May 2006 developments contents Put your heart in it Health Children’s Environmental to Action Plan – a new tool promotephysical activity across Europe Austria Belgium Estonia Finland France Greece Ireland Italy Netherlands Norway Slovenia Sweden UK 2 25 information Contact Heart Matters, focusing on cardiovascular disease prevention, is a publication relevant to policy makers, public health experts and organisations involved in health promotion, disease prevention and public health research. 1 Editorial 3 Feature article 5 European policy 8 activities Country Physical activity is the focus for campaigns is the focus activity Physical and Slovenia. Ireland Estonia, in Austria, fitness covers outdoor Such activities and advocacy campaigns programmes can support built environment on how the more enable them to be children and active. physically learnOur member organisations from their progress in each other by sharing as informingHeart Matters, as well decision European level and policy makers at urge fought. We about how CVD is being heart in it for a everyone to put their healthier Europe. that a strong signal from the believe We could have helped European Parliament strengthen the European Union’s main health objective to ensure that health is properly considered in all relevant EU policies. HeartMatters and energy expenditure. Italy, which has Italy, which expenditure. and energy its own platformset up on nutrition, on the and health, reports physical activity between the different interaction linked to These activities are stakeholders. obesity. In the UK, where addressing is high on childhood obesity combating a large-scale campaign the agenda, has been involving social marketing at children. But successfully targeted campaigns also different intervention continue to inform parents and teachers of healthy eating about the importance habits. Information specific actions on nutrition on The Netherlands is provided by Norway, vary from the and France. The actions establishment of a national alliance to develop a food labelling system to help consumers chose healthier products in Norway, to an education programme aimed at educating parents in The Netherlands, and a campaign directed health professionals and towards volunteers working with the needy and poor in France, to a campaign focusing on informing people about CVD risk factors and cholesterol in Greece. gains that are within reach – notably gains from reduction of premature deaths and suffering from CVD – the European Parliament could have provided an impetus to the EU’s role as a coordinator and facilitator of exchange of views and best practices as well as a guarantor for a high level of health protection.” Not surprisingly, many EHN member organisations report on their activities on nutrition and physical activity. Belgium describes its national health and nutrition plan, launched in April 2006, while Finland outlines its new nutrition recommendations, stressing amongst others the need to achieve a balance between energy intake concerning women and CVD can be found in this edition of Heart Matters. Sweden reports on its “red dress to campaign” for women, which responds the urgent need to better inform women on the risks they run of having cardiovascular diseases. Austria also reports on special interventions for women. “By emphasising the health By emphasising the health gains that are of within reach – notably gains from reduction – premature deaths and suffering from CVD the European Parliament could have provided an impetus to the EU’s role as a facilitator of exchange of and coordinator views and best practices as well as a guarantor for a high level of health this is a missed protection. Altogether, opportunity for health to assume a more prominent place in EU policy making. It is worsened, of course, by the Council’s decision to cut funds for action on health in the EU dramatically. But we are still putting our heart into the Heart 2006, the European fight. In March Network and the European Society of jointly organised a conference Cardiology health at heart – promoting on “Women’s and preventing health cardiovascular This conference disease”. cardiovascular confirmed that efforts to prevent CVD, both for men and women, need to be stepped up in Europe, especially in the Eastern European countries where mortality and morbidity from CVD are higher than ever. health at heart” conference The “Women’s highlighted the fact that too little attention is given to women and CVD even though CVD is the number one killer of women – accountable for 55% of all deaths among women in Europe. An example of the issues

we

Heart Matters

editorial

1 HeartMatters properly considered in all relevant EU policies. objective which is to ensure that health is strengthen the European Union’s main health European Parliament could have helped We believe that a strong signal from the We diseases. mental health, cancer and pulmonary are cardiovascular diseases, diabetes, are cardiovascular the major health burden in the EU. These the major health burden reference to those diseases that constitute European Parliament did not make a clear for a new health action programme the when adopting its opinion on the proposal determinants, we therefore regret that including risk factors and societal approach to health at European level, Because EHN advocates a matrix key diseases in the way we had hoped. programme that does not emphasise the The less-good news is an EU health action partners from institutions and industry. a range of stakeholders and involving of our member organisations, targeting variety of programmes in all the countries against heart disease goes on, with a better. The good news is that the fight better. report good news and news that could be report good news and news that could Europe. In this issue of the number one cause of death throughout Work is needed at many levels to combat Work its risk factors and the wider determinants. cardiovascular disease (CVD) both through cardiovascular EHN believes that it is important to address Put your heart in it Put your heart Children’s Environmental Health Action Plan CEHAPE action pack – case studies for all sectors – a new tool to promote physical activity across Europe by Génon K. Jensen, Executive Director, EPHA Environment Network (EEN)

For children and young people, physical activity and better nutrition are crucial to fighting the rising epidemic of obesity and reducing the risk of cardiovascular disease. As 80% of Europe’s young people live in urban areas, policy changes in city planning, including school settings, are another front for the health sector to ensure that messages about children increasing their exercise are coupled with real possibilities for doing so.

Transport policies prioritise motorised traffic rather than safe, easily accessible bike lanes and walking routes. This limits the possibility for physical activity in children’s daily routines. Competing demands on urban development plans, and lack of participation from the health sector, from parents and from young people themselves also negatively affect the prioritisation of green areas, playgrounds and sporting facilities by local authorities.

