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Roger Hughes - One of the best experts on this subject based on the ideXlab platform.
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Public Health Nutrition capacity assuring the quality of workforce preparation for scaling up Nutrition programmes
Public Health Nutrition, 2016Co-Authors: Roger Shrimpton, Barrie Margetts, Helene Delisle, Sonia Blaney, David Sanders, Lisanne M Du Plessis, Stephen J Atwood, Roger HughesAbstract:OBJECTIVE To describe why and how capacity-building systems for scaling up Nutrition programmes should be constructed in low- and middle-income countries (LMIC). DESIGN Position paper with task force recommendations based on literature review and joint experience of global Nutrition programmes, Public Health Nutrition (PHN) workforce size, organization, and pre-service and in-service training. SETTING The review is global but the recommendations are made for LMIC scaling up multisectoral Nutrition programmes. SUBJECTS The multitude of PHN workers, be they in the Health, agriculture, education, social welfare, or water and sanitation sector, as well as the community workers who ensure outreach and coverage of Nutrition-specific and -sensitive interventions. RESULTS OverNutrition and underNutrition problems affect at least half of the global population, especially those in LMIC. Programme guidance exists for underNutrition and overNutrition, and priority for scaling up multisectoral programmes for tackling underNutrition in LMIC is growing. Guidance on how to organize and scale up such programmes is scarce however, and estimates of existing PHN workforce numbers - although poor - suggest they are also inadequate. Pre-service Nutrition training for a PHN workforce is mostly clinical and/or food science oriented and in-service Nutrition training is largely restricted to infant and young child Nutrition. CONCLUSIONS Unless increased priority and funding is given to building capacity for scaling up Nutrition programmes in LMIC, maternal and child underNutrition rates are likely to remain high and Nutrition-related non-communicable diseases to escalate. A hybrid distance learning model for PHN workforce managers' in-service training is urgently needed in LMIC.
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the Public Health Nutrition intervention management bi cycle a model for training and practice improvement
Public Health Nutrition, 2012Co-Authors: Roger Hughes, Barrie MargettsAbstract:Objective: The present paper describes a model for Public Health Nutrition practice designed to facilitate practice improvement and provide a step-wise approach to assist with workforce development. Design: The bi-cycle model for Public Health Nutrition practice has been developed based on existing cyclical models for intervention management but modified to integrate discrete capacity-building practices. Setting: Education and practice settings. Subjects: This model will have applications for educators and practitioners. Results: Modifications to existing models have been informed by the authors’ observations and experiences as practitioners and educators, and reflect a conceptual framework with applications in workforce development and practice improvement. From a workforce development and educational perspective, the model is designed to reflect adult learning principles, exposing students to experiential, problem-solving and practical learning experiences that reflect the realities of work as a Public Health Nutritionist. In doing so, it assists the development of competency beyond knowing to knowing how, showing how and doing. This progression of learning from knowledge to performance is critical to effective competency development for effective practice. Conclusions: Public Health Nutrition practice is dynamic and varied, and models need to be adaptable and applicable to practice context to have utility. The paper serves to stimulate debate in the Public Health Nutrition community, to encourage critical feedback about the validity, applicability and utility of this model in different practice contexts.
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towards an international system of professional recognition for Public Health Nutritionists a feasibility study within the european union
Public Health Nutrition, 2012Co-Authors: Jennifer Davies, Roger Hughes, Barrie MargettsAbstract:Objective: To test the feasibility of a pan-European professional recognition system for Public Health Nutrition. Design: A multistage consultation process was used to test the feasibility of a model system for Public Health Nutritionist certification. A review of existing national-level systems for professional quality assurance was conducted via literature review and a web-based search, followed by direct inquiries among stakeholders. This information was used to construct a consultation document circulated to key stakeholders summarising the rationale of the proposed system and inviting feedback about the feasibility of the system. Two consultation workshops were also held. The qualitative data gathered through the consultation were collated and thematically analysed. Setting: Europe. Subjects: Public Health Nutrition workforce stakeholders across twenty-nine countries in the European Union. Results: One hundred and forty-five contacts/experts representing twenty-nine countries were contacted with responses received from a total of twenty-eight countries. The system proposed involved a certification system of professional peer review of an applicant’s professional practice portfolio, utilising systems supported by information technology for document management and distribution similar to peer-review journals. Through the consultation process it was clear that there was overall agreement with the model proposed although some points of caution and concern were raised, including the need for a robust quality assurance framework that ensures transparency and is open to scrutiny. Conclusions: The consultation process suggested that the added value of such a system goes beyond workforce development to enhancing recognition of the important role of Public Health Nutrition as a professional discipline in the European Public Health workforce.
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core functions for the Public Health Nutrition workforce in europe a consensus study
Public Health Nutrition, 2012Co-Authors: Svandis Jonsdottir, Susanna Kugelberg, Inga Thorsdottir, Agneta Yngve, N P Kennedy, Roger HughesAbstract:Objective: To assess and develop a consensus among a European panel of Public Health Nutrition workforce stakeholders (academics and employers) regarding core functions required for effective publi ...
