Swiss Nutrition Policy 2013-2016

Swiss Nutrition Policy 2013–2016 Based on the Main Findings of the 6th Swiss Nutrition Report 2 | Table of Contents Table of ConTenTs summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Part I : Main Findings of the 6th Swiss Nutrition report Dietary Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 food Utilisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 nutrient supply and Malnutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 nutrition and Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 success factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Part II : Swiss Nutrition Policy 2013–2016 Health Policy and nutrition in switzerland . . . . . . . . . . . . . . . . . . . . . . . 13 Developing a swiss nutrition Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 swiss nutrition Policy 2013–2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 stakeholders in Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Notes This publication is also available in German, french and Italian . This publication and corresponding bibliography are available online at www .nutritionreport .ch / section brochure . © federal office of Public Health (foPH) Date of publication: october 2012 Introduction | 3 InTRoDUCTIon the significance of nutrition a balanced diet meets our requirements in terms of energy (calories) and nutrients while avoiding unnecessary energy intake; it positively influences our mental and physical well-being and contributes to maintaining our health and preventing nutrition-related illnesses . In addition to a balanced diet, reg ular physical activity, foregoing tobacco and excessive alcohol use are also part of a healthy lifestyle . Nutritional challenges The strong prevalence of overweight and obesity (= severe overweight), which indicates an imbalance between energy intake (via one’s diet) and en ergy expenditure (through physical activity, among other things), is one of our greatest challenges . Cardiovascular disease, diabetes mellitus, cancer, osteoporosis and malnutrition (a lack of certain nutrients) are also important . Goal and target groups of the brochure The brochure provides an overview of the main findings of the 6th swiss nu trition Report and delineates the problem areas and fields of action derived from it, which form the basis for the swiss nutrition Policy . The brochure is aimed at members of the media, stakeholders in the nutrition and health sectors and everybody interested in getting a quick overview of the nutri tional situation and connected strategic measures in switzerland . additional information ■ Keller U, battaglia Richi e, beer M, Darioli R, Meyer K, Renggli a, Römer-lüthi C, stoffel-Kurt n . sechster schweizerischer ernährungsbericht . bern: bundesamt für Gesundheit, 2012 . www .nutritionreport .ch ■ Keller U, battaglia Richi e, beer M, Darioli R, Meyer K, Renggli a, Römer-lüthi C, stoffel-Kurt n . sixth swiss nutrition Report (summary) . bern: federal office of Public Health, 2012 . www .nutritionreport .ch ■ bundesamt für Gesundheit . ernährung und bewegung in der schweiz . bern: bundesamt für Gesundheit, 2012 . www .moseb .ch http://www.bag.admin.ch/themen/ernaehrung bewegung/05190/index.html?lang=en 4 | summary sUMMaRy Part I : Main Findings of the 6th Swiss Nutrition report In the face of societal changes and the increasing frequency of non-commu nicable diseases, a balanced diet is of paramount importance; it has a signif icant influence on the development and progression of various illnesses and risk factors, such as overweight/obesity, cardiovascular disease, Type 2 dia betes mellitus as well as certain types of cancer and osteoporosis . a particular need for action exists in terms of the implementation of the di etary recommendations and the imbalance between energy intake and ex penditure . The latter manifests in a high prevalence of overweight and obese adults and children, and a surge in the frequency of nutrition-related illness es . some population groups also run the risk of an undersupply of iodine, iron, folic acid and vitamin D . Measures creating an environment that facilitates a balanced diet and suffi cient physical activity are important and promising . This includes improved consumer information and an optimised food composition . Improving the swiss nutritional parameters in terms of quality as well as quantity is of crucial importance in determining success factors and good practices, among other things . Part II : Swiss Nutrition Policy 2013–2016 The six fields of action of the swiss nutrition Policy determine the priorities and goals in the area of nutrition and allow stakeholders to develop strate