A Europe-wide policy framework now exists thanks to the World Health Organization (WHO) and committed governments, institutions and health advocates – the Children’s Environment and Health Action Plan for Europe (CEHAPE). Adopted in 2004 by environment and health ministers from 52 countries at the WHO Budapest Ministerial Conference, it provides practical ideas and goals on protecting Europe’s children from environmental pollution and environment-related stressors that adversely affect their health. It highlights the fact that safe and balanced nutrition is still an unmet need for too many children. It recognises that the prevalence of obesity and the attendant risk of developing chronic diseases such as diabetes and cardiovascular disease are a direct consequence of unhealthy diet and inadequate physical activity. WHO provides countries with a menu of Examples of actions for Regional Priority More information can be found on evidence-based actions along with Goals II include: the WHO website: documented experience. The actions are - enacting legislation to promote http://www.who.dk/eprise/main/ The child’s environment – key to increasing exercise and reducing obesity broken down into environmental risk selection of healthy food and WHO/Progs/CHE/Policy/20050629_1 factors and environmental health encourage the food industry to make Within CEHAPE, countries work on four human settlements for children through: promotion activities in accordance with objectives. Actions to achieve each such foods available to children and overarching Regional Priority Goals (RPGs): the WHO Global Strategy on Diet, objective (CEHAPE table of actions) are adolescents, particularly in schools; - safe water and adequate sanitation; • child-friendly urban and sustainable Physical Activity and Health and the indicated, and real life examples (WHO - providing nutritionally balanced school - protection from injuries and adequate transport planning, promoting cycling, WHO Food and Nutrition Action Plan for collection of case studies), if available, meals for children; physical activity; walking and public transport, in order to the European Region of WHO for are shared. - developing infrastructure and - clean outdoor and indoor air; provide safer and healthier mobility 2000–2005; programmes to promote safe walking - chemical-free environments. within the community; • promoting physical activity in children’s Actions to be undertaken by national and and cycling to schools; • safe facilities for social interaction, play daily life through information and local authorities are grouped into six - promoting sustainable modes of The second RPG focuses on reducing and sports for children and adolescents; education, and pursuing synergies with categories: transport and mobility management morbidity from lack of adequate physical • reduction in the prevalence of other sectors to ensure child-friendly - legislative; plans taking into account the specific activity by promoting safe and secure overweight and obesity through health infrastructure. - educational/health promotion; needs of school-age children. - participation of stakeholders; The European Environment and Health - knowledge-building; Committee (EEHC) facilitates work on - monitoring; and these issues. It brings together environmental - service delivery. and health ministries, intergovernmental organisations and health advocacy groups such as the EPHA Environment 2006 focus on urban environments and obesity Network (EEN) to discuss the latest scientific evidence and policy developments on Governments are now drafting national technical counterpart, the CEHAPE Task improving child health. The Committee’s child action plans and consulting with Force, will focus on country progress for reports, agendas and statistics are stakeholders in order to present their Regional Priority Goal II, which combines available at http://www.euro.who.int/eehc. priorities at the 2007 mid-term review of work on reducing accidents with increasing the Budapest Ministerial commitments. physical activity and combating obesity. In the first half of 2006, the EEHC and its 4 3

HeartMatters HeartMatters Helping children to be more active: country highlights European policy developments

Austria – young people design school United Kingdom – public transport EEN would like to hear from organisations Green paper on “Promoting healthy diets and physical activity” mobility plans and health working on increasing physical activity or The School Mobility Management Plans SUSTRANS, the sustainable transport reducing obesity through better urban On 8 December 2005, the European labels. Furthermore, voluntary codes (“self- activity and health education at the project aims to improve environment, charity, works on projects encouraging environments for young people. Such Commission published its Green Paper on regulation”) are not an adequate tool for workplace, every workplace should have health and road safety for children on the people to walk, cycle and use public ideas will be shared on the EEN country “Promoting healthy diets and physical limiting the advertising and marketing of a healthy work life balance policy in which activity: a European dimension for the energy-dense and micronutrient-poor employers have high quality standards for way to school by increasing the number transport for health, safety and web map Healthier Environments for prevention of overweight, obesity and foods. foods and provide clear information on of playgrounds, creating school mobility environmental reasons. Their aim is to Children – www.cehape/env.health.org. chronic diseases.” the nutritional composition of the various plans and promoting walking and cycling. create a Safe Route to School for every When it comes to consumer education, offerings which makes it easy for employees Following the successful pilot project in child in the UK. A school travel kit and Other ways organisations can help For many years, EHN has been arguing public-private partnerships could make a to compare healthier to less healthy four schools, it will be expanded to all resource materials are available at influence their own country’s child action that a comprehensive and integrated EU useful contribution if public and private options. Employers should introduce food and nutrition policy is needed. EHN agencies send the same message and a number of measures to encourage Austrian schools. Teaching materials are http://www.saferoutestoschools.org.uk/ plans include: has also called for an EU health policy that agree not to promote conflicting messages. physical activity, for instance by giving available at www.schoolway.net. • contacting the governmental enhances physical activity. The European Messages have little impact if the surrounding decision prompts, i.e. signposting to remind A new country web map launched environment and health focal point to Commission’s Green Paper is a first step in environments are not supportive of them, people to take the stairs, and by switching Italy – walking bus by WHO suggest priority actions for the national that direction. however. support away from company cars to By involving school authorities and http://www.euro.who.int/eehc/ctryinfo/ctryinfo CEHAP; support for cyclists and pedestrians. This Commission Green Paper is meant to Comprehensive policies in schools should parents, the municipality of Rome provides an overview of the 52 individual • contributing their report, survey or be a consultation document on a broad ensure that children have education and In its conclusion, EHN points out that an launched the walking bus as a fun and countries’ activities, and is continuously innovative initiative to the WHO or EEN range of issues related to obesity, with a practical skills which will enable them to obesogenic environment refers to all healthy way to get children to and from updated by the countries themselves. web maps; view to gathering information for European eat a healthy diet. Food provided for aspects of the environment that promote school while providing exercise and • providing their expertise to the action concerning reducing obesity levels children in schools should be a result of behaviours that contribute to overweight/ improving the quality of urban environmental Involving health advocacy groups meetings on RPGII: CEHAPE Task Force, which could complement, support and high nutritional quality standards for food obesity, including aspects which promote coordinate existing national measures. in schools, whether provided as part of a unhealthy eating. To ensure that physical around schools. Parents act as the bus As a leading child environmental health 30-31 March 2006 in Dublin and the meal or from vending machines or other activity is part of people’s daily routine, drivers of the walking bus, picking up the advocate and member of these bodies, EEHC, 15-16 May 2006 in Oslo. In its reaction to the Green Paper, which outlets. Energy-dense and high salt snacks, measures needed include the development children at designated bus stops before EEN stimulates the debate and sharing of was sent to the Commission by the 15 high sugar soft drinks and confectionery of an integrated transport strategy that dropping them off at school. Authorities best practice on how to turn the “exercise March 2006 deadline, EHN brought out the that is high in fat or sugar should not be emphasises walking and cycling, ensuring hope to extend it to all schools in Rome. more” message into an obtainable reality. following points: available in schools. Relevant sectors of that streets are safe and well-lit to encourage • it is necessary to raise the awareness of industry should abstain from targeting their walking and cycling and that stairs are the measures, policies and interventions marketing of unhealthy food and drinks at prominent, accessible and well-lit in new needed to promote healthy diets and children and young people in schools and buildings. These policies can be achieved physical activity; elsewhere. through public-private partnerships. • the public health action programme can co-fund systematic reviews of The Green Paper asks for reactions Measures that will help reduce inequalities evidence of effectiveness of measures, concerning good practice for regular include general (legislative) measures that policies and interventions, training physical activity in schools. EHN notes that reach the whole population, availability of seminars and information meetings, and to improve the level of physical activity in inexpensive healthy food, such as fruits help to identify the essential elements for schools, a number of measures must be and vegetables, and easy access to well- making information campaigns envisaged. These include an increase in kept and inviting recreation areas and to effective; the number of hours devoted to physical affordable participatory sports activities. • information about existing evidence education in the curriculum across the EU, should be provided directly to the with a statutory three-hour minimum per Based on a consultation with eight Member States as well as to relevant week dedicated to physical education. European/international health organisations, European umbrella oganisations, which The concept of the health promoting EHN notes that the issues that should will ensure further dissemination amongst school advocated by EHN and other receive first priority at a European level their national member organisations. organisations should be further developed. are: This concept involves taking a whole • controlling sales of foods in public In response to the specific questions the school approach to health and ensuring institutions; Green Paper raises about consumer that physical activity is a core component • controls on food and drink advertising; information, advertising and marketing, of school life. Support in the wider community • mandatory nutritional information EHN responded that there should be is also vital. Easier access to facilities and labelling; and For more information, organisations 28 Boulevard Charlemagne mandatory nutrition labelling of six food activities must be provided, especially to • Common Agricultural Policy reform should contact B-1000 Brussels characteristics. These are energy, saturated activities that are not solely competitive. including subsidies to healthy foods. fat/trans fats and sodium, plus total fat, Access should target disadvantaged Ms Génon K. Jensen Tel.: + 32 2 234 3640 (general) added sugar and dietary fibre. Better areas. Executive Director Tel.: +32 2 234 3641 (direct) education for all age groups about EPHA Environment Network (EEN) E-mail: [email protected] nutrition and diet and about what is on The Commission invites contributions on Website: http://www.env-health.org 5 the label, accompanied by a harmonised how employers can contribute to healthy signposting system, will help consumers diets and increased physical activity. understand the information provided on When looking at food availability, physical 6

