lth, t

he

Food

Saf

ety

Auth

ority

and

the

Inst

itute

of P

ublic

Hea

lth h

ave

revi

sed

and

upda

ted

info

rmat

ion

for p

regn

ant w

omen

on

the

Mat

porta

len

web

site

, in

addi

tion

to th

eir o

wn

web

site

s.

The

Dire

ctor

ate

of H

ealth

has

had

regu

lar m

eetin

gs w

ith th

e Fo

od S

afet

y Au

thor

ity, d

istri

bute

d th

e ne

wsl

ette

r Fac

ts o

n fo

od

for i

nfan

ts a

nd m

onito

red

the

baby

food

on

the

mar

ket.

Seve

ral r

egis

tratio

n sy

stem

s ha

ve b

een

cons

ider

ed a

nd a

cho

ice

has

been

sug

gest

ed b

ut n

o sy

stem

has

yet

est

ablis

hed.

Heal

th &

Car

e Se

rvic

es

Heal

th &

Car

e Se

rvic

es

Heal

th &

Car

e Se

rvic

es;

Agric

ultu

re &

Fo

od

Heal

th &

Car

e Se

rvic

es

reco

mm

enda

tions

dur

ing

wor

king

hou

rs

3.5

Revi

se a

nd d

evel

op

natio

nal r

ecom

men

datio

ns

and

guid

elin

es o

n in

fant

and

yo

ung

child

nut

ritio

n an

d nu

tritio

n fo

r pre

mat

ure

babi

es

3.6

Stre

ngth

en g

uida

nce

on

nutri

tion

for p

regn

ant w

omen

by

impl

emen

ting

prof

essi

onal

gu

idel

ines

for m

ater

nity

car

e an

d pu

blis

hing

info

rmat

ion

mat

eria

ls

3.7

Cont

inue

the

mea

sure

s re

latin

g to

the

impl

emen

tatio

n of

the

EC d

irect

ives

on

infa

nt

food

in N

orw

ay

3.8

Wor

k to

est

ablis

h a

syst

em fo

r nat

iona

l br

east

feed

ing

stat

istic

s

53

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

3.9

Cons

ider

intro

duci

ng a

na

tionw

ide

prog

ram

me

of

free

vita

min

D s

uppl

emen

ts

for i

nfan

ts w

ith n

on-w

este

rn

back

grou

nds

4.1

Revi

se g

uide

lines

for f

ood

in k

inde

rgar

tens

.

Heal

th &

Car

e Se

rvic

es

Heal

th &

Car

e Se

rvic

es;

Educ

atio

n &

Re

sear

ch

A na

tionw

ide

offe

r has

bee

n m

ade

sinc

e 20

09 a

fter t

estin

g in

ei

ght w

ell-b

aby

clin

ics.

Thi

s is

bas

ed o

n a

PhD

thes

is s

how

ing

that

free

vita

min

D d

rops

impr

ove

the

vita

min

D s

tatu

s fo

r in

fant

s of

non

-wes

tern

imm

igra

nts.

The

Guid

elin

es fo

r foo

d in

kin

derg

arte

ns w

ere

revi

sed

in 2

007

and

sent

to a

ll ki

nder

garte

ns a

nd m

unic

ipal

ities

. Im

plem

enta

tion

of th

e gu

idel

ines

with

sup

porti

ng in

form

atio

n w

as s

uppo

rted

by

train

ing

and

mee

tings

at c

ount

y le

vel.

The

guid

elin

es h

ave

been

de

scrib

ed in

cen

tral d

ocum

ents

suc

h as

the

Nat

iona

l cur

ricul

um

regu

latio

ns o

n th

e co

nten

t and

dut

ies

of k

inde

rgar

tens

(C

hapt

er 3

.2, B

ody,

mov

emen

t and

hea

lth).

In a

dditi

on, t

he

guid

elin

es a

re a

n in

tegr

al p

art o

f ong

oing

wor

k an

d in

form

atio

n ef

forts

and

are

par

t of t

he F

iske

spre

ll se

afoo

d pr

ojec

t (se

e 1.

3).

It ha

s be

en s

ugge

sted

that

the

Inst

itute

of

Publ

ic H

ealth

sho

uld

take

ove

r res

pons

ibili

ty

for t

his

proj

ect,

but n

o de

cisi

on h

as b

een

take

n.

Info

rmat

ion

is a

vaila

ble

in E

nglis

h, N

orw

egia

n,

Som

ali,

Turk

ish

and

Urdu

.

A m

appi

ng o

f mea

ls, p

hysi

cal a

ctiv

ity a

nd

envi

ronm

enta

l hea

lth in

kin

derg

arte

ns in

spr

ing

2011

sho

wed

that

90%

of a

dmin

istra

tors

and

70

% o

f hea

d te

ache

rs w

ere

awar

e of

the

guid

elin

es. T

his

is fa

r mor

e th

an in

200

5 w

hen

36%

and

21%

, res

pect

ivel

y, w

ere

awar

e of

th

em. T

hose

dire

ctor

s w

ho w

ere

awar

e of

them

w

ere

aske

d ho

w th

ey h

ad m

ade

use

of th

e gu

idel

ines

: 71%

sai

d th

e gu

idel

ines

had

bee

n us

ed d

urin

g in

tern

al m

eetin

gs w

ith s

taff,

61%

sa

id th

ey w

ere

used

for m

easu

res

to in

crea

se

staf

f com

pete

nce

and

57%

sai

d th

ey w

ere

used

for p

lann

ing

educ

atio

nal a

ctiv

ities

. Am

ong

kind

erga

rtens

whe

re th

e he

ad te

ache

r was

aw

are

of th

e gu

idel

ines

, mor

e he

alth

y fo

ods

wer

e of

fere

d co

mpa

red

with

kin

derg

arte

ns

with

out s

uch

awar

enes

s.

4. H

ealth

y m

eals

in k

inde

rgar

tens

and

sch

ools

Goal

s: T

o he

lp k

inde

rgar

tens

, sch

ools

and

bef

ore-

and

afte

r-sch

ool p

rogr

amm

es to

pro

mot

e he

alth

y ea

ting

habi

ts a

mon

g ch

ildre

n an

d ad

oles

cent

s th

roug

h m

eals

in li

ne w

ith th

e he

alth

aut

horit

ies’

reco

mm

enda

tions

He

lp to

ens

ure

that

chi

ldre

n an

d ad

oles

cent

s ac

quire

hea

lthy

eatin

g ha

bits

Em

phas

ize e

fforts

tow

ards

wom

en a

nd c

hild

ren

with

a n

on-w

este

rn b

ackg

roun

d

54

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

The

map

ping

of m

eals

, phy

sica

l act

ivity

and

en

viro

nmen

tal h

ealth

in k

inde

rgar

tens

in s

prin

g 20

11 s

how

ed th

at 6

0% o

f the

adm

inis

trato

rs

and

46%

of t

he h

ead

teac

hers

had

rece

ived

the

book

let.

Amon

g th

e he

ad te

ache

rs w

ho h

ad

rece

ived

it, 8

0% fe

lt th

at it

had

bee

n us

eful

or

ver

y us

eful

. In

the

kind

erga

rtens

whe

re

the

head

teac

hers

had

rece

ived

the

book

let,

som

e m

ore

heal

thy

food

pro

duct

s w

ere

serv

ed

com

pare

d w

ith k

inde

rgar

tens

whe

re th

e he

ad

teac

hers

had

not

rece

ived

the

book

let.

Prim

ary

scho

ol (s

teps

1–7

) par

ticip

atio

n in

the

scho

ol fr

uit s

chem

e, 2

007–

2011

Ye

ar

Pupi

ls w

ith a

fruit/

Sc

hool

s with

vege

tabl

e sch

eme a

t a s

chem

e (re

duce

d or

redu

ced c

ost, s

teps

no

rmal

rate

) in s

teps

1–

7a %

1–7 %

20

07

25.6

57.2

20

08

27.4

55.2

20

09

19.6

59.3

20

10

18.3

56.8

20

11

18.4

57.1

a Per

cent

age

of to

tal n

umbe

r of p

rimar

y sc

hool

chi

ldre

n ea

ch

year

who

hav

e ac

cess

to fr

uit/

vege

tabl

es, e

ither

thro

ugh

subs

crip

tion

or w

ith fu

ll or

par

tial l

ocal

spo

nsor

ship

. The

pr

opor

tion

subs

crib

ing

has

alw

ays

been

larg

er th

an th

e pr

opor

tion

with

full

or p

artia

l loc

al s

pons

orsh

ip. T

he p

ropo

rtion

of

loca

l or m

unic

ipal

spo

nsor

ship

has

falle

n ea

ch y

ear,

affe

ctin

g pa

rtici

patio

n.

Mat

eria

l was

dev

elop

ed a

nd s

ent t

o al

l kin

derg

arte

ns

natio

nwid

e in

200

8. T

he p

acka

ge o

f mat

eria

l ent

itled

Goo

d fo

od in

the

kind

erga

rten

incl

udes

a 6

1-pa

ge in

stru

ctio

n bo

okle

t w

ith a

dvic

e on

die

t, fo

od a

nd m

eals

, cel

ebra

tions

, alle

rgie

s an

d hy

gien

e as

wel

l as

reci

pes,

and

two

post

ers

and

two

post

card

s.

Ther

e is

gre

at d

eman

d fo

r the

mat

eria

l.

The

book

let h

as b

een

prin

ted

in th

e fo

llow

ing

quan

titie

s: 1

8 00

0 in

200

8, 1

0 00

0 in

200

9 an

d 12

000

in 2

011,

tota

lling

40

000.

Sinc

e au

tum

n 20

07, P

arlia

men

t has

giv

en g

rant

s to

m

unic

ipal

ities

to e

nabl

e th

em to

pro

vide

pup

ils in

sec

onda

ry

scho

ols

(ste

ps 8

–10)

and

com

bine

d sc

hool

s (s

teps

1–1

0) w

ith

free

fruit

and

vege

tabl

es. T

his

has

been

est

ablis

hed

in la

w s

ince

20

08.

Pupi

ls in

prim

ary

scho

ols

(ste

ps 1

–7) c

an s

ubsc

ribe

to th

e sc

hool

fru

it sc

hem

e, w

here

by th

e go

vern

men

t sub

sidi

zes

each

frui

t or

vege

tabl

e by

NKr

1 s

o th

at th

e su

bscr

iptio

n co

sts

NKr

2.5

0 pe

r sc

hool

day

. Reg

istra

tion,

info

rmat

ion

and

activ

ities

can

be

foun

d on

the

Skol

efru

gt.n

o w

eb s

ite, w

hich

has

info

rmat

ion

abou

t the

sc

hem

e in

five

lang

uage

s ot

her t

han

Nor

weg

ian.

User

sur

veys

of t

he tw

o sc

hem

es a

re c

arrie

d ou

t eve

ry s

emes

ter.

A ne

w w

eb s

ite h

as b

een

deve

lope

d to

geth

er w

ith s

impl

ified

re

gist

ratio

n, in

form

atio

n in

sev

eral

lang

uage

s, m

otiv

atio

nal

item

s su

ch a

s t-s

hirts

, boo

k bi

ndin

gs a

nd c

ompe

titio

ns, a

nd

fund

ing

for m

odel

dev

elop

men

t and

film

s to

bro

aden

the

subs

crip

tion

base

and

focu

s on

frui

ts a

nd v

eget

able

s. T

he w

ork

Heal

th &

Car

e Se

rvic

es;

Educ

atio

n &

Re

sear

ch

Educ

atio

n &

Re

sear

ch;

Heal

th &

Car

e Se

rvic

es

4.2

Prep

are

and

offe

r ed

ucat

iona

l too

ls a

nd

info

rmat

ion

mat

eria

ls re

latin

g to

the

revi

sed

guid

elin

es

for f

ood

and

mea

ls in

ki

nder

garte

ns

4.3

Intro

duce

a p

rogr

amm

e fo

r fru

it an

d ve

geta

bles

for

all p

upils

in p

rimar

y an

d se

cond

ary

scho

ols

55

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

Appr

oxim

atel

y 28

0 00

0 pu

pils

atte

nd s

choo

ls

cove

red

by th

e fre

e sc

hem

e.

The

TIN

E da

iry c

oope

rativ

e an

d th

e Da

iry

Prod

ucts

Info

rmat

ion

Offic

e pl

an to

incr

ease

ef

forts

in u

pper

sec

onda

ry s

choo

ls w

ith a

se

para

te p

rodu

ct p

ortfo

lio.

Enro

lmen

t in

the

scho

ol m

ilk s

chem

e co

vers

99

% o

f all

prim

ary

scho

ols

(ste

ps 1

–7) a

nd

com

bine

d pr

imar

y- a

nd lo

wer

sec

onda

ry

scho

ols

(ste

ps 1

–10)

. In

tota

l, 50

.7%

of t

he

pupi

ls in

thes

e sc

hool

s pa

rtici

pate

d in

201

1,

a sl

ight

dec

reas

e on

the

prev

ious

yea

rs w

hen

parti

cipa

tion

was

51.

1% a

nd 5

1.7%

in 2

010

and

2009

, res

pect

ivel

y. Se

mi-s

kim

med

milk

is c

onne

cted

to th

e Di

rect

orat

e of

Hea

lth’s

guid

elin

es fo

r sch

ool

mea

ls in

prim

ary

and

seco

ndar

y sc

hool

s.

Littl

e op

portu

nity

to c

hoos

e th

e fru

it or

veg

etab

le is

one

of t

he

reas

ons

give

n fo

r low

par

ticip

atio

n. It

is d

ifficu

lt to

get

sch

ools

to

put w

ork

into

a p

aid

pare

ntal

sch

eme

in w

hich

onl

y so

me

of th

e pu

pils

par

ticip

ate,

for e

xam

ple,

by

givi

ng th

em a

cho

ice

betw

een

at le

ast t

wo

fruits

or v

eget

able

s. T

he re

spon

se is

gre

ates

t in

the

first

cla

ss a

nd fa

lls o

ff as

the

pupi

ls m

ove

up th

e sc

hool

. Pric

e on

ly s

eem

s to

be

sign

ifica

nt fo

r par

ents

on

the

low

est h

ouse

hold

in

com

es (r

efer

ence

: asp

ect o

f soc

ial i

nequ

ality

in h

ealth

). So

me

scho

ol s

taff

and

pare

nts

also

gav

e th

e un

fairn

ess

of th

e sc

hem

e no

t bei

ng fr

ee in

sch

ools

with

ste

ps 1

–7 a

s a

reas

on n

ot to

pa

rtici

pate

.

