Norwegian National Action Plan for a Healthier Diet – an outline

Healthy diet, meal enjoyment and good health for everyone! 2 3 The Magic Meal Eating involves more than just stopping the rumbling in your stomach. Good food and good meals help us to play and learn. Good food and good meals help us to lift heavy things and to think clearly. Good food and good meals help people to enjoy each other’s company.

Are you struggling with a poor school environment? Let the children make good food and enjoy it together.

Is there a lot of sick leave at your workplace? Create a pleasant cafeteria that encourages employees to sit down together.

Are there people coming from far away for a meeting to discuss challenging issues? Serve food and drink before the discussions begin. Do residents at the nursing home seem to have no appetite when dinner is served? Serve them when they’re hungry instead.

Good food and good meals don’t come about by themselves. That’s why we need a plan of action for a better diet. This plan is about nourishment and nutrition. It deals with food that is good for the body and food that is good for the planet. It deals with food that swims, food that flies, and food that does neither one.

It involves to make the healthier choices the easier choices. It involves to make our choices more healthy. It involves the magic that happens when we sit down at the table to eat. In preschool. At school. At work. In nursing homes. In hospitals.

Good food and good meals can’t solve all our problems. But they will make it easier to solve them.

And it stops that rumbling in your stomach.

Bent Høie Vidar Helgesen Minister of Health Minister of Climate Minister of Fisheries Minister of Agriculture and Care Services and Environment and Food

Torbjørn Røe Isaksen Per-Willy Amundsen Minister of Education Minister of Children Minister of Justice and Minister of Immigration and Research and Equality Public Security and Integration

This is a short version of the Norwegian National Action Plan for a Healthier Diet (2017–2021), which was launched in March 2017. The aim is that the plan will contribute to a healthier diet in the population, as well as strengthen the importance of the social and cultural functions of the meal.

3 The Norwegian National Action Plan for a Healthier Diet involves:

• Meal enjoyment, and a tasty and • Food, meals and nutrition in health healthier diet: and care services: Food is important Healthy food is good for physical throughout the course of our lives and mental health. A meal can create – for our quality of life, physical and contentment through good flavours mental health, and to help us to be and good company. active in our daily lives.

• Healthy and easy choices: It should • Research, development and be easy to choose healthy, good and innovation should contribute to reasonably priced food. A sustainable public health work and health care and environmentally friendly diet is services of high quality. Knowledge is recommended. essential to reduce social inequalities in health and to enhance better • Communication and knowledge: public health. The communication on food, diet and health aimed towards the public, should be clear, consistent and easily understood.

4 5 Our goal is a healthy diet, meal enjoyment and good health for everyone!

The objectives of the Public Health Report to the (White paper) The World Health Organization’s Meld. St. 19 (2014-2015) Coping and global targets to reduce opportunities – provide the foundation noncommunicable diseases (NCD) for the National Action Plan for a Healt- hier Diet: At the World Health Assembly in • will become one of the three 2012, the World Health Organiza- countries in the world with the highest tion (WHO) adopted a resolution life expectancy for a 25 % reduction in premature • We will have added years of life with mortality from noncommunicable good health and well-being for all diseases (NCDs), such as cardiovas- • We will reduce social inequalities in cular diseases, cancers, respiratory health diseases and diabetes by 2025. • We will create a society that promotes Global targets that are relevant for health for the entire population the current Plan of Action include: • Halt the rise in diabetes and Goals in the Action Plan obesity Vision • A 10 % relative reduction in the • Create a society that promotes meal harmful use of alcohol enjoyment, a healthy diet and good • A 10 % reduction in the prevalence health for the entire population. of insufficient physical activity • A 30 % reduction in the Main goal prevalence of tobacco use • A healthy and varied diet for the entire • A 25 % reduction in the preva- population, regardless of gender, age, lence of raised blood pressure geographical location, socioeconomic • A 30 % reduction in the mean status, cultural background, level of population intake of salt/sodium ability, religion and life philosophy.