HeartMatters HeartMatters Revision of Television without Frontiers Directive EU Platform on Diet, Physical Activity and Health

In December 2005, the European the percentage that promoted unhealthy • define children’s programmes In March 2004, the European Union’s categories: promotion of healthy lifestyle promotion of healthy lifestyle (18%); Commission adopted a proposal for the foods ranged from 49% to 100%. appropriately so as to ensure that Directorate-General Health and Consumer (24%); nutrition information (20%); education (17%); nutritional information revision of the existing Television without Referring to article 152 in the Treaty and advertising, sponsorship and product Protection (DG Sanco) launched the EU education (14%); dissemination of (15%); dissemination (13%). In the Frontiers Directive (89/552/EEC). The several Council Conclusions, EHN believes placements will not lead to an increase Platform on Diet, Physical Activity and information (9%); and product dissemination category, advertising objective of the proposed revision is to that the revision of the Television without in exposure to commercial Health. The members of this platform have development (8%). All other activities represents 9% of all activities. Here too, modernise and simplify the regulatory Frontiers Directive presents an ideal communications promoting unhealthy agreed to share information with each (advertising, marketing, monitoring/ the main target audiences overall for the framework for broadcasting, or linear opportunity to make a contribution to food and drinks to children. The other on their initiatives related to the evaluation, policy development, research actions are the general public (19%) and (scheduled) services, and introduce halting and reversing the epidemic of definition of children’s programmes issues of obesity, diet, physical activity and and surveys, training, selling) cover less children and adolescents (19%). However, minimum rules for non-linear (on demand) obesity and to preventing avoidable diet- should be broad enough to take into health, setting out what they intend to than 5% of the activities. Most of these industry (12%), health professionals (10%) audiovisual media services. The proposal related chronic diseases, in particular account all programmes where a achieve and by what means. Platform activities are oriented towards the general and policy makers (9%) are also well covers linear audiovisual media services cardiovascular diseases. significant proportion of the audience members were asked to submit their public or children and adolescents. represented here. (e.g. cable television) and non-linear are children, based on the actions carried out in 2004 and 2005 audiovisual media services (e.g. digital EHN recommends that the revised acknowledged audience profile of the (baseline actions) and their commitments When considering the Commitments for A review of these commitments is coming television). Directive: programme. Restrictions should not be for 2006 in an online database. 2006, 70 activities have been submitted by up soon, and in order to complete the limited to those programmes whose 14 members. Most of these commitments existing information, the Commission will In the framework of the pan-European • establish a basic tier of qualitative rules stated target audience are children, but For the baseline activities, 23 platform come from NGOs (47%), the advertising ask for more information on the evaluation project on “Children, obesity and applicable to all commercial should also include programmes that members have submitted 319 actions. Of sector (16%) , consumer organisations of activities and events that will take place associated avoidable chronic diseases”, communications regardless of are likely to be watched by children; these actions, 28% were submitted by (16%) and catering (11%). To a great in 2006 (the commitments). the extent and nature of food marketing audiovisual media; NGOs. The activities introduced by all extent the types of activities cover the of unhealthy food to children was assessed. • prohibit product placement in members mainly relate to the following same subjects as for the baseline activities: One of the findings was that of TV • prohibit advertising of unhealthy food programmes that are watched by advertisements for food aimed at children, and drinks to children; children.