It w

ill b

e im

porta

nt to

est

ablis

h a

fruit

and

vege

tabl

e pr

ogra

mm

e th

at re

ache

s al

l pup

ils.

Mee

tings

with

repr

esen

tativ

es o

f the

inde

pend

ent a

gric

ultu

ral

sect

or In

form

atio

n Of

fice

for m

ilk a

nd th

e TI

NE

dairy

coo

pera

tive

are

orga

nize

d an

nual

ly to

dis

cuss

topi

cal i

ssue

s. M

eetin

gs a

re

also

hel

d w

ith th

e re

leva

nt m

inis

tries

(of H

ealth

& C

are

Serv

ices

, Ed

ucat

ion

& R

esea

rch

and

Agric

ultu

re &

Foo

d). T

he g

uide

lines

fo

r mea

ls in

prim

ary

and

seco

ndar

y sc

hool

s, d

evel

oped

by

the

Dire

ctor

ate

of H

ealth

, for

m th

e ba

sis

of w

ork

and

info

rmat

ion

abou

t the

sch

ool m

ilk s

chem

e.

A ne

w v

arie

ty o

f milk

with

add

ed fl

avou

r and

a n

ew o

nlin

e re

gist

ratio

n fo

rm w

ere

laun

ched

in 2

010.

Wor

k is

con

tinui

ng, a

nd

plan

ning

has

beg

un fo

r a g

reat

er fo

cus

on m

ilk in

kin

derg

arte

ns.

Heal

th &

Car

e Se

rvic

es;

Agric

ultu

re &

Fo

od;E

duca

tion

& R

esea

rch

4.4

Prom

ote

incr

ease

d pa

rtici

patio

n in

the

scho

ol

milk

pro

gram

me

in p

rimar

y an

d se

cond

ary

scho

ol

56

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

(1.5

% fa

t) is

the

mos

t pop

ular

of t

he m

ilk

varia

nts,

cho

sen

by 6

1% o

f the

pup

ils.

Parti

cipa

tion

is g

reat

est a

mon

g th

e yo

unge

st

child

ren.

In lo

wer

sec

onda

ry s

choo

ls (s

teps

8–

10),

only

8%

of t

he p

upils

enr

olle

d in

the

sche

me

in 2

011.

A re

sear

ch g

roup

at t

he U

nive

rsity

of B

erge

n (H

EMIL

-sen

treet

) has

eva

luat

ed th

e Ph

ysic

al

Activ

ity a

nd M

eals

at S

choo

l pro

ject

(ava

ilabl

e in

Nor

weg

ian

upon

requ

est).

Part

one

of th

e ev

alua

tion

of th

e pr

ojec

t abo

ut

cohe

renc

e be

twee

n sc

hool

and

the

befo

re- a

nd

afte

r-sch

ool p

rogr

amm

es (H

elhe

tlig

Skol

edag

) is

ava

ilabl

e in

Nor

weg

ian

upon

requ

est.

Heal

th-p

rom

otin

g sc

hool

s ha

ve b

een

a to

pic

at

vario

us m

eetin

gs fo

r pub

lic h

ealth

adv

iser

s at

co

unty

leve

l. It

is a

lso

men

tione

d in

the

Whi

te

Pape

r on

the

Nat

iona

l Hea

lth a

nd C

are

Plan

for

Nor

way

(201

1–20

15).

A to

tal o

f 400

prim

ary

and

low

er s

econ

dary

sch

ools

and

18

uppe

r se

cond

ary

scho

ols

rece

ived

gra

nts

betw

een

2004

and

200

7 to

pa

rtici

pate

in th

e Ph

ysic

al A

ctiv

ity a

nd M

eals

in S

choo

l pro

ject

. Ex

perie

nce

from

the

proj

ect w

as s

hare

d th

roug

h pr

esen

tatio

ns

and

dist

ribut

ion

of a

gui

danc

e bo

okle

t and

a D

VD w

ith e

xam

ples

of

bes

t pra

ctic

e to

all

prim

ary

and

low

er s

econ

dary

sch

ools

and

m

unic

ipal

ities

. A n

atio

nal c

onfe

renc

e w

as o

rgan

ized

in 2

007

and

the

coun

ty g

over

nors

org

anize

d re

gion

al c

onfe

renc

es in

the

sprin

g of

200

8 to

spr

ead

expe

rienc

e fro

m th

e pr

ojec

t.

A w

eb s

ite fo

r sha

ring

idea

s an

d re

sour

ces

in th

e ar

ea o

f ph

ysic

al a

ctiv

ity w

as la

unch

ed in

200

9. T

his

does

not

, how

ever

, in

clud

e m

easu

res

rela

ting

to d

iet.

In th

e pe

riod

2009

–201

2, th

e M

inis

try o

f Edu

catio

n &

Res

earc

h ca

rried

out

a p

roje

ct te

stin

g va

rious

mod

els

in s

choo

ls w

ith

the

purp

ose

of im

prov

ing

the

cohe

renc

e be

twee

n sc

hool

and

th

e be

fore

- and

afte

r-sch

ool p

rogr

amm

es (H

elhe

tlig

Skol

edag

). Co

mpo

nent

s of

the

prog

ram

me

incl

ude

food

in s

choo

l, ph

ysic

al

activ

ity, h

elp

with

hom

ewor

k an

d va

rious

cul

tura

l act

iviti

es.

Educ

atio

n &

Re

sear

ch;

Heal

th &

Car

e Se

rvic

es

4.5

Diss

emin

ate

expe

rienc

es

from

mod

els

deve

lope

d in

the

Phys

ical

Act

ivity

and

Mea

ls

in S

choo

l pro

ject

and

col

lect

an

d sp

read

kno

w-h

ow a

bout

sc

hool

bre

akfa

st p

rogr

amm

es

in lo

wer

and

upp

er s

econ

dary

sc

hool

s

57

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

The

need

to re

vise

the

guid

elin

es h

as b

een

disc

usse

d.

The

eval

uatio

n of

the

Phys

ical

Act

ivity

and

M

eals

in S

choo

l pro

ject

sho

wed

that

no

scho

ols

offe

red

soft

drin

ks d

urin

g th

e pr

ojec

t pe

riod

2003

–200

6, a

nd th

at a

cces

s to

col

d dr

inki

ng-w

ater

impr

oved

.

The

map

ping

exe

rcis

e in

200

8 on

frui

t, ve

geta

bles

, drin

king

-wat

er a

nd m

eals

was

lin

ked

to a

com

petit

ion.

Loca

l exp

erie

nces

with

sch

ool b

reak

fast

s ha

ve n

ot b

een

com

pile

d an

d di

strib

uted

, but

som

e co

untie

s ha

ve te

sted

mod

els

for b

reak

fast

at s

choo

l.

In 2

007/

2008

, the

Dire

ctor

ate

of E

duca

tion

and

Trai

ning

car

ried

out a

pro

ject

with

pro

long

ed s

choo

l day

s (U

tvid

et S

kole

dag)

in

11 m

unic

ipal

ities

and

34

scho

ols.

Mod

els

for s

choo

l mea

ls w

ere

incl

uded

.

The

guid

elin

es fo

r mea

ls in

sch

ool a

re p

art o

f the

pro

ject

w

ith p

rolo

nged

sch

ool d

ays

in 2

007/

2008

. Inf

orm

atio

n ab

out

the

guid

elin

es is

ava

ilabl

e th

roug

h on

goin

g w

ork

and

vario

us

proj

ects

(see

4.3

and

4.5

), in

rele

vant

mat

eria

l and

on

rele

vant

w

eb s

ites,

incl

udin

g th

e Di

rect

orat

e of

Hea

lth a

nd S

kole

frugt

. It

was

als

o av

aila

ble

on a

n ea

rlier

web

site

(sko

lene

ttet.n

o), b

ut

this

web

site

was

shu

t dow

n an

d th

e m

ater

ial w

as n

ot m

oved

to

the

web

site

of t

he D

irect

orat

e of

Edu

catio

n an

d Tr

aini

ng.

Seve

ral h

igh-

leve

l mee

tings

hav

e be

en h

eld

(bet

wee

n th

e M

inis

try o

f Hea

lth &

Car

e Se

rvic

es a

nd th

e M

inis

try o

f Edu

catio

n &

Res

earc

h), f

ocus

ing

inte

r alia

on

the

guid

elin

es.

In 2

008,

a jo

int l

ette

r fro

m th

e M

inis

ters

of H

ealth

& C

are

Serv

ices

, Edu

catio

n &

Res

earc

h an

d Lo

cal G

over

nmen

t &

Regi

onal

Dev

elop

men

t was

sen

t to

all c

ount

y au

thor

ities

en

cour

agin

g th

em to

ens

ure

that

hea

lthy

food

s an

d dr

inks

wer

e m

ade

avai

labl

e in

upp

er s

econ

dary

sch

ools

. A c

ompe

titio

n w

as

used

as

a fo

llow

-up

and

a m

appi

ng e

xerc

ise

was

car

ried

out

(68%

par

ticip

atio

n ra

te).

Heal

th &

Car

e Se

rvic

es;

Educ

atio

n &

Re

sear

ch

Educ

atio

n &

Re

sear

ch;

Heal

th &

Car

e Se

rvic

es

4.6

Cont

inue

the

wor

k of

sp

read

ing

info

rmat

ion

abou

t th

e he

alth

aut

horit

ies’

gu

idel

ines

for m

eals

in

prim

ary

and

seco

ndar

y sc

hool

s

4.7

Enco

urag

e sc

hool

ow

ners

to

pre

vent

acc

ess

to s

oft

drin

ks a

nd p

rom

ote

good

ac

cess

to c

old

drin

king

-wat

er

58

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

In 2

011,

the

Dire

ctor

ate

of H

ealth

car

ried

out a

sim

ple

map

ping

(via

e-m

ail)

abou

t the

fo

llow

-up

to th

e in

itiat

ive

to b

an s

oft d

rinks

by

vario

us c

ount

y au

thor

ities

. Thi

s sh

owed

that

si

x co

untie

s ha

d ta

ken

the

polit

ical

dec

isio

n to

of

fer h

ealth

y ca

ntee

ns, a

nd th

ree

of th

ese

had

also

take

n th

e po

litic

al d

ecis

ion

not t

o al

low

th

e sa

le o

f sof

t drin

ks (R

ogal

and,

Ves

tfold

and

Øs

tfold

).

The

map

ping

of m

eals

, phy

sica

l act

ivity

and

en

viro

nmen

tal h

ealth

in k

inde

rgar

tens

in th

e sp

ring

of 2

011

show

ed th

at (a

ccor

ding

to th

e ad

min

istra

tors

) 83%

of t

he k

inde

rgar

tens

The

sam

e m

essa

ge h

as a

lso

been

com

mun

icat

ed th

roug

h w

ork

bein

g ca

rried

out

by

the

Dire

ctor

ate

of H

ealth

, the

Dire

ctor

ate

of

Educ

atio

n &

Trai

ning

, cou

nty

auth

oriti

es a

nd o

ther

s.

Thro

ugh

the

deve

lopm

ent a

nd tr

ial p

hase

s of

the

Heal

th in

M

aste

r Pla

ns (H

else

i Pl

an) p

roje

ct, s

ever

al c

ount

ies

have

car

ried

out h

ealth

pro

mot

ion

effo

rts in

upp

er s

econ

dary

sch

ools

. The

se

have

em

phas

ized

the

impo

rtanc

e of

the

avai

labi

lity

of fo

od a

nd

drin

ks. S

ome

coun

ties

have

dev

elop

ed n

etw

orks

for e

mpl

oyee

s in

sch

ool c

ante

ens

to s

hare

exp

erie

nces

.

The

coun

ty o

f Opp

land

has

a c

ertifi

catio

n sc

hem

e fo

r hea

lth-

prom

otin

g sc

hool

s, w

ho c

an a

pply

for f

unds

.

The

Dire

ctor

ate

of E

duca

tion

and

Trai

ning

is d

evel

opin

g m

odel

s fo

r bet

ter c

oher

ence

bet

wee

n sc

hool

s an

d th

e be

fore

- and

af

ter-s

choo

l pro

gram

mes

(Hel

hetli

g Sk

oled

ag) (

see

4.5)

. The

Di

rect

orat

e of

Hea

lth’s

guid

elin

es fo

r mea

ls in

sch

ools

is

incl

uded

in th

is p

roje

ct.

This

mea

sure

is p

art o

f the

ong

oing

info

rmat

ion

and

com

mun

icat

ions

wor

k of

the

Dire

ctor

ate

of H

ealth

.

The

Dire

ctor

ate

of H

ealth

has

par

ticip

ated

in a

gro

up p

lann

ing

the

proj

ect o

n co

here

nce

betw

een

scho

ols

and

the

befo

re- a

nd

afte

r-sch

ool p

rogr

amm

es (H

elhe

tlig

Skol

edag

) (se

e 4.

5).

The

Dire

ctor

ate

of H

ealth

wor

ks w

ith th

e M

inis

try o

f Hea

lth &

Ca

re S

ervi

ces

to in

form

mun

icip

al d

epar

tmen

ts o

f env

ironm

enta

l he

alth

abo

ut th

e ap

prov

al s

chem

e in

the

regu

latio

ns o

n en

viro

nmen

tal h

ealth

pro

tect

ion

in k

inde

rgar

tens

and

sch

ools

so

Educ

atio

n &

Re

sear

ch;

Heal

th &

Car

e Se

rvic

es

Heal

th &

Car

e Se

rvic

es;

Agric

ultu

re &

Fo

od;F

ishe

ries

4.8

Enco

urag

e sc

hool

ow

ners

to

stre

ngth

en fo

od a

nd m

eal

prog

ram

mes

in b

efor

e- a

nd

afte

r- sc

hool

pro

gram

mes

for

scho

olch

ildre

n

4.9

Stre

ngth

en a

nd c

oord

inat

e in

spec

tion

of fo

od a

nd m

eals

in

kin

derg

arte

ns, s

choo

ls

and

befo

re- a

nd a

fter-s

choo

l

59

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

wer

e ap

prov

ed a

ccor

ding

to th

e re

gula

tions

on

env

ironm

enta

l hea

lth p

rote

ctio

n in

ki

nder

garte

ns a

nd s

choo

ls. H

owev

er, a

bout

one

th

ird o

f the

kin

derg

arte

ns h

ad n

ot b

een

subj

ect

to s

uper

visi

on in

the

prev

ious

thre

e ye

ars.

as to

stre

ngth

en th

e su

perv

isio

n of

kin

derg

arte

ns a

nd s

choo

ls,

incl

udin

g as

con

cern

s m

eals

.