Subgoals The World Health Organization’s • Facilitate changes in diet in accordance global targets to improve maternal, with advice from the health authorities. infant and young child nutrition • Reduce social inequality in diet • Enhance knowledge of the correlation In 2012, the World Health Organiza- between diet and physical and mental tion determined six global targets health for improving maternal, infant and • Promote the development of safe and young child nutrition, by 2025. healthy foods, and strive for healthy The two most relevant targets in a and environmentally friendly practices Norwegian context include: in the production and consumption • Objective 4. No increase in child- of food hood overweight • Enhance and assuring the quality of • Objective 6. Increase the rate of efforts for healthier food, meals and exclusive breastfeeding in the nutrition in the health and care services first 6 months up to at least 50 %.

5 International cooperation

Norway participates in an international As early as 1972, Norway entered the cooperation to promote a healthy diet International Covenant on Economic, and nutrition. The United Nations (UN) Social and Cultural rights. Article 11 has declared this decade (2016–2025) as recognises the right of everyone to a “Decade of Action on Nutrition”. This adequate food. This involves the right Plan of Action will provide guidelines for to a quantity and quality of food that is national implementation, including the sufficient to satisfy the dietary needs of WHO Action Plan for the Prevention and individuals, as a basis for an active life Control of NCDs 2013–2020. and good health. This Covenant was incorporated into Norwegian law through The Plan of Action will also contribute the Human Rights Act of 21 May 1999. towards achieving the UN’s Sustainable Development Goals. More sustainable As described In the UN Guiding Principles and diversified consumption and on Business and Human Rights (UNGP) production of food is necessary in order of 2011, the states have a duty to protect to nourish more people while nurturing human rights and companies have a the planet. responsibility to respect them.

To achieve the UN’s Sustainable Development Goals

The UN’s 17 Sustainable Development The following three goals are essential Goals is a set of goals to end poverty, to the National Action Plan protect the planet and ensure prosperity Goal 2. End hunger, achieve food safety for all by 2030. and improved nutrition, and promote sustainable agriculture (including fisheries The National Action Plan for a Healthier and the aquaculture industry) Diet will contribute towards achieving these goals. Goal 3. Ensure healthy lives and promote well-being for all at all ages

Goal 12. Ensure sustainable consumption and production patterns

6 7 Why do we need a National Action Plan for a Healthier Diet?

Healthy food and meals are essential for social inequality, and may lead to disease good physical and mental health, while and a poor quality of life. an unhealthy diet is one of the major risk factors for disease and premature death. Non-communicable diseases (cardio- The Action Plan for a Healthier diet also vascular diseases, cancers, chronic emphasises the importance of the social respiratory diseases and diabetes) are functions of a meal. responsible for more than 50 % of all deaths occurring before the age of 75 in The aim is that the Action Plan will Norway. An unhealthy diet is one of the contribute towards a healthier diet and greatest risk factors in developing these more enjoyable mealtimes for all. To diseases. Diet alone may be the cause of ensure success, efforts will be required 8000 deaths per year in Norway. from all sectors, with cooperation from public, private and voluntary sectors. If the population follows national dietary recommendations, both women and men Despite several positive trends in the food could gain two extra healthy years of life, consumption in Norway in recent years, and save significant expenditures for the large parts of the Norwegian population society. still have a low intake of vegetables, fruits, fish and whole-grain foods and have a The measures in this Action Plan are high intake of saturated fat, sugar and salt. directed towards the entire population by facilitating healthy and easy choices Another challenge involves those who for everyone. The Plan focuses particularly eat too little, and who are therefore at on children, adolescents, young families risk of malnutrition and undernutrition, and senior citizens. which is the case with many chronically ill and elderly individuals. Government ministries and agencies will be implementing the National Action An unhealthy diet is associated with Plan for a Healthier Diet (2017–2021).

Photo: www.unsplash.com

7 Key figures regarding the Norwegian diet

Vegetables, fruits and berries Breastfeeding 34 % of men and 41 % of women eat the 95 % of infants are breastfed at the age of recommended amount of fruit and berries. 2 weeks of age, 81 % at 4 months, 55 % at 9 months, and 35 % at 12 months of age. 15 % of men and 13 % of women eat the recommended amount of vegetables. Sugar 55 % of 9 and 13 year olds have a higher Whole grain foods consumption of sugar than recommended. 25 % of adults eat the recommended amount of whole grain foods. More than 20 % of adults have a higher consumption of sugar than recommended. Fish 39 % of men and 31 % of women eat the Saturated fat recommended amount of fish. 85 % of 9 and 13 year olds have a higher consumption of saturated fat than 24 % of men and 21 % of women eat the recommended. recommended amount of fatty fish. Nearly 80 % of adults have a higher Meat consumption of saturated fats than 45 % of men and 67% of women eat the recommended. recommended amount of red meat. Salt 25 % of men eat twice as much red meat The mean intake of salt in the population is as recommended. nearly twice the recommended amount.