Women’s Health at Heart Conference

On 7 March 2006 the European Heart • The 7th Framework Programme for - guidelines on risk assessment, optimal Network (EHN) and the European Society Research should provide sufficient funds preventive methods, treatment, of Cardiology (ESC) organised a conference for cardiovascular research, including rehabilitation and screening. entitled “Women’s Health at Heart – gender-specific research. Promoting Cardiovascular Health and • The Commission should continue to Preventing Cardiovascular Disease”. support activities that promote cardiovascular health, for example by The following call for action was adopted collecting relevant information, establishing at the conference. expert networks, and drafting guidelines • The European Union needs to mobilise its on prevention and on screening through health community to ensure that the existing and future EU public health cardiovascular health is properly action programmes. considered in all relevant EU policies. • In order to ensure the best cardiovascular • The EU’s role as a coordinator and health for all Europeans, gender-specific facilitator of exchanges of views and aspects must be taken into account in best practices must be applied across all every EU strategy for future research and fields. The EU health action programme action. (Programme of Community action in the • EHN and ESC call upon the Council field of health and consumer protection of Ministers to adopt an EU 7 (2007-2013)) must therefore make a Recommendation on a concrete EU- clear reference to those diseases that wide cardiovascular strategy from the constitute the major health burden in European Commission encompassing: the EU, namely cardiovascular diseases, - cardiovascular health promotion; 8 diabetes, mental health, cancer and - mechanisms in support of the Member pulmonary diseases. States’ strategies and activities;

1 For more information on the platform and its members, please go to http://europa.eu.int/comm/health/ph_determinants/life_style/nutrition/platform/platform_en.htm

HeartMatters HeartMatters News from Austria News from Belgium by Petra Scharff, Austrian Heart Foundation by Nicolas Guggenbühl, Dietician and nutritionist Promoting physical activity in Austria What is Belgium doing to control obesity?

In Austria cardiovascular diseases are the diseases each year, 60% are women. Low Austrian Heart Foundation also organised In Belgium, official awareness of the Fruit and vegetables diet and physical exercise, it has been main cause of loss of productivity and of awareness of the risk of heart disease Nordic Walking courses, with groups of importance of diet and exercise has - Increase the population’s consumption of thought necessary to give people clear, death. Around 45% of all deaths are specifically for women is the main reason ten people, and the assistance of a resulted in numerous initiatives designed to fruit and vegetables, to reach a minimum valid and coherent messages, in order to caused by cardiovascular diseases. An for this fact. professional trainer. control the huge rise in obesity. The task is of 400 g a day. counteract the great confusion that increase in physical activity is one of the The project “proWomen Zell am See” is a not an easy one and isolated initiatives - Reduce the number of “small eaters” of currently prevails with regard to the measures that would have a significant pilot programme especially designed by have little chance of bringing about a fruit and vegetables, particularly among relationship between diet and health. positive influence on the Austrian the Austrian Heart Foundation to identify lasting change in lifestyles. Therefore, the young (schoolchildren and teenagers) Accordingly various communication tools population’s health. women at risk and to intervene on a long- following the example of several other are being developed (television On the occasion of World Heart Day 2005, term basis. The programme started in a European countries, Belgium is now Lipids advertisements, brochures, website), some the Austrian Heart Foundation took the district with a female administrator, in three implementing its own “National Nutrition - Limit fat intake (i.e. bring it down to no of which are directly aimed at children (e.g. opportunity to promote physical activity in villages with female mayors managed by and Health Plan” (PNNS), aimed at more than 35% of the total a “food fact booklet” concerning the diet the following ways: a female coordinator. improving the health of the population by recommended energy intake) of children between the ages of 3 and 12). increasing public awareness and - Improve the composition of fat intake Football for better heart health As the first step all the women in these three motivating the various players involved. (give preference to unsaturated fats At school villages between the ages of 15 and 60 Workout for every person with health The plan promotes a better dietary rather than saturated or trans fats) The Austrian Heart Foundation and the (1,990 women) were contacted by the insurance balance and more physical exercise (2006 Within the school environment, the Belgian Austrian Football League promoted the mayors and invited to fill in a questionnaire – 2010). The prevention of obesity, best Carbohydrates and fibre National Nutrition and Health Plan (PNNS) World Heart Day theme at five football concerning their eating habits, physical Sixty percent of the Austrian population started as early in life as possible, underlies - Promote carbohydrate consumption (i.e. will work on incorporating the idea of “diet matches on 24 and 25 September 2005 in activities, smoking behaviour, blood practise physical activity fewer than one several of the nutritional objectives and aim at a minimum of 50% of total and physical exercise” into educational Vienna and other parts of Austria. The pressure, blood sugar, cholesterol, body or two times monthly – this is the finding of strategic approaches in this Plan. recommended energy intake) by programmes and activities by harmonising Federal President of Austria, Dr Heinz mass index and stress. a study by the Austrian ministry of sport. emphasising complex sources of existing programmes and creating health Fischer, supported this event. The study also shows that 86% of Austrians Reference points carbohydrate (starch etc), such as education modules in training programmes For this purpose the Austrian Heart As the second step information on diet, are basically interested in physical unrefined or only slightly refined food- for future teachers. Behavioural factors will Foundation produced a special leaflet exercises, quitting