The

Min

istry

of A

gric

ultu

re a

nd F

ood

repo

rts th

at a

New

Nor

dic

Food

pro

ject

hig

hlig

hts

good

sys

tem

s fo

r ser

ving

food

and

in

form

atio

n ab

out c

hild

ren’s

food

and

hea

lth.

& C

oast

al

Affa

irspr

ogra

mm

es

5.1

Esta

blis

h a

dial

ogue

be

twee

n em

ploy

ers

and

unio

ns a

nd th

e he

alth

au

thor

ities

to p

rom

ote

heal

thy

diet

ary

habi

ts

5.2

Asse

ss h

ow d

ieta

ry

cons

ider

atio

ns c

an b

e ad

dres

sed

at w

orkp

lace

s

Heal

th &

Car

e Se

rvic

es

Heal

th &

Car

e Se

rvic

es;

Labo

ur &

Soc

ial

Incl

usio

na

The

Dire

ctor

ate

of H

ealth

has

initi

ated

and

par

ticip

ated

in

seve

ral m

eetin

gs w

ith re

pres

enta

tives

of w

orki

ng li

fe. S

ome

of

the

orga

niza

tions

hav

e ag

reed

to a

ct a

s in

form

atio

n ch

anne

ls fo

r th

e ov

eral

l mes

sage

from

the

Dire

ctor

ate.

Thro

ugh

the

Wor

kpla

ce H

ealth

Pro

mot

ion

prog

ram

me,

the

Dire

ctor

ate

of H

ealth

has

est

ablis

hed

coop

erat

ion

with

the

Labo

ur In

spec

tora

te in

Inne

r Øst

land

, sev

en c

ount

y co

unci

ls

and

the

Nor

dic

Acad

emy

for P

ublic

Hea

lth. I

n w

orki

ng w

ith th

e ki

osk,

pet

rol s

tatio

n an

d se

rvic

e m

arke

t, co

ntac

ts h

ave

been

es

tabl

ishe

d w

ith th

e Co

nfed

erat

ion

of N

orw

egia

n En

terp

rise

and

othe

r key

pla

yers

in w

orki

ng li

fe, s

uch

as th

e Tr

ansp

ort W

orke

rs

Unio

n.

Incl

uded

in 5

.1 a

nd 5

.3.

The

reco

mm

enda

tions

for f

ood

in c

afet

eria

s an

d re

stau

rant

s gi

ven

by th

e Di

rect

orat

e of

Hea

lth a

re th

e ba

sis

for f

ood

See

also

2.5

.

Eval

uatio

n of

the

Wor

kpla

ce H

ealth

Pro

mot

ion

prog

ram

me

show

sth

atit

ise

ffect

ive;

60%

of

the

resp

onde

nts

feel

that

em

ploy

ees’

die

ts a

re

rela

ted

to th

eir j

obs,

and

that

ava

ilabl

e fo

od

serv

ices

are

impo

rtant

to jo

b sa

tisfa

ctio

n, th

e w

ork

envi

ronm

ent a

nd p

rodu

ctiv

ity.

A fo

llow

-up

of th

e pr

ogra

mm

e is

requ

ired,

pr

efer

ably

in th

e se

lect

ed s

ecto

rs.

Ther

e is

a n

eed

to lo

ok a

t the

rela

tions

hip

betw

een

wor

k, th

e N

orw

egia

n La

bour

and

W

elfa

re S

ervi

ce, h

ealth

y liv

ing

cent

res,

hea

lth

serv

ices

, etc

.

5. F

ood

and

heal

th in

the

wor

kpla

ceGo

als:

Con

tribu

te to

ava

ilabi

lity

of h

ealth

y fo

od a

nd b

ever

ages

in th

e w

orkp

lace

St

imul

ate

the

mot

ivat

ion

of e

mpl

oyee

s to

ado

pt h

ealth

y ha

bits

and

mak

e go

od fo

od c

hoic

es

Help

em

ploy

ers

to in

tegr

ate

diet

ary

cons

ider

atio

ns in

per

sonn

el p

olic

y

60

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

All i

nitia

tives

rega

rdin

g pu

blic

hea

lth s

houl

d be

m

ade

avai

labl

e on

the

Dire

ctor

ate

of H

ealth

’s w

eb s

ite.

Arra

ngem

ents

for a

trai

ning

wor

ksho

p (o

r w

orks

hops

) for

can

teen

sta

ff sh

ould

be

upda

ted

and

poss

ibly

con

nect

ed to

the

Good

Foo

d tra

inin

g w

orks

hop

in th

e lo

ng te

rm.

An u

pdat

ed le

aflet

on

food

and

hea

lth a

t wor

k w

ill b

e pr

esen

ted.

prov

isio

n. T

hey

are

revi

sed

or d

evel

oped

acc

ordi

ng to

new

di

etar

y ad

vice

. Arti

cles

and

adv

ice

are

avai

labl

e on

the

web

si

tes

and

thro

ugh

lect

ures

, etc

. The

Nor

weg

ian

Labo

ur a

nd

Wel

fare

Ser

vice

Wor

king

Cen

tre in

Ves

t-Agd

er a

nd V

est-A

gder

Co

unty

Cou

ncil

ran

a He

alth

y W

orkp

lace

s pi

lot p

roje

ct in

200

7.

The

futu

re c

halle

nge

is to

enc

oura

ge e

mpl

oyee

s to

be

heal

thy.

To b

e co

nsid

ered

in re

latio

n to

mea

sure

s 2.

2 an

d 5.

1.

Artic

les

and

mat

eria

ls h

ave

been

pub

lishe

d on

web

site

s an

d sp

read

thro

ugh

ongo

ing

wor

k an

d le

ctur

es.

The

Min

istry

of A

gric

ultu

re &

Foo

d ra

n a

cant

een

proj

ect d

urin

g Th

e W

eek

of Ta

ste

with

men

u su

gges

tions

and

exh

ibiti

ons

focu

sing

on

basi

c fla

vour

s an

d fo

od q

ualit

y (a

lso

in 2

011)

.

The

Info

rmat

ion

Offic

e fo

r Fru

it an

d Ve

geta

bles

hav

e a

com

mitm

ent c

alle

d M

ORE

(mor

e fru

it an

d ve

geta

bles

), fo

llow

ing

up in

itiat

ives

and

mea

sure

s pr

evio

usly

giv

en to

all

coun

ties

in

colla

bora

tion

with

the

Dire

ctor

ate

of H

ealth

. MOR

E in

clud

es

advi

ce a

nd c

ante

en c

ours

es (i

n co

llabo

ratio

n w

ith p

artn

er

com

pani

es) a

nd in

form

atio

n an

d pr

ogra

mm

es o

n th

e w

eb s

ite.

The

Dire

ctor

ate

of H

ealth

and

the

Info

rmat

ion

Offic

e fo

r Fru

it an

d Ve

geta

bles

hel

d a

natio

nal t

rain

ing

wor

ksho

p on

wor

kpla

ce

cant

een

mea

ls in

200

6 an

d an

othe

r on

high

sch

ool c

ante

ens

in

the

coun

ties

of Te

lem

ark

and

Nor

d-Tr

ønde

lag

in 2

007.

Bot

h th

e w

orks

hops

wer

e fo

llow

ed u

p in

the

coun

ties

afte

rwar

ds w

ith,

for e

xam

ple,

loca

l cou

rses

. Sev

eral

cou

ntie

s ha

ve e

stab

lishe

d

Heal

th &

Car

e Se

rvic

es;

Agric

ultu

re &

Fo

od;F

ishe

ries

& C

oast

al

Affa

irs

5.3

Build

com

pete

nce

and

ensu

re a

cces

s to

tool

s on

di

et a

nd h

ealth

for g

roup

s su

ch a

s ca

ntee

n em

ploy

ees,

tra

de u

nion

repr

esen

tativ

es,

man

ager

s an

d co

mpa

ny

heal

th s

ervi

ce s

taff

61

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

The

Asso

ciat

ion

of V

ocat

iona

l Reh

abili

tatio

n En

terp

rises

is a

n em

ploy

er a

nd in

tere

st

orga

niza

tion

for a

ppro

xim

atel

y 10

0 en

terp

rises

sp

read

acr

oss

Nor

way

.

The

Asso

ciat

ion

of V

ocat

iona

l Reh

abili

tatio

n En

terp

rises

pro

vide

s se

rvic

es to

mor

e th

an

35 0

00 p

eopl

e an

nual

ly.

expe

rienc

e fo

rum

s fo

r can

teen

sta

ff in

bus

ines

ses

and

high

sc

hool

s as

a re

sult

of c

ours

es h

eld

by th

e Di

rect

orat

e of

Hea

lth

and

the

Info

rmat

ion

Offic

e fo

r Fru

it an

d Ve

geta

bles

in th

e co

untie

s du

ring

the

perio

d 19

97–2

006.

In 2

007,

the

Min

istry

of L

abou

r and

Soc

ial I

nclu

sion

offi

cial

ly

requ

este

d th

e Di

rect

orat

e of

Lab

our a

nd W

elfa

re to

take

the

initi

ativ

e to

mot

ivat

e vo

catio

nal r

ehab

ilita

tion

ente

rpris

es to

in

clud

e di

et a

nd p

hysi

cal a

ctiv

ity in

voc

atio

nal r

ehab

ilita

tion

(see

te

xt, 5

.4).

Nut

ritio

n w

ork

in re

habi

litat

ion

com

pani

es w

as a

sub

-to

pic

at a

nat

iona

l con

fere

nce

for p

ublic

hea

lth a

dvis

ers

in 2

010.

The

Dire

ctor

ate

of H

ealth

has

a c

ontin

uing

dia

logu

e w

ith th

e As

soci

atio

n of

Voc

atio

nal R

ehab

ilita

tion

Ente

rpris

es. T

he

Asso

ciat

ion,

toge

ther

with

the

wei

ght l

oss

and

nutri

tion

cour

ses

firm

Lib

ra, h

as d

evel

oped

its

own

nutri

tion

plan

as

part

of it

s in

tern

al tr

aini

ng. T

he A

ssoc

iatio

n ha

s in

crea

sed

the

focu

s on

die

t in

its

wor

k as

a re

sult

of th

e co

llabo

ratio

n w

ith th

e Di

rect

orat

e,

and

has

muc

h in

form

atio

n on

its

web

site

. The

Dire

ctor

ate

has

held

exh

ibiti

ons

and

lect

ures

at t

he v

ocat

iona

l reh

abili

tatio

n ex

hibi

tion

in 2

010

and

at re

leva

nt m

eetin

gs o

f thi

s gr

oup.

Regu

latio

ns o

n w

ork-

rela

ted

mea

sure

s (in

forc

e sin

ce 1

Jan

uary

20

09),

Chap

ter 3

.1, m

ake

it po

ssib

le to

pro

vide

life

styl

e co

unse

lling

as

part

of v

ocat

iona

l reh

abili

tatio

n. To

geth

er w

ith

the

high

sch

ool i

n Ak

ersh

us a

nd th

e As

soci

atio

n of

Voc

atio

nal

Reha

bilit

atio

n En

terp

rises

, the

Dire

ctor

ate

of H

ealth

has

de

velo

ped

a co

urse

in d

iet a

nd li

ving

hab

its: 1

10 s

tude

nts,

pr

imar

ily e

mpl

oyee

s of

the

reha

bilit

atio

n co

mpa

ny w

ith o

ne

pers

on fr

om th

e N

orw

egia

n La

bour

and

Wel

fare

Ser

vice

, hav

e co

mpl

eted

thei

r stu

dies

. The

cou

rses

hav

e be

en fu

nded

by

the

Dire

ctor

ate

of H

ealth

.

5.4

Mot

ivat

e vo

catio

nal

reha

bilit

atio

n en

terp

rises

to

incl

ude

diet

and

phy

sica

l ac

tivity

in v

ocat

iona

l re

habi

litat

ion

Labo

ur &

Soc

ial

Incl

usio

n;a

Heal

th &

Car

e Se

rvic

es

62

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

The

Good

Food

for B

ette

r Hea

lth sc

hem

e is

cont

inui

ng. T

he e

valu

atio

n of

the

first

four

tra

inin

g co

urse

s sho

wed

that

alm

ost o

ne

quar

ter o

f the

peo

ple

train

ed in

the

wor

ksho

ps

had

impl

emen

ted

the

prog

ram

me

in th

eir o

wn

mun

icipa

litie

s. Al

mos

t eve

ryon

e w

ho a

ttend

ed

the

wor

ksho

ps fo

und

the

sem

inar

s val

uabl

e,

espe

cially

the

mat

eria

l the

y wer

e gi

ven.

Mod

um m

unic

ipal

ity h

as re

porte

d th

at

appr

oxim

atel

y 60

% o

f the

par

ticip

ants

in th

e co

urse

s ar

e un

empl

oyed

or o

utsi

de th

e la

bour

m

arke

t, w

hich

is c

onsi

sten

t with

figu

res

from

20

10.

See

5.4

and

6.8.

The

low

thre

shol

d di

etar

y-re

late

d sc

hem

e Br

a M

at fo

r Bed

re

Hels

e (G

ood

Food

for B

ette

r Hea

lth) w

as la

unch

ed in

200

8. In

the

perio

d of

the

Actio

n Pl

an (2

008–

2011

), th

e Di

rect

orat

e of

Hea

lth

held

trai

ning

wor

ksho

ps in

16

of th

e 19

cou

ntie

s.

By D

ecem

ber 2

011,

135

hea

lthy

livin

g ce

ntre

s ha

d be

en

regi

ster

ed. O

f the

se, 5

0 ei

ther

had

or p

lann

ed to

sta

rt Go

od F

ood

for B

ette

r Hea

lth c

ours

es. G

uide

lines

for h

ealth

y liv

ing

cent

res

wer

e pu

blis

hed

in F

ebru

ary

2011

.

