REGIONAL OFFICE FOR EUROPE___________________________

EUR/00/5026926ORIGINAL: ENGLISH

UNEDITEDE71724

Food and Agriculture Organization of the United Nations

INTERSECTORAL FOOD AND

NUTRITION POLICY DEVELOPMENT:

A WORKSHOP FOR DECISION-MAKERS

Report on a WHO Workshop

Sigulda, Latvia29–31 August 2000

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2000 EUROPEAN HEALTH21 TARGET 11

EUROPEAN HEALTH21 TARGET 11

HEALTHIER LIVING By the year 2015, people across society should have adopted healthier patterns of living

(Adopted by the WHO Regional Committee for Europe at its forty-eighth session, Copenhagen, September 1998)

ABSTRACT

Following a consultation in Malta in November 1999, attended by representatives of most of the Member States of the WHO European Region, the Regional Office began a process to help develop food and nutrition action plans throughout the Region. The participants in the present Workshop were from the Baltic and Nordic countries. They met to improve the skills needed to develop intersectoral policies in relation to food and nutrition, and to establish a Baltic/Nordic food and nutrition network. This will enable them to promote sustainable development as well as regional cohesion through the development of food and nutrition action plans. The 27 participants, who came from 8 countries and represented 8 different sectors, expressed interest in and commitment to developing vital cross-sectoral links in the areas of nutrition, food safety and sustainable development. The Workshop was based on a training manual entitled Intersectoral food and nutrition policy development: a manual for decision-makers, which is being finalized. The Workshop therefore served to test the training manual, and the participants provided useful feedback in this respect.

Keywords NUTRITION POLICY

INTERSECTORAL COOPERATION DECISION MAKING STRATEGIC PLANNING REGIONAL HEALTH PLANNING FOOD CONTAMINATION – prevention and control SUSTAINABILITY EUROPE, NORTHERN BALTIC STATES

© World Health Organization – 2000 All rights in this document are reserved by the WHO Regional Office for Europe. The document may nevertheless be freely reviewed,abstracted, reproduced or translated into any other language (but not for sale or for use in conjunction with commercial purposes)provided that full acknowledgement is given to the source. For the use of the WHO emblem, permission must be sought from the WHORegional Office. Any translation should include the words: The translator of this document is responsible for the accuracy of thetranslation. The Regional Office would appreciate receiving three copies of any translation. Any views expressed by named authors aresolely the responsibility of those authors.

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Participants and facilitators outside the Hotel Sigulda.

nowledgements

workshop was generously supported by the French Government. The support of the tries of health in the Baltic States, especially the Ministry of Health in Latvia, is also wledged. Grateful thanks are extended to Dr Aiga Rurane and Daina Biezaite, WHO

an Liaison Office and Dr Olafs Stengrevics, Director of the Latvian Food Centre for their ance in organizing this workshop. Sincere appreciation is expressed to Professor Tim Lang developed this successful workshop with the help of Dr Martin Caraher, Dr Charlie rbuck and Ms Chizuru Nishida. Many thanks are also due to the Food and Agriculture ization (FAO), and in particular Dr Dorina Minoiu, FAO Hungary for excellent technical oration and in addition supporting the participation of several representatives from the ltural sector in all the Baltic States. In addition, thanks are extended to the Nordic experts y Steingrimsdottir (Iceland), Lars Johansson (Norway), Kaija Hasunen (Finland), Cecilia all (Sweden) and Jørgen Højmark Jensen (Denmark) for sharing their time, resources, tise and invaluable technical input. Finally, the enthusiastic participation of all the ssionals from Estonia, Latvia and Lithuania in this workshop is gratefully appreciated.

CONTENTS

Page Foreword ................................................................................................................................................... i

Background .................................................................................................................................................. 1

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

Summary of the Workshop........................................................................................................................... 2

Opening .................................................................................................................................................. 3

Session 1. Mapping yourself in the food system....................................................................................... 5

Session 2. The impact of food and nutrition on public health................................................................... 6

Session 3. The policy context: what is a food and nutrition policy? ......................................................... 7

Session 4. Developing a comprehensive and integrated food and nutrition policy................................... 8

Session 5. Examples of food and nutrition policies .................................................................................. 9

Session 6. NGOs campaigning for food and nutrition policy ................................................................... 9

Session 7. The contents of national food and nutrition policies and action plans..................................... 9

Session 8. The procedure for developing/strengthening national policies and action plans ................... 10

Session 9. Implementation of new/existing food and nutrition action plans........................................... 10

Session 10. Review of the workshop......................................................................................................... 11 Round-table evaluation .......................................................................................................... 11 Written final evaluation.......................................................................................................... 11

Annex 1. Participants............................................................................................................................. 13 Annex 2. Programme ............................................................................................................................. 17 Annex 3. Pre-course questionnaire ........................................................................................................ 18 Annex 4. Course evaluation by participants .......................................................................................... 20 Annex 5. Examples of presentations by working groups ...................................................................... 22 Annex 6 Background documents.......................................................................................................... 39 Annex 7 WHO Regional Committee for Europe resolution EUR/RC50/R8........................................ 41

EUR/00/5026926 page i

Foreword

This report summarizes a pilot workshop, designed to test workshop materials on food and nutrition policy, held in June 2000 at Hotel Sigulda in Sigulda, Latvia. It was jointly organized by the WHO Regional Office for Europe (Food and Nutrition Policy unit, the Countrywide Integrated Noncommunicable Disease Intervention (CINDI) programme and the Child Health Development unit), the Food and Agriculture Organization (FAO) and the Centre for Food Policy at Thames Valley University, London. Arrangements at the course site were coordinated by the Ministry of Health of Latvia, Dr Aiga Rurane and Daina Biezaite, WHO Latvian Liaison Office and Dr Olafs Stengrevics, Director of the Latvian Food Centre. The training manual Food and nutrition action plans. A manual for decision-makers is being developed by Professor Tim Lang, with the support of Dr Martin Caraher, Dr Charlie Clutterbuck and Ms Chizuru Nishida. The purpose of the workshop was to bring together participants from professional and organizational backgrounds to explore current policy related to food and nutrition; to develop an intersectoral food safety, nutrition and supply chain action plan; and to evaluate current policies in the light of new objectives and changing circumstances. The sessions were accompanied by working groups at which participants were set a series of activities aimed at contributing to the drawing up of a strategy to develop and implement a national food and nutrition action plan. The purpose of bringing together countries of the Baltic region and their Nordic neighbours in this initiative was to:

• build on natural advantages and the geo-economic position of the Nordic/Baltic region in relation to food and nutrition policy;

• promote sustainable development in the Nordic/Baltic region as well as regional cohesion through development of food and nutrition policies and action plans;

• improve skills needed to develop intersectoral policies in relation to food and nutrition;

• establish a Nordic/Baltic Food and Nutrition Network. The 27 participants came from 8 different countries (Annex 1) and represented 8 different sectors, thanks in particular to the tremendous efforts of the hosts and the FAO. This show of interest and commitment across sectors was especially gratifying as it demonstrates that the vital cross-sectoral links on the topics of nutrition, food safety and sustainable development and social concerns are being recognized and acted on at the policy level. The majority of participants attended the whole workshop (Annex 2) and completed pre-questionnaires before and evaluation forms at the end of the workshop. Everyone gave constructive feedback, both formally and informally, on the relevance, usefulness and quality of the workshop. The feedback from participants will be used to finalize the tool “Intersectoral policy development for decision-makers”. Dr Aileen Robertson Acting Regional Adviser for Nutrition WHO Regional Office for Europe Copenhagen

Professor Tim Lang Thames Valley University London United Kingdom

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Background

The dynamic world food system makes it hard for national governments to keep apace of the changes and to bring in legislation to tackle the global food system. Recent food scares such as the bovine spongiform encephalopathy (BSE) crisis in the United Kingdom, the Asian flu crisis with the chickens in Hong Kong and China and the breakdown of the food supply system in the Russian Federation and the newly independent states highlight the importance of the need for global surveillance and response systems. Changes in health and health protection legislation can be difficult to achieve and slow to bring about at both international and national level. Enlightened administrators and policy-makers can play a pivotal role in enabling the necessary transformation to be made. Food and nutrition policy is important at all levels ranging from global/international through national to the local level. Once decision-makers have been sensitized to the importance of food and nutrition policies, the importance of an interagency approach and the steps necessary to develop and implement policies, they will be more likely to encourage and support the process. Those who initiate institutional change will need to be convinced of the long-term value and benefits to society of the development of food and nutrition policy. A workshop on intersectoral food and nutrition policy development was held in Sigulda, Latvia from 29 to 31 August 2000. It was designed as multidisciplinary and intended for those able to influence policies related to food and nutrition. The participants came from a range of backgrounds such as policy-making, health, academia, agriculture, environment, education, social welfare, finance, the food industry and the nongovernmental sector. Any process to develop healthy food and nutrition policy needs to involve the relevant sectors and key players; food policy is not just of concern to governments and health professionals, but also consumers, the food producers and industry. Because of the changing nature of food safety and food security it was imperative that the participants represent as many sectors as possible. Different sectors, including health and agriculture, were represented. Policy-makers were encouraged to address specific topics relevant to food policy, including the public health implications of food and nutrition security and food safety, barriers to change, and how to develop a national food and nutrition action plan.

Introduction

The WHO Regional Office for Europe began a process to help develop national food and nutrition action plans (FNAP) following a consultation in Malta in November 19991 attended by most of the 51 Member States. This process is based on WHO’s Food and Nutrition Policy and Action Plan2, which includes the three core strategies of nutrition, food safety and a sustainable food supply. The objectives of this workshop were to:

• encourage debate over a range of issues related to food and nutrition policy;

• identify local, national and international forces which are barriers to change and those which are helping forces;

1 Consultation on the development of the first food and nutrition action plan for the WHO European Region Copenhagen, WHO Regional Office for Europe (document). 2 The impact of food and nutrition on public health. The case for a food and nutrition policy and an action plan for the European Region of WHO 2000–2005. Copenhagen, WHO Regional Office for Europe (document EUR/RC50/R8). This was endorsed at Regional Committee 14th September 2000 (see resolution, Annex 7).

EUR/00/5026926 page 2 • help participants to gain knowledge, skills and confidence about the latest developments in

food and nutrition policies and apply these to their situations;

• clarify future directions for both participants and the policy development process;

• identify action that the participants can take to influence food policies;

• begin to develop an intersectoral action plan and an agreed schedule for its further development.