smoking, etc. were activities. For 55% – more men than From a nutritional viewpoint, the Belgian stuffs (wholegrain cereals, pulses etc) be emphasised by encouraging a balanced and invited the spectators attending the assembled. Several different physical women – the main reason for exercising is PNNS draws much of its inspiration from the - Reduce consumption of added simple diet and physical activity, which will be football games to participate in a lottery. activity events took place as well, and to have a well trained body. Another 28% “Global Strategy on Diet, Physical Activity carbohydrates (sugars etc.) promoted in various subjects rather than in The leaflets included a description of the the women were very enthusiastic about exercise for health reasons and 22% and Health” adopted by the World Health - Increase consumption of fibre specific lessons, in this way reaching out positive effects of football and suggested Nordic Walking, cross-country skiing and percent for increased well-being. Organization (2004). Seven nutritional more widely to pupils across the different it as a healthy sport for all. different gymnastic exercises. In May 2006 objectives have been defined, five of Salt levels of teaching. Before the beginning of the matches the a second questionnaire will be distributed, The Austrian politicians are discussing a which directly tackle the problem of obesity - Limit salt consumption and partially football teams displayed a banner with and during the summer the Austrian Heart special motivation system to help people from a preventive (rather than curative) replace it with iodised salt. By means of a ministerial circular, the PNNS a health slogan. The management of the Foundation will evaluate the outcomes and to be more active: every person with perspective, focusing on the following also hopes to encourage the various football stadium demonstrated its support will make a decision about how to continue health insurance should have the possibility themes: energy, fruit and vegetables, Minerals, trace elements, vitamins, other Belgian language communities (French, for the Austrian Heart Foundation by this campaign. of exercising at the expense of the health lipids, carbohydrates and fibre, and water. substances Flemish and German) and the competent showing the World Heart Day message insurance system. Only a small personal - Reduce specific intake deficiencies (iron, authorities to bring the composition of on the display panel and by having the contribution is meant to be paid by the The fight against physical inactivity, folates, vitamin D, calcium) in certain school meals into line with PNNS moderators of the matches make insured person. All courses that are offered particularly in children, is an integral part population groups (the young, pregnant recommendations. Dialogue will be announcements during the matches. by accredited associations are meant to of the nutritional objective concerned and breastfeeding women, the elderly) encouraged between the parties concerned The presidents of the Austrian Heart be implemented – from “healthy back with maintaining a balance between - Correct iodine deficiencies with a view to promoting a healthy diet Foundation and the Austrian Football gym” to volleyball. The plan is to reserve a energy intake and expenditure. Along - Promote an optimum diet and sufficient physical activity in schools. League invited the Austrian journalists to budget of 3 million euros for this purpose. with encouraging children to be active In addition to better school meals, this will a press conference to promote the during their leisure time, the intention is to Water involve promoting the drinking of water occasion. More physical activity in Austrian adapt existing sports infrastructures suitably - Encourage people to drink more water and making it available free of charge, companies and to provide areas designed to (at least 1.5 litres a day) offering a more balanced choice of drinks Nordic Walking activities facilitate more active leisure pursuits. and snacks (the problem of what vending In order to increase health awareness in Coherent messages machines should sell), providing adequate Nordic Walking will be one of the companies a pilot project started in every Belgium’s National Nutrition and Health sports infrastructures, etc. principal topics of the spring programme federal state of Austria in 2005. One Plan - seven nutritional objectives The Belgian approach is based on the of the Austrian Heart Foundation (see also company was selected in each of the principle that eating should remain a free Lastly, the PNNS will promote partnerships News from Slovenia for more information states to participate in this health promotion Energy choice. It is therefore based more on with the private sector to encourage about this sport). programme. After every staff member in - Promote a better match between energy information and education than on initiatives falling within the framework of In Vienna a rental system for Nordic the company undergoes a medical intake and energy expenditure. authoritarian measures (e.g. taxing the PNNS objectives. A specific logo will be Walking sticks was initiated which allows examination, a special physical training - Increase physical activity levels (at least unhealthy foodstuffs). Although it is awarded for identification purposes. Such everybody the use of Nordic Walking programme will be developed. Costs will 30 minutes walking or another equivalent recognised that information is not enough are the various measures, whose impact Focus on women sticks. In addition, interested parties have be shared between the company and the activity per day) in itself to change behaviour in the area of will have to be assessed. the possibility of learning the Nordic Health Ministry, with each paying 50%. An Cardiovascular disease is still the most Walking technique from a professional evaluation of the project is planned in six frequent cause of death for women. In trainer. Both special services are free of months; this phase began in Austria, of the more than 35.000 people charge and should especially reach the the spring of 2006. who die of heart and cardiovascular less-affluent classes of the population. The Nicolas Guggenbühl is a Professor at the Paul Lambin Institute, Brussels and a member of the “Nutrition Policy Expert Group” in charge of implementing Belgium’s National Nutrition and Health Plan (PNNS). HeartMatters 9 HeartMatters 10 News from Estonia News from Finland by Monika Tartu, Estonian Heart Association by Anna-Liisa Rajala, Finnish Heart Association Health and fitness from the outdoors New Finnish nutrition recommendations

