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Food and health
in Europe:
a new basis
for action
Food and health in Europe:
a new basis for action
96
WHO Regional Publications
European Series, No. 96
The World Health Organization was established in 1948 as a specialized
agency of the United Nations serving as the directing and coordinating
authority for international health matters and public health. One of WHO’s
constitutional functions is to provide objective and reliable information and
advice in the field of human health, a responsibility that it fulfils in part
through its publications programmes. Through its publications, the
Organization seeks to support national health strategies and address the
most pressing public health concerns.
The WHO Regional Office for Europe is one of six regional offices
throughout the world, each with its own programme geared to the particular
health problems of the countries it serves. The European Region embraces
some 870 million people living in an area stretching from Greenland in the
north and the Mediterranean in the south to the Pacific shores of the Russian
Federation. The European programme of WHO therefore concentrates both
on the problems associated with industrial and post-industrial society and
on those faced by the emerging democracies of central and eastern Europe
and the former USSR.
To ensure the widest possible availability of authoritative information
and guidance on health matters, WHO secures broad international
distribution of its publications and encourages their translation and
adaptation. By helping to promote and protect health and prevent and
control disease, WHO’s books contribute to achieving the Organization’s
principal objective – the attainment by all people of the highest possible
level of health.
i
Food and health in Europe:
a new basis for action
ii
WHO Library Cataloguing in Publication Data
Food and health in Europe : a new basis for action
(WHO regional publications. European series ; No. 96)
1.Nutrition 2.Food supply 3.Food contamination - prevention and control
4.Nutritional requirements 5.Nutrition policy 6.Intersectoral cooperation
7.Sustainability 8.Europe
I.Series
ISBN 92 890 1363 X (NLM Classification: WA 695)
ISSN 0378-2255
Te xt editing: Mary Stewart Burgher
iii
Food and health
in Europe:
a new basis for action
Edited by:
Aileen Robertson, Cristina Tirado,
Tim Lobstein, Marco Jermini,
Cecile Knai, Jørgen H. Jensen,
Anna Ferro-Luzzi and W.P.T. James
WHO Regional Publications, European Series, No. 96
iv
ISBN 92 890 1363 X
ISSN 0378-2255
© World Health Organization 2004
All rights reserved. The Regional Office for Europe of the World Health
Organization welcomes requests for permission to reproduce or translate its
publications, in part or in full.
The designations employed and the presentation of the material in this publi-
cation do not imply the expression of any opinion whatsoever on the part of
the World Health Organization concerning the legal status of any country, ter-
ritory, city or area or of its authorities, or concerning the delimitation of its
frontiers or boundaries. Where the designation “country or area” appears in the
headings of tables, it covers countries, territories, cities, or areas. Dotted lines
on maps represent approximate border lines for which there may not yet be full
agreement.
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not imply that they are endorsed or recommended by the World Health Or-
ganization in preference to others of a similar nature that are not mentioned.
Errors and omissions excepted, the names of proprietary products are distin-
guished by initial capital letters.
The World Health Organization does not warrant that the information con-
tained in this publication is complete and correct and shall not be liable for any
damages incurred as a result of its use. The views expressed by authors or edi-
tors do not necessarily represent the decisions or the stated policy of the World
Health Organization.
Address requests for copies of publications of the WHO Regional Office
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pubrights@euro.who.int; or contact Publications, WHO Regional
Office for Europe, Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark,
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who.int).