gies, plans of action and measures in the area of nutrition . The fields of ac tion are based on problem areas derived from the 6th swiss nutrition Re port . Implementation of the swiss nutrition Policy requires the participa tion of stakeholders within and outside the health sector and has to take place on a voluntary or statutory basis by means of appropriate measures . summary | 5 Conclusion ■ food utilisation of the swiss population (in kg per capita) has not markedly changed in the past 30 years . The high rate of overweight and obese persons is one of our greatest challenges . ■ Coverage of nutrition-related issues is a prerequisite for developing a swiss nutrition Policy aimed at improving the nutritional and health situation in switzerland . but its implementation will be successful only if the various stakeholders at the municipal, cantonal and national levels participate in it . 6 | Main findings of the 6th swiss nutrition Report Part I Figure 1: Swiss Food Pyramid © swiss society for nutrition ssn, federal office of Public Health foPH, 2011 Why do the Swiss not adhere to dietary recommendations? ■ by their own admission, close to 30% of the swiss population do not pay attention to anything in particular when it comes to their diet and thus show no interest in dietary recommendations . ■ Too little importance is attributed to nutrition in connection with the pre vention of illnesses or maintaining health and well-being . ■ a lack of nutritional knowledge and insufficient information, pricing, taste preferences and everyday habits and constraints are further reasons . * food utilisation data are drawn from the agricultural statistics and correspond to the food quantities available on the swiss market (page 7) . DIeTaRy ReCoMMenDaTIons What have we accomplished? (Examples) + a majority of the swiss population is familiar with the main dietary recommen dations . + In the past 20 years, the utilisation* of vegetable oils and fats (e .g . rapeseed and olive oil) in switzerland has increased, and the utilisation of animal oils and fats (e .g . butter, lard) has decreased . + In the past 30 years, the utilisation* of fish in switzerland has increased by close to 50%, contributing to a greater supply of healthy fatty acids . Where do we see a continued need for action? (Examples) – The strong prevalence of overweight and obesity (= severe overweight) is one of our greatest challenges (page 9) . – The average daily salt intake in switzerland is 11 g for men and 8 g for women, versus the WHo recommendations of maximum 5 g per day . – The utilisation* of sugar and honey increased by 5% between 2001/02 and 2007/08 . – only 30% of the swiss population adhere to the “5 a day” recommendation for fruit and vegetable consumption . © Swiss Society for Nutrition SSN, Federal Office of Public Health FOPH / 2o11 Main findings of the 6th swiss nutrition Report | 7 Part IfooD UTIlIsaTIon food utilisation of the swiss population (in kg per capita) has not markedly changed in the past 30 years . The main changes concern: ■ Vegetables: after decades of continuous increase, vegetable utilisation has decreased for the first time in 2007/08 (decrease of 6% compared to 2001/02) . ■ Fruit: The downward trend in fruit utilisation has increased in recent years; traditional fruit types are particularly affected . ■ Milk and dairy: after a continuous decline between 1979/80 and 2001/02, the milk and dairy utilisation has stabilised for the first time in 2007/08 . ■ Meat and meat products: Meat utilisation declined by 20% between 1987 and 2001/02 . In 2007/08 utilisation stagnated at the 2001/02 level . Figure 2: Food utilisation in Switzerland between 1979/80 and 2007/08 Food utilisation vs. food consumption ■ food utilisation data are drawn from the agricultural statistics and correspond to the food available on the swiss market . ■ Individual consumption data take into account various losses: inter alia, preparation losses (e .g . vegetable peelings), non-consumable food parts (e .g . bones), spoiled foods, discarded leftovers or food fed to pets . There are no individual consumption data for switzerland (textbox page 8) . 