The Estonian Heart Association has been In December 2005, the Estonian Heart achieve its goals. Last year a significant The national nutrition recommendations • increase the intake of carbohydrates use the Heart Symbol. New criteria include actively promoting the healthy way to be Association was happy to present a very amount of educational work was done for the whole population are issued by with a high fibre content; three product groups. The limit of maximum physically active. The organisation’s focus special calendar – “Physical activity with the general public and city government the National Nutrition Council. The • decrease the intake of refined sugars; sugar content varies across the groups, is on introducing and promoting healthy throughout the year – health and fitness executives in the framework of the “Tallinn National Nutrition Council is an expert • decrease the intake of hard fat and depending on the general sugar content ways to be physically active. Though from the outdoors! Calendar 2006”. This is moving” project (organised by the Sports body under the Ministry of Agriculture and increase the proportion of soft fats; of similar foods in the market. The new Forestry, whose members serve three-year • decrease the intake of salt (sodium); criteria are the following: these are widely accepted principles in calendar contains valuable information on and Youth Department of the Tallinn City terms. The members are representatives • have a moderate level of alcohol Europe, they are still new in Estonia. different types of physical activities and Government). The Association is in the of authorities handling nutrition issues, consumption. • yoghurts, low-fat curd cheese and other hints on optimising exercising from the process of expanding its collaboration with consumer, health promotion and catering similar products: sugars ≤ 12g/100g; Raising awareness perspective of health. It also encourages the Tallinn City Government to help distribute organisations, and food industry, trade Recommendations on physical activity are • pastry, biscuits, rusks: sugars ≤ 20g/100g; people to keep track of their daily physical the healthy heart message. and agricultural organisations. The also included. The adult population should • breakfast cereals: sugars ≤ 16g/100g. The majority of Estonians do not think of activities by making entries each day using president of the Council is Director undertake a minimum of 30 minutes of physical activity as a part of their daily the abbreviated codes that are provided. Promotion of physical activity health General Pekka Puska, who is also the daily physical activity of moderate The main aim of this change is to prevent lifestyle that is important for maintaining a Functioning as an information source as awareness has been directed toward very President of the Finnish Heart Association. intensity. For prevention of weight gain products with a high sugar content from healthy mind and body. Most people who well as a personal physical activity different groups of people: teachers, local more physical activity, about 60 minutes, having the right to use the Heart symbol. It are active do not know how to optimise “workbook“, the calendar introduced the sports organisations, local municipalities, The aims of the National Nutrition Council may be needed. For children and also aims at reducing energy intake from physical activity for their health (i.e. the UKK Institute’s Physical Activity Pie, which personnel departments, workers, executives, (2005-2008) are: adolescents there should be a minimum of these common and frequently consumed 60 minutes of physical activity every day. foods and in this way also at reducing the correct amount, level of physical activity combines physical activity recommendations and parents. Last year at an international • to observe and improve the nutritional risk of overweight. etc.). Fewer than 10% of the people in for health and fitness, for the first time in educational seminar for teachers that took situation in Finland by making Nutrition Short food-based guidelines Estonia get sufficient physical activity. Estonia. The calendar is sold in many place in Estonia, the Estonian Heart Recommendations, creating Action By sugars we mean all mono- and bookstores all over Estonia, and the Estonian Association introduced physical activity Programmes and observing how the There are also short food-based dietary disaccharides that the product contains, One of the central reasons may be that as Heart Association has introduced it to and health related principles that are well Action Programmes are fulfilled and what guidelines in the new recommendations. including sugars naturally included in fruit, a post-Soviet state, Estonia is still struggling different groups and people (city known in Europe. the effects on the nutritional situation are; These guidelines help in choosing food berries and milk as well as added sugars. with the paradigm of emphasising and governments, companies, etc.) in several • to promote comprehensive nutritional which meets the demands of the glorifying competitive sports. This paradigm Estonian cities. Following Finland’s example risk monitoring; recommendations. The guidelines aim at By February 2006 the right to use the is something the Estonian Heart Association • to submit proposals and reports and an increased consumption of vegetables, symbol had been granted to 259 products has set out to change. Promoting seasonal exercise In the work of introducing the proper ways issue statements that concern the fruit, berries, potatoes, whole-grain cereal from 27 companies. According to a to be physically active in Estonia, the nutritional and health situation in products, low-fat milk products, fish and consumer survey carried out in December Finland and take into account the food lean meat. They also aim at limiting the 2005, 82% of Finns (89% of women) over 15 Furthermore business groups in Estonia are A programme “Well-being to heart with Estonian Heart Association has observed chain as a whole, from farm to fork; consumption of salt and salty foods as well years of age know the Heart Symbol by influential, resulting in the promotion of physical activity” consists of two seasonal the great examples set by the Finnish Heart • to observe the development of nutrition as sugar and sugar-rich foods. sight. Especially encouraging is the finding health related information and products sessions. The green session lasts from April Association, as well as other Finnish health policy in Europe and to promote the that 42% of consumers (49% of women) that are expensive and are not based on to November, and the white session from organisations. The Estonians have been Council’s information services. Simple advice to the consumers claimed to have made their food choices scientific evidence (i.e. extreme diets, pills, November to April. The programme fortunate to utilise valuable Finnish materials especially because of the symbol often or expensive gyms, etc.). Therefore, another encourages people to be physically active and physical activity models that have New 2005 recommendations add physical The nutrition recommendations can mainly occasionally. task of the Estonian Heart Association is to in the outdoors throughout the year. The already proved successful. The well- activity to good nutrition be used for planning mass catering, as make people realise that within their reach aim is to have people walking every day received green and white seasons, and basic material for nutrition education and At the beginning of year 2000 the Finnish are safe (i.e. scientifically proven), simple, for at least one hour – that equals 8000 the idea and the information for our The Finnish nutrition recommendations training and as reference values for estimating Heart Association and the Finnish Diabetes and cost-effective ways to exercise and steps towards heart health. As part of the physical activity calendar are based on were revised in 2005, based on the new the food consumption and nutrient intake Association launched the Heart Symbol, eat right. programme information brochures are materials from Estonia’s Finnish neighbours. Nordic Nutrition Recommendations which of groups. They are not applicable to diet which tells the consumer at a glance that were approved in 2004 by the Nordic assessments for individuals. For ordinary the product marked with this symbol is a provided that give an overview of the right Council of Ministers. The goal of the people the recommendations are in fact better choice in its product group regarding Tools for encouraging physical activity level for exercising, energy expenditures of Finland is internationally recognized for its recommendations is to improve the diet of very difficult to understand. That is why the fat and sodium. Many consumers find it certain physical activities, and a chart for remarkable progress in the promotion of a the Finnish people and public health in National Nutrition Council is now preparing difficult in practice to put together a Described below are some of the most recording daily physical activity. healthy lifestyle. The tangible support and Finland. The most important diet-related special material for consumers. The material healthy diet. The Heart Symbol makes it recent “tools” provided by the Estonian inspiration the Estonian Heart Association health problems are cardiovascular will contain the basic food-based guidelines easier. It is an easy-to-notice addition to Heart Association to assist people in In addition to the activities above, the receives from Finland is another great disease, osteoporosis, diabetes, obesity expressed in a very simple and concrete way. the nutritional information on the food moving in the right direction. By accepting Estonian Heart Association provides public example of how like-minded health and dental caries, To tackle these packages and helps the consumer to pick daily physical activity as part of their educational events and consultation organisations in neighbouring countries can problems it is important that Finns: Changes to the granting principles of out a better choice regarding the quality lifestyle people can take charge of their sessions, disseminates informational brochures support each other, and grow stronger the Heart Symbol and quantity of fat and sodium. own health. and participates at public sports events to together. • achieve a balance between energy intake and energy expenditure; Sugar content is currently taken into • have a balanced nutrient intake; consideration when granting the right to