Coop

erat

ion

and

supp

ort h

ave

been

giv

en to

Act

ive

in th

e Da

ytim

e ac

tiviti

es in

Osl

o an

d th

e co

unty

of N

ordl

and.

The

se a

re

loca

lly o

rgan

ized

activ

ities

for p

eopl

e w

ho a

re w

holly

or p

artly

ou

tsid

e th

e w

orkp

lace

.

5.5

Deve

lop

and

test

low

th

resh

old

diet

ary

sche

mes

fo

r peo

ple

on lo

ng-te

rm s

ick

leav

e an

d ot

hers

who

are

pe

riodi

cally

une

mpl

oyed

Heal

th &

Car

e Se

rvic

es

6.1

Cons

ider

how

the

mun

icip

aliti

es c

an p

rovi

de

satis

fact

ory

serv

ices

in

gene

ral a

nd c

linic

al n

utrit

ion

in th

e lo

nger

term

Heal

th &

Car

e Se

rvic

esTh

e Di

rect

orat

e of

Hea

lth h

as a

lloca

ted

fund

s to

sta

rt th

e te

stin

g of

mod

els

for o

rgan

izing

and

stre

ngth

enin

g w

ork

in b

oth

gene

ral

and

clin

ical

nut

ritio

n. D

urin

g th

e pe

riod

of th

e Ac

tion

Plan

it

prov

ided

fund

ing

for fi

ve d

iffer

ent m

odel

s of

how

mun

icip

aliti

es

can,

in th

e lo

ng te

rm, p

rovi

de a

sat

isfa

ctor

y se

rvic

e. A

mee

ting

was

hel

d in

Aug

ust 2

011

with

gra

nt re

cipi

ents

. A p

relim

inar

y

Ther

e is

a n

eed

for b

ette

r acc

ess

to q

ualifi

ed

pers

onne

l in

mun

icip

aliti

es to

ass

ure

the

qual

ity o

f nut

ritio

n se

rvic

es. A

s an

exa

mpl

e,

only

8 o

f the

135

hea

lthy

livin

g ce

ntre

s ha

ve

empl

oyed

any

one

with

exp

ertis

e in

nut

ritio

n.

The

Dire

ctor

ate

of H

ealth

has

reco

mm

ende

d

6. N

utri

tion

in h

ealth

and

soc

ial c

are

serv

ices

Goal

s: C

ontri

bute

to s

treng

then

ing

nutri

tion-

rela

ted

wor

k in

chi

ld h

ealth

clin

ics

and

the

scho

ol h

ealth

ser

vice

He

lp p

atie

nts

in th

e pr

imar

y he

alth

ser

vice

and

spe

cial

ist h

ealth

ser

vice

rece

ive

indi

vidu

al d

ieta

ry g

uida

nce

and

treat

men

t

Cont

ribut

e to

stre

ngth

enin

g nu

tritio

n-re

late

d pr

ogra

mm

es in

nur

sing

and

car

e se

rvic

es

Find

out

abo

ut p

atie

nts’

or s

ervi

ce re

cipi

ents

’ foo

d an

d m

eals

, die

t and

nut

ritio

nal s

tatu

s an

d th

e qu

alifi

catio

ns

of

hea

lth w

orke

rs

63

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

that

nut

ritio

n pr

ogra

mm

es s

houl

d be

anc

hore

d in

cro

ss-s

ecto

ral p

lann

ing.

Peo

ple

with

a

bach

elor

’s de

gree

in n

utrit

ion

can

have

key

sk

ills

in g

ener

al a

nd p

reve

ntiv

e nu

tritio

n. O

ne

expe

rienc

ed c

linic

al n

utrit

ioni

st e

mpl

oyed

at a

se

nior

leve

l in

a m

unic

ipal

ity o

r cou

nty

mig

ht

prov

ide

a m

odel

to e

nsur

e qu

ality

and

impr

ove

nutri

tion

serv

ices

in b

oth

gene

ral a

nd c

linic

al

nutri

tion.

Exp

ertis

e in

food

eco

nom

ics

is a

lso

a ke

y co

mpe

tenc

e fo

r qua

lity

cont

rol o

f foo

d se

rvic

es in

inst

itutio

ns.

The

annu

al re

ports

from

the

regi

onal

hea

lth

auth

oriti

es in

201

0 sh

ow th

at a

con

tinue

d fo

cus

is n

eede

d. T

he in

stru

ctio

n le

tter f

rom

th

e M

inis

try o

f Hea

lth &

Car

e Se

rvic

es

to th

e he

alth

aut

horit

ies

in 2

012

stat

es

that

they

sho

uld

impr

ove

the

nutri

tiona

l st

atus

of p

atie

nts

at ri

sk o

f poo

r nut

ritio

n.

Docu

men

tatio

n re

latin

g to

nut

ritio

nal s

tatu

s m

ust f

ollo

w p

atie

nts

as th

ey m

ove

betw

een

treat

men

t uni

ts o

r to

anot

her h

ealth

ser

vice

.

The

Dire

ctor

ate

of H

ealth

has

pre

pare

d a

plan

fo

r im

plem

enta

tion

of th

e gu

idel

ines

and

is

wor

king

on

a st

rate

gy o

n ov

erw

eigh

t.

repo

rt w

as s

ent t

o th

e M

inis

try o

f Hea

lth &

Car

e Se

rvic

es in

De

cem

ber 2

011,

and

a fi

nal r

epor

t will

be

mad

e av

aila

ble

to th

e M

inis

try w

hen

all t

he s

ub-re

ports

are

fina

lized

.

Nut

ritio

n ha

s be

en in

clud

ed a

s a

spec

ific

them

e in

the

cont

ract

do

cum

ents

sen

t by

the

Min

istry

of H

ealth

& C

are

Serv

ices

to th

e re

gion

al h

ealth

aut

horit

ies

annu

ally

sin

ce 2

008.

Prof

essi

onal

gui

delin

es w

ere

publ

ishe

d in

Feb

ruar

y 20

11 fo

r ad

ults

and

for c

hild

ren

and

youn

g pe

ople

.

Heal

th &

Car

e Se

rvic

es

Heal

th &

Car

e Se

rvic

es

Heal

th &

Car

e Se

rvic

es

6.2

A fo

cus

on n

utrit

ion

shou

ld b

e in

clud

ed in

the

over

all s

ervi

ces

offe

red

in th

e sp

ecia

list h

ealth

ser

vice

6.3

Prep

are

and

impl

emen

t pr

ofes

sion

al g

uide

lines

and

in

stru

ctio

ns fo

r nut

ritio

n th

erap

y

6.3.

1 De

velo

p an

d im

plem

ent

prof

essi

onal

gui

delin

es fo

r

64

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

As fo

r 6.3

.1.

The

Dire

ctor

ate

of H

ealth

has

pre

sent

ed

thes

e gu

idel

ines

at a

num

ber o

f con

fere

nces

an

d co

urse

s or

gani

zed

eith

er b

y th

e re

gion

al

heal

th a

utho

ritie

s (fo

r hos

pita

ls) o

r by

coun

ty

gove

rnor

s (fo

r nur

sing

hom

es).

The

univ

ersi

ty h

ospi

tal i

n Be

rgen

has

mad

e th

e m

ost p

rogr

ess

in im

plem

entin

g th

e gu

idel

ines

. Th

ey c

ondu

ct fo

ur p

oint

-pre

vale

nce

surv

eys

of

mal

nutri

tion

and

treat

men

t ann

ually

.

The

Nut

ritio

n an

d di

et m

anua

l – g

uida

nce

for n

utrit

ion

in h

ealth

and

car

e se

rvic

es w

as

publ

ishe

d in

spr

ing

2012

. The

Dire

ctor

ate

of

Heal

th h

as p

repa

red

a pl

an fo

r im

plem

enta

tion.

As fo

r 6.3

.4.

Prof

essi

onal

gui

delin

es w

ere

publ

ishe

d in

Feb

ruar

y 20

11.

Prof

essi

onal

gui

delin

es w

ere

publ

ishe

d in

Jun

e 20

09.

The

revi

sion

was

sta

rted

in 2

009,

bas

ed o

n th

e na

tiona

l pr

ofes

sion

al g

uide

lines

for t

he p

reve

ntio

n an

d tre

atm

ent o

f nu

tritio

nal d

efici

ency

, the

Nor

dic

nutri

tion

reco

mm

enda

tions

an

d th

e ne

w n

atio

nal g

uide

lines

on

nutri

tion.

It w

ill c

over

in

stitu

tions

, you

th h

ealth

ser

vice

s, s

choo

l hea

lth s

ervi

ces,

he

alth

y liv

ing

cent

res,

dom

icili

ary

heal

th a

nd c

are

serv

ices

, and

re

habi

litat

ion.

As fo

r 6.3

.4.

Heal

th &

Car

e Se

rvic

es

Heal

th &

Car

e Se

rvic

es

Heal

th &

Car

e Se

rvic

es

Heal

th &

Car

e Se

rvic

es

prev

entio

n an

d tre

atm

ent o

f ov

erw

eigh

t/ob

esity

6.3.

2 De

velo

p an

d im

plem

ent

prof

essi

onal

gui

delin

es fo

r w

eigh

ing

and

mea

surin

g at

ch

ild h

ealth

clin

ics

and

in th

e sc

hool

hea

lth s

ervi

ce.

6.3.

3 De

velo

p an

d im

plem

ent

prof

essi

onal

gui

delin

es o

n pr

even

tion

and

treat

men

t of

pat

ient

s w

ith n

utrit

iona

l de

ficie

ncy

and

patie

nts

at

nutri

tiona

l ris

k.

6.3.

4 Re

vise

and

issu

e gu

idel

ines

for d

ieta

ry

man

agem

ent i

n he

alth

car

e in

stitu

tions

6.3.

5 Pr

epar

e in

stru

ctio

ns fo

r nu

tritio

n-re

late

d pr

ogra

mm

es

65

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

In 2

011,

the

Dire

ctor

ate

of H

ealth

hel

d a

sem

inar

on

diet

and

min

oriti

es.

Thes

e in

dica

tors

are

not

cur

rent

ly b

eing

im

plem

ente

d in

the

spec

ialis

t hea

lth s

ervi

ces

exce

pt a

t Hau

kela

nd U

nive

rsity

Hos

pita

l. Th

ey

are

not y

et in

clud

ed in

nat

iona

l sta

tistic

s.

The

nutri

tion

and

diet

man

ual i

nclu

des

a ch

apte

r on

nutri

tiona

l is

sues

in v

ario

us re

ligio

ns a

nd c

ultu

res.

Nat

iona

l pro

fess

iona

l gui

delin

es fo

r the

pre

vent

ion

of n

utrit

iona

l de

ficie

ncy

have

pro

pose

d se

vera

l qua

lity

indi

cato

rs: f

or e

xam

ple,

th

e pr

opor

tion

of p

atie

nts

wei

ghed

, the

pro

porti

on o

f pat

ient

s at

nu

tritio

nal r

isk

and

nutri

tiona

l defi

cien

cy, a

nd th

e pr

opor

tion

of

patie

nts

treat

ed fo

r nut

ritio

nal r

isk

or m

alnu

tritio

n.

A na

tiona

l sur

vey

of fo

od a

nd d

iet i

n nu

rsin

g-ho

mes

was

take

n am

ong

lead

ers

and

heal

th p

erso

nnel

and

pub

lishe

d in

200

8 by

Øs

tfold

Uni

vers

ity C

olle

ge. T

his

stud

y sh

owed

that

onl

y 16

% h

ad

writ

ten

proc

edur

es fo

r nut

ritio

nal s

tatu

s, th

e ni

ght f

ast w

as to

o lo

ng a

t tw

o ou

t of t

hree

nur

sing

-hom

es, a

nd th

e nu

rsin

g-ho

me

staf

f nee

ded

mor

e kn

owle

dge

abou

t nut

ritio

n.

A su

rvey

of f

ood

and

mea

ls a

mon

g re

side

nts

of n

ursi

ng h

omes

in

Øst

fold

Cou

nty

was

pub

lishe

d in

201

0. T

his

stud

y sh

owed

th

at m

ost o

f the

pat

ient

s w

ere

satis

fied

with

the

food

itse

lf, b

ut

ther

e is

a n

eed

for i

mpr

ovem

ent r

egar

ding

min

imizi

ng th

e ni

ght

fast

, the

con

tent

of s

ervi

ngs

and

mea

ls, a

nd u

ser i

nvol

vem

ent i

n m

eal-r

elat

ed a

ctiv

ities

.

A na

tiona

l sur

vey

amon

g em

ploy

ers

in h

ome

care

ser

vice

was

pu

blis

hed

in 2

012.

Heal

th &

Car

e Se

rvic

es

Heal

th &

Car

e Se

rvic

es

Heal

th &

Car

e Se

rvic

es

in th

e nu

rsin

g an

d ca

re

serv

ices

6.3.

6 In

clud

e di

et in

de

velo

ping

a g

uide

for h

ealth

pe

rson

nel o

n co

mm

unic

atio

n ab

out h

ealth

with

spe

aker

s of

m

inor

ity la

ngua

ges

6.4

Prep

are

suita

ble

diet

- an

d nu

tritio

n-re

late

d qu

ality

in

dica

tors

in th

e he

alth

in

stitu

tions

and

dom

icili

ary

serv

ices

6.5

Surv

ey th

e fo

od s

ervi

ces

avai

labl

e to

, and

die

t and

nu

tritio

nal s

tatu

s of

use

rs o

f nu

rsin

g an

d ca

re s

ervi

ces

66

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

Ther

e is

stil

l a s

igni

fican

t nee

d fo

r im

prov

emen

t in

the

heal

th a

nd c

are

serv

ices

with

resp

ect

to w

ritte

n pr

oced

ures

on

nutri

tiona

l sta

tus,

ni

ght f

astin

g, k

now

ledg

e ab

out n

utrit

ion

and

know

ledg

e ab

out d

aily

pra

ctic

e in

the

prev

entio

n, id

entifi

catio

n an

d tre

atm

ent o

f nu

tritio

nal d

efici

ency

.

See

5.5

and

6.1.