0 20 40 60 80 100 120 140 160 180 Alcoholic beverages Oils, fats Nuts, seeds Eggs Fish Meat, meat products Milk, dairy 2007/082001/021994/951987 1987 1979/80 0 5 10 15 20 2007/082001/021994/951979/80 Nüsse, Samen Eier Fisch Hülsenfrüchte U ti lis at io n ( kg p e r ca p it a) V e rb ra u ch ( kg p ro K o p f) alkoholische Getränke Öle, Fette Nüsse, Samen Eier Fisch Fleisch, Fleischprodukte Milch, Milchprodukte Cereals Potatoes Sugar Vegetables Legumes Fruit Getreide Kartoffeln Zucker Gemüse Hülsenfrüchte Früchte 8 | Main findings of the 6th swiss nutrition Report Part I nUTRIenT sUPPly anD MalnUTRITIon ■ based on the available data, the supply of vitamin D, folic acid and iodine in the population or parts of the population in switzerland is insufficient . ■ Certain population groups may exhibit a lack of additional nutrients, e .g . iron . based on the poor data availability, only limited assertions are pos sible in this respect . ■ Today, one fifth to one fourth of patients entering hospital suffer from nutritional deficiencies or exhibit a risk of malnutrition . The growing ratio of older people in switzerland is likely to lead to an increase in malnutrition . Data gaps ■ switzerland does not dispose of any nationally representative high-quality data on individual food consumption or eating behaviour . ■ Therefore, no confirmed assertions are possible regarding the rate of energy (calorie) or nutrient supply within the population or individual population groups in switzerland . Main findings of the 6th swiss nutrition Report | 9 Part InUTRITIon anD HealTH In addition to other factors, nutrition has a significant influence on the devel opment and progression of various illnesses and risk factors, such as over weight, cardiovascular disease, Type 2 diabetes mellitus as well as certain types of cancer and osteoporosis . Body weight Roughly 46% of adult men and 29% of adult women in switzerland are over weight or obese* . fortunately, there is now, for the first time, evidence that the prevalence of overweight and obesity* among children as well as among adults is not increasing at the same rate as in the past . *obesity = severe overweight (body mass index ≥ 30 .0) **bMI = body mass index Figure 3: Prevalence of underweight, overweight and obesity* among adults (15 years or older) in Switzerland between 1992 and 2007 (self-reported) 100 90 80 70 60 50 40 30 20 10 0 P e rs o n s af fe ct e d ( in % ) 1992 1997 2002 2007 obesity* (bMI ≥ 30 .0**) overweight (bMI 25 .0–29 .9**) normal weight (bMI 18 .5–24 .9**) Underweight (bMI < 18 .5**) M e n W o m e n M e n W o m e n M e n W o m e n M e n W o m e n 1 .6 5 3 .0 3 7 . 4 8 .0 6 .2 6 4 .6 2 1 .7 7 . 5 1 .0 5 2 .7 3 7 . 6 8 .7 5 .9 6 5 .5 2 0 .8 7 . 8 1 .4 5 6 .5 3 5 .4 6 .8 6 .7 6 5 .1 2 1 .1 7 . 0 1 .3 5 9 .5 3 3 .1 6 .1 7 . 8 7 0 .3 1 7 . 1 4 .7 10 | Main findings of the 6th swiss nutrition Report Part I Cardiovascular disease ■ Cardiovascular disease is the most common cause of death in switzerland . Most deaths occur past the age of retirement . ■ nutrition-related risk factors include obesity*, Type 2 diabetes mellitus, high blood pressure and fat metabolism disorder . ■ The risk of an obese* person dying from cardiovascular disease is roughly double that of a person with normal weight . between 9% and 14% of all cardiovascular deaths are caused by obesity* . ■ In 2007, 3 .1% of men and 1 .2% of women stated that they were being treated or had been treated in the past due to a heart attack . The numbers for stroke were 1 .3% for men and 0 .8% for women . Diabetes mellitus ■ between 5% and 6% of men and between 4% and 5% of women in swit zerland are affected by diabetes mellitus . ■ almost 90% of (Type 2) diabetes mellitus cases are attributable to over weight or obesity* . Cancer ■ Cancer is the second most common cause of death (after cardiovascular disease) . ■ one of the principal risk factors for cancer that can be influenced is tobacco use . Various nutritional factors, such as alcohol or obesity*, are also linked to an increased risk of certain types of cancer . Osteoporosis ■ approximately 300,000 people with the bone disease osteoporosis are cur rently living in switzerland; women are affected more often than men . ■ The calcium and protein supply of the swiss population is sufficient; how ever, certain population groups often seem to be undersupplied with vita min D . Data gaps switzerland does not dispose of nationally representative data on measured risk factors or on the prevalence of nutrition-related illnesses . Thus the health effects of the population’s eating habits cannot be unambiguously inferred . *obesity = severe overweight (body mass index ≥ 30 .0) Main findings of the 6th swiss nutrition Report | 11 Part IsUCCess faCToRs Promoting a balanced diet requires a combination of measures on the behav ioural as well as the environmental levels . schools, particularly those with lunch and after-school programmes, are especially apt for reaching children and their caregivers on both levels, independent of their social class . The range of food services in school canteens or vending machines, for exam ple, can be influenced . Measures taken in schools are effective particular ly if the family is involved . The involvement of key figures and key institutions in the planning and im plementation of measures to promote a balanced diet are another important success factor . for example: ■ Projects aimed at the migrant population are promising if they involve community interpreters as key figures and foreigners’ associations as key institutions . ■ family counselling centres and day care services are considered key institu tions for projects aimed at infants . another promising approach is multisectoral, i .e . considering health promo tion and prevention in all policy areas . In addition to health policy, agricul tural policy (e .g . through its role in controlling the supply side) and educa tional policy, among others, are called upon to do their share for a balanced diet . To promote a healthy lifestyle, we have to direct our attention to phys ical activity as well – a challenge for suburban development, land use plan ning, sports and transportation policy . Behavioural and environmental factor-related prevention ■ behavioural factor-related prevention measures target the individual and aim at changing eating habits (e .g . via dietary recommendations) . ■ environmental factor-related prevention measures focus on environmental factors (e .g . availability, price, advertising, etc ., of foods) and aim at changing the context in a way that facilitates a balanced diet (e .g . by changing the availability or the pricing of foods) . environmental factor-related prevention is also called structural prevention . swiss nutrition Policy 2013–2016 | 13 Part IIHealTH PolICy anD nUTRITIon In sWITzeRlanD an ageing population and an increase in non-communicable diseases are a challenge for the health and welfare system as well as for the economy . nu tritional factors are often contributory causes of non-communicable diseases . Important risk factors, which can be influenced by dietary measures, are high blood pressure, high levels of blood cholesterol, overweight/obesity* and in sufficient fruit and vegetable consumption . Health policy approaches These challenges must be taken into account in the development and im plementation of health policy strategies . according to the federal Council’s strategy (legislative goals 2012–2015), prevention and health promotion are to be strengthened in order to ensure effective health care . Prevention uses a two-pronged approach: reinforcing the public’s person al responsibility and health literacy (behavioural factor-related prevention) on the one hand, and creating a context that facilitates a healthy lifestyle (environmental factor-related prevention) on the other . effective preven tion comprises, among other things, a coordinated approach by the vari ous stakeholders such as the federal government, cantons, local munici palities, the business community and non-governmental organisations and also requires a link to measures from other policy sectors such as agricul tural and educational policy . Measures in the areas of nutrition (supply, information, etc .) and food safe ty – on a voluntary or statutory basis – will succeed in preventing non-com municable diseases while taking into account societal, scientific and eco nomic developments . * obesity = severe overweight (body mass index ≥ 30 .0) Communicable and non-communicable diseases ■ Communicable diseases (infectious diseases) used to be the main focus in health policy . ■ In recent years the significance of non-communicable diseases has steadily ri sen . according to the WHo, this includes cardiovascular disease, Type 2 diabe tes mellitus, cancer and respiratory disease . 14 | swiss nutrition Policy 2013–2016 Part II DeVeloPInG a sWIss nUTRITIon PolICy The foundation for developing nutrition policies was laid in 1992 in the course of the WHo/fao’s 1992 International Conference on nutrition, dur ing which WHo Member states committed to creating national nutrition policies to improve their respective nutritional environment . The evidence-based swiss nutrition Policy 2013–2016 is based on the data from the 6th swiss nutrition Report, on current scientific knowledge and on national and international basic documents . The new swiss nutrition Poli cy replaces the earlier nutrition policy from 2001, which was based on the 4th swiss nutrition Report . at the national level, the national Programme on Diet and Physical activi ty nPDPa (nationales Programm ernährung und bewegung nPeb) is based on the swiss nutrition Policy . The nPDPa has five goals, which are imple mented by its four partners (the federal office of Public Health foPH, the federal office of sport fosPo, Health Promotion switzerland and the can tons) . Implementation of the swiss nutrition Policy