Milk Alcohol The consumption of low-fat and skim The consumption of alcohol constitutes milk has been reduced by 15 % from approx. 2 % of the total intake of energy, 2005 to 2015. The consumption of cheese although this varies considerably has increased by more than 7%. Sources: Norwegian Directorate of Health, Norwegian Institute of Public Health

Photo: foodiesfeed.com

8 9 Quantitative targets and indicators 2021 Population Level Target Starting point Level 2021 A higher proportion has a diet Increase the proportion Different needs for consistent with the dietary guidelines changes depending of the Norwegian Directorate of Health on the various elements of dietary guidelines Increased consumption of: A 20 % increase in consumption of Wholesale figures • Vegetables each of the food groups 78 kg 94 kg • Fruits and berries 90 kg 108 kg • Fish 49 kg (whole) 59 kg • Whole grain foods Data lacking Reduced dietary content of: • Added sugar Added sugar: 11 percentage of 13 E % • Saturated fats energy (E%) 1 14 E % • Salt Saturated fat: 12 percentage of Approx. 10 g per day Approx. 8 energy (E%)2 g per day Salt: 22 % reduction (15 % by 2018, and 50 % reduction in the long term) Infants Higher proportion of infants who are: • Exclusively breastfed 60 % are exclusively breastfed at 4 mo. 44 % • Breastfed 24 % are exclusively breastfed up 17 % to 6 mo. 35 % 50 % are breastfed at 12 mo. Children and adolescents Lower proportion of 15-year olds who: 50 % reduction 3 a) eat sweets 5 times a week or more a) 17 % a) 8,5 % b) drink soft drinks/sweetened b) 19% b) 9,5 % beverages once a week or more Higher proportion of 15-year olds who 50 % increase 3 daily (once or more) eat: a) vegetables a) 32% a) 48 % b) fruits b) 36% b) 54% Higher proportion of 15-24 year olds 20 % increase who eat: a) 71 a) 85 % a) fish for dinner at least once a week b) 7 % (tinned b) 9 % b) fish spread on bread (in sandwiches) mackerel in tomato at least three times a week sauce) Higher proportion of 15-year olds who 30 % increase 59 % 77 % eat breakfast every morning No increase in the proportion of 0 % a) 9 year olds: 15 % children and adolescents who are b) 17 year olds: 23 % overweight

Other Higher proportion are aware of the 80 % are aware of the guidelines 46 % dietary guidelines Higher proportion stating that 60 % answers “to a fairly large 46 % Keyhole labelling makes it easier for extent” or “to a very large extent” them to choose healthier options Higher proportion stating that they are 80 % are interested in reducing salt 49 % interested in reducing their salt intake intake Increased number of Keyhole products Yearly increase in number of Figure in 2016: 1419 Keyhole products

1 Percentage of energy (E%): Proportion of the total energy content in the diet from each of the energy yielding nutrients (fat, protein, carbohydrates and alcohol) 2 Recommended max. 10 E% 3 Average of boys and girls

9 Healthy and easy choices

It should be easy to choose healthy, that even more companies will sign the good and reasonably priced food. All agreement in the near future. sectors and businesses must cooperate in changing Norwegian dietary habits in In the agreement, the parties commit to a healthier direction. Public authorities, working towards achieving the following private actors and organisations must shared targets: work together in order to make changes in the diet of the population. • The average intake of added sugar shall be reduced by at least 12.5% Cooperation with the food industry by 2021. This means to reduce the In 2014 the Minister of Health and Care percentage of energy from sugar from Services has established a high level 13 to 11 by 2021. group comprised of major actors in the food industry, to agree on measures that • The average intake of saturated fat might contribute towards a healthier diet shall be reduced to 13 percentage of in accordance with the dietary guidelines, energy by 2018. In 2015 the percentage and to help achieve the targets of the of energy was 14. World Health Organization regarding the reduction of noncommunicable diseases. • The average intake of salt shall be Cooperation has begun on reducing reduced to 8 grams per person per salt, saturated fat and added sugar in day by 2021. The intake in 2010 was 10 foods, as well as facilitating an increased grams. consumption of fruits, vegetables, whole grain foods and fish. • There shall be an increase in the con- sumption of vegetables, fruits, whole In 2016, the Minister of Health and Care grain foods and fish, in line with the Services signed a letter of intent with targets in the national action plan. different actors in the food chain. By spring 2017 more than 70 different The collaboration will be evaluated. businesses have signed up. The aim is