HeartMatters HeartMatters 12 News from France by Céline dos Santos and Frédéric Dubus Duparloir, French Federation of Cardiology Food for thought – sustenance for life

The INPES (Institut National de Prévention and volunteers of non-profit organisations which extends far beyond simply teaching • Three chapters offering “instruction” Suggestions are given to help reach a et d’Education pour la Santé – National working in the medical and social field on about balanced meals: buying and sheets and slides. balanced diet by adapting it to fit each Institute for Disease Prevention and Health the one hand and to promote positive preparing food, varied eating styles, • “Buying wisely and well”: Factors person’s environment. Education) has been creating tools for actions about healthy eating habits with social relationships and inner wealth influencing purchases are discussed in nutritional education for several years, the poor on the other hand. connected with meal preparation, this chapter, along with the variety The context of eating habits particularly within the scope of the National introduction to other health issues), and quantities of food purchased, the Health and Nutrition Programme “Alimentation Atout Prix” sets out five explain how the tool is to be used budget devoted to food and making There are many meanings behind the act (Programme National Nutrition Santé or broad objectives: (methods and educational reference a shopping list. of eating and drinking. Eating is not just PNNS). points), and suggest complementary • “Preparing wisely and well”: This satisfying a physiological need. It represents • To provide those working in nutrition activities and tools, with real-life and chapter covers factors involved in the crossroads of emotional, cultural and Good eating habits summarised in a education with ideas about ethics virtual experiments. meal preparation (desire, know-how, social life. Each individual assigns a brochure based on their own cultural references knowledge about nutrition, eating different importance and role to food and and those of the needy, as well as • Preamble: “Ethics surrounding nutritional enjoyment), in equipping a kitchen drink – nourishment and staying alive, a In the framework of this programme, a suggestions about what to do when education” (storage, maintaining the cold chain, sign of affection, good hygiene and good brochure entitled “Alimentation Atout Prix” faced with public needs and demands The issue of ethics is especially intended cleaning, preparing and cooking), health, hedonistic pleasure, social enjoyment [Food for Thought – Sustenance for Life], for more appropriate and constructive to help professionals working with the simple, tasty recipes and meals ready and personal identity. which was first published in 1997, was actions; needy to create the most appropriate on time. updated in 2005. It is meant to be a actions. It also offers the possibility of • “Eating wisely and well”: The third More information on this brochure can be nutritional training and guidance tool • To discuss eating habits from three group discussions among team members chapter discusses why we eat, how obtained from the NPES (Institut National aimed at professionals and volunteers interrelated angles – buying food, where members express and analyse eating habits are established from de Prévention et d’Education pour la working with the needy. The brochure preparing meals and eating – and to their own emotions. It may help these childhood, frequency of meals (meal Santé) on the following website: places proper eating habits in the context help develop the corresponding persons accept their responsibility by times, number of meals, choice of http://www.inpes.sante.fr/. of promoting health and well-being for knowledge and know-how; identifying the limits of what can be done. food), and the role the senses play others. It touches upon a broad range of (sight, touch, smell, taste – sweetness, related problems such as a non-stressful • To allow its users to explore their own saltiness, acidity and bitterness). life, hygiene, substance abuse, leisure ideas and attitudes, discover factors activities, as well as self-confidence, related to their social and economic mental attitude, positive criticism and environment in order to better social life. understand what influences them in everything related to food; This brochure was updated by a working group composed of health education • To encourage personal solutions, professionals, representatives from the adapted to each individual; national health administration, and members of volunteer organisations • To give added value to the participants’ working with poor people on a daily basis eating habits and personal resources (food banks, the Red Cross, charity while at the same time encouraging or organisations such as Secours Populaire), reinforcing the joy to be found in specialists from INSERM (National Health preparing meals and eating, etc. and Medical Research Institute), CERIN (Nutritional Research and Information The binder is organised in the following way: Centre), as well as an advisor on social and family counselling. • Introduction: “The tool in all its forms” Intended to be a user’s guide, the first Passing on the message pages outline how the binder is designed and organised, describe the special With the brochure “Alimentation Atout characteristics of the final target “the Prix” the organisations involved tried to needy and the poor”, touch on specific 13 14 achieve two goals: to train professionals issues (scope of nutritional education

HeartMatters HeartMatters News from Greece News from Ireland by Stylianos Tzeis, MD, Research Fellow of the Hellenic Heart Foundation; George Andrikopoulos, MD, FESC, Scientific Advisor of the by Maureen Mulvihill, Irish Heart Foundation “Cholesterol Month” of the Hellenic Heart Foundation, President of the WG of Preventive Cardiology of the Hellenic Cardiological Society Irish National Heart Alliance promotes Greece’s “Cholesterol Month” reveals gaps in physical activity awareness of the obesity epidemic In Ireland, the National Heart Alliance Council and the Irish Heart Foundation. In Group examined Irish and international Despite the significant decline of measurement by research nurses and and diabetes mellitus are considered the (NHA) was established by the Irish Heart consultation with NHA members, it was literature relating to young people and cardiovascular mortality, largely attributed were also questioned by specifically most important risk factors at the Foundation in 1998 under the European decided that the focus should be on how environmental barriers to physical activity. to recent advances in therapeutic trained physicians about their self-reported population level, in the vast majority of the Heart Health Initiative as an independent the built environment can influence rates of By changing the environment, young management, optimism concerning occurrence of cardiovascular disease risk European populations. primary prevention of cardiovascular factors. Furthermore, in order to evaluate non-governmental organisation. The NHA physical activity for young people and that a people can be encouraged to take part diseases in the majority of European the viewpoint of the general population The alarming prevalence of obesity and aims to increase cooperation among position paper should be drafted on the in more physical activity. countries has been tempered by the which might enable us to properly redirect the impaired perception of the relative organisations involved in the fight against issue. For the paper, now being circulated in unfavourable nutrition trends in modern health care-offered information, participants significance of traditional coronary risk heart disease, and in particular to review its initial draft, the working group looked at Key findings: societies, which have resulted in the were asked to rank the cardiovascular risk factors represent the key messages of this policy at national level and make the current activity levels of Irish children and clustering of diabetes and coronary risk factors in order of perceived relative screening programme, which emphasised factors such as dyslipidemia, hypertension, significance. the need for the development of a more recommendations where appropriate. at the environmental barriers to physical • Key places important for youth physical metabolic syndrome and obesity. Obesity effective, multilateral cardiovascular Forty organisations in the Alliance include activity. activity are neighbourhoods, schools, and has reached epidemic proportions. The Greeks need more information about risk disease preventive strategy. The representatives from a wide range of facilities for physical activity (e.g. playgrounds, implementation of an effective action factors, especially obesity improvement of public awareness is medical and health professional How active are Irish children? parks and sports/recreation facilities). plan focusing on cardiovascular disease expected to trigger active lifestyle organisations including physicians, health prevention should include among its top The results of the Cholesterol Month modification and adoption of healthier priorities the improvement of public represent an urgent call for action. The nutritional attitudes, thus paving the way promotion, public and occupational Research for the draft paper found that in • Neighbourhood streets provide an area education regarding the relative contribution prevalence of overweight and obesity in to tackling the obesity and diabetes health, Health Services Executive, Healthy Ireland young people are not meeting the for play and active travel. The community of modifiable metabolic risk factors (obesity, our sample population was 63.2%, while epidemics in the long term and in turn Cities, Health Promoting Hospitals Network current recommendations of 60 minutes of environment should be functional, safe, physical inactivity, and atherogenic diet) only 25% of participants considered that contributing to the prevention of and academia. moderate physical activity every day. The aesthetically pleasing and have mixed- in the development of atherosclerotic they had excess weight. This reveals a avoidable coronary artery disease. Health Behaviours of School-Aged Children use purposes. cardiovascular diseases. limited awareness of optimum weight in the general population. Help needed at European level The Alliance has completed several (HBSC) survey found that participation in Finding out where the gaps in projects with a particular focus on children, regular physical activity was decreasing as • The design of the school environment knowledge are It should also be emphasised that the But how can these conclusions be including the “Position Paper on Physical children got older – from 59% of 10-11 year may influence physical activity. Schools majority of the individuals questioned transformed into effective actions? Activity for Children” (2001) and the olds active four or more times a week to can facilitate active travel through With this context in mind, the Hellenic considered that stress was the most Unfortunately, the only way to achieve a “Statement on Childhood Nutrition” 53% of 12-14 year olds to 35% of 15-17 year educational campaigns and through Heart Foundation organised the “Cholesterol important cardiovascular risk factor, measurable effect at European level Month”, a coronary risk factor screening underestimating the contribution of obesity, would be to persuade decision makers (2002) (available on www.irisheart.ie). olds.1 The Take Part studies examined policies that prioritise pedestrians and programme, which was conducted in diabetes mellitus and smoking in the that prevention of cardiovascular diseases physical activity levels of 2,500 students cyclists on school grounds. high-trafficked parts of two urban areas adverse cardiovascular risk profile (Figure). is affordable and cost-effective. In 2003 two areas of work were agreed by between the ages of 15 and 17 largely (Athens and Thessaloniki) in Greece. Although the pathogenesis of atherogenic Eventually, politicians will have to decide the NHA members. The first was a position around Dublin.2,3 Sixty percent of these • The school environment may also During this programme, 16 106 volunteers cardiovascular diseases is a complex issue, on the fundamental principles of a large- paper proposing policy options to the Irish students did not meet the current influence physical activity by providing were subjected to total cholesterol hypertension, cigarette smoking, dyslipidemia scale prevention programme. In this context, informing the representatives in Government on the “Marketing of Unhealthy recommendations for physical activity and supportive environments and places to the European Parliament may be equally Food to Children”. This was based on the were classified as not regularly active. be active including playgrounds/yards,