is achieved with plans of ac tion, programmes and projects through voluntary and statutory measures and in cooperation with various stakeholders at the national, cantonal and regional levels . Good health is not just the job of the foPH; other policy sectors, such as suburban development, agricultural, educational, land use planning, sports and transportation policy have to do their share for the pro motion of a healthy lifestyle . further stakeholders include non-governmen tal organisations, the business community and private institutions, also in their role as employers (page 19) . evaluation of the measures taken serves to identify examples of good prac tices and their success factors, which should be taken into account in future projects and which facilitate successful implementation . swiss nutrition Policy 2013–2016 | 15 Part II Figure 4: Developing a Swiss Nutrition Policy Ev al ua tio n S it u at io n an al ys is / a ss es sm ent Strategies for im proving the situ atio n Sw is s Nu tri tio n Re po rt è P ro bl em a re as w ith a ne ed fo r ac tion Im p lem entation of the strategy Swiss Nutrition Policy N ational Program m e è Priorities/goals on D iet and Physical A ctivity P lans of action / program m es / projects of various stakeholders è M easures Evalu atin g th e p lan s o f a ct io n / pr og ra m m es / p ro je ct s è E xam ples of go od pr ac tic es a nd th ei r su cc es s fa ct or s Research findings In te rn at io na l b as ic do cu m en ts (e .g . f ro m O EC D, W H O , E U ) Na tio na l s tra te gie s in th e a re a o f h ea lth Dietary recommendations Statutory and policy framework conditions 16 | swiss nutrition Policy 2013–2016 Part II sWIss nUTRITIon PolICy 2013–2016 Problem areas In addition to the 6th swiss nutrition Report, the specified problem areas are also based on other national and international documents, such as the WHo’s “Global strategy on Diet, Physical activity and Health” and the eU’s “White Paper on a strategy for europe on nutrition, overweight and obesi ty related health issues” . a. Overweight and secondary illnesses: The ratio of overweight and obese persons in switzerland is high (page 9) . Many of those affected suf fer from such secondary illnesses as cardiovascular disease and diabetes mellitus (page 10) . B. Nutritional situation: The swiss population consumes too little of some food groups (e .g . vegetables and fruit) and too much of others (e .g . sweets; page 6) . Parts of the population exhibit an insufficient nutrient sta tus (page 8) . C. Dietary recommendations and nutrition literacy: While the cur rent dietary recommendations are well known, not everybody implements them to their full extent (page 6) . Men, young people and socioeconomic ally disadvantaged people pay least attention to dietary recommendations and have little nutrition knowledge . D. a health-promoting environment: There is a lack, among other things, of choices featuring an optimised nutrient composition in out-of home catering as well as in the area of convenience food and instant me als . advertising messages generally do an inadequate job of raising aware ness for high fat, sugar and salt content . E. Consumer information: Today’s food labelling systems in switzerland (nutritional value and front-of-pack labelling) are difficult to understand and are little used in purchasing decisions . F. Evidence and efficacy: In switzerland, not enough weight is put on re search in the area of nutrition . There is a lack of nationally representative data on food consumption or eating behaviour, of swiss data on the effect of diet on illness and its risk factors, and of data on the efficacy and profita bility of health-promoting interventions (pages 8 and 10) . swiss nutrition Policy 2013–2016 | 17 Part II Vision and fields of action of the Swiss Nutrition Policy 2013–2016: an overview The six fields of action of the swiss nutrition Policy determine the priori ties and goals in the area of nutrition and allow various stakeholders to de velop their strategies, plans of action and measures in the area of nutrition (page 18) . first and foremost are the preservation, promotion and improve ment of the health of the swiss population . Vision based on their living conditions and their own skills, all people living in switzerland have the ability to eat in a sustainable and healthy manner and to lead a health-promo ting lifestyle, independent of their origin, their socioeconomic status or their age . Problem area Field of action a B C D E F 1 safe, sustainably produced foods and adequate food supply 2 Protecting health and preventing disease 3 Information and communication 4 Target groups and equal opportunity 5 