A he

alth

y liv

ing

cent

re is

defi

ned

as a

low

th

resh

old

grou

p or

indi

vidu

al s

truct

ured

pr

ogra

mm

e w

orki

ng o

n im

prov

ing

phys

ical

ac

tivity

, nut

ritio

n an

d an

tism

okin

g. T

he n

umbe

r of

hea

lthy

livin

g ce

ntre

s ha

s do

uble

d si

nce

2009

to 1

35 in

201

1. A

bout

50

of th

ese

are

offe

ring

or p

lann

ing

Good

Foo

d co

urse

s, b

ut

only

8 h

ave

staf

f with

exp

ertis

e in

nut

ritio

n.

No

natio

nal s

urve

y of

nut

ritio

nal s

tatu

s in

nur

sing

and

car

e se

rvic

es h

as b

een

star

ted.

In a

nat

ionw

ide

audi

t in

2010

, the

Boa

rd o

f Hea

lth S

uper

visi

on

iden

tified

: (i)

maj

or d

efici

enci

es in

the

daily

wor

k to

pre

vent

an

d tre

at n

utrit

iona

l defi

cien

cy in

old

er p

eopl

e w

ho re

ceiv

ed

heal

tha

nds

ocia

lser

vice

s;a

nd(i

i)in

suffi

cien

tinf

orm

atio

nab

out

the

nutri

tiona

l sta

tus

of p

atie

nt m

edic

al re

cord

s of

eld

erly

hip

fra

ctur

e pa

tient

s.

As fo

r 6.8

.

The

Dire

ctor

ate

of H

ealth

has

mad

e st

udy

visi

ts to

the

Nat

iona

l Ce

ntre

for L

earn

ing

and

Copi

ng a

t Ake

r Uni

vers

ity H

ospi

tal a

nd

the

Cent

re fo

r Lea

rnin

g an

d Co

ping

in B

erge

n. M

easu

res

to

faci

litat

e th

e up

take

of t

he G

ood

Food

con

cept

for l

earn

ing

and

copi

ng h

ave

been

intro

duce

d.

As fo

r 5.5

.

The

low

thre

shol

d di

et-re

late

d sc

hem

e Go

od F

ood

for B

ette

r He

alth

was

laun

ched

in 2

008.

In th

e pe

riod

2008

–201

1 th

e Di

rect

orat

e of

Hea

lth h

eld

train

ing

wor

ksho

ps in

16

of 1

9 co

untie

s. S

ever

al h

ealth

y liv

ing

cent

res

are

now

offe

ring

Good

Fo

od fo

r Bet

ter H

ealth

cou

rses

. See

als

o Gu

idel

ines

for h

ealth

y liv

ing

cent

res.

Heal

th &

Car

e Se

rvic

es

Heal

th &

Car

e Se

rvic

es

Heal

th &

Car

e Se

rvic

es

6.6

Ensu

re th

at fo

od s

ervi

ces

and

faci

litat

ion

of m

eals

are

in

clud

ed in

insp

ectio

ns o

f the

he

alth

ser

vice

s an

d nu

rsin

g ca

re s

ervi

ces

6.7

Deve

lop

furth

er p

atie

nt

train

ing

prog

ram

mes

thro

ugh

cent

res

for l

earn

ing

and

copi

ng a

nd b

y ot

her m

eans

.

6.8

Cont

inue

to d

evel

op

low

thre

shol

d di

et-re

late

d sc

hem

es

67

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

See

5.3,

6.3

and

6.8

.

Good

Foo

d fo

r Bet

ter H

ealth

mat

eria

l was

dev

elop

ed in

200

8 an

d re

vise

d in

201

1.

The

Cook

book

for a

ll ca

n be

pur

chas

ed a

t pro

duct

ion

cost

by

mun

icip

aliti

es.

Heal

th &

Car

e Se

rvic

es6.

9 De

velo

p in

form

atio

n m

ater

ials

and

tool

s ai

med

at

chan

ging

hab

its, i

nclu

ding

di

et, f

or u

se b

y th

e he

alth

se

rvic

e, p

atie

nts

and

user

s an

d re

lativ

es.

7.1

Emph

asize

the

need

to

take

nut

ritio

n in

to a

ccou

nt

as p

art o

f pub

lic h

ealth

wor

k in

cou

nty

and

mun

icip

al

plan

ning

Heal

th &

Car

e Se

rvic

es;

Envi

ronm

ent

A ne

w p

lann

ing

sect

ion

of th

e Pl

anni

ng a

nd B

uild

ing

Act c

ame

into

forc

e on

1 J

uly 2

009.

Pub

lic h

ealth

cons

ider

atio

ns w

ere

then

in

corp

orat

ed in

to th

e Pl

anni

ng a

nd B

uild

ing

Act.

Acco

rdin

g to

§ 3

-1

of th

e Ac

t on

Dutie

s and

cons

ider

atio

ns in

pla

nnin

g un

der t

he A

ct,

plan

s sho

uld

“(f) p

rom

ote

popu

latio

n he

alth

and

coun

tera

ct so

cial

ineq

ualit

ies i

n he

alth

, as w

ell a

s hel

ping

to p

reve

nt cr

ime.

” A n

ew

publ

ic he

alth

law

for c

ount

ies c

ame

into

forc

e in

201

0. T

he co

nten

t of

that

law

was

inclu

ded

in th

e ne

w la

w fo

r mun

icipa

litie

s, co

unty

go

vern

ors a

nd th

e st

ate

from

1 J

anua

ry 2

012.

By l

aw, c

ount

ies

have

a st

atut

ory r

espo

nsib

ility

to p

rom

ote

publ

ic he

alth

.

All 3

0 m

unici

palit

ies i

n th

e de

velo

pmen

t and

tria

l pro

ject

Hea

lth

in M

aste

r Pla

ns h

ave

inclu

ded

publ

ic he

alth

cons

ider

atio

ns in

the

mun

icipa

l pla

n’s so

cial c

ompo

nent

. Dev

elop

men

t wor

k for

Hea

lth

in M

aste

r Pla

ns, w

ith a

n em

phas

is on

nut

ritio

n, w

as in

itiat

ed in

fo

ur p

ilot m

unici

palit

ies i

n th

ree

coun

ties.

In th

e au

tum

n of

200

9,

This

is fo

llow

ed u

p in

the

new

pub

lic h

ealth

la

w a

nd th

e na

tiona

l hea

lth a

nd c

are

plan

(2

011–

2015

).

An e

valu

atio

n of

the

Heal

th in

Mas

ter P

lans

pr

ojec

t (20

10) r

efer

s to

a s

urve

y co

nduc

ted

amon

g al

l mun

icip

aliti

es in

200

8 of

thei

r pub

lic

heal

th e

fforts

and

how

the

wor

k w

as o

rgan

ized.

Th

e re

sults

sho

wed

that

at t

he ti

me

only

one

qu

arte

r of t

he m

unic

ipal

ities

repo

rted

that

nu

tritio

n-re

late

d w

ork

was

inte

grat

ed a

s a

them

atic

are

a in

thei

r mun

icip

al p

lans

.

7. D

iet i

n pu

blic

hea

lth e

ffort

s at

the

loca

l lev

elGo

als:

Con

tribu

te to

a m

ore

solid

bas

is fo

r, an

d m

etho

ds in

, pub

lic h

ealth

wor

k, in

clud

ing

nutri

tion-

rela

ted

wor

k, in

pla

nnin

g an

d bu

dget

sys

tem

s in

cou

ntie

s an

d m

unic

ipal

ities

Co

ntrib

ute

to s

yste

mat

ic a

nd in

terd

isci

plin

ary

coop

erat

ion

in n

utrit

ion

as p

art o

f par

tner

ship

s fo

r pub

lic h

ealth

in c

ount

ies

and

mun

icip

aliti

es

Cont

ribut

e to

pub

licizi

ng v

ario

us s

ubsi

dy s

chem

es a

nd o

ther

pro

gram

mes

to s

uppo

rt lo

cal p

ublic

hea

lth e

fforts

in g

ener

al a

nd d

ieta

ry w

ork

in p

artic

ular

En

cour

age

the

prov

isio

n of

hea

lthy

food

and

bev

erag

e al

tern

ativ

es in

recr

eatio

nal a

rena

s

Help

the

elde

rly re

ceiv

e of

fers

of g

ood

and

varie

d fo

od a

t cen

tral m

eetin

g pl

aces

68

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

The

Dire

ctor

ate

of H

ealth

has

not

impl

emen

ted

this

mea

sure

bec

ause

the

assu

mpt

ions

wer

e ch

ange

d.

Acco

rdin

g to

info

rmat

ion

rece

ived

by

the

Dire

ctor

ate,

the

Regu

latio

n w

ill b

e re

vise

d ag

ain.

The

Dire

ctor

ate

will

mon

itor

deve

lopm

ents

.

Seve

ral u

nive

rsiti

es a

nd v

ocat

iona

l col

lege

s of

fer p

rogr

amm

es in

pub

lic h

ealth

. In

2011

, five

of

thes

e in

stitu

tions

offe

red

cour

ses

abou

t the

He

alth

in M

aste

r Pla

ns p

roje

ct.

the

mun

icipa

lity o

f Eid

sber

g ad

opte

d th

e in

clusio

n of

nut

ritio

n pr

ogra

mm

es in

the

plan

for a

safe

and

hea

lthy c

hild

hood

. The

m

unici

palit

y of V

olda

has

inco

rpor

ated

the

Good

Food

trai

ning

co

urse

into

mun

icipa

l and

fina

ncia

l pla

nnin

g. Fi

nal r

epor

ts a

re st

ill

to b

e re

ceive

d fro

m th

e m

unici

palit

ies o

f Fau

ske

and

Vest

vågø

y.

In it

s an

nual

offi

cial

lette

r to

coun

ty g

over

nors

, the

Min

istry

of

Agric

ultu

re &

Foo

d ha

s in

clud

ed a

sen

tenc

e to

the

effe

ct th

at th

e go

vern

ors

shou

ld u

nder

take

wor

k re

late

d to

food

and

chi

ldre

n.

The

guid

elin

es w

ere

upda

ted

in c

onju

nctio

n w

ith th

e ne

w

sect

ion

on p

lann

ing

in th

e Ac

t and

wer

e im

plem

ente

d at

the

sam

e tim

e. P

ublic

hea

lth w

as in

clud

ed a

s a

cons

ider

atio

n in

the

Act b

ut n

ot n

utrit

ion

in p

artic

ular

. Acc

ordi

ng to

§ 4

of

the

Act o

n cr

iteria

for t

he a

sses

smen

t of s

igni

fican

t im

pact

s on

the

envi

ronm

ent a

nd s

ocie

ty, t

he p

lans

and

mea

sure

s sh

ould

be

asse

ssed

und

er th

e Re

gula

tion

if th

ey “

i) m

ay h

ave

cons

eque

nces

for t

he p

opul

atio

n he

alth

or t

he d

istri

butio

n of

he

alth

in th

e po

pula

tion.

”

The

Min

istry

of t

he E

nviro

nmen

t pla

nned

to p

repa

re a

gui

de to

th

e cr

iteria

in §

4, b

ut th

e Di

rect

orat

e of

Hea

lth is

not

aw

are

that

th

is w

ork

has

been

com

plet

ed.

The

Dire

ctor

ate

of H

ealth

is w

orki

ng to

bui

ld c

ompe

tenc

e in

nu

tritio

n an

d ha

s or

gani

zed

mee

tings

with

pub

lic h

ealth

wor

kers

at

loca

l and

regi

onal

leve

l to

disc

uss

this

issu

e.

The

Min

istry

of E

duca

tion

& R

esea

rch

com

men

ted

that

fa

cilit

atin

g co

mpe

tenc

e-bu

illdi

ng, a

s re

ques

ted

in th

is m

easu

re,

is th

e re

spon

sibi

lity

of in

stitu

tions

in h

ighe

r edu

catio

n.

Heal

th &

Car

e Se

rvic

es

Heal

th &

Car

e Se

rvic

es;

Educ

atio

n &

Re

sear

ch

7.2

Incl

ude

exam

ples

of h

ow

nutri

tion

can

be a

ddre

ssed

in

guid

elin

es fo

r reg

ulat

ions

and

en

viro

nmen

tal i

mpa

ct s

tudi

es

purs

uant

to th

e Pl

anni

ng a

nd

Build

ing

Act

7.3

Faci

litat

e co

mpe

tenc

e-bu

ildin

g in

voc

atio

nal c

olle

ge

prog

ram

mes

for p

ublic

hea

lth

wor

kers

on

how

the

Plan

ning

an

d Bu

ildin

g Ac

t can

ser

ve a

s a

key

inst

rum

ent f

or la

ying

a

69

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

No

addi

tiona

l nut

ritio

n-re

late

d in

dica

tors

ha

ve b

een

deve

lope

d as

a to

ol fo

r mun

icip

al

plan

ning

, but

this

wor

k is

in p

rogr

ess.

Sinc

e 20

09, s

ome

coun

ties

have

mer

ged

thei

r re

sour

ce g

roup

s in

nut

ritio

n w

ith o

ther

gro

ups

(toba

cco,

phy

sica

l act

ivity

, men

tal h

ealth

, su

bsta

nce

abus

e).

The

assi

gned

role

s an

d re

spon

sibi

litie

s fo

r pu

blic

hea

lth e

fforts

at r

egio

nal l

evel

, sha

red

betw

een

the

coun

ty a

utho

ritie

s an

d co

unty

go

vern

ors,

hav

e ch

ange

d si

nce

2010

with

im

plic

atio

ns fo

r the

org

aniza

tion

and

fund

ing

of p

ublic

hea

lth w

ork,

incl

udin

g th

e w

ork

of th

e re

sour

ce g

roup

s.

Until

201

0 th

ere

was

a n

atio

nal i

nter

net p

orta

l for

mun

icip

al

heal

th p

rofil

es w

hich

incl

uded

hea

lth in

dica

tors

as

a to

ol in

m

unic

ipal

pla

nnin

g (k

omm

uneh

else

profi

ler).

Birt

h w

eigh

t and

th

e pa

rtici

patio

n ra

te o

f sch

ools

in th

e fru

it an

d ve

geta

ble

subs

crip

tion

sche

me

wer

e in

clud

ed a

s nu

tritio

n-re

late

d in

dica

tors

ava

ilabl

e fro

m e

xist

ing

data

col

lect

ions

. Fur

ther

nu

tritio

n in

dica

tors

wer

e w

arra

nted

.