Photo: Ørjan Bertelsen/Norwegian Seafood Council

10 11 Food and beverage marketing directed to children The Food and Drink Industry Professional Practices Committee (MFU), a self- Government initiatives regulatory committee, was established in • Follow up a comprehensive and 2014 and evaluated in 2016. Results long-term letter of intent with the of this evaluation shall be followed up. food industry A Nordic protocol to monitor the marke- • Continue and develop the salt ting of unhealthy foods and beverages partnership directed to children and young people was developed in 2016. Norway has • Reduce the intake of saturated fat participated actively in the international and sugar work on restrictions on marketing of • Continue and develop the Keyhole foods and beverages to children. label as a brand system • Follow up work on the marketing of In 2016, the World Health Organization unhealthy foods and beverages to (WHO) passed a resolution and Guidance children on Ending the Inappropriate Promotion • Promote the increased consumption of Foods for Infants and Young Children. of vegetables and other plant-based The implementation of these guidelines foods will be evaluated as part of the action plan. • Promote the inclusion of fish and seafood in the diet ”Fiskesprell” • Ensure that the population has a sufficient intake of iron and vitamin D ”Fiskesprell” (”Fish Fun”) is a national • Ensure proper attention to nutrition dietary programme intended to increase in the health enterprises and other the intake of seafood among children public bodies and adolescents. Together with staff from schools and preschools, efforts • Stimulate food production, product will be made to promote seafood as a development and innovation natural choice for meals.

11 Sustainability

The National Action Plan for a Healthier Diet shall assist in promoting a sustainable How to get less food waste and environmentally friendly develop- ment. This involves ensuring the needs • Plan your shopping and use a of the current population, without shopping list. destroying opportunities for generations to come. A diet consisting of more fruits • Clean in your refrigerator. Then and vegetables, more fish, and less meat, you’ll know what you have. is a more sustainable diet. • Store your food properly. This is not simply about what we eat, but • Remember to maintain a fridge also about the food that we don’t finish. temperature of 2 to 4 degrees C. One-third of all food produced in the world is never eaten. This is due to food • Don’t immediately throw out loss and waste at all stages, from produ- food after the ”used by” date. ction to consumer. If we can reduce the Check the food to see if it’s loss and waste of food, we can ensure still good. food for everyone, without increasing production. This puts less strain on the • Cool your food quickly and climate and environment. either freeze or refrigerate the leftovers. Authorities, manufacturers, distributors and consumers must all take responsibility • Store leftovers in sealed storage to ensure a sustainable development. The containers. government will follow up these efforts • Freeze bread that won’t be eaten with an agreement with the food industry the next day. to reduce food loss and waste. The government aims to reduce greenhouse • Let Thursday be ”Leftover gas emissions from agriculture, increase Thursday”. Use up your leftovers carbon capture and storage and climate- before shopping for the we- friendly technologies, and maintain agri- ekend. cultural areas and adequate resource base. • Remember that wilted lettuce We shall continue our efforts for a sustai- will perk up after being dipped in nable management of the ocean and ma- icy water, and soft tomatoes can rine resources through quota regulations, be used to make tomato sauce. technical regulations for fishing, structural measures and international cooperation. Source: Matvett.no

Food that’s good for the body is good for the planet! Dietary guidelines by the Norwegian Directorate of Health facilitate a positive and sustainable development. The Directorate will consider the need to adjust the dietary guidelines to adequately safeguard the perspective of sustainability.