Summary of the Workshop

The workshop was attended by 27 people from the Baltic and Nordic countries representing many different sectors related to food and agriculture including public health, food enterprises, food control, food safety, consumer protection boards, ministries of agriculture, social affairs and health, nutrition councils and universities (list of participants in Annex 1). The workshop comprised 10 sessions:

1. Mapping yourself in the food system 2. The impact of food and nutrition on public health. 3. The policy context: what is a food and nutrition policy? 4. Developing a comprehensive and integrated food and nutrition policy 5. Examples of food and nutrition policies 6. NGOs campaigning for food and nutrition policy 7. The contents of national food and nutrition policies and action plans 8. The procedure how national policies and action plans will be developed/strengthened 9. Implementation of new/existing food and nutrition action plans 10. Review of workshop. The sessions were presented over a period of two and a half days (programme in Annex 2), prefaced by the completion of a pre-course questionnaire which served as a baseline against which to compare the information received in the final evaluation session. Pre-course questionnaires were completed by all 27 participants (Annex 3). Most participants attending the workshop came from organizations officially designated as responsible for developing national FNAPs. Examples given in the pre-course questionnaire of positive initiatives towards FNAP development included harmonization of legislation, development of health programmes and health promotion material, and market control regarding food safety and quality. The most common difficulty reported by participants was lack of resources, followed by lack of political acceptance, teamwork or intersectoral cooperation. Expectations of the participants from the workshop included:

• raising awareness among policy-makers and pushing food and nutrition policy onto the political agenda;

• improving national intersectoral collaboration;

• building networks among specialists from different sectors;

• creating a national group for the development of a FNAP;

• making comparisons with countries which already had experience of developing FNAPs.

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Pre-course questionnaires were then compared with final evaluation questionnaires filled in on the last day of the workshop by most of the participants (Annex 4). An informal, although important part of the workshop, were the social events ranging from coffee breaks and long walks to receptions and meals, during which participants met each other, exchanged ideas and information and gave feedback to their facilitators. This informal interaction was a vital part of the process to create dialogue between the participants from different countries and sectors, and helped to build a sense of cohesion in the development of food and nutrition policy. Social and informal interaction is essential for establishing and maintaining a sustainable food and nutrition network in the Baltic and Nordic countries. In addition, team-building was also facilitated by the fact that most participants stayed in the hotel in Sigulda, which was about one hour’s drive from Riga.

Opening

Dr Viktors Jaksons, Adviser of Ministry of Welfare, Latvia, opened the workshop with the following words:

I would like to welcome all of you and in particular the organizers and guests of this first Consultation on the Development of Food and Nutrition Action Plans in the Baltic States. This workshop has been designed as a multidisciplinary one intended for those able to influence policies related to food and nutrition. Food policy is not only the concern of governments and health professionals, but also consumers and the food producers and industry. Because of the changing nature of food safety and security it is imperative that the participants represent as many sectors as possible. During the Consultation on the Development of Food and Nutrition Action Plan for the WHO European Region in Malta last November, it was agreed by WHO European Member States that national food and nutrition councils could play a major role in the promotion of food and nutritional health issues in a country. In Latvia, we already have the Latvian Food Council. It is very important at this moment to involve medical doctors, specialists in nutrition, and scientists in the work of the Council and to improve its work in the direction of food safety and healthy food. The data from a recent national survey showed that in Latvia the nutritional habits of our population are not as healthy as we would wish them to be. Our diet includes too much fat, and too large a proportion of this consists of saturated fat. It also includes too few complex carbohydrates and not enough fruit and vegetables. Food-related risk factors are high and there is a trend towards an increasing prevalence of cardiovascular diseases and cancer. A major objective of the health sector is to promote health through a well balanced diet, the avoidance of nutritional deficiencies and the control of foodborne diseases. A multisectoral approach, including agriculture, the environment, the food industry, transport, advertising and commerce, is therefore essential to help place food and nutrition policy high on the political agenda. Health should be an expected outcome of food and nutrition policies. A comprehensive food and nutrition policy comprises three strategies: nutrition, food safety and a sustainable food supply. The three strategies are interrelated, since the food supply influences both the safety and the composition of food. Close collaboration between those responsible for nutrition, food safety and food security is required in order to develop comprehensive, intersectoral policies and concerted actions.

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I would like to ask a question. Why do we still consume a diet too high in fats and sugars and too low in fruit and vegetables? Do we not know the importance of healthy food? I am quite concerned that we find the correct solution. We need strategies, information and education. We need a change of attitude from a treatment approach to a public health one. We need good practices to improve health starting from early childhood. Risk factors, such as smoking and alcohol, are already targeted. It is therefore time to do the same regarding food and nutrition. A sustainable food supply should ensure food of good quality, while helping to stimulate rural economies and promote social cohesion within rural societies. With increasing urbanization there is a need for food and nutrition policies, which set out how best to feed large urban populations in a sustainable way, by stimulating rural economy and development. Dear participants, on behalf of the Ministry of Health and on myself I wish you success while trying to develop a common framework for food and nutrition action plans in this part of Europe.

Following Dr Viktors Jaksons’ speech Dr Dorina Minioiu, Policy Officer for Food and Agriculture Organization of the United Nations (FAO) welcomed the participants with the following words:

I am pleased that FAO has been given the opportunity to join this consultation and to support WHO activities in the European Region in order to achieve the ambitious goal of improving public health through the development of national multisectoral food and nutrition policies in central and eastern European countries. In fact, there is a long history of genuine collaboration between WHO and FAO, with magnificent achievements in terms of dissemination of knowledge, improving skills and strengthening institutions in the area of food, nutrition and health. Globally, regionally, sub-regionally and nationally, for half a century now, FAO has been trying to bring a sound contribution to the people’s food and nutrition wellbeing by promoting the economic, social and environmental sustainability of farming practices throughout the world. In the European Region, and in particular in countries undergoing transition to a market economy, as many as 30 million people are hungry and malnourished. This is equal to almost 30% of the Region’s population. In the Baltic States, the magnitude of food insecurity and nutrition imbalances are also becoming real concerns. Therefore, the need for the provision of a sustainable food supply of good quality throughout the year is a cardinal aim of FAO current and planned activities in central and eastern Europe and the Baltic countries. FAO also works towards fulfilling the seven commitments of the World Food Summit, held in Rome in November 1996, at which its member states declared their intention to halve by 2010 the current number of under and malnourished people, which is about 800 million people world-wide. To this end, immediately after the Summit, in 1997, FAO prepared for its member states which are developing countries and countries with economies in transition, strategies for national agricultural development – horizon 2010, with a view to helping governments define and implement comprehensive policy frameworks and the corresponding investment plans for achieving long-term and sustainable agricultural development. Three years later, in 2000, a series of national workshops has been organized in each country in central and eastern Europe to assess the progress made by the respective government in the implementation of World Food Summit commitments and the provisions of its Plan of Action. This was a good opportunity for policy-makers, the scientific community and the private sector in each country to discuss and analyse the latest policy developments, the need for policy reforms in certain areas to address the overriding constraints to agricultural development and better use the natural and human potential for the sector’s economic growth. Also, the extent of present national, household and individual food insecurity and malnutrition and the underlying factors have been revealed. Based on the workshop findings and

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recommendations the draft strategy for national agricultural development – horizon 2010 – has been revised and updated in each country. The workshops also stressed the need for enhancing the intersectoral dialogue among relevant national institutions in the policy and decision-making process, since food security is a complex and multifaceted issue increasingly implying not only the assurance of a certain availability but also the diversity, quality and hygiene norms of foodstuff, while respecting the environmental norms. The qualitative requirements are being developed and observed at global (WHO) and regional (EU) levels, therefore strict alignment of national food and nutrition policies, food norms and standards are a must for countries in transition in view of increased globalization and regionalization of production and consumption patterns. I would like to thank and congratulate the WHO Regional Office for Europe for having the laudable initiative to develop and test Guidelines for intersectoral food and nutrition policy development in the European Region, first in Slovenia with countries from south-eastern Europe and now in Latvia with the Baltic countries. It is my belief that this is a fundamental tool in the policy-making process, breaking the borders between the agriculture, food and health sectors and treating food and nutrition as determinant factors of the health of human beings.

Dr Robertson concluded the opening session by welcoming the participants on behalf of the WHO Regional Director for Europe and in particular thanked the Latvian Government for hosting this event and gathering representatives from such a wide range of sectors to take part. She also thanked the FAO for their excellent technical collaboration and for supporting the participation of members of the Ministry of Agriculture. Dr Robertson spoke of the ongoing development of the food and nutrition action plan, now entitled The impact of food and nutrition on public health: the case for a food and nutrition policy and action plan for the European Region of WHO 2000–2005, which will be presented to the WHO Regional Committee for Europe in September 2000. This presents a unique opportunity to place food and nutrition firmly on the public health political agenda. This complements and strengthens similar initiatives by the European Union, such as the White Paper on Food Safety3 and the French Presidency initiative.4 Before introducing Professor Tim Lang, Dr Robertson thanked him for his predominant role in developing the workshop training materials, and she summarized the main objective of the workshop: namely, for participating countries to begin developing their national food and nutrition action plans. A follow-up meeting would take place in Latvia, from 11 to 13 June 2001, when countries will be able to report back on their progress.

Session 1. Mapping yourself in the food system

The goals of the session were for the participants to obtain:

• an understanding of the food supply chain;

• a clear idea of where everyone fits into the supply chain;

• an understanding of the factors determining what consumers eat;

• an idea of how participants both in a professional capacity and as consumers can influence the food supply chain.

3 White Paper on Food Safety, Commission of the European Communities, Brussels, January 2000, COM (1999) 719 final. 4 Societé française de sante publique. Health and human nutrition: Elements for European action. Draft working paper for the French Presidency of the European Union, July 2000.

EUR/00/5026926 page 6 The participants were asked to introduce themselves and situate their role in the food chain, and were then asked to determine some of the main influences on the food supply chain. They were then divided into three Baltic country groups and one group of the Nordic representatives to redesign the map of the food supply chain (see Annex 5, Fig. 1). For detailed information on the feedback and group presentations please see Annex 5, session 1. The feedback on the redesigned food map differed between the country groups. For instance, the Nordic countries placed the individual in the centre of a multi-layered circle, whereas Lithuania presented a food map dominated by the sectors involved in the food chain. Estonia and Latvia placed the consumer, who they stated to be influenced by legislation, as a central figure in the food chain. In addition, both groups spoke of the need to educate consumers in order that they should make healthy and safe food choices.