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consensus on the competencies required for Public Health Nutrition workforce development in europe the jobnut project
Public Health Nutrition, 2011Co-Authors: Svandis Jonsdottir, Roger Hughes, Inga Thorsdottir, Agneta YngveAbstract:Objective: To assess and develop consensus among a European panel of Public Health Nutrition stakeholders regarding the competencies required for effective Public Health Nutrition practice and the level of proficiency required in different practice contexts. Design: A modified Delphi study involving three rounds of questionnaires. Setting: European Union. Subjects: Public Health Nutrition workforce development stakeholders, including academics, practitioners and employers, from twenty European countries. Results: A total of fifty-two expert panellists (84% of an initial panel of sixty-two Delphi participants) completed all three rounds of the Delphi study. The panellists rated the importance of fifty-seven competency units possibly required of a Public Health Nutritionist to effectively practice (Essential competencies). Twentynine of the fifty-seven competency units (51%) met the consensus criteria ($66?7% agreement) at the second round of the Delphi survey, with the highest agreement for competencies clustered within the Nutrition science, Professional, Analytical and Public Health services competency domains. Ratings of the level of competencies required for different levels in the workforce indicated that for a Public Health Nutrition specialist, advanced-level competency was required across almost all the twenty-nine competencies rated as essential. There were limited differences in rating responses between academics and employer panellists throughout the Delphi study. Conclusions: Competencies identified as essential can be used to review current Public Health Nutrition practices and provide the basis for curriculum design and re-development, continuing education and workforce quality assurance systems in Europe. These are all important tools for systematic and strategic workforce development.
Roger Michael Hughes - One of the best experts on this subject based on the ideXlab platform.
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a qualitative evaluation of an australian Public Health Nutrition workforce development intervention involving mentoring circles
Public Health Nutrition, 2011Co-Authors: Claire Palermo, Roger Michael Hughes, Louise MccallAbstract:Objective: To evaluate a mentoring circle workforce development intervention among a group of Public Health Nutrition novices. Design: The mentoring circle intervention focused on facilitating practice-based Public Health Nutrition competence development and supporting reorientation of practice from clinical services to preventive services. A retrospective post-intervention qualitative semi-structured interview was used to explore the experiences of those participating in the mentoring circle and to make evaluative judgements about intervention attributes and effectiveness. Setting: Victoria, Australia. Subjects: Thirty-two novice Public Health Nutrition practitioners employed in the state Public Health system. Results: Key evaluative theme categories relating to the mentoring circle intervention were identified, including the structure and function of the group, the utility of using advanced-level competency items to guide planning, having a safe and supportive environment for learning and the utility of learning via mentoring and on-the-job experiences. These qualitative evaluation data identify the attributes of the mentoring circle intervention contributing to intervention effectiveness. Conclusions: This qualitative evaluation indicates that mentoring circles can be an effective workforce capacity-building intervention, particularly in novice workforces characterised by professional isolation and split function roles.
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a socioecological analysis of the determinants of national Public Health Nutrition work force capacity australia as a case study
Family & Community Health, 2006Co-Authors: Roger Michael HughesAbstract:This article uses a socioecological analytical approach to assess the capacity of the Public Health Nutrition work force in Australia as a prelude to work force development strategy planning. It demonstrates how the socioecological model can be used to assess and inform the development of the infrastructure required for effective Public Health Nutrition effort. An interpretive case study method was used involving triangular analysis of quantitative and qualitative data from multiple sources including semistructured interviews with advanced-level practitioners, literature review, a cross-sectional national work force survey, and position description audit and consensus development using a Delphi study. The findings of this analysis indicate that the Australian Public Health Nutrition work force's capacity to effectively address priority Nutrition issues is limited by determinants that can be categorized as relating to human resource infrastructure, organizational and policy environments, intelligence access and use, practice improvement and learning systems, and work force preparation. This socioecological analysis supports an intelligence-based focus for work force development effort in Australia and a conceptual framework for work force capacity assessment with potential applications in other countries.
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competencies for effective Public Health Nutrition practice a developing consensus
Public Health Nutrition, 2004Co-Authors: Roger Michael HughesAbstract:Objectives: To assess the level of consensus amongst an international panel of Public Health Nutrition leaders regarding the essential competencies required for effective Public Health Nutrition practice. Design: A modified Delphi study involving three rounds of questionnaires. Subjects: A panel of 20 Public Health Nutrition experts from seven countries in the European Union, the USA and Australia. Results: Expert panellists completed three rounds of the study relating to competencies. A literature review conducted as a prelude to the expert panel survey identified common competency units from the fields of Public Health, Health promotion, Nutrition and dietetics, and Health education. These were categorised into seven competency areas including analytical, socio-cultural and political, Public Health service, communication, management and leadership, Nutrition science and professional competency categories. There was strong initial agreement ($90% of panellists at Round 1) that developing internationally recognised competencies for Public Health Nutrition specialists was a priority. Twenty-six of an initial listing of 52 competency units were rated as essential competencies by $80% of the panellists after Round 1. Iteration rounds resulted in the addition of five extra competency units suggested by panellists after Round 1 and an increase by 13 in the number of competencies rated as essential to consensus levels. From a total of 57 competency units rated after the final survey round, 41 competency units were rated as essential competencies by $80% of the panellists (consensus), with 21 of these unanimously rated as essential competencies. Conclusions: There is strong international agreement amongst Public Health Nutrition leaders in Europe, the USA and Australia about a range of competencies required for effective Public Health Nutrition practice. Essential competency units identified can be used to develop and review competency standards for Public Health Nutrition.