12 13 Meal enjoyment and a tasty and healthy diet for everyone

Food and meals are important throughout what they like to eat, when they want to the course of life - for children in preschool, eat, and with whom they wish to share kids at school and in after-school program- a meal. Many seniors enjoy combining mes, adults at work, and for seniors in meals with social activities, also across nursing homes or in their own homes. generations.

The nutritional value of what we eat is important, but it is just as important to Government initiatives make mealtime a meeting place for social interaction and inclusion. • Promote good food and mealtime habits in preschools. Children and adolescents are prioritised • Promote good meals and meal in the ten-year national programme for schemes in schools and after- community public health work. This school programmes. programme is intended to strengthen • Help to ensure that the health aut- municipal efforts to improve mental horities’ recommendation of 20 mi- health and quality of life. The Ministry of nute meals is carried out at school. Health and Care Services, the Norwegian Association of Local and Regional Authori- • Mobilise children as agents of change ties (KS), the Norwegian Institute of Public for food enjoyment and a healthy Health, and the Norwegian Directorate and sustainable diet. of Health are all working together on this • Enhance practical skills. programme. • Motivate for enjoyment of food and food care for seniors. Tasty food, good meals and a good nutri- • Include food and meals as measures tion situation are essential for health to promote a sense of community and quality of life among seniors. Elderly and to prevent loneliness. individuals are just as different from one another as individuals in other groups, • Healthy choices at the workplace with different needs and preferences for and in other food service venues.

Diet and mental health

A healthy diet is essential for physical illness has an impact on our lifestyle health, but has also importance for habits, and that a poor diet can have mental health and quality of life. The an impact on the course of mental Action Plan has included this topic, illness. Individuals with severe which has rarely been addressed. mental illnesses have a significantly shorter life expectancy than the A growing body of research indicates general population. The reasons that the dietary guidelines to promote for this are complex, but lifestyle health and prevent lifestyle diseases habits such as little physical activity also apply to good mental health. and poor nutrition are among the However, we also know that mental factors that may have an impact.

13 Communication and knowledge

Information and communication efforts shall contribute towards greater Government initiatives knowledge of food, diet and health in the population. A key task for health • Develop tools and resources for the authorities is to get through to the entire subject of food and health in pri- population with clear, easily understood mary and lower secondary school, and straightforward information about and contribute towards enhanced diet and nutrition. competency among teachers. • Continue and develop the commu- Children and adolescents, and some nication initiative ”Small steps, big immigrant groups may be difficult to difference”. reach. In order to reach out to those • Further develop communication who do not actively seek information that supports efforts to better ena- about diet and health, it is necessary to ble healthy choices. consider new methods and channels of communication. • Further develop and distribute existing informational material The Norwegian health authorities have about food and nutrition, for use by launched a long time communication municipalities in their efforts to help effort on nutrition and diet; the campaign refugees and immigrants. ”Small change, big difference”. The • Introduce self-catering and create campaign promotes the idea that small a cookbook that supports healthier adjustments in everyday life can make a food in prisons. big difference to health in the long term.

The campaign aims to increase knowledge of – and confidence in the dietary recommendations, while at the same time showing how they can easily be translated into everyday habits. The communication aims at being inspiring, informative and feasible for everyone – not moralizing.

14 15 Ung.no

Ung.no (Youth.no) is Norway’s largest The website provides quality assured information website directed at articles and an anonymous question youth, with more than 800 000 users & answer service that responds to per month. Ung.no is a low-threshold questions about different topics, gateway to public information ser- ranging from choice of education to vices. This service is operated by the initial military service, youth rights Norwegian Directorate for Children, and falling in love. Diet and nutrition Youth and Family Affairs (Bufdir). is a separate topic.

15 MiRA Resource Centre for Women Canteen course ”Påfyll” from Minority Groups (”Replenish”)

The MiRA Resource Centre for The Norwegian Directorate of Women from Minority Groups Health has developed the course offers training courses for mothers ”Påfyll” (”Replenish”), together who would like to act as advisors with the Agricultural Information for other mothers in their local offices and the Norwegian Seafood community. The women participate Council. This course combines in suggesting, developing and food preparation with food theory, planning activities and topics for and is intended to inspire those these courses. Health and nutrition working in cafeterias or food ser- are among the main topics. The vices in lower secondary schools to courses also address the rights of prepare more appealing and healt- the child, prevention of violence in hy food for pupils. The course also close relationships, occupational emphasises the important role of rights and physical fitness training. cafeteria employees in the social The women learn more about the life of pupils at the school. A course contents of various foods, how brochure with recipes has been to make healthy choices, the created for school cafeterias, and importance of taking care of e-learning tools are posted on the themselves in a hectic everyday websites of the National Centre for life, and dealing with stress. Food, Health and Physical Activity.

