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Food and Health in Europe: Europe: in Health and Food WHO Regional Publications Food and health in Europe: Food and health WHO Regional Publications European Series, No. 96 a new basis for action Food and health in Europe: a new basis for action 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. Food and health in Europe: a new basis for action i 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 e di t in g : Mary Stewart Burgher ii 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 iii ISBN 92 890 1363 X ISSN 0378-2255 Address requests for copies of publications of the WHO Regional Office to [email protected]; for permission to reproduce them to [email protected]; and for permission to translate them to [email protected]; or contact Publications, WHO Regional Office for Europe, Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark, (tel.: +45 3917 1717; fax: +45 3917 1818; web site: http://www.euro. who.int). © 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. The mention of specific companies or of certain manufacturers’ products does 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. iv 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 v 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 vi 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 vii 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
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