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competency development needs of the australian Public Health Nutrition workforce
Public Health Nutrition, 2003Co-Authors: Roger Michael HughesAbstract:Objectives: To assess factors affecting competency development of the Australian Public Health Nutrition workforce and investigate competency development intentions, barriers and self-reported training needs. Design: Cross-sectional study using self-administered mail- or email-delivered questionnaire. Setting and subjects: Two hundred and forty practitioners working in designated community and Public Health Nutrition positions in the Australian Health system. Results: An 87% questionnaire response rate was achieved. The profile of the sample included female practitioners (95%) within the age range of 26‐45 years (67%), from dietetic backgrounds (75%) and employed in state Health departments as community dietitians/Nutritionists (52%) or Public Health Nutritionists (32%). Only 14% had completed higher degree qualifications but most (80%) reported an intention to do so in the future. Entry-level dietetic education was considered by most respondents (57%) to be inadequate preparation for Public Health Nutrition practice but considered it had utility as a precursor for Public Health Nutrition competency development because of its strong grounding in Nutrition knowledge, basic research skills and problem-solving. On-the-job learning was the most prominent competency development influence reported by this workforce. Flexibility in teaching and learning approaches is needed to facilitate workforce participation in further competency development. The main competency development needs focused on analytical and policy process competencies; however, there was a general need expressed for competency development across many competency areas. Conclusions: These data provide intelligence to inform Public Health Nutrition workforce development, particularly that relating to continued professional development amongst the existing workforce.
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definitions for Public Health Nutrition a developing consensus
Public Health Nutrition, 2003Co-Authors: Roger Michael HughesAbstract:Objectives: To assess the level of agreement amongst a panel of Public Health Nutrition leaders regarding the key descriptors used to define the field of Public Health Nutrition. Design: Cross-sectional survey requiring quantitative and qualitative responses representing the first round of a consensus development Delphi technique. Setting: International. Subjects: Expert panel of 24 Public Health Nutrition leaders from nine countries in the European Union, the USA and Australia. Results: All but one of the panel agreed it was important to have a consensus definition for Public Health Nutrition to describe the field consistently. Opinion about the length and complexity of this definition tended to vary depending on the intended use of the definition. The large majority (18/24) supported the inclusion of specific reference to physical activity in a definition of Public Health Nutrition, although there was not consensus (.83% agreement as criterion) on this point. Consensus descriptors regarded as important in a definition of Public Health Nutrition included: population-based, focus on Health promotion, food and Nutrition systems focus, wellness maintenance, primary prevention, applies Public Health principles, education, environmental and political descriptors. Treatment as a descriptor was rated as unimportant by a majority (14/24) of panellists, delineating Public Health Nutrition from clinical practice. Conclusions: There is strong international agreement amongst Public Health Nutrition leaders in Europe, the USA and Australia about a range of descriptors that can be used to define Public Health Nutrition. The limitations of using word-for-word definitions between and within countries may be overcome by explicit use of the consensus descriptors identified in this process.
Barrie Margetts - One of the best experts on this subject based on the ideXlab platform.
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capacity building for a strong Public Health Nutrition workforce in low resource countries
Bulletin of The World Health Organization, 2017Co-Authors: Helene Delisle, Roger Shrimpton, Sonia Blaney, Lisanne Du Plessis, Stephen Atwood, David Sanders, Barrie MargettsAbstract:CITATION: Delisle, H. et al. 2017. Capacity-building for a strong Public Health Nutrition workforce in low-resource countries. Bulletin of the World Health Organization, 95:385-388. doi:10.2471/BLT.16.174912
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Public Health Nutrition capacity assuring the quality of workforce preparation for scaling up Nutrition programmes
Public Health Nutrition, 2016Co-Authors: Roger Shrimpton, Barrie Margetts, Helene Delisle, Sonia Blaney, David Sanders, Lisanne M Du Plessis, Stephen J Atwood, Roger HughesAbstract:OBJECTIVE To describe why and how capacity-building systems for scaling up Nutrition programmes should be constructed in low- and middle-income countries (LMIC). DESIGN Position paper with task force recommendations based on literature review and joint experience of global Nutrition programmes, Public Health Nutrition (PHN) workforce size, organization, and pre-service and in-service training. SETTING The review is global but the recommendations are made for LMIC scaling up multisectoral Nutrition programmes. SUBJECTS The multitude of PHN workers, be they in the Health, agriculture, education, social welfare, or water and sanitation sector, as well as the community workers who ensure outreach and coverage of Nutrition-specific and -sensitive interventions. RESULTS OverNutrition and underNutrition problems affect at least half of the global population, especially those in LMIC. Programme guidance exists for underNutrition and overNutrition, and priority for scaling up multisectoral programmes for tackling underNutrition in LMIC is growing. Guidance on how to organize and scale up such programmes is scarce however, and estimates of existing PHN workforce numbers - although poor - suggest they are also inadequate. Pre-service Nutrition training for a PHN workforce is mostly clinical and/or food science oriented and in-service Nutrition training is largely restricted to infant and young child Nutrition. CONCLUSIONS Unless increased priority and funding is given to building capacity for scaling up Nutrition programmes in LMIC, maternal and child underNutrition rates are likely to remain high and Nutrition-related non-communicable diseases to escalate. A hybrid distance learning model for PHN workforce managers' in-service training is urgently needed in LMIC.
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the Public Health Nutrition intervention management bi cycle a model for training and practice improvement
Public Health Nutrition, 2012Co-Authors: Roger Hughes, Barrie MargettsAbstract:Objective: The present paper describes a model for Public Health Nutrition practice designed to facilitate practice improvement and provide a step-wise approach to assist with workforce development. Design: The bi-cycle model for Public Health Nutrition practice has been developed based on existing cyclical models for intervention management but modified to integrate discrete capacity-building practices. Setting: Education and practice settings. Subjects: This model will have applications for educators and practitioners. Results: Modifications to existing models have been informed by the authors’ observations and experiences as practitioners and educators, and reflect a conceptual framework with applications in workforce development and practice improvement. From a workforce development and educational perspective, the model is designed to reflect adult learning principles, exposing students to experiential, problem-solving and practical learning experiences that reflect the realities of work as a Public Health Nutritionist. In doing so, it assists the development of competency beyond knowing to knowing how, showing how and doing. This progression of learning from knowledge to performance is critical to effective competency development for effective practice. Conclusions: Public Health Nutrition practice is dynamic and varied, and models need to be adaptable and applicable to practice context to have utility. The paper serves to stimulate debate in the Public Health Nutrition community, to encourage critical feedback about the validity, applicability and utility of this model in different practice contexts.