Session 2. The impact of food and nutrition on public health

The goals of the session were for the participants to:

• gain an understanding of the impact of food and nutrition on health • be able to identify the need for a comprehensive food and nutrition policy • be aware that this policy has to operate within society-wide trends such as globalization. This session took place in plenary. First, participants were asked to identify the food trends in society. Secondly, they were asked to list both positive and negative impacts of food and nutrition on health. Thirdly, they were asked to give examples of what governments can do to ensure health, and finally, they were asked to list ideas of what the government can do to ensure that health is included in food policy. All comments volunteered by participants were recorded by the facilitators on a flip chart (Annex 5). For detailed information of the plenary discussions please see Annex 5, session 2. It was evident from the plenary discussion that 20 years ago the Nordic countries already had an advanced food industry but unhealthy dietary habits. Furthermore, expensive food and smaller shops dominated the market. In contrast, 20 years ago the Baltic countries had a more organic food pattern, which followed the changes of season and consisted mainly of local produce. In addition, food was less processed and more food was prepared in the home compared with today. It was suggested that over the next 20 years the food trends would move towards more novel and functional foods as well as further globalization, and that Internet shopping and hypermarkets would dominate the way people shop for food. On the other hand, participants believed that local markets would continue to exist and more niche shops would appear. Inequalities in dietary habits were not mentioned, even though in the public health sector awareness of the effects of the food choices in different social groups is vital. The participants suggested that positive features of nutrition and diet in health included treatment and prevention of disease, whereas the negative features included development of noncommunicable and foodborne diseases and malnutrition. The participants also discussed how governments can ensure that health is at the heart of a food policy and concluded that nutrition can be improved through promoting health education, ensuring that the agricultural sector produces more healthy products such as vegetables and lean meat, and by legislation regarding food processing. Similarly, to ensure food safety legislation, implementation of hazard analysis critical

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control point (HACCP) and health education is needed. With regard to a sustainable food supply, participants suggested increasing the availability of vegetables and decreasing that of meat. While discussing how governments can ensure that health is included in food policy, participants proposed that the agricultural sector could increase production of healthy crops through production and ecological subsidies to ensure both healthy nutrition and a sustainable environment. In addition, a sustainable environment can be ensured via recycling, reducing waste and packaging. Healthy nutrition policy could be assisted by regulating advertisements and ensuring sound information to the consumer. Also, policies to reduce inequalities in food consumption needs to be considered. Methods to address these inequalities could include school meals and social catering for the sustainable development of society.

Session 3. The policy context: what is a food and nutrition policy?

The goals of the session were for the participants to: • understand what food and nutrition policy is; • be aware of key international policy commitments and networks; • begin to see how partnerships, based on agreements already made by governments, can be

developed; • understand how the three strategies of food safety, nutrition and a sustainable food supply

can be linked. The participants worked in groups according to country. Their task was to examine United Nations documents in order to familiarize themselves with WHO recommendations for ensuring food safety, nutrition or sustainable development. Each group was given a document to consider (either the World Health Assembly resolution WHA53.15 2000 on food safety, the 12 steps to healthy eating or the summary of The urban food and nutrition action plan on sustainable development) and asked to list what their respective governments had done in relation to the allocated theme. The participants then reported back in the plenary session. For detailed information of the country presentations please see Annex 5, session 3. Latvia was asked to review the Resolution on food safety. The group presented a long list of initiatives and legislation already instigated by the Latvian government showing that extensive work had already been carried out regarding the issue. The Lithuanian group was asked to review the recommendations of The urban food and nutrition action plan on sustainable development. The group highlighted the problems faced by wastage of fruit and vegetables during storage, which result from seasonal variations in food consumption. The government supports less use of pesticides and more ecological agricultural development. Other areas of initiatives mentioned include availability, access, consumption and legislation. The Nordic countries were also asked to review the recommendations of The urban food and nutrition action plan on sustainable development. They spoke mainly of the conflict of local production versus healthy nutrition. For instance, due to climate conditions in Iceland it is expensive to grow vegetables. As a consequence, the government imposes taxes on imported vegetables in order to support local farmers. In addition, the group mentioned other initiatives such as a project by the municipality of Copenhagen, Denmark, where farmers get paid not to use pesticides.

EUR/00/5026926 page 8 Estonia was asked to review the 12 steps to Healthy Eating from the CINDI dietary guide. The group presented a list of legislation and national health programmes that have been or will be carried out. They also mentioned the importance of basing nutrition advice on scientific evidence, and that changing lifestyle habits is a lengthy process.

Session 4. Developing a comprehensive and integrated food and nutrition policy

The goals of the session were for the participants to:

• visualize a grid or a check-list to decide what links are made between nutrition, food safety and sustainable development (social and environmental);

• learn how to develop a comprehensive and integrated food and nutrition policy;

• understand which settings are appropriate for implementing the three strategies;

• be aware that many health problems linked to food can only be tackled successfully by coordination between different sectors at local, national and international levels.

The participants were grouped according to country. Each group was allocated a specific problem. They were asked to link food safety and nutrition with sustainable development and identify the actors at different governmental levels involved in solving the problem. The participants reported back in plenary how they viewed the solutions to the problem they were addressing. For detailed information on the country presentations please see Annex 5, session 4. All the groups divided their presentations into three categories: a strategy for the solution, the agencies involved and the level of action needed for the solution. Latvia was asked to provide policy solutions relating to food poverty, and they mentioned the need for action at international level to be involved in this question (e.g. aid and experiences of similar situations). Moreover the Latvian group commented that no sustainable solution was achievable at present. The Estonian group were asked to address the issue of an optimal diet for schoolchildren. They said that the quality of a programme, in this case school meals, would depend on issues such as local conditions, organization at local level, food sources, education of catering personnel and the children’s preferences. The group stressed that several areas needed to be considered to achieve a successful programme. Lithuania was asked to address the problem of the increasing prevalence of obesity and related noncommunicable diseases. The group acknowledged that all stages of the life course should be targeted in order to tackle these issues. Their strategy included special programmes, access and price policy. They emphasized the importance of coordination and an integrated approach between sectors, monitoring and evaluation of progress. Furthermore, they suggested that different agencies should be involved in solving the problem such as the church, nongovernmental organizations (NGOs), the commercial sector, ministries and international agencies. The Nordic countries were asked to address the issue of older people suffering due to their food situation. They emphasized that this group is in many ways far from homogenous and hence the strategy needs to be flexible. They also mentioned the importance of enabling the elderly to help themselves function in their day-to-day life while keeping the environmental aspect in mind.

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Session 5. Examples of food and nutrition policies

The goals of the session were for the participants to:

• be aware of the experience already gained in developing food and nutrition policy • learn from case studies • think about what constitutes good policy and what they could apply in their national contexts. To open this session the Nordic participants were invited to speak about their experiences of developing national FNAPs in their respective countries. The participants were then grouped by country and allocated a case study, which they were asked to discuss and to report back in plenary what lessons they had learned from them. For detailed information of the country presentations please see Annex 5, session 5. The strengths of the Nordic countries’ national FNAPs mentioned in the presentations included the long-term view, based on evidence, involvement of NGOs and intersectoral cooperation. The weaknesses concerned the lack of allocation of responsibilities, economic evaluation of FNAP, human resources and political power for decision-making.

Session 6. NGOs campaigning for food and nutrition policy

The goals of the session were for the participants to identify:

• what NGOs are and how they help shape and implement food and nutrition policy • what makes NGO campaigns successful • potential barriers to the success of an NGO. The participants were asked to work in groups according to country. The task was to explore the contribution that NGOs can make to food and nutrition policies. The groups were required to create a fictitious NGO in their respective countries to address the specific cause they were allocated. The participants reported back in plenary. For detailed information of the country presentations please see Annex 5, session 6. The groups suggested that for an NGO to achieve its goal, information, education and legislative initiatives are required. Furthermore, it was suggested that the NGOs could obtain funding from a variety of sources such as health insurance, foreign assistance, universities and government agencies. Voluntary assistance could be obtained from persons affected by the issue, universities and government agencies. The barriers to success mentioned by the groups were be mainly lack of knowledge, old beliefs, and conflicting agendas.

Session 7. The contents of national food and nutrition policies and action plans

The goals of the session were for the participants to have:

• a clear idea of the WHO Food and Nutrition Plan for the European Region • start to outline the contents of their national food and nutrition policy and action plans. The participants were grouped by country and asked to draft an outline of a national FNAP for their respective countries. The Nordic representatives participated as expert external consultants

EUR/00/5026926 page 10 to the Baltic working groups. The participants reported back in plenary. For detailed information of the country presentations please see Annex 5, session 7. The presentations identified the goals of an FNAP to be prevention of disease and promotion of health while doing no harm to the environment. All outlines of FNAPs comprised food safety, nutrition and sustainable food supply. In addition, the country groups listed the priority areas to be targeted in their respective national FNAPs.

Session 8. The procedure for developing/strengthening national policies and action plans

The goals of the session were for the participants to obtain:

• an idea of how a food and nutrition action plan is to be developed • awareness that everyone has to “own” this development process. The participants, in national groups, were asked to draft a plan and identify action to develop and implement a national FNAP within the next 12 months. The Nordic representatives joined the Baltic working groups as expert external consultants. The participants reported back in plenary. For detailed information of the country presentations please see Annex 5, session 8. Lithuania and Latvia presented drafts of the issues to be included in their respective action plans, including the responsible bodies and whether the action should be permanent or short-term. In contrast, the Estonian group presented a flow diagram to illustrate the process from development to adoption of an FNAP.

Session 9. Implementation of new/existing food and nutrition action plans

The goals of the session were for the participants to:

• identify what needs to be done to implement national food and nutrition policy • calculate budgetary considerations • identify the cost/benefit of food and nutrition policy. The participants were grouped by country and asked to develop strategies for implementing a national FNAP. This task required consideration of the resources needed. A budget had to be drafted for the administration of a national food and nutrition council, which would be responsible for developing the policy and monitoring its implementation. For detailed information on the country presentations please see Annex 5, session 9. Lithuania outlined the current national situation and estimated the resources needed for a food and nutrition council and to develop a national FNAP. In addition, the group listed people to lobby and sources of funding in order to reach their objective. The Estonian group prepared a budget required for a working group, a food and nutrition council and for printing materials. The Latvian group listed the key partners and estimated an appropriate budget.

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Session 10. Review of the workshop

The course was evaluated by a round-table individual feedback discussion and a written final evaluation questionnaire filled in at the end of the workshop. For the feedback in plenary the participants were invited to describe their experience of the workshop and to give the facilitators suggestions for improvement.