Photo: kaboopics.com

16 17 Food, meals and nutrition in health and care services

Nutrition is an essential part of treatment and follow-up in all health and care Government initiatives services. A healthy diet is important for quality of life, physical and mental health, • Enhance competency regarding and for the ability to stay active in nutrition, food and meals throughout everyday life. health and care services, through measures such as ”Competence Malnutrition reduces the immune Plan 2020”. response, and can increase the risk of complications, reduce physical and • Follow up development of cognitive function, and lead to an appropriate tools, guidelines increased risk of mortality. and quality indicators. • Implement the National guidelines on infant nutrition. ”Live well throughout your life” – Creating a quality reform for • Promote, support and protect senior citizens breastfeeding, through the Baby- Friendly Hospital initiative and To ensure that the basic needs of The Baby Friendly Initiative in senior citizens are being met, in Community Health Services terms of food, activity and sociali- sation, the government will initiate • Follow up efforts towards a work on a reform. The purpose of comprehensive nutritional strategy the reform is to ensure additional in the health enterprises. years of healthy life and greater • Promote good measures on diet mastery, and to ensure that the and nutrition in community health elderly feel secure that they are and care services. receiving appropriate and timely assistance to meet their health • Follow up measures on nutrition in and social needs. Food and meals services directed at persons with will be one of four primary areas. intellectual disabilities.

• Ensure that nutritional considerati- ons are included in health and social care services for mental health and substance abuse disorders.

• Follow up dietary measures as part of the National Guideline on Dental Health Services for Children and Adolescents.

Photo: Ministry of Health and Care Services

17 municipality: Food in housing for adults with intellectual disabilities

Personnel in residential facilities for 227 employees from approximately adults with intellectual disabilities 70 residential facilities in all districts have requested courses in practical of the city had participated in the cooking. In 2012, Oslo municipality cooking courses. Gatherings have carried out one-day courses in also been held, were personnel practical cooking in cooperation could share experiences regarding with Oslo and Akershus University good nutritional practices. An eva- College. This measure has been luation indicated that the partici- carried forward in cooperation with pants were very pleased with the Etterstad upper secondary school, content of the courses, and nearly and is part of Oslo municipality’s all of them would recommend that initiative entitled ”Initiative for Bet- their colleagues participate in ter Nutrition”. By the end of 2016, similar courses.

Sami food traditions in nursing homes

The Centre for Development food on a daily basis. It is, however, of Institutional and Home Care possible to offer patients food from Services for the Sami population their local community, prepared in has asked if it might be possible a Sami manner. The project group to enhance the diet of Sami pati- recommends that the Centre for ents in municipal institutions and Development and the municipalities residential care homes. Personnel pursue this issue, and place grea- in seven Finnmark municipalities ter focus on how institutions can have replied to the questionnaire grant the patients’ meal wishes. The concerning Sami food traditions at report ”Is it necessary and possible their institution. The results indicate to enhance Sami food traditions at that personnel are interested in municipal nursing homes and resi- offering such meals, but that it was dential care housing in Sami settle- not routine practice to serve Sami ment areas” is available online.

18 19 19 Norwegian National Advisory Unit on Breastfeeding and Mother-Baby- Friendly Initiative