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towards an international system of professional recognition for Public Health Nutritionists a feasibility study within the european union
Public Health Nutrition, 2012Co-Authors: Jennifer Davies, Roger Hughes, Barrie MargettsAbstract:Objective: To test the feasibility of a pan-European professional recognition system for Public Health Nutrition. Design: A multistage consultation process was used to test the feasibility of a model system for Public Health Nutritionist certification. A review of existing national-level systems for professional quality assurance was conducted via literature review and a web-based search, followed by direct inquiries among stakeholders. This information was used to construct a consultation document circulated to key stakeholders summarising the rationale of the proposed system and inviting feedback about the feasibility of the system. Two consultation workshops were also held. The qualitative data gathered through the consultation were collated and thematically analysed. Setting: Europe. Subjects: Public Health Nutrition workforce stakeholders across twenty-nine countries in the European Union. Results: One hundred and forty-five contacts/experts representing twenty-nine countries were contacted with responses received from a total of twenty-eight countries. The system proposed involved a certification system of professional peer review of an applicant’s professional practice portfolio, utilising systems supported by information technology for document management and distribution similar to peer-review journals. Through the consultation process it was clear that there was overall agreement with the model proposed although some points of caution and concern were raised, including the need for a robust quality assurance framework that ensures transparency and is open to scrutiny. Conclusions: The consultation process suggested that the added value of such a system goes beyond workforce development to enhancing recognition of the important role of Public Health Nutrition as a professional discipline in the European Public Health workforce.
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developing an evidence based approach to Public Health Nutrition translating evidence into policy
Public Health Nutrition, 2001Co-Authors: Barrie Margetts, Agneta Yngve, Daniel Warm, Michael SjostromAbstract:The aim of this paper is to highlight the importance of an evidence-based approach to the development, implementation and evaluation of policies aimed at improving Nutrition-related Health in the population. Public Health Nutrition was established to realise a population-level approach to the prevention of the major Nutrition-related Health problems world-wide. The scope is broad and integrates activity from local, national, regional and international levels. The aim is to inform and develop coherent and effective policies that address the key rate-limiting steps critical to improving Nutrition-related Public Health. This paper sets out the rationale for an evidence-based approach to Public Health Nutrition developed under the umbrella of the European Network for Public Health Nutrition.
Helen Bromley - One of the best experts on this subject based on the ideXlab platform.
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smorgasbord or symphony assessing Public Health Nutrition policies across 30 european countries using a novel framework
BMC Public Health, 2014Co-Authors: Ffion Lloydwilliams, Helen Bromley, Lois Orton, Corinna Hawkes, David Taylorrobinson, Martin Oflaherty, Rory Mcgill, Elspeth Anwar, Lirije Hyseni, M MoonanAbstract:Countries across Europe have introduced a wide variety of policies to improve Nutrition. However, the sheer diversity of interventions represents a potentially bewildering smorgasbord. We aimed to map existing Public Health Nutrition policies, and examine their perceived effectiveness, in order to inform future evidence-based diet strategies. We created a Public Health Nutrition policy database for 30 European countries . National Nutrition policies were classified and assigned using the marketing "4Ps" approach Product (reformulation, elimination, new Healthier products); Price (taxes, subsidies); Promotion (advertising, food labelling, Health education) and Place (schools, workplaces, etc.). We interviewed 71 senior policy-makers, Public Health Nutrition policy experts and academics from 14 of the 30 countries, eliciting their views on diverse current and possible Nutrition strategies. Product Voluntary reformulation of foods is widespread but has variable and often modest impact. Twelve countries regulate maximum salt content in specific foods. Denmark, Austria, Iceland and Switzerland have effective trans fats bans. Price EU School Fruit Scheme subsidies are almost universal, but with variable implementation. Taxes are uncommon. However, Finland, France, Hungary and Latvia have implemented ‘sugar taxes’ on sugary foods and sugar-sweetened beverages. Finland, Hungary and Portugal also tax salty products. Promotion Dialogue, recommendations, Nutrition guidelines, labelling, information and education campaigns are widespread. Restrictions on marketing to children are widespread but mostly voluntary. Place Interventions reducing the availability of unHealthy foods were most commonly found in schools and workplace canteens. Interviewees generally considered mandatory reformulation more effective than voluntary, and regulation and fiscal interventions much more effective than information strategies, but also politically more challenging. Public Health Nutrition policies in Europe appear diverse, dynamic, complex and bewildering. The "4Ps" framework potentially offers a structured and comprehensive categorisation. Encouragingly, the majority of European countries are engaged in activities intended to increase consumption of Healthy food and decrease the intake of "junk" food and sugary drinks. Leading countries include Finland, Norway, Iceland, Denmark, Hungary, Portugal and perhaps the UK. However, all countries fall short of optimal activities. More needs to be done across Europe to implement the most potentially powerful fiscal and regulatory Nutrition policies.