Round-table evaluation Positive comments included:

• it was useful that different sectors were represented as vertical sectors are generally not aware of the problems faced by other sectors;

• the workshop was very successful and well prepared;

• the training material was very useful;

• it was extremely useful to have Nordic representatives to share their experiences;

• a workshop should be the beginning of national intersectoral collaboration;

• long walks out-of-doors at mid-day were appreciated as the programme was very intense;

• the style of facilitation and stand-up teaching was appreciated;

• the experience of two international organizations working together (FAO and WHO) set a good example;

• the team-building process was very successful as individual professionals gradually became members of the group.

Some participants suggested that:

• group work is difficult and ways to ensure a democratic process would improve its quality;

• they would have preferred to receive training material before the workshop;

• the programme was too crowded;

• the use of PowerPoint would save time in preparing feedback presentations from the working groups;

• mixing countries during group work and alternating the Nordic experts among the different Baltic groups during the course would have made the workshop more interesting.

Written final evaluation A total of 23 final evaluation questionnaires were completed by the 27 participants (response rate 85.2%). For detailed information please see Annex 4. The majority of the participants were satisfied with the length of the sessions, but some thought that there was not enough time to cover the course contents scheduled for each session. About two thirds thought that the course was “extremely relevant”, whereas the rest of the participants found it “somewhat relevant”. The consensus was that the teaching material was very useful and made the importance of FNAP very clear. However, some thought that too much material was distributed during the workshop.

EUR/00/5026926 page 12 The majority of the participants found the teaching of very high quality, rating the quality of the facilitated discussions “somewhat high” and “very high”. They commented that the facilitators managed to involve all the participants in the discussion and that the teaching environment was friendly. More time would have improved the quality of the sessions and reduced the stress on the facilitators.

EUR/00/5026926 page 13

Annex 1

PARTICIPANTS

Estonia Mrs Helle Aruniit Director General, Consumer Protection Board Kirku 4 15071 Tallinn

Tel.: 372 620 1700 Fax: 372 620 1701 E-mail: hellea@consumer.ee

Piret Hein Chief Specialist, Department of Agro-Food and Trade Ministry of Agriculture 15056 Tallinn

Tel.: 372 625 6217 E-mail: piret.hein@agri.ee

Piret Laur Head, Public Health Department Ministry of Social Affairs Gonsiori 29 15027 Tallinn

Tel..: 372 6269 785 Fax: 372 6269 738 E-mail: Piret@sm.ee

Katrin Lõhmus Senior Officer, Ministry of Agriculture Veterinary and Food Department Food Safety Bureau Lai 39/41 15056 Tallinn

Tel.: 372 6256 234 Fax: 372 6256 210 E-mail: katrin.lohmus@agri.ee

Natalia Vyzelevskaia Deputy Director-General, Health Protection Inspectorate Estonian Sanitary Quarantine Service Narva mnt. 48 10150 Tallinn

Tel.: 372 6484 379 Fax: 372 6484 026 E-mail: eskt@eol.ee

Mrs Mai Maser Head, Children’s Health Programme Estonian Centre for Health Education and Promotion Ryytli 24 Tallinn

Tel.: 372 7 442 141 Fax: 372 7 442 141 E-mail: mai@tervis.ee

Mrs Anneli Zirkel Public Health Specialist Tartu County Government 5001 Tartu

Tel.: 372 7 305204 Fax: 372 7 305 201 E-mail: anneli@tartumaa.ee

Latvia Maris Veldre Chief Specialist, Latvian School of Public Health/CINDI Pilsonu Str. 13, Sect. 29 Riga LV-1012

Tel./Fax: +371 761 4440 E-mail: veldrem@hotmail.com

EUR/00/5026926 page 14 Dr Andis Bremanis President, Latvian Association of Clinical Nutritionists Siguldas Prospekts 37 Riga, LV 1014

Tel.: +371 7612611/6543556 Fax: +371 614168 E-mail: mbrazma@latnet.lv

Daina Karklina Latvia University of Agriculture Dean, Faculty of Food Technology Liela iela 2 Jelgava LV 3001

Tel.: +371 30 21075 Fax: +371 30 22829 E-mail: aired@inka.cs.llu.lv

Viktors Mende President, Latvian Federation of Food Enterprises Sporta Str. 2a Riga LV1013

Tel.: 371 7325557 Fax: 371 7322371 E-mail: puf@delfi.lv

Dr Iveta Pudule Head, Health Education Division Health Promotion Centre Skolas iela 3 LV-1010 Riga

Tel.: 371 724 0446 Fax: 371 724 0447 E-mail: iveta.vvc@parks.lv

Dr Guntars Selga Head of Department Nutrition Policy Latvian Food Centre K. Valdemara Str. 38 Riga LV 1010

Tel.: 371 702 1583 Fax 371 702 1755 E-mail: selga@lpc.gov.lv

Dr Olafs Stengrevics Director, Latvian Food Centre Kr. Valdemara 38 1010 Riga

Fax +371 7 021755 Office +371 7021713 E-mail: FoodCenter@Parks.lv

Lithuania Associate Professor Algis Abaravicius Hygiene Doctor, National Nutrition Centre Kalvariju 153 LT 2600 Vilnius

Tel.: 370 2 77 89 19, 370 2 33 52 24 Fax: 370 2 77 87 13 Mobile: 370 99 483-08 E-mail: algis.abaravicius@mf.vu.lt

Dr Regina Ramutyte Head of Division, Ministry of Agriculture Gedimino 19 Vilnius LT 2600

Tel.: +370 139 1169 Fax: +370 222 24440 E-mail: regina@zum.lt

Dr Audrone Astrauskiene Director, State Public Health Care Service Ministry of Health Vilnius str. 33 Vilnius

Tel.: 370 2 685 108 Fax: 370 2 610621 E-mail: algis.petrulis@sam.lt

Dr Ilona Drulyte Head, Department of Drinking Water National Nutrition Centre Kalvariju st 153 LT 2042 Vilnius

Tel.: 370 2 76 92 00 Fax: 370 2 77 87 13 E-mail: Ilona@rmc.lt

EUR/00/5026926 page 15

Dalia Luksiene Assistant, Institute of Cardiology Kaunas University of Medicine Sukileliu 17 Kaunas 3007

Tel.: 370 7 730160 Fax: 3707 796498 E-mail: klbioch@kmu.lt

Associate Professor Janina Petkeviciene Institute for Biomedical Research Kaunas Medical University Eiveniu str. 4 3007 Kaunas

Tel.: 370 7 731170 Fax: 370 7 796498 E-mail: profmed@kmu.lt

Dr Romualdas Zemeckis Scientific Secretary, Lithuanian Institute of Agrarian Economics V. Kudirkos 18 2600 Vilnius

Tel.: (370) 2 61 66 70 Fax: (370) 2 61 45 24 E-mail: ROMAS@LAEI.LT

Temporary Advisers

Dr Martin Caraher (Workshop facilitator) Centre for Food Policy Wolfson Institute of Health Sciences Thames Valley University 32–38 Uxbridge Road, Ealing GB-London W5 2BS United Kingdom

Tel.: 44 181 280 5060 Fax 44 207 280 5125 E-mail: martin.caraher@tvu.ac.uk

Dr Kaija Hasunen Ministerial Adviser (Nutrition) Ministry of Social Affairs and Health P.O. Box 33 FIN-00023 Helsinki Finland

Tel.: 358 9 160 4035 Fax: 358 9 160 4492 E-mail: Kaija.hasunen@stm.vn.fi

Dr J. Højmark Jensen Director, Regional Office for Food Control Flæsketorvet 75 DK-1711 Copenhagen V Denmark

Office +45 33 22 17 67 Fax +45 33 85 24 01 E-mail: JHJ.koebenhavn@FDIR.DK

Dr Lars Johansson National Council on Nutrition and Physical Activity P.O. Box 8139 dep 0033 Oslo Norway

Tel.: 47 22 24 90 61 Fax: 47 22 24 90 91 E-mail: lars.johansson@sef.no www.sef.no

Professor Tim Lang (Workshop facilitator) Centre for Food Policy Thames Valley University Wolfson School of Health Sciences 32–38 Uxbridge Road, Ealing GB-London W5 2BS United Kingdom

Fax +44 181 280 5125 Office +44 181 280 5070 E-mail Tim.Lang@tvu.ac.uk

EUR/00/5026926 page 16 Cecilia Lindvall Nutritionist, National Food Administration Box 622 S-75126 Uppsala Sweden

Office +46 18 17 55 65 Fax +46 18 17 14 79 cecl@slv.se

Dr Laufey Steingrimsdottir Director, Icelandic Nutrition Council Baronsstigur 47 101 Reykjavik Iceland

Tel.: 354 585 1480 Fax: 354 585 1313 E-mail: laufey@manneldi.is

World Health Organization

Regional Office for Europe Ms Carina Madsen Food and Nutrition Policy Unit

E-mail: car@who.dk

Dr Robertas Petkevicius WHO Liaison Officer Vilnius str. 33 LT-2001 Vilnius Lithuania

Tel.: 370 2 226 743 Fax: 370 2 226 605 E-mail: ltwho@ktl.mii.lt

Dr Aileen Robertson (Workshop facilitator) Acting Regional Adviser for Nutrition Food and Nutrition Policy Unit

Tel..: 45 39 17 13 62 Fax: 45 39 17 18 18 E-mail: aro@who.dk

Dr Aiga Rurane WHO Liaison Officer UN House L. Pils iela 21 LV-1167 Riga Latvia

Fax +371 7503603 Office +371 7503619 E-mail aiga.who@undp.riga.lv

Headquarters Chizuru Nishida Department of Nutrition for Health and Development

Tel..: 41 22 791 3317/3455 Fax: 41 22 791 4156 E-mail: nishidac@who.int

Tiina Mutru Department of Nutrition for Health and Development

Tel..: 41 22 791 4339 Fax: 41 22 791 4156 E-mail: mutrut@who.int

Food and Agriculture Organization

Dr Dorina Minoiu Policy Officer, Subregional Office for Central and Eastern Europe 34 Benczúr utca 1068 Budapest, Hungary

Tel.: 36 1 461-20 23/461-20 00 Fax: 36 1 351 7029 E-mail: Dorina.Minoiu@fao.org

EUR/00/5026926 page 17

Annex 2

PROGRAMME

Monday 28 August

1800–1830 Registration

1930 Welcome reception

Tuesday 29 August 0830–0900 Official welcome and opening of the Consultation

• Dr Viktors Jaksons, Adviser, Ministry of Welfare, Latvia • Dr Dorina Minioiu, Policy Officer, Food and Agriculture Organization • Dr Aileen Robertson, Acting Regional Adviser for Nutrition, WHO Regional Office

for Europe 0900–1030 Session 1: Mapping yourself in the food system 1030–1100 Coffee break 1100–1130 Session 1 (continued) 1130–1230 Session 2: The impact of food and nutrition on public health 1230–1400 Lunch break 1345–1530 Session 3: The policy context: what is food and nutrition policy? 1530–1800 Walk 1800–1830 Coffee break 1830–2000 Session 4: Comprehensive and integrated food and nutrition policy Wednesday 30 August 0830–1030 Session 5: Examples of food and nutrition policies 1030–1100 Coffee break 1100–1140 Session 5 (continued) 1140–1230 Session 6: NGOs campaigning for food and nutrition policy 1230–1345 Lunch break 1345–1500 Walk 1500– 1520 Coffee break 1520–1630 Session 7: The content of national food and nutrition policies 1630–1800 Session 8: The procedure how national policies and action plans will be developed/strengthened Thursday 31 August 0830–1030 Session 9: Implementation of new/existing food and nutrition action plans 1030–1100 Coffee break 1100–1230 Session 10: Review of course and closure

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Annex 3

PRE-COURSE QUESTIONNAIRE

A total of 27 pre-course questionnaires were completed by the 27 participants.