The Norwegian National Advisory must meet the requirements inclu- Unit on Breastfeeding (NKA) con- ded in WHO/UNICEF’s ten steps for ducts research, participates in the successful breastfeeding. This pro- development of national guidelines, fessional standard is well-documen- assesses clinical issuess regarding ted in WHO’s report ”Evidence for breastfeeding, and offers courses the ten steps to successful breast- for, and supervision of healthcare feeding”, and has had a significant personnel. effect. Standards for neonatal units and the community health services The NKA is responsible for work have been developed based on the related to the Baby-friendly Hos- Baby-friendly Initiative. pital Initiative (BFHI) in Norway, and The Baby-friendly Initiative in 40 out of 46 maternity units in Nor- community health services. way have been designated Baby-Fri- endly. More than 90 percent of all In 1991, the World Health Organiza- births in the country take place in tion (WHO) and the United Nations these units. Children’s Fund (UNICEF) launched the Baby-Friendly Hospital Initiative In 2016, 110 out of 428 municipaliti- (BFHI) to promote breastfeeding es were designated as Baby-Friend- and early close contact betwe- ly community health centres. More en mothers and their infants at than half of the nation’s infants hospital maternity units. Norway and small children participate in adopted this initiative in 1993 with the routine preventive programme the Mother-Baby-Friendly Initiative. offered by the community health In order to be an approved Moth- centres. er-Baby-Friendly hospital, a hospital

20 21 Research, development and innovation

We need good monitoring systems in or- der to follow and describe changes in the Government initiatives Norwegian diet over time, and the relati- onship between dietary risk factors and • Follow and describe changes in health problems. Research, development the Norwegian diet over time. To and innovation will contribute towards further develop the food composi- high quality public health work and tion table, and determine whether healthcare services. It will give us greater to establish systems for keeping up knowledge of how to reduce social ine- with changes in declarations, volu- quality in health, and what is needed to me and sales over time. give the population additional years of • Develop and implement food, nutri- life with good health and well-being. tion and health indicators. • Promote research on food, nutrition The National Nutrition Council advises and health. the Norwegian Directorate of Health on matters regarding diet, nutrition • Follow up the food and health and health. The Norwegian Scientific section of the government’s plan Committee for Food Safety (VKM) carries of action for the implementation of out independent risk assessments for Health&Care21 (HelseOmsorg21). the Norwegian Food Safety Authority Acquire more knowledge of, and (Mattilsynet) across the Authority’s field highlight the relationship between of responsibility as well as environmental mental health and diet. risk assessments. • Enhance competency with respect to the effect of measures and be- havioural economics.

The APPETITE App

Tablet applications can strengthen dietary measures by showing people what they are actually eating and drinking. They can also help to prevent weight loss and other problems that may ensue after falls, cognitive decline or loneliness. The University of Oslo has created an app called APPETITE, and is testing it out in four municipalities: Oslo, Tvedestrand, Bærum and Drammen.

21 Dietary guidelines by the Norwegian Directorate of Health

• Enjoy a varied diet with lots of vegetables, fruit and berries, whole-grain foods and fish, and limited amounts of processed meat, red meat, salt and sugar.

• Maintain a good balance between the amount of energy you obtain through food and drink and the amount of energy you expend through physical activity.

• Eat at least five portions of vegetables, fruit and berries every day.

• Eat whole grain foods every day.

• Eat fish two to three times a week. You can also use fish as a spread on bread.

• Choose lean meat and lean meat products. Limit the amount of processed meat and red meat.

• Include low-fat dairy products in your daily diet.

• Choose edible oils, liquid margarine and soft margarine spreads instead of hard margarines and butter.

• Choose foods that are low in salt and limit the use of salt when preparing food and at the table.

• Avoid foods and drinks that are high in sugar.

• Choose water as a thirst-quencher.

• Be physically active for at least 30 minutes each day.

Look for the Keyhole when shopping for food.

Source: Norwegian Directorate of Health

22

Published by: The Ministry of Health and Care Services, Norway The Action Plan can be downloaded on regjeringen.no Public institutions may order several copies from: The Norwegian Government Security and Service Organisation Website: www.publikasjoner.dep.no Email: [email protected] Phone: 222 40 000 Publication code: I-1178 E Design and layout: Kord Photos, where otherwise not specified: Ole Walter Jacobsen. Thanks to Aminah Cittadella Jacobsen, Luna and her parents, Bjørgunn and Simon; children at the Norlandia Furulund preschool; students at Blindern Upper Secondary School; residents at the Fagerborghjemmet nursing home, and visiting teenagers Eilof, Josephine Alicia, Jonathan Eugene, Lucia, Jenny and Sofia. Printing: The Ministry’s Security and Service Organisation 07/2017 – 300 copies