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abstract p409 assessing Public Health Nutrition policies using a novel framework across 30 european countries lessons for the usa
Circulation, 2014Co-Authors: Ffion Lloydwilliams, Helen Bromley, Lois Orton, Corinna Hawkes, David Taylorrobinson, Martin Oflaherty, Rory Mcgill, Elspeth Anwar, Lirije Hyseni, Maria Guzman CastilloAbstract:Background: Countries across Europe have introduced a wide variety of policies to improve Nutrition. However, the sheer diversity of interventions is potentially bewildering. We therefore aimed to map existing Public Health Nutrition policies and identify their perceived effectiveness, in order to inform future evidence-based diet strategies. Methods: Mapping exercise: We created a Public Health Nutrition policy database for 30 European countries (EU 27 plus Iceland, Norway and Switzerland), by summarising policy documents, grey literature, web searches and advice from topic experts. National Nutrition policies were then classified using the marketing “4Ps” approach: Product (reformulation, elimination, new Healthier products); Price (taxes, subsidies); Promotion (advertising, food labelling and Health education) and Place (schools, workplaces, etc.) Policy interviews: We interviewed 71 senior policy-makers, Public Health Nutrition policy experts and academics from 14 of the 30 countries, eliciting their views on diverse current and possible Nutrition strategies. Results Product: Voluntary reformulation of foods, (especially salt, sugar and total fat) is widespread but with questionable impact. Denmark, Austria, Iceland and Switzerland have trans fats bans. Twelve countries regulate maximum salt content in specific foods. Price: EU School Fruit Scheme subsidies are almost universal, with variable implementation. Taxes are uncommon. However, Finland, France, Hungary and Latvia have implemented ‘sugar taxes’ on sugary foods and sugar-sweetened beverages. Finland, Hungary and Portugal also tax salty products. Promotion: Dialogue, recommendations, Nutrition guidelines, information and education campaigns are widespread (all 30 countries). Labelling information is widespread, but variable. Restrictions on marketing to children are widespread but mostly voluntary. Place: Interventions reducing the availability of unHealthy foods were most commonly found in schools and workplace canteens (e.g. vending machines). Comparative effectiveness: Interviewees generally considered mandatory reformulation more effective than voluntary, and regulation and fiscal interventions much more effective than information strategies, but politically much more challenging. Implications: Public Health Nutrition policies in Europe appear diverse, dynamic, complex and bewildering. However, the “4Ps” framework potentially offers a structured and comprehensive categorisation. Most European countries are active in Nutrition policy. However, exemplars are few, including Finland, Norway, Iceland, Denmark, Hungary, Portugal and the UK. Do these offer any useful lessons for US states addressing similar challenges? In conclusion, fiscal and regulatory Nutrition policies appear potentially powerful and should be considered across Europe, and perhaps across the US?
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Public Health Nutrition actions across 14 eu countries a qualitative study to elicit the views of policy makers and thought leaders
The Lancet, 2013Co-Authors: Ffion Lloydwilliams, Mike Rayner, Helen Bromley, Lois Orton, Corinna Hawkes, David Taylorrobinson, Martin Oflaherty, M Moonan, Simon CapewellAbstract:Abstract Background Cardiovascular disease (CVD) is the main cause of death in Europe. EuroHeart II is a research programme led by the European Heart Network and European Society of Cardiology to address the burden of CVD in Europe and to determine interventions for prevention of avoidable deaths and disability. One aspect identifies the most effective Public Health Nutrition policies, to inform future evidence-based strategies to promote cardiovascular Health. Methods We mapped national Nutrition policies across 30 European countries, then contacted and recruited potential participants in 14 of those countries. Participants were identified through various sources; for example, the European Heart Network, via national Heart Foundations, via published work, the internet, and the snowballing technique. Before interview, participants were emailed information about the project, the interview questions (developed and piloted with senior stakeholders in the UK), and a summary of Public Health Nutrition policies in their country. Policy makers, academics, and other Public Health Nutrition experts at the national level shared their views on a range of possible approaches to Public Health Nutrition strategies, covering the entire policy spectrum. The interviews were done in English, either by person, telephone, or Skype. The interviews typically lasted 45–60 min. The interview questions were open ended and used as a topic guide. This structure enabled the interviews to be led by the interviewees, not the interviewers. Also, the interviews were flexible with no maximum time limit. Interviews were transcribed and entered into NVivo software. The Framework approach was used to analyse transcripts. Cross checking of coding and interpretation of data was done by three researchers from the research team. Findings We did 70 interviews in 14 countries across Europe. The interviews enabled more up-to-date and accurate information than was provided on websites or in reports. Responses revealed important differences between official lists of food policies and their actual implementation on the ground. European countries are at very different stages of addressing Public Health Nutrition issues. Most are promoting dialogue, recommendations, and guidelines (often regarded as an early part of the policy process). Voluntary reformulation of foods is also common, especially for salt, sugar, and total fat. Legislation, regulation, or fiscal interventions targeting salt, sugar, fat, or fruit and vegetable consumption are still uncommon. Many interviewees expressed a preference for regulation and fiscal interventions and generally believed that they were more effective than voluntary measures and information-based interventions, albeit politically more challenging. Conversely, information-based interventions were often seen as being more politically feasible than regulation and fiscal measures. Interpretation Public Health Nutrition policies in Europe represent a complex, dynamic, and rapidly changing arena. Encouragingly, most countries are engaged in activities intended to increase consumption of Health food and decrease the intake of junk food and sugary drinks. Exemplar countries showing notable progress might include Finland, Norway, Iceland, Hungary, the UK, and Portugal. However, most countries fall well short of optimum activities. Implementation of potentially powerful Nutrition policies remains frustratingly patchy across Europe. This study provides only a snapshot of activities up until 2012; developments are ongoing, and data may not be complete and will require regular updating. We propose future work to identify and assess population-based policy actions across the WHO European Region to expand and refine the evidence base. This information could support development of a Nutrition policy assessment method for each country to use to promote—and implement—Healthier food strategies. Funding European Union Health Programme.