With

the

new

pub

lic h

ealth

law

of J

anua

ry 2

012,

a n

ew w

eb

porta

l for

hea

lth in

dica

tors

for e

ach

mun

icip

ality

has

bee

n de

velo

ped

(folk

ehel

sepr

ofile

r). A

ccor

ding

to th

e ne

w la

w, t

he

Dire

ctor

ate

of H

ealth

and

the

Nor

weg

ian

Inst

itute

of P

ublic

He

alth

sha

ll su

ppor

t loc

al a

utho

ritie

s in

obt

aini

ng a

n ov

ervi

ew o

f th

e pu

blic

hea

lth s

ituat

ion

in th

e co

mm

unity

.

In 2

009,

18

out o

f 19

coun

ties

had

reso

urce

gro

ups

in n

utrit

ion.

Th

ese

grou

ps w

ere

esta

blis

hed

in o

rder

to a

dvoc

ate

and

cons

titut

e a

reso

urce

net

wor

k in

rela

tion

to in

tegr

atin

g nu

tritio

n in

par

tner

ship

s fo

r pub

lic h

ealth

at c

ount

y an

d m

unic

ipal

leve

l. Th

e Di

rect

orat

e of

Hea

lth o

rgan

ized

annu

al m

eetin

gs fo

r the

re

sour

ce g

roup

s fro

m 2

007

to 2

010.

Heal

th &

Car

e Se

rvic

es

Heal

th &

Car

e Se

rvic

es

loca

l fou

ndat

ion

for n

utrit

ion

initi

ativ

es

7.4

Deve

lop

effe

ctiv

e in

dica

tors

for n

utrit

ion

and

publ

ic h

ealth

for i

nclu

sion

in

mun

icip

al h

ealth

pro

files

7.5

Cont

inue

nut

ritio

n an

d di

et in

itiat

ives

toge

ther

with

ph

ysic

al a

ctiv

ity a

nd a

nti-

toba

cco

prog

ram

mes

as

a pr

iorit

y fo

cus

in p

artn

ersh

ips

for p

ublic

hea

lth

70

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

A re

port

abou

t the

Par

tner

ship

s fo

r Pub

lic

Heal

th in

itiat

ive

is a

vaila

ble

in N

orw

egia

n fro

m

the

Dire

ctor

ate

of H

ealth

.

Som

e re

ports

are

ava

ilabl

e as

a re

sult

of N

ordi

c co

llabo

ratio

n.

The

min

istri

es h

ave

been

enc

oura

ged

to

inco

rpor

ate

nutri

tion-

rela

ted

mea

sure

s in

to

thei

r wor

k, w

here

rele

vant

.

Annu

al re

ports

from

the

coun

ty g

over

nors

, cou

nty

auth

oriti

es a

nd

the

Boar

d of

Hea

lth S

uper

visi

on a

re re

view

ed a

nd s

umm

arize

d by

the

Dire

ctor

ate

of H

ealth

with

resp

ect t

o nu

tritio

n pr

ogra

mm

es. I

n ad

ditio

n, c

ount

y an

d m

unic

ipal

mee

tings

and

co

nfer

ence

s ar

e or

gani

zed

for t

he p

urpo

se o

f exc

hang

ing

know

ledg

e, id

eas,

exp

erie

nce

and

mod

els.

The

Dire

ctor

ate

of

Heal

th a

lso

cont

ribut

es to

the

exch

ange

s th

roug

h its

regu

lar

wor

k. In

add

ition

, the

re is

Nor

dic

coop

erat

ion

in th

is fi

eld.

See

7.5.

Heal

th &

Car

e Se

rvic

es;

Agric

ultu

re

&F

ood;

Fi

sher

ies

&

Coas

talA

ffairs

;Ch

ildre

n,

Equa

lity

& S

ocia

l In

clus

ion;

La

bour

;En

viro

nmen

t

Heal

th &

Car

e Se

rvic

es;

Agric

ultu

re &

Fo

od;L

abou

r;Fi

sher

ies

&

Coas

talA

ffairs

;Ch

ildre

n,

Equa

lity

& S

ocia

l In

clus

ion;

En

viro

nmen

t

7.6

Colle

ct, c

omm

unic

ate

and,

if n

eces

sary

, dev

elop

to

ols

and

mod

els

for n

utrit

ion

activ

ities

7.7

Coor

dina

te a

nd c

hann

el

ince

ntiv

e fu

nds

from

va

rious

nat

iona

l foo

d,

diet

, phy

sica

l act

ivity

and

he

alth

pro

gram

mes

to lo

cal

mea

sure

s

71

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

See

1.4.

Ther

e is

no

eval

uatio

n of

or d

ocum

enta

tion

on

use

of th

e m

ater

ial,

nor w

heth

er s

choo

ls a

nd

teac

hers

are

aw

are

of it

s ex

iste

nce.

Othe

r rel

evan

t mat

eria

l is

avai

labl

e on

line,

su

ch a

s gu

idan

ce o

n th

e su

bjec

t of f

ood

and

heal

th (h

ome

econ

omic

s) a

t the

Dire

ctor

ate

of

Educ

atio

n.

Teac

hing

mat

eria

l is

avai

labl

e as

par

t of t

he

annu

al W

eek

of Ta

ste

proj

ect i

nitia

ted

by th

e M

inis

tries

of F

ishe

ries

& C

oast

al A

ffairs

and

Fi

nanc

e.

The

proj

ect D

en n

atur

lige

skol

esek

ken

[The

N

atur

al S

choo

lbag

], by

the

Min

istri

es o

f

See

1.4.

The

Cook

ery

book

for a

ll w

as p

ublis

hed

in S

epte

mbe

r 200

7. It

is

dis

tribu

ted

free

to p

upils

at t

he lo

wer

sec

onda

ry le

vel a

nd

to te

ache

r-tra

inin

g st

uden

ts. M

unic

ipal

ities

can

buy

the

book

at

pro

duct

ion

cost

for t

rain

ing

purp

oses

and

it is

als

o av

aila

ble

in b

ooks

hops

. It i

s up

date

d w

ith in

form

atio

n ab

out k

eyho

le

labe

lling

and

new

die

tary

adv

ice.

Teac

hing

mat

eria

ls h

ave

been

dev

elop

ed b

y th

e Di

rect

orat

e of

Hea

lth, i

n co

llabo

ratio

n w

ith th

e Di

rect

orat

e of

Edu

catio

n an

d N

orw

egia

n Fo

od S

afet

y Au

thor

ity, f

or v

ario

us g

rade

s on

nu

tritio

n, la

belli

ng, h

ygie

ne a

nd k

eyho

le la

belli

ng.

Heal

th &

Car

e Se

rvic

es

Heal

th &

Car

e Se

rvic

es;

Agric

ultu

re

&F

ood;

Fi

sher

ies

&

Coas

talA

ffairs

;Ed

ucat

ion

&

Rese

arch

8.1

Offe

r a b

asic

coo

kery

bo

ok fr

ee to

pup

ils a

t the

lo

wer

sec

onda

ry le

vel a

nd to

te

ache

r-tra

inin

g st

uden

ts

8.2

Deve

lop

and

offe

r w

eb-b

ased

edu

catio

nal

prog

ram

mes

for u

se in

pr

imar

y sc

hool

s

8. C

apac

ity-b

uild

ing

in n

utri

tion-

rela

ted

issu

esGo

als:

Con

tribu

te to

con

sist

ent k

now

ledg

e an

d sk

ills

in fo

od, f

ood

prep

arat

ion,

die

t and

hea

lth a

mon

g yo

ung

peop

le

Cont

ribut

e to

goo

d qu

alifi

catio

ns in

food

, die

t and

hea

lth a

mon

g te

ache

rs in

food

and

hea

lth

Cont

ribut

e to

ade

quat

e kn

owle

dge

abou

t nut

ritio

n an

d so

cial

ineq

ualit

ies

in d

iet a

nd h

ealth

am

ong

rele

vant

hea

lth p

erso

nnel

gro

ups,

and

em

pow

er th

em

to

use

this

kno

wle

dge

in th

eir d

aily

wor

k

Cont

ribut

e to

mor

e kn

owle

dge

abou

t the

nee

d fo

r nut

ritio

n qu

alifi

catio

ns a

nd h

ow a

ny n

eeds

can

be

cove

red

72

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

Educ

atio

n &

Res

earc

h an

d th

e En

viro

nmen

t, ha

s in

tegr

ated

the

lear

ning

obj

ectiv

es fo

r the

su

bjec

t of f

ood

and

heal

th. T

he fo

cus

area

of

the

proj

ect i

s pr

imar

ily o

n th

e en

viro

nmen

t and

su

stai

nabi

lity

in g

ener

al.

Teac

hing

mat

eria

l is

also

ava

ilabl

e fro

m a

ll of

th

e in

form

atio

n of

fices

for f

ruit

and

vege

tabl

es,

eggs

and

mea

t, da

iry p

rodu

cts,

sea

food

and

br

eads

and

cer

eals

. Thi

s te

achi

ng m

ater

ial i

s be

ing

used

ext

ensi

vely.

Seve

ral m

inis

tries

hav

e re

ceiv

ed a

lette

r fro

m

the

Asso

ciat

ion

of Te

ache

rs in

Foo

d an

d He

alth

ex

pres

sing

thei

r con

cern

rega

rdin

g th

e fu

ture

of

the

subj

ect,

its s

tatu

s an

d th

e po

ssib

ilitie

s of

re

achi

ng th

e le

arni

ng o

bjec

tives

. For

exa

mpl

e,

ther

e is

no

text

book

for t

his

subj

ect i

n pr

imar

y sc

hool

s.

Colla

bora

tion

betw

een

the

Dire

ctor

ate

of H

ealth

and

the

Dire

ctor

ate

of E

duca

tion

and

Trai

ning

has

hig

hlig

hted

the

need

to

stre

ngth

en th

e po

sitio

n of

the

subj

ect H

ome

Econ

omic

s, F

ood

and

Heal

th. C

once

rns

abou

t thi

s su

bjec

t hav

e be

en ra

ised

in

seve

ral p

oliti

cal a

rena

s. It

is e

stim

ated

that

aro

und

70%

of t

he

teac

hers

in fo

od a

nd h

ealth

in p

rimar

y an

d lo

wer

sec

onda

ry

educ

atio

n do

not

hav

e su

bjec

t-spe

cific

trai

ning

.

In 2

007

and

2008

, the

Dire

ctor

ate

of H

ealth

org

anize

d se

min

ars

for s

tude

nt te

ache

rs in

voc

atio

nal c

olle

ges

and

univ

ersi

ties.

A m

eetin

g w

as h

eld

in 2

009

betw

een

the

Dire

ctor

ate

of

Heal

th a

nd th

e Di

rect

orat

e of

Edu

catio

n an

d Tr

aini

ng a

nd

repr

esen

tativ

es fr

om th

e Bu

sker

ud a

nd V

estfo

ld v

ocat

iona

l co

llege

s as

wel

l as

the

Asso

ciat

ion

of Te

ache

rs in

Hom

e Ec

onom

ics,

who

are

resp

onsi

ble

for f

ood

and

heal

th in

prim

ary

and

low

er s

econ

dary

sch

ools

, to

disc

uss

the

chal

leng

es w

ith th

e su

bjec

t.

Heal

th &

Car

e Se

rvic

es;

Educ

atio

n &

Re

sear

ch;L

ocal

Go

vern

men

t &

Reg

iona

l De

velo

pmen

t

Heal

th &

Car

e Se

rvic

es;

Educ

atio

n &

Re

sear

ch;L

ocal

Go

vern

men

t &

Reg

iona

l De

velo

pmen

t

8.3

Enco

urag

e th

e al

loca

tion

of re

sour

ces

for p

ract

ical

tra

inin

g in

food

and

hea

lth

8.4

Stim

ulat

e th

e es

tabl

ishm

ent o

f con

tinui

ng

and

furth

er e

duca

tion

prog

ram

mes

in n

utrit

ion,

di

et a

nd fo

od a

nd h

ealth

an

d di

ssem

inat

e in

form

atio

n ab

out t

hem

73

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

8.5

Asse

ss n

eeds

and

po

ssib

ilitie

s fo

r stre

ngth

enin

g nu

tritio

n in

rele

vant

nat

iona

l cu

rricu

la

8.6

Ensu

re a

dequ

ate

qual

ifica

tions

in d

iet a

nd

nutri

tion

in th

e nu

rsin

g an

d ca

re s

ecto

r

Educ

atio

n &

Re

sear

ch;

Heal

th &

Car

e Se

rvic

es

An a

dditi

onal

mee

ting

was

hel

d in

the

autu

mn

of 2

010

betw

een

the

Dire

ctor

ate

of H

ealth

and

the

Asso

ciat

ion

of Te

ache

rs o

f Ho

me

Econ

omic

s, w

ho a

re re

spon

sibl

e fo

r foo

d an

d he

alth

in

prim

ary

and

low

er s

econ

dary

sch

ools

.

Follo

win

g pu

blic

atio

n of

the

repo

rt Ko

mpe

tans

e fo

r kva

litet

–

stra

tegi

for v

ider

eutd

anni

ng a

v læ

rere

(200

8–20

12) [

Com

pete

nce

for q

ualit

y –

stra

tegy

for t

he fu

rther

edu

catio

n of

teac

hers

(2

008–

2012

)], th

e go

vern

men

t gav

e fin

anci

al s

uppo

rt fo

r fur

ther

ed

ucat

ion

prog

ram

mes

for t

each

ers,

incl

udin

g te

ache

rs o

f foo

d an

d he

alth

(hom

e ec

onom

ics)

. Not

all

the

stud

ent p

lace

s in

this

su

bjec

t hav

e be

en fi

lled.

The

mun

icip

al a

utho

ritie

s an

d sc

hool

he

ads

deci

de w

hich

teac

hers

and

/or d

isci

plin

es s

houl

d ge

t fu

rther

edu

catio

n.

The

univ

ersi

ty s

ecto

r in

all s

ix e

duca

tiona

l reg

ions

is s

uppo

sed

to o

ffer c

lass

es fo

r stu

dent

teac

hers

ena

blin

g th

em to

teac

h al

l su

bjec

ts in

prim

ary

and

low

er s

econ

dary

sch

ool.