v
Contents
Page
Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Editors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xii
Abbreviations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
Introduction: the need for action on food and nutrition in Europe . . . 1
Overview of the book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
WHO activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1. Diet and disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Diet-related diseases: the principal health burden in Europe. . . . . . 7
Variations in CVD: the fundamental role of diet . . . . . . . . . . . . . . 23
Diet’s role in limiting the development of cancer . . . . . . . . . . . . . . 32
Epidemic of overweight and obesity . . . . . . . . . . . . . . . . . . . . . . . . 35
Type 2 diabetes and excessive weight gain. . . . . . . . . . . . . . . . . . . . 38
Impact of physical inactivity on health . . . . . . . . . . . . . . . . . . . . . . 38
Impaired infant and child development from
micronutrient deficiency. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Pregnancy and fetal development . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Feeding of infants and young children . . . . . . . . . . . . . . . . . . . . . . 50
Dental health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
The health of the ageing population of Europe. . . . . . . . . . . . . . . . 57
Nutritional health of vulnerable groups . . . . . . . . . . . . . . . . . . . . . 64
Social inequalities and poverty . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
2. Food safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Food safety and food control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Causes of foodborne disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Effects of foodborne disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Extent of foodborne disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
vi
Trends in foodborne disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
The burden of foodborne disease . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Microbial hazards in food. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Chemical hazards in the food chain . . . . . . . . . . . . . . . . . . . . . . . . 112
Risk assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Food safety, diet and nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Inequality in food safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Case studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Emerging food control issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
WHO and food safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
3. Food security and sustainable development . . . . . . . . . . . . . . . . . . 155
Food security . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Food production and health policies. . . . . . . . . . . . . . . . . . . . . . . . 156
Food and nutrition insecurity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Current trends in food supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
Agricultural policies and diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
Policies for food and nutrition security. . . . . . . . . . . . . . . . . . . . . . 196
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210
4. Policies and strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
WHO Action Plan on Food and Nutrition Policy . . . . . . . . . . . . . 221
Need for integrated and comprehensive food and nutrition policies 222
Food and nutrition policies in the European Region. . . . . . . . . . . . 230
Nutrition policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Food control policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Food security and sustainable development policy . . . . . . . . . . . . . 270
Mechanisms to help health ministries set priorities for future action 277
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
5. Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310
Annex 1. The First Action Plan for Food and Nutrition Policy,
WHO European Region, 2000–2005 . . . . . . . . . . . . . . . . . . . . . . 313
Annex 2. International and selected national recommendations
on nutrient intake values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341
vii
Acknowledgements
This publication was prepared by the nutrition and food security and the
food safety programmes of the WHO Regional Office for Europe. We, the
editors, gratefully acknowledge the financial support provided by the Govern-
ment of the Netherlands. We are particularly grateful to the following people
for helping us with the conceptual framework: Dr Eric Brunner (University
College London, United Kingdom), Dr Raymond Ellard (Food Safety
Authority of Ireland, Dublin, Ireland), Professor Tim Lang (Thames Valley
University, London, United Kingdom), Professor Martin McKee (London
School of Hygiene and Tropical Medicine, United Kingdom), Dr Mike
Rayner (British Heart Foundation Health Promotion Research Group,
Oxford, United Kingdom) and Dr Alan Lopez (Evidence and Information for
Policy, WHO headquarters).
It is impossible to give individual credit for all the ideas and inspiration in-
cluded in this book. We give references for the evidence we present, but the
thinking and the arguments that allow us to interpret the evidence have come
from many sources. We acknowledge the help we have received from a wide
array of experts who contributed to individual sections or reviewed the draft
text. These generous people have provided information and given their com-
ments and support without any question of charge or any attempt to ex-
change favours. For this, we and WHO are immensely grateful.