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op15 identifying the most effective Public Health Nutrition policies the views of policy makers and thought leaders across 14 eu countries
Journal of Epidemiology and Community Health, 2013Co-Authors: Ffion Lloydwilliams, Helen Bromley, Lois Orton, David Taylorrobinson, Martin Oflaherty, Rory Mcgill, Elspeth Anwar, M Moonan, N Calder, Guzman M CastilloAbstract:Background EuroHeart 2 is a European research programme led by the European Heart Network and European Society of Cardiology (http://www.ehnheart.org/euroheart-ii.html). One aspect of the project aimed to identify the most effective Public Health Nutrition policies, in order to inform future evidence-based strategies to promote cardiovascular Health. We interviewed senior policy-makers and thought-leaders in 14 diverse EU countries to elicit their views on a very wide range of possible Nutrition strategies covering the entire Public Health policy spectrum aimed at improving approaches to Public Health Nutrition. Methods We first mapped national Nutrition policies across 30 European countries. We then identified contacted and recruited potential participants in 14 diverse countries. Policy-makers, thought-leaders and others active in the field of Public Health Nutrition at the national level were interviewed. Questions were first developed and piloted with senior stakeholders in the UK. The interviews were conducted in English, either by person, telephone or Skype. The interviews typically lasted between 45 and 60 minutes. The interviews were transcribed and entered into NVIVO software. The Framework approach was used to analyse the transcripts. Results We conducted 66 interviews in 14 countries across Europe. The interviews enabled more up to date and accurate information than was provided on websites or in reports. Responses revealed important differences between official lists of food policies and their actual implementation “on the ground”. European countries are at very different stages of addressing Public Health Nutrition issues. Most are promoting dialogue, recommendations and guidelines (often considered an early part of the policy process). Voluntary reformulation of foods is also common, especially for salt, sugar and total fat. However, legislation regulation or fiscal interventions targeting salt, sugar, fat or fruit and vegetable consumption are still uncommon. Many interviewees expressed a preference for regulation and fiscal interventions and generally believed they were more effective, albeit politically more challenging. Conversely, information-based interventions were often seen as being more politically feasible. Conclusion Public Health Nutrition policies in Europe represent a complex, dynamic and rapidly changing arena. Encouragingly, the majority of countries are engaged in activities intended to increase consumption of Health food, and decrease the intake of junk food and sugary drinks. Exemplar countries demonstrating notable progress might include Finland, Norway, Iceland, Hungary, the UK and Portugal. However, most countries fall well short of optimal activities. Implementation of potentially powerful Nutrition policies remains frustratingly patchy across Europe.
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op16 utilising a novel framework to assess Public Health Nutrition actions across 30 european countries euroheart ii project
Journal of Epidemiology and Community Health, 2013Co-Authors: Helen Bromley, Lois Orton, Martin Oflaherty, Rory Mcgill, Elspeth Anwar, M Moonan, N Calder, Lloyd F Williams, Taylor D Robinson, Guzman M CastilloAbstract:Background EuroHeart II is a European programme designed to inform cardiovascular Health strategies across Europe. Our project examines the role of food policies in cardiovascular disease prevention, including the development and piloting of a novel conceptual framework for categorising Public Health Nutrition policies. Methods We conducted a mapping exercise to identify and categorise Public Health Nutrition policy actions across 30 European countries using a novel framework. The framework was based on the traditional marketing “4Ps” approach: Price, Product, Promotion and Place (the “marketing mix”). A database was created to summarise Public Health Nutrition policy for 30 European countries (EU 27 plus Iceland, Norway and Switzerland). National policies were classified according to Price (taxes, subsidises, other economic incentives); Product (reformulation, new Healthier products); Place (schools, workplaces, community settings); and Promotion (advertising to children/general population, food labelling and Health education initiatives). Results Dialogue, recommendations and Nutrition guidelines are now widespread across Europe. Information and education campaigns are also widespread. These include campaigns covering the general population, and campaigns targeting schools, the workplace or communities. Subsidies for fruit in schools are almost universal through the EU School Fruit Scheme, but implementation differs across the 30 countries. New EU legislation supports limited, back of pack food labelling. Some countries have also implemented national legislation requiring more detailed label information about the Nutritional value of foods (e.g. Finland). However, the presentation and information vary widely. Voluntary reformulation of foods is common, especially for salt, sugar and total fat (e.g. salt reduction in the UK). However, mandatory reformulation of products to reduce saturated fat and salt are still limited to trans fat bans in Austria, Denmark, Iceland and Switzerland. Legislation/regulation affecting salt, sugar, fat and fruit and vegetable consumption is uncommon, although several countries have legal requirements regarding the maximum salt content in certain foods (Belgium, Bulgaria, Finland, Greece, Latvia, Lithuania, Netherlands, Portugal, Romania, Slovak RePublic, Slovenia and Wales). Taxes to promote Healthy Nutrition are currently used infrequently. However, Finland, France, Hungary and Portugal have implemented ‘sugar taxes’ on sugary foods and sugar-sweetened beverages. Hungary and Portugal also tax salty products. Conclusion The diverse Public Health Nutrition activities across 30 European countries might initially appear complex and bewildering. However, the “4Ps” framework offers a potentially structured and comprehensive categorisation of these diverse interventions. National food policies in Europe are currently at very different stages of development and implementation. However, exemplar countries might include Denmark, Finland, Hungary, Iceland, the UK and Portugal.