Questionnaire results 1. What is the status of your organization in relation to either the development or furthering the

action of a national food and nutrition action plan? [2] Has not been involved in either the development or implementation of the food and nutrition

initiative [1] Has not yet decided whether to become involved [10] Has received an invitation to become involved [14] Has been officially designated responsibilities in relation to the food and nutrition action plan. Comments included:

• will be organizing FNAP on the basis of the Nordic experiences and WHO recommendations; • initiative for development of FNAP is taken and preparation is going on. 2. Please list and describe any positive changes that have been made by your organization to support

the food and nutrition action plan. Comments included:

• none; • draft of national public health strategy, law of food and reorganization of hygiene and food control

system according to EU directives; • training food enterprises to produce healthy products; • interministerial cooperation in the field of nutrition policy; • provision of necessary expertise to develop food strategies; • national nutrition survey and surveillance; • national nutrition goals; • educational material; • harmonization of legal acts in food products and agricultural sectors; • translation of CINDI dietary guide into three national languages; • support, analysis, translation and distribution of WHO/EURO/FNAP to key persons; • development of dietary guidelines; • market control regarding food safety and quality; • a strategy of food industry, but only one step towards development of FNAP; • delegated the responsibilities for the follow-up of FNAP; • coordination of projects; • educate specialists for food industry regarding healthy foods; • research possibilities and development of new food products which are healthier, safer and of better

quality; • evaluation of dietary trends, training of medical students and health professionals in promotion of

healthy nutrition.

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3. What are the most important difficulties/challenges your facility still faces in supporting the food and nutrition action plan?

• political acceptance; • lack of intersectoral collaboration; • decreased budgets in public health; • implementation of FNAP in all food production sectors; • nutrition is not of interest to doctors→ public health→ politicians; • problem to join efforts between different actors in order to optimize expertise and prepare FNAP; • lack of funding and redirection of priorities; • to obtain knowledge of the FNAP by all relevant actors; • acceptance of shifting the focus from the individual to the structural perspective; • price policy on vegetables; • no governmental programme/lack of a FNAP; • competition between two ministries (health and agriculture) for state food control; • lack of satisfactory education of population and lack of willingness to be educated; • lack of nutritional expertise and power at regional and local level; • power of national nutrition council is too weak; • different vested interest of different groups; • lack of awareness and understanding of the importance of the issue; • lack of political decision to support food and nutrition action plan; • traditional habits and views of population regarding foods and meals. 4. How could this workshop be most useful in helping you address these difficulties/challenges and in

assisting your organization to fully support the development or the actions outlined in the food and nutrition action plan?

• learning about experiences and problems from other countries, which can help focus on solutions for our problems;

• to help clarifying the role of food control institutions and ministry of health in nutrition policy; • information of the FNAP will be useful for food enterprises; • networking of people working in the area and discuss how to work together; • how to obtain more political influence; • intersectoral collaboration facilitated; • foreign expertise and international authorities advising on the best direction; • start development of food and nutrition action plan; • increases the importance of the issue; • analyse the problems and possible solutions; • identify what needs to be done and by whom; • identify and understand the responsibilities of other sectors in preparation and implementation of

FNAP. 5. Please list any other expectations you have of this workshop

• possibility to use Nordic and United Kingdom experiences in the Baltic countries; • improvement of willingness of the Ministry of Welfare, Agriculture and food producers to work in

the field of nutrition; • time for some sightseeing; • learn about nutrition and health situation in the Baltic countries; • sharing experiences and having an exciting work time; • to meet experts and colleagues working in this very important field and share challenges, problems

and possible ways of solving these; • to learn systematic way of analysing and promoting interest of the importance of nutrition policy; • comparison of other FNAP in Europe – both positive and negative; • create a national group for the development of a FNAP.

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Annex 4

COURSE EVALUATION BY PARTICIPANTS

The 27 participants completed a total of 23 evaluation forms. 1. The time allotted to the session was: too short 7 about right 16 too long 0 no answer 0 Comments included:

• a new area and for introduction there was enough time; • workshop was very intense and for details more time is needed; • 50% of sessions were too short; • excellent; • programme too crowded and facilitators under great stress because of time keeping; • too ambitious and unclear aim for working groups. 2. Was the content of the workshop relevant to your work? extremely relevant 16 somewhat relevant 7 not very relevant 0 not at all relevant 0 Comments included:

• material presented made me understand how important nutritional issues are, which is a point that the agricultural sector has missed; it gave the agricultural sector a perspective;

• all material will be very useful to create an educational programme regarding FNAP; • a brilliant concentration of food and nutrition decision-makers from different countries. 3. Will your participation in the workshop help make a contribution to the development or strengthening

of national food and nutrition policies and implementation? extremely relevant 13 somewhat relevant 9 not very relevant 10 not at all relevant 0 Comments included:

• improve consulting work regarding these issues with the ministry of agriculture, food sector and government of municipality;

• will be much stronger in the future; • will try to implement nutritional issues in agricultural policy.

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4. The quality of the teaching was: very high 20 somewhat high 3 somewhat low 0 very low 0 Comments included:

• too much material distributed during the workshop; • presentations and teaching was carried out in a very effective way; • well designed study material and clear tasks for group work- clear and comprehensive; • manual going to be very useful for preparation of strategies other than food and nutrition; • very interesting presentation of methodology, actions, comments, explanations of problems; • excellent teachers. 5. The quality of the facilitated discussion was: very high 11.5 somewhat high 10.5 somewhat low 0 very low 0 Comments included:

• facilitators manage to involve all participants into the discussion; • friendly environment; • excellent idea to invite the Nordic countries; • differed a lot between the sessions; • fewer sessions would avoid rush and obtain better quality; • excellent combination of high professionalism and good sense of humour; 6. Do you have any other comments and suggestions for improving the workshop? Comments included:

• some material could be presented before the seminar; • main material presented by PowerPoint; • more time for sightseeing or other cultural events; • mix working groups from different countries; • no suggestions – just perfect; • always to keep a good balance between working and walking; • good to have a follow-up; • good to discuss the contents of the workshop with the participants beforehand in order to tailor it to

actual needs; • be more flexible regarding keeping to the programme, and asking the opinion of the participants

during the workshop would increase quality; • good not to have formal lectures; • do not drown participants in material and reports; • very good stand-up teaching.

EUR/00/5026926 page 22

Annex 5

EXAMPLES OF PRESENTATIONS BY WORKING GROUPS

Session 1. Mapping yourself in the food system

Fig. 1. Principal stages of the food supply chain

Supply of Agricultural Imputse.g. fertilizers, pesticides, drugs, GMOs, fodder

Domestic Food Preparation

Food retailinge.g. supermarkets, shops

Food Cateringe.g. restaurants, hospitals, schools

Food Distributione.g. national/international, import/export

Secondary Food Processinge.g. canning, freezing, drying, brewing

Primary Food Processinge.g. on-farm, dairies, abattoirs, grain mills

Primary Productione.g. farmers, fisherman, fish farmers

Activity 1 In groups, by country, participants were asked to redesign the map of the food chain. Estonia

The group had prepared a model of interaction between the different sectors involved in the food system. In the middle food production, primary, secondary production and the consumer were positioned. The ministries and the industry surrounded these and at the outer layer of the model legislation was placed to illustrate that legal acts controls the rest of the sectors. The Estonian group emphasized that education will influence the consumer preferences and that education is important at all stages of development and in all sectors. Latvia

Latvia presented a flow diagram with the consumer as the central figure. The group explained that there is a need for research to improve agricultural and food industry legislations in order to protect the environment and food safety. The consumer is lazy and wants food which is ready to eat. Consequently the consumer needs to be educated about what is healthy, as poor food is the main health problem. Education of family doctors and health professionals is needed to overcome the detrimental dietary habits in the country. The industry will do what the consumers ask and advertising is one of the most important influences on dietary habits.

EUR/00/5026926 page 23

Lithuania Lithuania presented a table of four groups involved in the food chain:

1. Policy, regulation and control 2. Food supply 3. Research and education 4. Environment and other sectors. Nordic countries The presentation by the Nordic countries placed the individual in the centre of a multi-layered square. The inner layer consisted of personal factors which influence the individual such as work, culture, family and knowledge. The second layer was occupied by factors such as the food chain, education, media and research. The third layer consisted of national policies and ministries and finally the outermost layer consisted of international policies, Codex, EU and WTO (see below).