For personal contributions and additional research, we are indebted to (in
alphabetical order): Dr Martin Adams (University of Surrey, Guildford,
United Kingdom), Dr Brian Ardy (South Bank University, London, United
Kingdom), Dr Paolo Aureli (Istituto Superiore di Sanità, Rome, Italy), Dr
Bruno de Benoist (Department of Nutrition for Health and Development,
WHO headquarters), Dr Elisabeth Dowler (University of Warwick, United
Kingdom), Dr Margaret Douglas (Common Services Agency for the National
Health Service (NHS) Scotland, Edinburgh, United Kingdom), Dr Robert
Goodland (World Bank, Washington, DC, United States of America), Dr
Jens Gundgaard (University of Southern Denmark, Odense, Denmark), Dr
Corinna Hawkes (Sustain: the alliance for better food and farming, London,
United Kingdom), Dr Annemein Haveman-Nies (National Institute of Public
Health and the Environment (RIVM), Bilthoven, Netherlands), Dr Anne
Käsbohrer (Bundesinstituts für gesundheitlichen Verbraucherschutz und
viii
Veterinärmedizin (BgVV), Berlin, Germany), Dr Alan Kerbey (International
Obesity TaskForce, London, United Kingdom), Dr Marion Koopmans (Re-
search Laboratory for Infectious Diseases, Bilthoven, Netherlands), Dr Karen
Lock (London School of Hygiene and Tropical Medicine), Professor Jim
Mann (University of Otago, Dunedin, New Zealand), Dr Eric Millstone
(University of Sussex, Brighton, United Kingdom), Dr Gerald Moy (Depart-
ment of Food Safety, WHO headquarters), Dr Joceline Pomerleau (London
School of Hygiene and Tropical Medicine, United Kingdom), Dr Elio Riboli
(International Agency for Research on Cancer, Lyon, France), Dr Maura
Ricketts (Communicable Disease Surveillance and Response, WHO head-
quarters), Dr Jocelyn Rocourt (Department of Food Safety, WHO headquar-
ters), Dr Katrin Schmidt (Bundesinstituts für gesundheitlichen Verbrauch-
erschutz und Veterinärmedizin (BgVV), Berlin, Germany), Professor Aubrey
Sheiham (University College London, United Kingdom) and Professor Leigh
Sparks (University of Stirling, United Kingdom).
For assistance with reading and commenting on drafts of the text, we ex-
press our appreciation and gratitude to (in alphabetical order): Dr Martin
Adams (University of Surrey, Guildford, United Kingdom), Dr Carlos
Alvarez-Dardet (University of Alicante, San Vicente del Raspeig, Spain), Dr
Dieter Arnold (Bundesinstituts für gesundheitlichen Verbraucherschutz und
Veterinärmedizin (BgVV), Berlin, Germany), Dr Paolo Aureli (Istituto Supe-
riore di Sanità, Rome, Italy), Dr Sue Barlow (Institute for Environment and
Health, University of Leicester, United Kingdom), Dr Wolfgang Barth (Cen-
tre for Epidemiology and Health Research, Zepernick, Germany), Dr Bruno
de Benoist (Department of Nutrition for Health and Development, WHO
headquarters), Dr Carsten Bindslev-Jensen (Allergy Centre, Odense Univer-
sity Hospital, Denmark), Dr Gunn-Elin Bjørneboe (National Nutrition
Council, Oslo, Norway), Dr Zsuzsanna Brazdova (Masaryk University, Brno,
Czech Republic), Dr Eric Brunner (University College London, United King-
dom), Dr Caroline Codrington (University of Crete, Heraklion, Greece), Pro-
fessor Finn Diderichsen (Karolinska Institute, Stockholm, Sweden), Dr Carlos
Dora (European Centre for the Environment and Health, Rome, WHO Re-
gional Office for Europe), Dr Elisabeth Dowler (University of Warwick,
United Kingdom), Dr Guy van den Eede (European Commission Joint Re-
search Centre, Institute for Health and Consumer Protection, Ispra, Italy), Dr
Raymond Ellard (Food Safety Authority of Ireland, Dublin, Ireland), Dr
Maria Ellul (Health Promotion Department, Floriana, Malta), Dr Gino
Farchi (Istituto Superiore di Sanità, Rome, Italy), Dr Peter Fürst (Chemical
and Veterinary Control Laboratory, Münster, Germany), Professor Igor
Glasunov (State Research Centre for Preventive Medicine, Moscow, Russian