Ffion Lloydwilliams - One of the best experts on this subject based on the ideXlab platform.
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smorgasbord or symphony assessing Public Health Nutrition policies across 30 european countries using a novel framework
BMC Public Health, 2014Co-Authors: Ffion Lloydwilliams, Helen Bromley, Lois Orton, Corinna Hawkes, David Taylorrobinson, Martin Oflaherty, Rory Mcgill, Elspeth Anwar, Lirije Hyseni, M MoonanAbstract:Countries across Europe have introduced a wide variety of policies to improve Nutrition. However, the sheer diversity of interventions represents a potentially bewildering smorgasbord. We aimed to map existing Public Health Nutrition policies, and examine their perceived effectiveness, in order to inform future evidence-based diet strategies. We created a Public Health Nutrition policy database for 30 European countries . National Nutrition policies were classified and assigned using the marketing "4Ps" approach Product (reformulation, elimination, new Healthier products); Price (taxes, subsidies); Promotion (advertising, food labelling, Health education) and Place (schools, workplaces, etc.). We interviewed 71 senior policy-makers, Public Health Nutrition policy experts and academics from 14 of the 30 countries, eliciting their views on diverse current and possible Nutrition strategies. Product Voluntary reformulation of foods is widespread but has variable and often modest impact. Twelve countries regulate maximum salt content in specific foods. Denmark, Austria, Iceland and Switzerland have effective trans fats bans. Price EU School Fruit Scheme subsidies are almost universal, but with variable implementation. Taxes are uncommon. However, Finland, France, Hungary and Latvia have implemented ‘sugar taxes’ on sugary foods and sugar-sweetened beverages. Finland, Hungary and Portugal also tax salty products. Promotion Dialogue, recommendations, Nutrition guidelines, labelling, information and education campaigns are widespread. Restrictions on marketing to children are widespread but mostly voluntary. Place Interventions reducing the availability of unHealthy foods were most commonly found in schools and workplace canteens. Interviewees generally considered mandatory reformulation more effective than voluntary, and regulation and fiscal interventions much more effective than information strategies, but also politically more challenging. Public Health Nutrition policies in Europe appear diverse, dynamic, complex and bewildering. The "4Ps" framework potentially offers a structured and comprehensive categorisation. Encouragingly, the majority of European countries are engaged in activities intended to increase consumption of Healthy food and decrease the intake of "junk" food and sugary drinks. Leading countries include Finland, Norway, Iceland, Denmark, Hungary, Portugal and perhaps the UK. However, all countries fall short of optimal activities. More needs to be done across Europe to implement the most potentially powerful fiscal and regulatory Nutrition policies.
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abstract p409 assessing Public Health Nutrition policies using a novel framework across 30 european countries lessons for the usa
Circulation, 2014Co-Authors: Ffion Lloydwilliams, Helen Bromley, Lois Orton, Corinna Hawkes, David Taylorrobinson, Martin Oflaherty, Rory Mcgill, Elspeth Anwar, Lirije Hyseni, Maria Guzman CastilloAbstract:Background: Countries across Europe have introduced a wide variety of policies to improve Nutrition. However, the sheer diversity of interventions is potentially bewildering. We therefore aimed to map existing Public Health Nutrition policies and identify their perceived effectiveness, in order to inform future evidence-based diet strategies. Methods: Mapping exercise: We created a Public Health Nutrition policy database for 30 European countries (EU 27 plus Iceland, Norway and Switzerland), by summarising policy documents, grey literature, web searches and advice from topic experts. National Nutrition policies were then classified using the marketing “4Ps” approach: Product (reformulation, elimination, new Healthier products); Price (taxes, subsidies); Promotion (advertising, food labelling and Health education) and Place (schools, workplaces, etc.) Policy interviews: We interviewed 71 senior policy-makers, Public Health Nutrition policy experts and academics from 14 of the 30 countries, eliciting their views on diverse current and possible Nutrition strategies. Results Product: Voluntary reformulation of foods, (especially salt, sugar and total fat) is widespread but with questionable impact. Denmark, Austria, Iceland and Switzerland have trans fats bans. Twelve countries regulate maximum salt content in specific foods. Price: EU School Fruit Scheme subsidies are almost universal, with variable implementation. Taxes are uncommon. However, Finland, France, Hungary and Latvia have implemented ‘sugar taxes’ on sugary foods and sugar-sweetened beverages. Finland, Hungary and Portugal also tax salty products. Promotion: Dialogue, recommendations, Nutrition guidelines, information and education campaigns are widespread (all 30 countries). Labelling information is widespread, but variable. Restrictions on marketing to children are widespread but mostly voluntary. Place: Interventions reducing the availability of unHealthy foods were most commonly found in schools and workplace canteens (e.g. vending machines). Comparative effectiveness: Interviewees generally considered mandatory reformulation more effective than voluntary, and regulation and fiscal interventions much more effective than information strategies, but politically much more challenging. Implications: Public Health Nutrition policies in Europe appear diverse, dynamic, complex and bewildering. However, the “4Ps” framework potentially offers a structured and comprehensive categorisation. Most European countries are active in Nutrition policy. However, exemplars are few, including Finland, Norway, Iceland, Denmark, Hungary, Portugal and the UK. Do these offer any useful lessons for US states addressing similar challenges? In conclusion, fiscal and regulatory Nutrition policies appear potentially powerful and should be considered across Europe, and perhaps across the US?
