Congratulations to PAfH members, Prof Catherine Woods, Dr Liam Kelly, Dr Enrique Garcia Bengoechea (Now I-PARC / Sport Ireland), and Mr Kevin Volf, for their contribution to the Policy Evaluation Network (PEN) Special Issue published today in the European Journal of Public Health. The issue is packed with evidence, reflections and concrete calls for action towards better policies addressing unhealthy dietary behaviours and physical inactivity.
TABLE OF CONTENTS
1. Editorial: Call for policy actions based on evidence from the Policy Evaluation Network
Wolfgang Ahrens, Jeroen Lakerveld, Catherine B. Woods.
2. Development of a framework to guide research into policies promoting physical activity and healthy diets in the European context: The system-based Policy Evaluation Network (PEN) framework
Carlijn B.M. Kamphuis, Sarah Forberger, Nanna Lien, Eva Rehfuess, Aleksandra Luszczynska, on behalf of the PEN consortium
3. Reaching consensus on definitions for food and physical activity policies: Experience from the Policy Evaluation Network
Liam Kelly, Cliona Twohig, Catherine B. Woods, Aleksandra Luszczynska, Celine Murrin, Nanna Lien, Biljana Meshkovska, Carlijn B. M. Kamphuis, Maartje P. Poelman, Laura Terragani, Antje Hebestreit, Wolfgang Ahrens, Janas M. Harrington, on behalf of the PEN consortium
4. Towards a harmonised pan-European surveillance for dietary and physical activity indicators in young and adult populations
Antje Hebestreit, Stefanie Do, Maike Wolters, Gert B.M. Mensink, Lina Garnica Rosas, Karim Abu-Omar, Sven Messing, Agnieszka Neumann-Podczaska, Katarzyna Wieczorowska-Tobis, Nanna Lien, Isobel Stanley, Wolfgang Ahrens and Celine Murrin, on behalf of the PEN consortium
5. Acceptability of policies targeting dietary behaviours and physical activity: A systematic review of tools and outcomes
Marie Scheidmeir, Thomas Kubiak, Aleksandra Luszczynska, Janine Wendt, Daniel A. Scheller, Biljana Meshkovska, Annabel Sandra Müller-Stierlin, Sarah Forberger, Karolina Łobczowska, Agnieszka Neumann-Podczaska, Katarzyna Wieczorowska-Tobis, Hajo Zeeb, Jürgen M. Steinacker, Catherine B. Woods, Jeroen Lakerveld, on behalf of the PEN Consortium
6. The development of the Physical Activity Environment Policy Index (PA-EPI): A tool for monitoring and benchmarking government policies and actions to improve physical activity
Catherine B. Woods, Liam Kelly, Kevin Volf, Peter Gelius, Sven Messing, Sarah Forberger, Jeroen Lakerveld, Nicolette R. den Braver, Joanna Zukowska and Enrique García Bengoechea, on behalf of the PEN consortium
7. What do we know about the actual implementation process of public physical activity policies: Results from a scoping review
Sarah Forberger, Lucia A. Reisch, Biljana Meshkovska, Karolina Lobczowska, Daniel A. Scheller, Janine Wendt, Lara Christianson, Jennifer Frense, Jürgen M. Steinacker, Catherine B. Woods, Aleksandra Luszczynska, Hajo Zeeb, on behalf of the PEN Consortium
8. How theory can help to understand the potential impact of food environment policies on socioeconomic inequalities in diet: An application of Bourdieu’s Capital Theory and the Scarcity Theory
Sanne K. Djojosoeparto, Carlijn B.M. Kamphuis, Janas M. Harrington, Anne Lene Løvhaug, Gun Roos, Alexia D. Sawyer, Karien Stronks, Laura Terragni, Liv Elin Torheim, Stefanie Vandevijvere, Maartje P. Poelman, Frank J. van Lenthe, on behalf of the PEN Consortium
9. The impact of mass-media campaigns on physical activity: A review of reviews through a policy lense
Nicolette R. den Braver, Enrique Garcia Bengoechea, Sven Messing, Liam Kelly, Linda J Schoonmade, Kevin Volf, Joanna Zukowska, Peter Gelius, Sarah Forberger, Catherine B. Woods, J Lakerveld, on behalf of the PEN Consortium
10. Estimating the impact of nutrition and physical activity policies with quasi-experimental methods and simulation modelling: An integrative review of methods, challenges, and synergies
Karl M.F. Emmert-Fees, Sara Capacci, Franco Sassi, Mario Mazzocchi, Michael Laxy, on behalf of the PEN Consortium
11. Using GRADE Evidence to Decision frameworks to support the process of health policy-making: An example application regarding taxation of sugar-sweetened beverages
Julia Stadelmaier, Eva A Rehfuess, Sarah Forberger, Angelika Eisele-Metzger, Blin Nagavci, Holger J. Schünemann, Joerg J Meerpohl, Lukas Schwingshackl, on behalf of the PEN consortium
12. Sustainable Urban Mobility Plans in European cities: Barriers and facilitators of implementation and their potential influence on transport-related physical activity
Romanika Okraszewska, Noah V. Peters, Lucia A. Reisch, Marion Flechtner-Mors, Carlijn B.M. Kamphuis, Janine Wendt, Daniel A. Scheller, Karolina Konsur, Joanna Zukowska, on behalf of the PEN consortium
13. Applying a systems’ perspective to understand the mechanisms of the European School Fruit and Vegetable Scheme
Mahshid Zolfaghari, Biljana Meshkovska, Anna Banik, Carlijn B.M. Kamphuis, Birgit Kopainsky, Aleksandra Luszczynska, Celine Murrin, Nanna Lien, on behalf of the PEN consortium
14. Dietary behaviour and physical activity policies in Europe: Learnings from the Policy Evaluation Network (PEN)
Wolfgang Ahrens, Catherine B. Woods, Jeroen Lakerveld, on behalf of the PEN Consortium
Non-communicable diseases
How policies can protect the health and life of millions
The covid-19-pandemic may give a different impression, but non-communicable diseases are by far the leading cause of disability and death in Europe. New research shows: These diseases are much better prevented by policies that tackle the environmental drivers of unhealthy behaviours, rather than by advocating for individual behaviour change. The EU-funded Policy Evaluation Network (PEN) aims to identify public policies most likely to sustain healthy lifestyles, for example by making the healthy choice the default choice. It now summarizes its key research findings in a special issue of the European Journal of Public Health.