[...]... improved standards of living and greater access to services, there have also been significant negative consequences in terms of inappropriate dietary patterns and decreased physical activities, and a corresponding increase in nutritional and diet-related diseases 18 Food and health in Europe Food and food products have become commodities produced and traded in a market that has expanded from an essentially... Israel Italy United Kingdom Russian Federation Belgium–Luxembourg Estonia Switzerland Lithuania Netherlands Ireland Germany Poland Austria Latvia Czech Republic Ukraine Slovenia Slovakia a TFYR Macedonia Hungary Croatia Bulgaria Kazakhstan Georgia Turkmenistan Albania Romania Azerbaijan Belarus Armenia Republic of Moldova Kyrgyzstan Uzbekistan 0 50 100 150 200 250 300 Availability (g per person per day)... population targets for healthy eating These targets have become increasingly specific in the last 20 years, moving from general statements about the need to eat a healthy diet to numerical recommendations for certain nutrients and foods Such targets as increasing fruit and vegetable consumption and reducing fat, salt and sugar intake have implications beyond the orbit of health educators and public advice,... primary and processed products, across national boundaries and around the globe, national regulations are coming under scrutiny, and international agencies (such as the Codex Alimentarius Commission) are increasingly involved in setting safety standards International standards for the food trade need to be set to protect health, and the health impact of trading policies needs to be assessed Chapter... the European Region, examines the links between disease and food, and looks upstream at the nature of food supplies It 1 2 Food and health in Europe shows that policies on food supply and a range of related topics – such as sustainable agriculture and rural development, transport and food retailing and planning – are all linked to the problems of nutrition, food safety and food quality In doing this,... home and at work largely replacing physically demanding manual tasks, and leisure time often being dominated by physically undemanding pastimes Because of these changes in dietary and lifestyle patterns, diet-related diseases – including obesity, type II diabetes mellitus, cardiovascular disease, hypertension and stroke, and various forms of cancer – are increasingly significant causes of disability and. .. prions), as well as longer-standing concerns about the impact on health of agrochemicals and veterinary drugs used to enhance agricultural productivity Good evidence links these aspects of food and health – principally food safety and nutrition – in certain circumstances Each affects the other On the 4 Food and health in Europe one hand, nutritional status can determine the risk of infectious disease, and. .. agricultural, industrial and food policies can harm health, the environment and the economy, but harmful effects can be reduced and health can be promoted if all sectors are aware of the policy options National policies on food and nutrition should address three overlapping areas: nutrition, food safety and a sustainable food supply (food security) The First Action Plan for Food and Nutrition Policy calls for. .. consistent, and widely accepted and promoted by all stakeholders Nutrition, food safety and food standards are the policy areas that directly affect food- related ill health As suggested, many other human activities and the policies that govern them have an influence These activities include the growing, transport, processing, distribution and marketing of food Policies 6 Food and health in Europe on these activities... Finland and the province of North Karelia were especially affected by CVD, a major comprehensive prevention project was started in 1972, and developed from a demonstration project into national action Legislative and other policy decisions included the development of low-fat spreads, fat and salt labelling for many food groups and improving the quality of meals at schools and in the army The food industry . health. i Food and health in Europe: a new basis for action ii WHO Library Cataloguing in Publication Data Food and health in Europe : a new basis for action (WHO regional publications. European series. Food and health in Europe: a new basis for action Food and health in Europe: a new basis for action 96 WHO Regional Publications European Series, No. 96 The World Health Organization was. diet-related ill health: that diet can be a primary cause of disease or cause a reduction in disease, and that the extent of 1 Food and health in Europe: a new basis for action. Summary (http://www.euro.who.int/Information- Sources/Publications/Catalogue/20030224_1).
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Xem thêm: Food and health in Europe: a new basis for action pptx, Food and health in Europe: a new basis for action pptx, Annex 1. The First Action Plan for Food and Nutrition Policy, WHO European Region, 2000–2005, Annex 2. International and selected national recommendations on nutrient intake values Nutrient intake values