International policy agreements

Codex

Euro

pean

Uni

on

World Trade Organization

National policies

Minist r ies

Food chain Education

Media

NG

O

ResearchHealth care

Dec

isio

n m

aker

sK

n o wle dg ePh

ysio

logy

Social/economy

Family CultureWork

Aedo

nics

International policy agreements

Codex

Euro

pean

Uni

on

World Trade Organization

National policies

Minist r ies

Food chain Education

Media

NG

O

ResearchHealth care

Dec

isio

n m

aker

sK

n o wle dg ePh

ysio

logy

Social/economy

Family CultureWork

Aedo

nics

Session 2. The impact of food and nutrition on public health

Activity 2.1 Identify the food supply trends in society

This exercise took place in plenary. The participants were requested to consider how the food supply chain has changed and how it will change in the future. What was eaten 20 years ago? Baltic countries • food was cheaper; • no additives used; • no/less choice; • no globalization → mainly more local food consumed; • more animal fats; • more primary food/less processed and factory food; • more homemade food and different social division → women prepared the food; • more home gown vegetables to supply the household; • more black/rye bread; • food consumption followed the seasons;

EUR/00/5026926 page 24 • used less oils; • no tropical fruits; • no cereals in packets for breakfast; • fewer shops; • home preservation of food; • food was obtained from markets and smaller shops; • deficiencies of primary foodstuffs as most sent to Moscow and St Petersburg. Nordic countries • food industry advanced; • food more expensive; • more fatty food and fish; • less import of food; • less consumption of fruit and vegetables; • food industry liberated the women from cooking; • hobby to grown your own fruit and vegetables; • more small shops; • shops less powerful. What will be eaten in 20 years time?

• internet shopping; • GMO/novel foods/functional foods; • hypermarkets; • supplements; • global “coca-colalization”/globalization; • fast foods; • ecological agriculture; • more organic foods; • both cheaper and more expensive foods; • more diversity of food; • people will spend more on food creating niche markets (e.g. less on bread but more on specialities); • markets will continue; • shops will disappear, but niche shops will stay maybe in conjunction with internet shopping; • quality of food will decrease and result in food millets; • less local foods → more global foods and transportation of foods resulting in increased risk of

spread of disease; • food safety unknown; • increased urbanization.

Activity 2.3 The impact of food and nutrition on health

The participants were asked in plenary to list positive and negative impacts of the diet on health. Positive features Negative features

Treatment Cardiovascular disease Osteoporosis Clinical nutrition Cancer Diabetes Longevity Allergies IDD Quality of life Foodborne diseases (main problems:

Nordic countries – Campylobacter, Baltic countries – Salmonella)

Anaemia Rickets (↑ Norway, ↓ Baltic countries)

Alcohol Dental caries Obesity Malnutrition Anorexia nervosa/bulimia

EUR/00/5026926 page 25

Activity 2.4 How can the government ensure that health is at the heart of food policy?

Nutrition Food safety Sustainable food security/supply

Health education Health education ↑ Vegetables Agriculture; ↑ vegetables, ↑ lean meat HACCPa implementation ↓ Meat Food processing Food control Codex Alimentarius Legislation Standards

a Hazard analysis and critical control point. • Loss of legislative power concerning nutrition when entering international organizations was a

surprise to the Baltic countries. The government will have less room for action and therefore there will be a need to work more at an international level to influence policies e.g. WTO and Codex.

• Campaign within the government to promote public health.

Activity 2.5 What can government do to ensure health is included in food policy

Sector Nutrition Food safety Sustainable development (society and environment)

Agriculture ↑ Vegetables ↑ Lean meat Production subsidies

Standards ↑ Ecological subsidies Legislation

Food processing Waste, packaging and recycling Distribution Regulating advertisement Mass catering ↑ Fruit and vegetables School meals

Social catering Consumers Policy to reduce inequality

Session 3. The policy context: what is a food and nutrition policy?

Activity 3.3 Check some UN policy documents

Participants worked in groups by country and each group were allocated a topic to consider in order to become familiar with WHO recommendations and list what their government has done in relation to their allocated theme. Latvia was asked to review the WHA Resolution (2000) on Food Safety in the context of the Latvian strategy for food safety/control.

The Latvian government has instigated:

1. Integration of food safety in collaboration with epidemiological programmes. Surveillance system NEHC and Food Safety: Food Law (1998).

2. Establishment of administrative infrastructure: SBI, SVI, SSI, SIPO. Harmonizing with EU regarding e.g. flavour, food additive and pesticides. Also education, information and mass media.

3. Regional structures and laboratories have improved. Tests are based on self-control. Implementation of ISO, HACCP and GMP.

4. Do not employ antibiotics in locally produced animal food. Control of drug residues in raw material (including immuno-methods)

5. Scientific state programme: Quality of safe food (SIGRA)

EUR/00/5026926 page 26 6. Included food safety matters in primary and secondary school curriculum. Well-developed

educational programmes on consumer education in mass media and education and training of professionals.

7. Education programmes for farmers on food safety (Ozolrieki kons. Centre).

8. Intersectoral collaboration; Latvian Food Centre and Food council.

9. Latvia does not always attend Codex Alimentarius meetings, but participates when they can afford it.

10. Labelling 08-02/00 of CM.

11. 08-02/00 of CM and Law “On Product safety and producers liabilities”. Lithuania was asked to review the recommendations of “The Urban Food and Nutrition Action Plan on Sustainable Development”

Lithuania is self-sufficient in main products, e.g. milk, meat, grain, vegetables and potatoes, but it lacks fruit. A large part of fruit and vegetables are destroyed during storage and therefore seasonal variations in consumption are marked. The north of Lithuania is sensitive to water pollution. As a result the government supports the use of less pesticides and ecological agricultural development. The Ministry of Environment is interested in establishing collaboration between ministries involved in the issue. Availability

Rural support programme/fund/price support • Ecological agriculture • Quality of raw materials, food produce

Land reform Training Access

Supermarket development ↑ Local market development Recommendation exist to provide ecological produce to hospitals and schools, but there is a lack of ecological foods. Consumption

Healthy school, healthy cities, CINDI Media, TV Harvest festivals National health programme Food law NEHAP National rural development plan Strategy of agricultural and rural development NAPP The Nordic countries were asked to review the recommendations “The Urban Food and Nutrition Action Plan on Sustainable development” Norway/Iceland/Finland Conflict of local production and nutrition

• Expensive to grow local vegetables (e.g. Iceland has high prices of vegetables and support local farmers by putting tax on imported vegetables)

• Border trade.

EUR/00/5026926 page 27

Sweden Study of sustainable production supports nutrition. Denmark and others Local initiatives: Copenhagen, Randers, Helsingborg and Finland have had experience with local municipal initiatives such as the municipality of Copenhagen paying the farmers not to use pesticides. Estonia was asked to review the 12 steps to Healthy Eating from the CINDI dietary guidelines

Nutrition advice is often based on myths, but should be based on science. There are sometimes conflicts between scientists. Government expect immediate results, but lifestyle patterns do not change immediately. Need to be careful who is targeted and provide basic knowledge and not only short messages. Legislation Public Health Law 1995 Estonian Nutrition Recommendations 1995 Food Labelling 1998 (EU directive) Food Act 1999 (EU directive) Advertising Law 1998. National Public Health Programme Heart Health 1995– Child health programme 1996

• School meal project • Milk at school 2000 (financed by Ministry of Agriculture and the Ministry of Agriculture and

Ministry of Social Affairs collaborate regarding this project). Session 4. Developing a comprehensive and integrated food and nutrition policy

Activity 4 Mapping the different dimensions of specific food-related ill health

Participants were grouped according to country and allocated a different problem each. There were asked to consider the following three issues in relation to nutrition, food safety and food sustainability.

1. Strategy 2. Level of action (regional, national and international) 3. Agencies or bodies involved. Latvia was asked to provide the policy solutions relating to food shortage due to a large part of the population living in poverty Strategy

1. Survey of vulnerable groups 2. Analysis, assessment of needs 3. Solutions:

(a) No solution- means used give no permanent result, e.g. humanitarian aid or school meals (b) Development of local primary products and processing for local consumption (c) Investments, subsidies, humanitarian aid, international level (d) Recalculation of subsidizes minimum (minimum consumption basket) (e) International experience e.g. African countries.

EUR/00/5026926 page 28 Agencies

• Ministry of Welfare • Local municipalities • NGOs, churches • Baltic Council of Ministers • IRFC. Levels of action

• Local • National • EU level • International. Estonia was asked to address the situation involving a minister of education who decides that school-age children must receive an optimum quantity of high quality, safe and nutritious food to improve educational performance Strategy It is important to supply schoolchildren with a healthy meal, as this will increase educational performance. School meals should be of the right: • quantity • quality • safety • nutritious food. Precondition for legislation: • Distribution of school meals according to rules of provision of meals • Support to organize school settings and conditions to provide meals. Finance (national and local) • Ideal if all schoolchildren could be provided with a free meal paid by the government. Quality guarantee depend on: • Local conditions • Organization at local level • Source of the food • Education of the catering personnel • Preferences of the children, e.g. survey of children’s taste preferences every second year. Agencies

• Parents advisory committee in schools • School staff • Local municipals • Ministries • Involve the media in the nutrition education of the population. Level of action • Mainly national level → have good legislation to ensure food safety • State level → programmes to change attitude and support the financial side of nutrition.

EUR/00/5026926 page 29

Lithuania was asked to address the situation of a minister of health, who decides to tackle the problem of increasing prevalence of obesity and related noncommunicable diseases

Strategy Agencies Level of action

Family, children Schools, kindergartens Local Education and promotion of healthy nutrition Companies National Breastfeeding NGOs Dietary habits Mass media Increasing physical activity Catering Settings (HPS, CINDI) International agencies (WHO, FAO, UNICEF) Special programmes (e.g. cycle paths, distribution of weight equipment)

Ministries of Health, Education, Finance, Agriculture)

Access to healthy products Municipalities Price policy Public health Insurance of health Primary health care Integrated approach Churches Coordination National Health Board Monitoring Evaluation Annual reporting

The Nordic countries were asked to address a situation where the health of older people is suffering because of the food situation The age of the population has increased due to better health promotion and therefore more elderly are living longer with problems. The group concentrated on free-living elderly; however, this population group is far from homogenous. The strategy is to formulate self-help in order to try to make elderly people stay as long as possible in their own homes. This is an area where society has a large role to play. Flexibility in services is very important, e.g. various kinds of meals-on-wheels and different degrees of food preparation. Planners can contribute by delivery of food. If food is not delivered every day then the elderly require proper storage facilities. In addition, retailers can deliver food to the elderly. The environmental aspect of the transportation of the food deliveries needs to be considered at all levels.

Nutrition Food safety Sustainable environment

Strategy Help to self-help Flexibility in services

→ →

Agencies Social sector NGOs Retailers Transport Church Catering Health sector

Housing planners Storage facilities

Level Local National

EUR/00/5026926 page 30 Session 5. Examples of food and nutrition policies

Activity 5 Checking policies in practice The country groups were allocated a case study and asked to discuss the lessons learned from this experience with the nutrition policy. Lithuania was asked to review the Icelandic food and nutrition policy

Strengths Weaknesses

• Nutrition council (as a separate institute) • Nutrition council (only academic members) • Intersectoral cooperation • Not all sectors involved in implementation • All action is based on dietary surveys

(evidence-based) • No responsibilities allocated to other sectors

• Nutrition and food safety separately • No cooperation between agriculture, health and

environment institutions • No economic evaluation for action plan

Estonia was asked to review the food and nutrition policies of Norway and Finland Difficult to distinguish the factors as all are related and every thing are transferable.