The burden of these diseases is serious: Chronic diseases caused by physical inactivity and poor nutrition such as cardiovascular diseases, diabetes, cancer and respiratory diseases account for 77 per cent of the burden of disease and almost 86 per cent of premature mortality, and these diseases are still on the rise. The main reasons for this trend are well-known: In their daily life many Europeans combine physical inactivity and extended sedentary time with the excessive consumption of energy-dense food and drinks rich in saturated fat, trans-fatty acids, sugar and salt, while eating only low amounts of vegetables, fruits and whole grains.
“The causes of major non-communicable diseases are well-understood since decades, but we see little to no improvement in tackling their root-causes. As we are facing increasing health inequities political action is needed to curb this negative trend”, says Professor Wolfgang Ahrens, who is Deputy Director of the Leibniz Institute for Prevention Research and Epidemiology – BIPS in Bremen, Germany, and Project Coordinator of PEN. “To change the current situation, it is necessary to move beyond individual behaviour change to broader policy and system-oriented approaches. Policy is about changing systems, not people. Public policies include processes activated across multiple sectors to achieve specific outcomes, for example, a reduction in population levels of physical inactivity. This requires a delicate balance between what is achievable, what is evidence informed and what has political will or ‘buy in’. The outcomes of PEN show what successful policy action looks like, and how policy action, if implemented in full, has the potential to fundamentally improve the health and well-being of an entire population.”
PEN’s vision
As part of the Joint Programming Initiative on a Healthy Diet for a Healthy Life (JPI HDHL), 28 research institutes from seven European countries and New Zealand combined their expertise to form PEN. The network’s vision is to provide Europe with tools to identify, evaluate and benchmark policies designed to directly or indirectly address physical inactivity, unhealthy diets and sedentary behaviour while accounting for existing health inequities. Until now, systematic research of this field across Europe was sparse.
The existing body of evidence on the topic has substantially changed with PEN’s special issue of the European Journal of Public Health. The journal supplement comprises thirteen manuscripts that are output from the PEN project. Topics examined include new theoretical models to advance our understanding of the policy process and its evaluation. It provides an overview of priority public policies and policy areas most likely to sustainably reduce physical inactivity, unhealthy diets and sedentary behaviour. It explores the first steps in a bespoke policy monitoring and health surveillance system for Europe, and a refinement of our knowledge of appropriate research designs and methods for the quantification of policy impact. PEN scientists illustrate how best to evaluate the implementation and impact of policy in order to yield the best results for a healthy life of European citizens. Importantly, PEN has provided recommendations on equity and diversity to ensure that policy actions are inclusive as opposed to exclusive.
A call to action
“Through this supplement, we make a call to action. A call to governments and policymakers from national and local levels to use the newly acquired knowledge to develop, implement and evaluate strong, comprehensive policy solutions that are sustainable, equitable and address the current health challenges effectively”, says Professor Ahrens. He adds: “It is a call to funding agencies at European, national and local levels to continue to prioritize and fund policy research, to build on the work of PEN which has really only begun to understand the potential policy impact on human behaviours and environments. A call to policy researchers to move beyond peer-reviewed publications and to translate their findings into relevant and meaningful advice and advocacy documents for policymakers to use to advance policy action to promote health-for-all citizens across Europe.”
PEN – Public policies addressing health-related behaviours in Europe
PEN is funded by the Joint Programming Initiative (JPI) “A Healthy Diet for a Healthy Life”, a research and innovation initiative of EU member states and associated countries. The funding agencies supporting this work are: Germany: Federal Ministry of Education and Research (BMBF); Ireland: Health Research Board (HRB); Italy: Ministry of Education, University and Research (MIUR); The Netherlands: The Netherlands Organisation for Health Research and Development (ZonMw); New Zealand: The University of Auckland, School of Population Health; Norway: The Research Council of Norway (RCN); and Poland: National Centre for Research and Development (NCBR).