In th

e de

velo

pmen

t of t

he n

ew re

gula

tion

for t

each

er tr

aini

ng,

the

Min

istry

of H

ealth

& C

are

Serv

ices

sub

mitt

ed in

put o

n th

e ne

ed fo

r bet

ter c

ompe

tenc

e in

hea

lth p

rom

otio

n am

ong

teac

hers

. Thi

s w

as n

ot ta

ken

into

acc

ount

in th

e su

bseq

uent

re

gula

tions

.

Ther

e is

a n

eed

for m

ore

nutri

tion

educ

atio

n fo

r hea

lth c

are

prof

essi

onal

s, e

spec

ially

doc

tors

, nur

ses

and

soci

al w

orke

rs.

This

is re

ferre

d to

in th

e w

hite

pap

er fr

om th

e M

inis

try o

f Ed

ucat

ion

Educ

atio

n fo

r the

wel

fare

sta

te (R

epor

t No.

13

(201

1–20

12) t

o pa

rliam

ent).

An e

valu

atio

n re

port

on th

e ed

ucat

ion

of p

re-

scho

ol te

ache

rs is

ava

ilabl

e fro

m N

OKUT

(the

N

atio

nal O

rgan

izatio

n fo

r Qua

lity

in E

duca

tion)

.

A ne

w n

atio

nal c

urric

ulum

regu

latio

n fo

r pre

-sc

hool

edu

catio

n is

und

er d

evel

opm

ent.

See

8.4.

See

the

Min

istry

of H

ealth

& C

are

Serv

ices

pu

blic

atio

n Lo

ng-te

rm c

are

– fu

ture

cha

lleng

es.

74

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

The

repo

rt fro

m th

e Di

rect

orat

e of

Hea

lth

estim

ates

that

700

clin

ical

nut

ritio

nist

s ar

e ne

eded

in th

e he

alth

and

car

e se

rvic

es b

y 20

20. I

n 20

11, a

bout

140

nut

ritio

nist

s w

ere

empl

oyed

, mos

t of t

hem

in h

ospi

tals

. Onl

y 3%

w

ere

empl

oyed

in m

unic

ipal

hea

lth a

nd c

are

serv

ices

.

In th

e bu

dget

for 2

011–

2012

, the

gov

ernm

ent

allo

wed

for t

he n

umbe

r of s

tude

nts

in c

linic

al

nutri

tion

to b

e in

crea

sed

by 2

0 (1

5 at

the

Univ

ersi

ty o

f Osl

o an

d 5

at th

e Un

iver

sity

of

Berg

en).

In 2

012,

the

Univ

ersi

ty o

f Osl

o pl

anne

d to

adm

it 35

stu

dent

s an

d th

e Un

iver

sity

of

Berg

en 1

5 to

do

Mas

ter’s

deg

rees

in c

linic

al

nutri

tion.

At t

he U

nive

rsity

of B

erge

n, h

owev

er,

not a

ll of

the

proj

ecte

d 13

stu

dent

s st

arte

d in

20

10, a

nd in

201

1 on

ly 7

new

Mas

ter’s

stu

dent

s st

arte

d.

The

Min

istry

of E

duca

tion’s

repo

rt Ed

ucat

ion

for

the

wel

fare

sta

te c

onfir

ms

that

the

gove

rnm

ent

will

wor

k to

ens

ure

that

ther

e is

acc

ess

to

clin

ical

nut

ritio

nist

s in

the

who

le c

ount

ry.

From

201

0, a

spe

cial

effo

rt w

as m

ade

to s

treng

then

nut

ritio

n co

mpe

tenc

e in

the

nurs

ing

and

care

sec

tor.

In 2

011,

the

Dire

ctor

ate

of H

ealth

ann

ounc

ed fu

ndin

g op

portu

nitie

s fo

r m

unic

ipal

ities

to s

treng

then

thei

r com

pete

nces

in n

utrit

ion

in

this

sec

tor a

s pa

rt of

the

Com

pete

nce

Lift

2015

pro

ject

.

See

also

6.1

and

6.5

.

The

surv

ey o

n fo

od a

nd m

eals

in n

ursi

ng h

omes

(6.5

) sho

wed

th

at th

e st

aff n

eed

incr

ease

d ac

cess

to n

utrit

ion

expe

rtise

.

Repo

rts w

ere

deliv

ered

to th

e M

inis

try o

f Hea

lth &

Car

e Se

rvic

es in

200

9, 2

010

and

2011

on

the

futu

re n

eeds

for

clin

ical

nut

ritio

nist

s. T

he re

ports

des

crib

e ho

w d

iffer

ent g

roup

s of

per

sonn

el m

ay b

e qu

alifi

ed to

eng

age

in v

ario

us fo

rms

of

nutri

tion

wor

k an

d pr

esen

t diff

eren

t mod

els

for s

treng

then

ing

com

pete

nce

in n

utrit

ion.

Feed

back

from

the

Min

istry

of H

ealth

& C

are

Serv

ices

is n

eede

d to

follo

w u

p th

e m

easu

res

in th

e on

goin

g w

ork

in th

e Di

rect

orat

e of

Hea

lth.

Heal

th &

Car

e Se

rvic

es

Heal

th &

Car

e Se

rvic

es8.

7 Co

nsid

er fu

ture

nee

ds fo

r nu

tritio

n sp

ecia

lists

in th

e he

alth

ser

vice

75

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

Fifte

en re

sear

ch p

roje

cts

are

bein

g ca

rried

out

in

the

prog

ram

me

rela

ted

to n

utrit

ion.

Som

e ex

ampl

es a

re li

sted

bel

ow (a

com

plet

e lis

t has

be

en re

ques

ted

from

the

Rese

arch

Cou

ncil)

.

•

The

heal

the

ffect

sof

ad

ietr

ich

inp

lant

-ba

sed

food

s an

d fis

h. F

ocus

on

Nor

dic

food

s.•

Fr

uits

and

Veg

etab

les

Mak

eth

eM

arks

III:

How

to im

prov

e ad

oles

cent

s’ e

atin

g ha

bits

?•

Fo

oda

nde

atin

gam

ong

youn

gN

orw

egia

ns.

A so

ciol

ogic

al a

naly

sis

of te

enag

ers’

food

id

eolo

gies

and

pra

ctic

es in

an

ever

yday

co

ntex

t.

The

Rese

arch

Cou

ncil

is c

oord

inat

ing

the

Nor

weg

ian

inpu

ts to

the

plan

ned

EU

prog

ram

me

A He

alth

y Di

et fo

r a H

ealth

y Li

fe.

A w

orks

hop

has

been

hel

d w

here

Nor

weg

ian

rese

arch

ers

drew

up

a le

tter w

ith in

puts

to th

e pr

ogra

mm

e.

The

Rese

arch

Cou

ncil

and

the

Min

istry

of

Heal

th &

Car

e Se

rvic

es a

re m

embe

rs o

f

The

Min

istry

of H

ealth

& C

are

Serv

ices

allo

cate

d a

budg

et fo

r 20

07–2

010

to th

e re

sear

ch p

rogr

amm

e on

pub

lic h

ealth

at t

he

Rese

arch

Cou

ncil.

Res

earc

h on

hea

lthie

r die

ts w

as o

ne o

f fou

r pr

iorit

ized

rese

arch

are

as, a

nd 1

5 re

sear

ch p

roje

cts

rece

ived

fu

ndin

g. T

he A

ctio

n Pl

an w

as a

lso

refe

rred

to in

the

gene

ral

allo

catio

n le

tter t

o th

e Re

sear

ch C

ounc

il. A

repo

rt fo

r the

pr

ogra

mm

e pe

riod

is a

vaila

ble.

The

Min

istry

of E

duca

tion

& R

esea

rch

initi

ated

a s

yste

mat

ic

revi

ew o

f the

effe

cts

of p

rovi

ding

mea

ls in

sch

ools

and

ki

nder

garte

ns o

n he

alth

and

lear

ning

, a d

escr

iptio

n of

exi

stin

g m

eal a

rrang

emen

ts in

sch

ools

and

kin

derg

arte

ns in

the

diffe

rent

N

ordi

c co

untri

es, a

nd a

n an

alys

is o

f cur

rent

kno

wle

dge

abou

t th

e ef

fect

on

heal

th a

nd le

arni

ng b

y pr

ovid

ing

food

in th

ese

inst

itutio

ns, a

s w

ell a

s id

entif

ying

rese

arch

gap

s w

ithin

this

fie

ld.

Heal

th &

Car

e Se

rvic

es9.

1 St

reng

then

rese

arch

on

the

rela

tions

hip

betw

een

diet

an

d he

alth

9. R

esea

rch,

mon

itori

ng a

nd d

ocum

enta

tion

Goal

s: P

rovi

de in

crea

sed

know

ledg

e ab

out t

he li

nks

betw

een

diet

and

hea

lth

Prov

ide

know

ledg

e ab

out t

he s

tatu

s of

and

tren

ds in

die

t and

mea

l hab

its in

Nor

way

Pr

ovid

e kn

owle

dge

abou

t fac

tors

that

affe

ct th

e fo

od c

hoic

es a

nd d

ieta

ry h

abits

of t

he g

ener

al p

opul

atio

n an

d va

rious

pop

ulat

ion

grou

ps

Prov

ide

know

ledg

e ab

out t

he e

ffect

s of

die

tary

mea

sure

s to

impr

ove

the

natio

nal d

iet a

nd re

duce

soc

ial i

nequ

aliti

es in

die

t

Prov

ide

know

ledg

e ab

out t

he c

ultu

ral a

nd s

ocia

l sig

nific

ance

of m

eals

for h

ealth

Pr

ovid

e th

e ba

sis

for N

orw

egia

n fo

od p

rodu

ctio

n th

at re

spec

ts h

ealth

con

cern

s

76

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

the

Man

agem

ent B

oard

. The

Dire

ctor

ate

of

Heal

th h

as o

ne re

pres

enta

tive

on th

e St

rate

gy

Advi

sory

Boa

rd.

Seve

n pr

ojec

ts re

ceiv

ed fu

ndin

g on

food

and

he

alth

from

the

Food

Pro

gram

me

durin

g th

e pe

riod

of th

e Ac

tion

Plan

.

Two

proj

ects

hav

e be

en in

itiat

ed b

y th

e Pr

ogra

mm

e: (i

) Hea

lthM

eal:

Poss

ibili

ties

and

Barri

ers

for I

ncre

ased

Con

sum

ptio

n of

Fis

h an

d Ve

geta

bles

in M

eals

Eat

en a

t Hom

e an

d Ou

tsid

e Ho

me,

by

the

Stat

ens

Inst

itutt

for F

orbr

uksf

orsk

ning

[Nat

iona

l Ins

titut

e fo

r Co

nsum

er R

esea

rch]

, and

(ii)

Heal

thy

Mea

ls a

nd

Prev

entio

n of

Life

styl

e Di

seas

es, b

y N

ofim

a.

A Re

sear

ch C

ounc

il re

port

in 2

010

drew

at

tent

ion

to th

e st

atus

of a

nd n

eeds

with

in

Nor

weg

ian

rese

arch

on

food

and

hea

lth.

The

repo

rt w

as w

ritte

n by

NIF

U-ST

EP a

nd is

av

aila

ble

(in N

orw

egia

n).

Nofi

ma

is w

orki

ng o

n ne

w re

sear

ch o

n he

alth

y in

gred

ient

s an

d m

eals

. The

Nor

weg

ian

food

in

dust

ry is

invo

lved

in th

e re

sear

ch p

latfo

rm

Food

for L

ife.

The

Nor

dic

Cent

re o

f Exc

elle

nce

prog

ram

me

(200

7–20

11) o

n fo

od p

rodu

cts,

nut

ritio

n an

d he

alth

is c

o-fin

ance

d by

Nor

dFor

sk

and

the

Nor

dic

rese

arch

fund

ing

agen

cies

.

The

Min

istry

of A

gric

ultu

re &

Foo

d al

loca

ted

fund

s to

the

Rese

arch

Cou

ncil’s

Foo

d Pr

ogra

mm

e in

200

7–20

10.

The

Min

istry

of F

ishe

ries

& C

oast

al A

ffairs

allo

cate

d fu

nds

to

the

Rese

arch

Cou

ncil’s

Foo

d Pr

ogra

mm

e in

200

7–20

10. T

he

Min

istry

has

rais

ed it

s co

ncer

n w

ith th

e Co

unci

l for

the

need

fo

r mor

e re

sear

ch o

n se

afoo

d an

d he

alth

. The

Min

istry

als

o su

ppor

ts fo

od re

sear

ch th

roug

h al

loca

tions

to N

ofim

a an

d th

e N

atio

nal I

nstit

ute

of N

utrit

ion

and

Seaf

ood

Rese

arch

.

Agric

ultu

re

&F

ood;

Fi

sher

ies

&

Coas

talA

ffairs

;He

alth

& C

are

Serv

ices

;Tra

de

& In

dust

ry

9.2

Prom

ote

rese

arch

to

stim

ulat

e de

velo

pmen

t of

bette

r and

hea

lthie

r pro

duct

s

77

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

9.3

Cont

inue

and

furth

er

deve

lop

mon

itorin

g of

the

popu

latio

n’s d

iet

9.4

Ensu

re e

xper

t stu

dies

an

d up

date

d of

ficia

l re

com

men

datio

ns

Heal

th &

Car

e Se

rvic

es;

Agric

ultu

re &

Fo

od;F

ishe

ries

& C

oast

al

Affa

irs

The

follo

win

g da

ta h

ave

been

col

lect

ed:

•

infa

ntfo

od(s

pedk

ost)

(n=3

000

pare

nts

invi

ted)

:dat

aon

in

fant

sag

ed6

and

12

mon

ths

colle

cted

in2

006–

2007

;•

sm

allc

hild

ren’s

food

(sm

åbar

nsko

st):

data

on

child

ren

colle

cted

in2

009;

•

natio

nwid

esu

rvey

(nor

kost

)ofa

ppro

xim

atel

y50

00p

eopl

eag

ed 1

8–70

yea

rs: p

ilot c

olle

ctio

n in

200

9, m

ain

data

co

llect

ion

in2

010;

repo

rtpu

blis

hed

in2

012.

Data

are

als

o av

aila

ble

from

oth

er n

atio

nal s

urve

ys s

uch

as

Stat

istic

s N

orw

ay’s

Heal

th In

terv

iew

Sur

vey.