Strengths Weaknesses

• NGOs to population to raise awareness • Lack of human resources- specialists • Realistic goals • Lack of political power for decision- making • Enthusiastic people to lobby government • Small countries sensitive to influences and regulations

from outside, e.g. import and export regulations • Involve stakeholders • To obtain focus on nutrition • Council reputation • Price policy • Marketing the idea in the media • Identify interests, the right stakeholders and the right

people • Leading ministry- one ministry • Difficult interest groups

Latvia was asked to review the food and nutrition policies of Sweden and Denmark

Strengths Weaknesses

• Published documents • Nutrition is not on the political agenda • Long-term view • Political pressure (nutrition under food safety and environment) • Mutual understanding in and between

ministries • Constant institutional changes

• Successful cooperation with other institutions

• Politicians want to be seen to be doing something rather than actually change nutrition/food safety

Lessons learned: • The relationship between politicians and food professionals may be problematic (“ignore

politicians”, “manipulate politicians”) • Trade (free movement…) is much more important than public health • Plans versus change the reality • If you want the plan to be implemented the process behind it must make the key people/institutions

think that they own it – feel part of it. Not transferable: • Oil from Norway to Latvia!

EUR/00/5026926 page 31

Session 6. NGOs campaigning for food and nutrition policy

Activity 6 Develop a NGO to address one a issue in your country The participants were grouped by country and given a cause for which they were asked to develop an NGO. Latvia was asked to establish an NGO to address the problem of low rates of breastfeeding 1. Main goal of NGO:

Promotion of breastfeeding

2. What does the NGO do to achieve its goal? • Inform • Educate • Actions against the aggressive policy of transnational corporations • Legislation initiatives

3. How does the NGO function by voluntary assistance? Involvement of mothers

4. Where do they get their funds? ?

5. How effective is the NGO in achieving its goal? Breastfeeding committee under the Ministry of Welfare. Information campaigns, baby-friendly

hospitals, etc.

6. Necessary skills and inputs and where are gaps likely to be: Presentation skills, enforcement, legislation, research

7. Outline the barriers that hinder success: Lack of information, old beliefs

8. List of opportunities and criteria for success: • Consumer concern • International commitments (IBFAN) • Training of health professionals • Health education • Legislation

Estonia was asked to establish an NGO to address the issue of a lack of information on processed foods to allow consumers to make informed choices Estonia chose an existing organization in Estonia to report on, namely the Heart Union.

1. Main goal of NGO: To provide heart-friendly information on processed food • to risk groups • to whole population

2. What does the NGO do to achieve its goal? Information campaign “heart week”. Information continuously available (web, printed materials)

3. How does the NGO function by voluntary assistance? Cooperation with: • producers • unions • other NGOs • government agencies

4. Where do they get their funds? Health promotion foundation and health insurance

EUR/00/5026926 page 32 5. How effective is the NGO in achieving its goal?

– 6. Necessary skills and inputs and where are gaps likely to be:

Training and information is very important 7. Outline the barriers that hinder success:

– 8. List of opportunities and criteria for success:

–

Lithuania was asked to develop an NGO to address the issue of excessive use of pesticides in local food production which is hampering nutrition campaigns to promote vegetable consumption 1. Main goal of NGO:

• To reduce pesticide use • To protect environment

2. What does the NGO do to achieve its goal?

Main activities: • Unification of the legal acts revision related with pesticide use, control, etc. • Push responsible control bodies to strengthen control • Provide information and education to farmers, consumers, students and doctors

3. How does the NGO function by voluntary assistance?

Ecological farmers, university lectures, consumers, students 4. Where do they get their funds?

Foreign assistance, universities, government agencies 5. How effective is the NGO in achieving its goal?

It depends on the leaders and members as to how effective they will be 6. Necessary skills and inputs and where are gaps likely to be:

Skills in agriculture, environment, and public health on a professional level are needed

7. Outline the barriers that hinder success: Chemical production companies, lack of knowledge of farmers

8. List of opportunities and criteria for success: • The amount of pesticides used • Balanced use of pesticides • Pesticide free produce available (organic produce) • Increase demand of organic produce

The Nordic countries were asked to develop an NGO to address the issue of the EU’s agriculture policy and national concerns about food in the light of joining the EU The following comments were used to describe the Common Agriculture Policy (CAP): • Outdated “dino” • 50% of EU budget • Unhealthy production system • Mobilize • Collect facts • NGO; heart, cancer, environment The group had prepared a drawing of a “dino” to illustrate the expenditure of money and mountains of butter in the CAP. The group saw the CAP as outdated. The main problem is that health is a low priority.

EUR/00/5026926 page 33

Session 7. The contents of national food and nutrition policies and action plans Participants were grouped according to country and the Nordic experts participated in the different Baltic groups. The participants were requested to prepare an outline of a national FNAP following the lines of the WHO recommendations.

Activity 7

Estonia The goal and existing political commitments • Growing, buying and eating the right kind of food reduces the risk of disease, promotes sustainable

environment • Provides accountability • Functioning market surveillance Health education into basic education for:

• Producers • Providers • Consumers

Supply of healthy food Sustainable development law Self-sufficiency on national level Environment friendly = health friendly Lithuania The goal and existing political commitments • Reduce the prevalence of dietary-related diseases • Ensure food safety and security Analysis of current situation • The prevalence of foodborne diseases is quite high (salmonella and shigella) • Breastfeeding rate is 30% until 4 months • Iodine deficiency disorder (≈ 24% goitre) • Anaemia (≈ 30% pregnant) • Mortality from cardiovascular disease and some cancers remain higher than EU average • High prevalence of noncommunicable disease risk factors: obesity, cholesterol and hypertension • Lack of knowledge of social inequalities in nutrition. A comprehensive policy Food safety strategy • Legislation (food law, hygiene norms) • Food contamination monitoring • Hazard analysis critical control point implementation (obligatory) • Codex of good agriculture practice • Nutrition strategies • Develop food-based dietary guidelines • RDA implementation • Fibre, fat • Breastfeeding Proposed action plan 2000–2005 • Establish food and nutrition council • Food-based dietary guidelines

EUR/00/5026926 page 34 • Surveillance of dietary habits (develop food composition tables) • Surveillance of health status • Monitoring • Education (primary health care reform) • Partnership/intersectoral cooperation • International cooperation (e.g. WHO, FAO, Nordic/Baltic) • Reduce social gaps in inequalities • Education of professionals • Harmonization of legislation to EU • NGOs Latvia The goal and existing political commitments • Health protection and promotion Political commitments • National in line with international Diseases • NCD • Obesity • Nutrient deficiency (Zn, Fe, Se) • Foodborne diseases • Food insecurity (mainly related to imported food) A comprehensive policy • Food safety strategy • Nutrition strategy; lifecycle approach • Sustainable food supply strategy (at the very beginning of development) Proposed action plan 2000–2005 • Developing a comprehensive approach • Monitoring health information • Improving knowledge • Mobilizing partners (co-thinkers e.g. WHO) • Promoting the establishment of advisory and coordination mechanism Session 8. The procedure for developing/strengthening national policies and action plans

Activity 8

The participants were grouped by country and the Nordic experts joined the Baltic country groups. The participants were asked to make plans and identify the actions and actors in relation to the development of national FNAP. Lithuania

• Establish intersectoral working group including ministries of health, agriculture, environment and education

• Draft available for comments from state institutes, public and NGOs • Timing:

– Draft 6 months – Consultations 1 year – Approval?

EUR/00/5026926 page 35

Action plan

• Establish food and nutrition council State Health Affairs Commission Medium term • Food based dietary guidelines Ministries of Health, Agriculture

and Education Short term

• Surveillance of dietary habits (food composition tables)

National Nutrition Centre Short term and permanent

• Surveillance of health status Research, Ministry of Health, Information Centre

Permanent

• Food contamination monitoring Ministry of Health and food and veterinary inspector

Permanent

• Education of healthy nutrition Health promotion centre Permanent Lacking: • Support from politicians • Intersectoral cooperation • Finances • Experience How to overcome:

• Information, persuasion of politicians Council representatives • Clarify responsibilities between different sectors Government and ministries • Increase budget Ministry of Finance • International cooperation Regional, Nordic/Baltic, WHO, FAO • Local training courses Ministries and regional offices Estonia Estonia prepared a flow diagram to illustrate the development and adoption of national FNAP.

DraftWorking group under the Ministry of Health

Councils and universities Science

NGOs

Professional groups

Process of commitment between ministries

Government

Forum, May 2000

Parliament

Open collaborationDraft

Working group under the Ministry of Health

Councils and universities Science

NGOs

Professional groups

Process of commitment between ministries

Government

Forum, May 2000

Parliament

Open collaboration

EUR/00/5026926 page 36

Latvia

Organizations involved: Ministry of Welfare

• Food centre • Health promotion centre • Environmental health centre • CINDI • Health professionals

Ministry of Agriculture Ministry of Environmental Protection Ministry of Economics Ministry of Education and Science Ministry of Finance Universities and schools Teachers Farmers NGOs Food industry Food retailers Mass media Local communities Local authorities Monitoring

Surveillance of health status Permanent Ministry of Welfare Surveillance of dietary habits Permanent Ministry of Welfare Surveillance food supply Permanent Ministry of Economy Surveillance foodborne diseases Permanent Environmental health centre Surveillance of food contaminants Permanent Ministries of Welfare and

Agriculture Education

Professional education, nutritionists Short-term and permanent

Universities

Teachers education Short-term and permanent

Universities

School health education Short-term and permanent

Ministry of Education

Public information Permanent Ministry of Welfare and mass media Guidelines and dietary advice Permanent Ministry of Welfare and mass media Preparation of nutritional guidelines Short-term Ministry of Welfare and CINDI Preparation of food tables Medium-term Ministry of Welfare? Nutritional labelling Medium-term Ministry of Welfare Health promotion Short-term Ministry of Education and Ministry

of Welfare Promotion of physical activity Short-term Ministry of Education and Ministry

of Welfare Raising awareness, knowledge and skills of the consumer

Short-term NGOs and health promotion centres

Community actions Short-term NGOs and health promotion centres

EUR/00/5026926 page 37

Session 9. Implementation of new/existing food and nutrition action plans

Activity 9 The participants were grouped by country and the Nordic experts joined the Baltic groups. The activity built on the work in session 7, where participants were asked to prepare a draft of their FNAP. In this session the participants were asked to outline the resources required for the implementation of the food and nutrition policy and calculate a budget for the administration of a national food and nutrition council. Lithuania

Current situation • Lack of funding especially on crisis basis • Ordinary structure is working on small budgets • 24 state programmes approved • National health programme (2010) • Legislative acts Realistic approach

• Council (2000) 2–3 periods, equipment, facilities, etc. US $100 000 • FNAP (2000) Resources, justification, experts US $200 000

Lobbying • Coordination • Intersectoral cooperation • Information system • Education and promotion • Evaluation • Concrete next stages Priorities state programme ≈ 100 million LLT • Mass media campaign • Nutrition centre • Local public health centre • State public health centre • Laboratory renovation Sources of funding • State budget • Health funds • Rural support funds • EU • Municipalities • Private sector • Reallocation of resources Estonia

Budget for the preparation of FNAP

US $

Working group; 4 experts, 1 secretary Salary, location cost 8 000 Council Services 10 000 Forum Transport, per diem, materials 800 +2 400 Print Publications 400 21 600

The budget is for one year, but the project is a continuous process.