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Public Health Nutrition actions across 14 eu countries a qualitative study to elicit the views of policy makers and thought leaders
The Lancet, 2013Co-Authors: Ffion Lloydwilliams, Mike Rayner, Helen Bromley, Lois Orton, Corinna Hawkes, David Taylorrobinson, Martin Oflaherty, M Moonan, Simon CapewellAbstract:Abstract Background Cardiovascular disease (CVD) is the main cause of death in Europe. EuroHeart II is a research programme led by the European Heart Network and European Society of Cardiology to address the burden of CVD in Europe and to determine interventions for prevention of avoidable deaths and disability. One aspect identifies the most effective Public Health Nutrition policies, to inform future evidence-based strategies to promote cardiovascular Health. Methods We mapped national Nutrition policies across 30 European countries, then contacted and recruited potential participants in 14 of those countries. Participants were identified through various sources; for example, the European Heart Network, via national Heart Foundations, via published work, the internet, and the snowballing technique. Before interview, participants were emailed information about the project, the interview questions (developed and piloted with senior stakeholders in the UK), and a summary of Public Health Nutrition policies in their country. Policy makers, academics, and other Public Health Nutrition experts at the national level shared their views on a range of possible approaches to Public Health Nutrition strategies, covering the entire policy spectrum. The interviews were done in English, either by person, telephone, or Skype. The interviews typically lasted 45–60 min. The interview questions were open ended and used as a topic guide. This structure enabled the interviews to be led by the interviewees, not the interviewers. Also, the interviews were flexible with no maximum time limit. Interviews were transcribed and entered into NVivo software. The Framework approach was used to analyse transcripts. Cross checking of coding and interpretation of data was done by three researchers from the research team. Findings We did 70 interviews in 14 countries across Europe. The interviews enabled more up-to-date and accurate information than was provided on websites or in reports. Responses revealed important differences between official lists of food policies and their actual implementation on the ground. European countries are at very different stages of addressing Public Health Nutrition issues. Most are promoting dialogue, recommendations, and guidelines (often regarded as an early part of the policy process). Voluntary reformulation of foods is also common, especially for salt, sugar, and total fat. Legislation, regulation, or fiscal interventions targeting salt, sugar, fat, or fruit and vegetable consumption are still uncommon. Many interviewees expressed a preference for regulation and fiscal interventions and generally believed that they were more effective than voluntary measures and information-based interventions, albeit politically more challenging. Conversely, information-based interventions were often seen as being more politically feasible than regulation and fiscal measures. Interpretation Public Health Nutrition policies in Europe represent a complex, dynamic, and rapidly changing arena. Encouragingly, most countries are engaged in activities intended to increase consumption of Health food and decrease the intake of junk food and sugary drinks. Exemplar countries showing notable progress might include Finland, Norway, Iceland, Hungary, the UK, and Portugal. However, most countries fall well short of optimum activities. Implementation of potentially powerful Nutrition policies remains frustratingly patchy across Europe. This study provides only a snapshot of activities up until 2012; developments are ongoing, and data may not be complete and will require regular updating. We propose future work to identify and assess population-based policy actions across the WHO European Region to expand and refine the evidence base. This information could support development of a Nutrition policy assessment method for each country to use to promote—and implement—Healthier food strategies. Funding European Union Health Programme.
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op15 identifying the most effective Public Health Nutrition policies the views of policy makers and thought leaders across 14 eu countries
Journal of Epidemiology and Community Health, 2013Co-Authors: Ffion Lloydwilliams, Helen Bromley, Lois Orton, David Taylorrobinson, Martin Oflaherty, Rory Mcgill, Elspeth Anwar, M Moonan, N Calder, Guzman M CastilloAbstract:Background EuroHeart 2 is a European research programme led by the European Heart Network and European Society of Cardiology (http://www.ehnheart.org/euroheart-ii.html). One aspect of the project aimed to identify the most effective Public Health Nutrition policies, in order to inform future evidence-based strategies to promote cardiovascular Health. We interviewed senior policy-makers and thought-leaders in 14 diverse EU countries to elicit their views on a very wide range of possible Nutrition strategies covering the entire Public Health policy spectrum aimed at improving approaches to Public Health Nutrition. Methods We first mapped national Nutrition policies across 30 European countries. We then identified contacted and recruited potential participants in 14 diverse countries. Policy-makers, thought-leaders and others active in the field of Public Health Nutrition at the national level were interviewed. Questions were first developed and piloted with senior stakeholders in the UK. The interviews were conducted in English, either by person, telephone or Skype. The interviews typically lasted between 45 and 60 minutes. The interviews were transcribed and entered into NVIVO software. The Framework approach was used to analyse the transcripts. Results We conducted 66 interviews in 14 countries across Europe. The interviews enabled more up to date and accurate information than was provided on websites or in reports. Responses revealed important differences between official lists of food policies and their actual implementation “on the ground”. European countries are at very different stages of addressing Public Health Nutrition issues. Most are promoting dialogue, recommendations and guidelines (often considered an early part of the policy process). Voluntary reformulation of foods is also common, especially for salt, sugar and total fat. However, legislation regulation or fiscal interventions targeting salt, sugar, fat or fruit and vegetable consumption are still uncommon. Many interviewees expressed a preference for regulation and fiscal interventions and generally believed they were more effective, albeit politically more challenging. Conversely, information-based interventions were often seen as being more politically feasible. Conclusion Public Health Nutrition policies in Europe represent a complex, dynamic and rapidly changing arena. Encouragingly, the majority of countries are engaged in activities intended to increase consumption of Health food, and decrease the intake of junk food and sugary drinks. Exemplar countries demonstrating notable progress might include Finland, Norway, Iceland, Hungary, the UK and Portugal. However, most countries fall well short of optimal activities. Implementation of potentially powerful Nutrition policies remains frustratingly patchy across Europe.