In 2

008,

650

0 pe

ople

took

par

t. Th

e m

ost r

ecen

t sur

vey

was

in 2

012.

Met

hods

for a

pan

-Nor

dic

mon

itorin

g of

tren

ds in

die

t, ph

ysic

al

activ

ity a

nd o

verw

eigh

t hav

e be

en d

evel

oped

and

val

idat

ed.

Base

line

data

wer

e co

llect

ed in

201

1. T

he o

vera

ll fo

cus

for t

he

proj

ect i

s he

alth

pro

mot

ion

and

prev

entio

n, w

here

die

t and

ph

ysic

al a

ctiv

ity is

one

of fi

ve a

reas

(74)

.

In e

arly

201

1, th

e N

atio

nal C

ounc

il on

Nut

ritio

n pr

esen

ted

its

reco

mm

enda

tions

for r

evis

ed n

atio

nal d

ieta

ry g

uide

lines

and

re

com

men

datio

ns (s

ee 1

.2).

Wor

k is

con

tinui

ng o

n th

e de

velo

pmen

t of p

an-N

ordi

c di

etar

y re

com

men

datio

ns. T

he D

irect

orat

e of

Hea

lth is

repr

esen

ted

on th

e st

eerin

g co

mm

ittee

, the

refe

renc

e gr

oup

and

one

of th

e ex

pert

grou

ps (s

ee 1

0.3)

.

The

mos

t rec

ent fi

ndin

gs a

re p

rese

nted

in a

se

para

te d

ocum

ent.

In 2

000,

dat

a w

ere

colle

cted

abo

ut y

oung

pe

ople

’s fo

od fr

om a

ppro

xim

atel

y 20

00

scho

olch

ildre

n fro

m g

rade

s 4

and

8, a

s w

ell

as 4

00 c

hild

ren

aged

4 y

ears

. The

nex

t dat

a co

llect

ion

is p

lann

ed fo

r 201

3.

Ther

e is

an

ongo

ing

proc

ess

head

ed b

y th

e In

stitu

te fo

r Pub

lic H

ealth

to d

evel

op to

ols

for

heal

th in

dica

tors

for m

unic

ipal

ities

(see

7.4

).

The

Scie

ntifi

c Co

mm

ittee

for F

ood

Safe

ty

publ

ishe

d th

e re

port

Impa

ct o

n he

alth

whe

n su

gar i

s re

plac

ed w

ith in

tens

e sw

eete

ners

in

soft

drin

ks, ‘

saft’

and

nec

tar i

n 20

07.

The

Scie

ntifi

c Co

mm

ittee

for F

ood

Safe

ty h

as

appo

inte

d a

wor

king

gro

up w

ho a

sses

s th

e be

nefit

s an

d ris

ks o

f bre

ast-m

ilk. T

heir

repo

rt sh

ould

be

publ

ishe

d in

201

3.

78

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

Nor

way

has

par

ticip

ated

act

ivel

y in

Wor

ld H

ealth

Ass

embl

ies,

bo

th in

pre

para

tory

wor

k an

d du

ring

the

mee

tings

.

The

Dire

ctor

ate

of H

ealth

has

giv

en it

s in

put t

o W

HO’s

Mat

erna

l, in

fant

and

you

ng c

hild

nut

ritio

n: d

raft

com

preh

ensi

ve

impl

emen

tatio

n pl

an.

Nor

way

has

bee

n re

pres

ente

d in

the

EU’s

High

-Lev

el G

roup

on

Nut

ritio

n an

d Ph

ysic

al A

ctiv

ity a

nd in

the

Euro

pean

Sal

t Act

ion

Net

wor

k si

nce

2008

.

The

Dire

ctor

ate

of H

ealth

is th

e se

cret

aria

t for

and

cha

irs th

e Eu

rope

an n

etw

ork

on re

duci

ng th

e m

arke

ting

of u

nhea

lthy

food

s an

d be

vera

ges

tow

ards

chi

ldre

n, in

col

labo

ratio

n w

ith th

e W

HO

Regi

onal

Offi

ce fo

r Eur

ope.

Twen

ty E

urop

ean

coun

tries

are

in

volv

ed.

The

Dire

ctor

ate

of H

ealth

was

tech

nica

lly re

spon

sibl

e fo

r the

W

HO R

egio

nal H

igh-

Leve

l Con

sulta

tion

in th

e Eu

rope

an R

egio

n on

the

Prev

entio

n an

d Co

ntro

l of N

onco

mm

unic

able

Dis

ease

s,

held

in O

slo

on 2

5 an

d 26

Nov

embe

r 201

0, in

pre

para

tion

for t

he

high

-leve

l mee

ting

on n

onco

mm

unic

able

dis

ease

s he

ld d

urin

g th

e Un

ited

Nat

ions

Gen

eral

Ass

embl

y in

Sep

tem

ber 2

011.

Civ

il so

ciet

ies

orga

nize

d th

eir o

wn

mee

tings

and

pre

pare

d th

eir o

wn

sugg

estio

ns fo

r res

olut

ions

on

the

day

befo

re th

e co

nfer

ence

. A

reso

lutio

n pr

opos

ed b

y N

orw

ay o

n re

duci

ng th

e m

arke

ting

of

Heal

th &

Car

e Se

rvic

es10

.1 P

artic

ipat

e ac

tivel

y in

W

HO’s

wor

k on

nut

ritio

n,

glob

ally

and

regi

onal

ly

10. N

utri

tion

in a

n in

tern

atio

nal p

ersp

ectiv

e Go

als:

Con

tribu

te a

ctiv

ely

in c

oope

ratio

n w

ith o

ther

cou

ntrie

s an

d in

tern

atio

nal o

rgan

izatio

ns o

n nu

tritio

n is

sues

St

reng

then

the

focu

s on

nut

ritio

n in

aid

and

dev

elop

men

t coo

pera

tion

Ra

ise

awar

enes

s th

at b

reas

tfeed

ing

and

nutri

tion

are

impo

rtant

com

pone

nts

in p

riorit

y ar

eas,

suc

h as

act

ion

to im

prov

e ch

ild h

ealth

and

redu

ce c

hild

mor

talit

y

79

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

unhe

alth

y fo

ods

and

non-

alco

holic

bev

erag

es to

war

ds c

hild

ren

at th

e W

orld

Hea

lth A

ssem

bly

in 2

010

was

app

rove

d.

At th

e fir

st W

HO G

loba

l Min

iste

rial C

onfe

renc

e on

Hea

lthy

Life

styl

es a

nd N

onco

mm

unic

able

Dis

ease

Con

trol,

held

in

Mos

cow

on

28 a

nd 2

9 Ap

ril 2

011,

the

Regi

onal

Offi

ce

cons

ulte

d M

embe

r Sta

tes

and

othe

r key

sta

keho

lder

s on

the

repo

rt an

d pr

esen

ted

the

final

ver

sion

at t

he s

ame

conf

eren

ce.

The

Nor

weg

ian

Min

iste

r of H

ealth

cha

ired

the

roun

d-ta

ble

disc

ussi

on o

n nu

tritio

n.

Nor

way

cha

ired

the

bila

tera

l gro

up w

ithin

the

Stan

ding

Co

mm

ittee

on

Nut

ritio

n fo

r 10

year

s up

to 2

010.

The

Min

istry

of A

gric

ultu

re &

Foo

d w

as o

bser

ver d

urin

g a

mee

ting

with

the

Wor

ld C

ance

r Res

earc

h Fu

nd in

Lon

don

whe

re

the

asso

ciat

ions

bet

wee

n ca

ncer

and

inta

ke o

f mea

t wer

e de

bate

d. R

epre

sent

ativ

es o

f Nor

weg

ian

mea

t pro

duce

rs a

lso

parti

cipa

ted.

A N

ordi

c w

orki

ng g

roup

(lin

ked

to th

e N

ordi

c Co

unci

l of

Min

iste

rs fo

r Fis

herie

s an

d Aq

uacu

lture

, Agr

icul

ture

, Foo

d an

d Fo

rest

ry a

nd th

e N

ordi

c W

orki

ng G

roup

for D

iet,

Food

&

Toxi

colo

gy) h

as in

itiat

ed p

roje

ct c

olla

bora

tion

on m

onito

ring,

co

mm

unic

atio

n an

d ev

alua

tion

of th

e ke

yhol

e la

belli

ng s

yste

m,

com

mun

icat

ion

mea

sure

s to

war

ds c

hild

ren,

exa

mpl

es o

f bes

t pr

actic

e an

d tra

inin

g of

teac

hers

in fo

od a

nd h

ealth

. Thi

s in

itiat

ive

is a

follo

w-u

p to

the

Nor

dic

Actio

n Pl

an fo

r Bet

ter

Heal

th a

nd Q

ualit

y of

Life

.

Fore

ign

Affa

irs;

Heal

th &

Car

e Se

rvic

es

Heal

th &

Car

e Se

rvic

es

10.2

Con

tribu

te a

ctiv

ely

to th

e w

ork

of th

e Un

ited

Nat

ions

St

andi

ng C

omm

ittee

on

Nut

ritio

n

10.3

Con

tribu

te a

ctiv

ely

to

Nor

dic

and

Nor

dic-

Balti

c co

oper

atio

n

80

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

The

Min

istry

of A

gric

ultu

re &

Foo

d pa

rtici

pate

d in

the

surv

ey o

f fo

od a

nd c

hild

ren

initi

ated

by

the

Nor

dic

Coun

cil o

f Min

iste

rs

(New

Nor

dic

Food

).

The

Dire

ctor

ate

of H

ealth

par

ticip

ates

in a

Nor

dic

netw

ork

on

phys

ical

act

ivity

, nut

ritio

n an

d ob

esity

with

the

Dani

sh B

oard

of

Heal

th (S

undh

edss

tyre

lsen

) and

Sw

edis

h N

atio

nal P

ublic

Hea

lth

Inst

itute

(Sta

tens

Fol

khäl

soin

stitu

t). T

he N

ordi

c Sc

hool

of P

ublic

He

alth

is th

e ad

min

istra

tor.

A pr

ojec

t gro

up a

ppoi

nted

by

the

Min

iste

r of D

evel

opm

ent A

id

has

subm

itted

a re

port

on fo

od s

ecur

ity a

nd h

unge

r.

In 2

008,

the

Nor

weg

ian

Agen

cy fo

r Dev

elop

men

t Coo

pera

tion

and

the

Dire

ctor

ate

of H

ealth

arra

nged

a s

emin

ar o

n nu

tritio

n an

d de

velo

pmen

t.

The

Unite

d N

atio

ns D

epar

tmen

t of t

he M

inis

try o

f For

eign

Af

fairs

has

bee

n ac

tive

in w

ritin

g a

new

stra

tegy

for t

he W

orld

Fo

od P

rogr

amm

e, a

nd h

as p

artic

ipat

ed in

the

high

-leve

l mee

ting

on th

e fo

od s

uppl

y cr

isis

. Nor

way

is a

boa

rd m

embe

r of t

he

Wor

ld F

ood

Prog

ram

me.

An in

tern

al s

tatu

s re

port

with

sug

gest

ions

for m

easu

res

to

stre

ngth

en n

utrit

ion-

rela

ted

prog

ram

mes

in d

evel

opm

ent a

id

was

dra

wn

up in

200

9.

The

whi

te p

aper

s on

Env

ironm

ent a

nd D

evel

opm

ent a

nd G

loba

l He

alth

incl

ude

poin

ts o

n fo

od s

ecur

ity, e

nviro

nmen

t, he

alth

and

nu

tritio

n. N

utrit

ion

in d

evel

opm

ent a

id w

ill b

e an

chor

ed in

whi

te

pape

rs a

nd fo

cus

area

s.

Heal

th &

Car

e Se

rvic

es;

Fore

ign

Affa

irs

10.4

Ens

ure

that

nut

ritio

n m

easu

res

and

asse

ssm

ent o

f nu

tritio

nal c

onse

quen

ces

are

incl

uded

as

an e

lem

ent i

n ai

d an

d de

velo

pmen

t coo

pera

tion

81

Focu

s ar

ea a

nd g

oals

M

inis

try

Mea

sure

s Co

mm

ents

resp

onsi

ble

The

Min

istry

of F

orei

gn A

ffairs

and

the

Nor

weg

ian

Agen

cy fo

r De

velo

pmen

t Coo

pera

tion

wer

e ac

tive

in th

e de

velo

pmen

t of t

he

Unite

d N

atio

ns S

ecre

tary

-Gen

eral

’s Gl

obal

Stra

tegy

on

Mat

erna

l an

d Ch

ild H

ealth

(inc

ludi

ng n

utrit

ion-

rela

ted

issu

es).

The

Min

istry

of F

orei

gn A

ffairs

and

the

Nor

weg

ian

Agen

cy

for D

evel

opm

ent C

oope

ratio

n co

ntrib

uted

to th

e W

orld

Foo

d Pr

ogra

mm

e’s n

ew H

IV/A

IDS

polic

y, w

hich

incl

udes

sup

port

for

the

prov

isio

n of

nut

ritio

nal p

rodu

cts

to H

IV-in

fect

ed p

erso

ns.

Nor

way

is in

volv

ed in

the

inte

rnat

iona

l ini

tiativ

e on

incr

easi

ng

the

focu

s on

nut

ritio

n in

dev

elop

ing

coun

tries

– S

calin

g Up

N

utrit

ion

(SUN

) – w

hich

was

laun

ched

in A

pril

2010

.

a Soc

ial i

nclu

sion

was

tran

sfer

red

from

the

Min

istry

of L

abou

r to

the

Min

istry

of C

hild

ren

& E

qual

ity in

200

8.

Evaluation of the Norwegian Nutrition Policy with focus on the Action Plan on Nutrition (2007-2011)

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Evaluation of the Norwegian Nutrition Policy with focus on the Action Plan on Nutrition (2007-2011)

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Evaluation of the Norw

egian nutrition policy with a focus on the A

ction Plan on Nutrition 2007–2011

Evaluation of the Norwegian Nutrition Policy with focus on the Action Plan on Nutrition (2007-2011)Evaluation of the Norwegian nutrition policy with a focus on the Action Plan on Nutrition 2007–2011

World Health Organization Regional Office for EuropeUN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark

Tel.: +45 45 33 70 00. Fax: +45 33 70 01. Email: contact@euro.who.intWeb site: www.euro.who.int