EUR/00/5026926 page 38 Latvia Implementation of FNAP Key partners: • Ministry of Welfare (Latvian Food Centre, HDC) • Ministry of Agriculture • Ministry of Economy (consumers rights protection centre) • Ministry of Education (research grant) • Latvian University of Agriculture • MGO (Federation of food enterprises) • International Budget 3.8% of state budget → for health = 130 million Ls 3.5 million Ls for public health 30 000 Ls already allocated for development of nutrition policy A diagram was drawn showing the interaction between the different actors and where financial resources could be obtained.

F ina nces o f the F ood and N u tritio n A ction P lan Im plem enta tion

S ta te bu d g et

L a tvia n Fo o d C e n tre

M in is try o f Ag ric u ltu re

Ag ric u ltu re U n ive rs ity

R esearch g ran ts

M in is try o f E d uc ation

FA OT ech n ica l as s is tan ce

p ro je c ts

N G O

E u ro pe an 5 th F ram ew ork P ro g ram m e

P riva te s ecto r

M u n ic ipa lities

E U s tru c tu ra l fu n ds(Sapard , P hare)

W o rld B an kFrom 2001

30 ,000 L s/year fro m 20 00

5 ,0 00 Ls /ye ar

EUR/00/5026926 page 39

Annex 6

BACKGROUND DOCUMENTS

Document Distribution

General Provisional programme All participants Provisional list of participants All participants Intersectoral food and nutrition policy development: A manual for decision-makers

All participants

Pre-course questionnaire All participants Questionnaire on evaluation of sessions All participants

Nutrition World Declaration and Plan of Action for Nutrition. FAO/WHO International Conference on Nutrition, Rome, December WHO/FAO 1992

All participants

Draft Urban Food and Nutrition Action Plan. WHO Regional Office for Europe. October 1999

All participants

HEALTH21. WHO Regional Office for Europe. 1999 All participants The impact of food and nutrition on public health. The case for a food and nutrition policy and action plan for the European Region of WHO 2000–2005. WHO Regional Office for Europe. Final Draft August 2000.

All participants

Comparative analysis of nutrition policies in WHO European Member States. WHO Regional Office for Europe, 1998

All participants

Comparative analysis of elimination of iodine deficiency disorders in the WHO European Region. WHO Regional Office for Europe, 2000.

All participants

Elimination of IDD in central and eastern Europe, the Commonwealth of Independent States and the Baltic States, Munich, September 1997. ICCIDD and WHO

2 per group

Copies of country reports: Estonia, Latvia, Lithuania, Denmark, Finland, Iceland, Norway, Sweden, 1999.

All participants

Development of the first food and nutrition action plan for the WHO European Region. Report on a WHO Consultation, Malta, November 1999. EUR/ICP/LVNG 01 02 10. WHO Regional Office for Europe, 2000

All participants

CINDI dietary guidelines. Draft. WHO Regional Office for Europe, Draft May 2000

All participants

CINDI posters All participants Prevention and control of iron deficiency anaemia in women and children. Report of UNICEF/WHO Regional Consultation. Geneva, 3–5 February 1999

2 per group

Healthy living: what is a healthy lifestyle? WHO Regional Office for Europe, 1998

All participants

List of nutrition documents and publications All participants Presentation Leaflet 1999. Overview of activities of the Programme for Nutrition Policy, Infant Feeding and Food Security

2 per group

Healthy food and nutrition for women and their families. Training manual for health professionals. Draft May 2000

1 per group

Guidelines for consumer policy in central and eastern Europe. Consumers International. 2000

1 reference copy

Healthy English schoolchildren: a new approach to physical activity and food. W.P.T. James & K.A. McColl. Rowett Research Institute, Aberdeen. October 1997

1 per group

EUR/00/5026926 page 40 Health Behaviour Survey of schoolchildren 1 per group Schools project to increase vegetable and fruit intake, United Kingdom 1 per group Agriculture, environment, rural development. Facts and figures. A challenge for agriculture. European Commission.

1 reference copy

A sustainable food supply chain. A Swedish case study. Swedish Environmental Protection Agency

1 reference copy

Information on Food Chain 21 Website (Final call for Congress on Agriculture and Food Ethics

1 reference copy

Nutrition and lifestyle in the Baltic Republics. EUR/ICP/LVNG 02 03 04. WHO Regional Office for Europe,1999

All participants

Patterns of body weight in the Baltic Republics. Iveta Pudule, Daiga Grinberga, Kamelija Kadziauskiene, Algis Abaravicius, Sirje Vaask, Aileen Robertson, Martin McKee, Joceline Pomerleau. Public Health Nutrition 2000: 3(1), 3–10 English only

2 per group

Patterns of alcohol consumption in the Baltic Republics. Iveta Pudule, Daiga Grinberga, Kamelija Kadziauskiene, Algis Abaravicius, Sirje Vaask, Aileen Robertson, Martin McKee, Joceline Pomerleau. J Epidemiol Community Health 2000; 54:361–366. English only

2 per group

Patterns of smoking in the Baltic Republics. Iveta Pudule, Daiga Grinberga, Kamelija Kadziauskiene, Algis Abaravicius, Sirje Vaask, Aileen Robertson, Martin McKee. J. Epidemiol. Community Health 1999; 53:277–282

2 per group

Dietary beliefs in the Baltic Republics. Joceline Pomerleau, Martin McKee, Aileen Robertson, Kamelija Kadziauskiene, Algis Abaravicius, Roma Bartkeviciute, Sirje Vaask, Iveta Pudule, Daiga Grinberga. Draft. 2000

2 per group

Comparability of data between micro-nutrica nutritional analysis program and Russian food-composition database by using Baltic Nutrition Survey. Sirje Vaask, Iveta Pudule, Joceline Pomerleau, Aileen Robertson. Draft 2000

2 per group

United Kingdom dietary reference values 1 reference copy

Nordic dietary reference values 1 reference copy

Infant Feeding Comparative analysis of implementation of the Innocenti Declaration in WHO European Member States

All participants

Extract from WHO draft publication Feeding and nutrition of infants and young children. Guidelines for the WHO European Region, with emphasis on the former Soviet countries. Recommendations

All participants

Healthy eating during pregnancy and breastfeeding 1 per group Breastfeeding: How to support success. Manual for health professionals 1 per group Evidence for the ten steps to successful breastfeeding. WHO headquarters 1 per group Infant feeding in emergencies. Booklet for mothers 1 per group

Food Safety WHO (1997). Food safety and globalisation of trade in food: a challenge to the public health sector. Geneva: World Health Organization (WHO/FSF/FOS/97.8)

2 per group

HACCP Introducing the hazard analysis and critical control point system, Food Safety Unit, WHO headquarters, Geneva WHO/FSF/FOS/97.2

2 per group

Guidelines for strengthening a national food safety programme, Food Safety Unit, WHO Headquarters, Geneva. WHO/FNU/FOS/96.2

2 per group

ICN: A challenge to the food safety community, Food Safety Unit, WHO Headquarters, Geneva. WHO/FNU/FOS/96.4

2 per group

EUR/00/5026926 page 41

Annex 7

WHO REGIONAL COMMITTEE FOR EUROPE RESOLUTION EUR/RC50/R8

THE IMPACT OF FOOD AND NUTRITION ON PUBLIC HEALTH THE CASE FOR A FOOD AND NUTRITION POLICY AND AN ACTION PLAN

FOR THE EUROPEAN REGION OF WHO 2000–2005 The Regional Committee,

Concerned by the threat to public health from the lack of safe and healthy food; Recognizing the roles of other international organizations and sectors with an interest in food; Recalling Health Assembly resolution WHA46.7, which called for implementation of

comprehensive plans of action on nutrition and which endorsed the goals of the fourth United Nations Development Decade and the World Summit for Children;

Further recalling previous Health Assembly resolutions and particularly WHA49.15 on infant and

young child nutrition and WHA52.24 on the prevention and control of iodine deficiency, which demonstrate the need for comprehensive food and nutrition policies;

Having considered document EUR/RC50/8, entitled The impact of food and nutrition on public health

– The case for a food and nutrition policy and action plan for the European Region of WHO 2000–2005;

1. ENDORSES the Action Plan for the European Region of WHO for 2000–2005; 2. RECOMMENDS that Member States take steps to carry out the Action Plan, taking account of differences in their cultural, social, legal and economic environments; 3. REQUESTS European integrational, intergovernmental and nongovernmental organizations to undertake joint action with Member States and the Regional Office to maximize Region-wide efforts to promote public health through food and nutrition policy; 4. REQUESTS the Regional Director:

(a) to ensure appropriate support for the Action Plan from the WHO Regional Office for Europe; (b) to cooperate with and support Member States and other organizations in comprehensive efforts

to promote public health through appropriate food and nutrition policies; (c) to examine the possibility of setting up, in collaboration with international agencies, the

European Commission and the Council of Europe, a Task Force for Food and Nutrition Policies in the European Region of WHO;

(d) to organize a ministerial conference in 2005 to evaluate the implementation of comprehensive food and nutrition policies at regional and country levels;

5. URGES Member States to report on steps taken to promote the health of their population through a food and nutrition policy at the ministerial conference to be held in 2005; 5. REQUESTS the Regional Director to report to the Regional Committee in 2002 on the progress made

in implementing the Action Plan.