Cooperation, coordination and multisectoral approach 6 Research and data availability Problem area a overweight and secondary illnesses B nutritional situation C Dietary recommendations and nutrition literacy D a health-promoting environment E Consumer information F evidence and efficacy Figure 5: Swiss Nutrition Policy 2013–2016: Vision, problem areas and derived fields of action 18 | swiss nutrition Policy 2013–2016 Part II Fields of action in detail 1. Safe, sustainably produced foods and adequate food supply: The swiss population’s supply of safe, high-quality and sustainably produced food is ensured at all times . This is the foundation for a nutritional situation that optimally protects public health . 2. Protecting health and preventing disease: The swiss population’s available food and its eating habits contribute to the preservation and pro motion of their health in every stage of life and minimise the emergence of nutrition-related illnesses and their risk factors . To ensure an even energy balance, physical activity (especially the everyday kind) must also be tak en heed of . 3. Information and communication: The swiss population is informed about the dietary recommendations as well as (in a general way) the fea tures of a health-promoting and sustainable lifestyle; people understand this information and implement it in their lives . food labelling supports the pop ulation in making conscious and healthy choices . 4. target groups and equal opportunity: all target groups, in particu lar the socioeconomically disadvantaged population groups as well as in fants, children and young adults, are taken into account and addressed via their schools and places of employment . equal opportunity is accounted for . 5. Cooperation, coordination and a multisectoral approach: all con cerned parties recognise the importance of national and international as well as multisectoral and interdisciplinary cooperation and the necessity of coor dinating activities . They take into account national and international guide lines, recommendations and standards . 6. research and data availability: Research and data acquisition for mon itoring and evaluation in the areas of nutrition, health and nutrition-related illnesses have a key role and form the foundation for evidence-based meas ures . swiss nutrition Policy 2013–2016 | 19 Part IIsTaKeHolDeRs In IMPleMenTaTIon The federal government with its sectoral policies is just one stakeholder in the process of implementing the swiss nutrition Policy . The participation and col laboration of additional stakeholders following a common, consistent approach that considers the respective regional conditions wherever possible is neces sary and promising . at the same time those stakeholders dispose of different skills and scopes of influence, given the fact that they don’t all come from the nutrition or health sectors but also from such areas as education and agriculture . The following list shows a number of options for the stakeholders mentioned below to contribute to the implementation of the swiss nutrition Policy: state institutions can, for example, adopt measures on a voluntary or statutory ba sis at the structural level, the former preferably in cooperation with the busi ness community . non-governmental organisations are more involved at the be havioural level, where they address certain target groups . acting as mediators, health professionals can target the specific needs of individuals . Stakeholders in implementing the Swiss Nutrition Policy Government and policymakers ■ federal government, cantons, local municipalities and their policies ■ federal Commission for nutrition ■ Research institutions ■ educational institutions Non-governmental organisations ■ Health Promotion switzerland ■ Professional organisations in the health sector (e .g . swiss society for nutrition, Public Health switzerland) ■ associations, federations, foundations ■ Consumer organisations ■ supplementary day care services (e .g . crèches) Business community ■ food sector (food industry & retailers, suppliers, food service industry) ■ employers ■ Health insurance providers Health professions ■ Health professionals (e .g . dieticians) ■ Medical professionals (e .g . general practitioners, paediatricians) 20 | schweizer ernährungsstrategie 2013–2016 ColophoN Publisher Federal office of public health (Foph) authors part I: pascale Mühlemann, Mühlemann Nutrition Gmbh part II: Andrea Renggli, Federal office of public health technical Participation Michael Beer, liliane Bruggmann, Margreet Duetz Schmucki, Ulrich Keller, Nadine Stoffel-Kurt Design and Layout Merkur Druck AG Photographs Fotografie peter leuenberger, www.peter-leuenberger.com