50% as important as informing the general evidence documented in the EHN report Females were significantly less likely to sports fields/courts, sports halls/gymnasiums 46% population. It is to be hoped that their 45% (2005) on the impact of marketing on meet minimum physical activity and swimming pools. 42% conclusions will be based on widely children’s food consumption. A major requirements than males. 40% Smoking available solid data and not on subjective 35% 35% Hypercholesterolemia perceptions like the ones faced during strength of the document is that it is • Facilities for physical activity should be Hypertension 30% the “Cholesterol Month.” supported by a broad range of Low levels of physical activity among young convenient, accessible and low cost. 25% Diabetes 25% organisations. In addition we also secured people is of particular concern given the Rural Irish youth cite a lack of facilities for 19% 19% Stress 20% support from other relevant bodies such current health status of Irish children and activities as the most common reason 18% Obesity as the Children’s Rights Alliance and young people – one in every five children for not joining an activity that they 15% Physical inactivity 12% 5 10% Family history of CVD Barnardos (Children’s Charity). aged 5 to 12 years and 22% of 15 to 17- would like to join. 4 5% year-olds are overweight or obese.

0% Physical activity for children was identified as • The presence of facilities for physical Figure. Perception of risk factors: Ranking of the major cardiovascular risk factors in order of perceived relative the second priority area for the NHA. How the built environment could support activity alone is not enough to influence significance as depicted by the answers of 16,106 study participants. The study participants were asked to rank only A working group on physical activity was young people’s physical activity physical activity.6,7 the risk factors that they considered significant. In the short list of the most important risk factors that each study participant created, stress was included 11,164 times, while obesity and diabetes were included 5,771 and 3,408 established, with members from Dublin times, respectively. In this figure, the values represent the proportion of participants who valued the respective risk City University, the Irish Cancer Society, For the draft position paper, Dublin City factors as the most important ones. Note the markedly underestimated role of diabetes, obesity and physical the Health Service Executive, the Irish Sports University on behalf of the NHA Working inactivity in contrast to the overestimated role of stress. 15 HeartMatters HeartMatters 16 News from Italy by Sergio Oliveri, Italian Association against Thrombosis (ALT) Important steps in the right direction All members of the National Heart Alliance Forging new alliances planners and government departments, have been invited to consider the draft to consider how multi-sectoral action and Obesity is no longer a peculiar pathology – Italian Department for Education (MIUR) Projects at school position paper in the context of their own In addition for 2006, the NHA Working policies could create a more supportive it has become a dramatic problem for our work and to give feedback on the ways Group plans to consult with external environment. society, intimately related to social well- Even though nutrition is not currently a The best school nutritional education each organisation could use the final agencies and stakeholders that play a role being and to lifestyles in the developed school subject, the “Moratti Law” (Lex projects were based on the following position paper. in determining the built environment, for countries. 53/2003, executive order 59/2004) includes themes: example town planners, architects, traffic it in other subjects such as “education for • rediscovering local food and tradition; During the last few months of 2005, in order human society” and “Science”. In any • knowing the fundamentals of a healthy diet; to promote a radical change in this field case, this law does not prescribe strict • making the companies managing and to make people sensitive to the programmes, but provides national targets school canteens sensitive to healthy problem of obesity, the Italian media the students are supposed to reach. diets; started a public service advertisement Therefore during primary school, students • learning to read labels and understand campaign to stimulate the Italians to should be able to describe their own diet marketing techniques. increase their physical activity and turn and understand whether it is a healthy to a healthy diet. The main message diet. After primary school, students should Every year in Lombardia (a member of the of the TV spot was that “physical understand the meaning of “calorie”, and Platform), the regional authority promotes activity is healthy”: it is necessary for they should be able to analyse nutritional school education projects concerning a good health. claims and be aware of the importance of healthy diet, dealing with physical activity a healthy diet. and with a healthy lifestyle. The project Platform on childhood obesity “Food into play” formulated by the District In order to reach these targets, MIUR Council of Milan is an example. The project As obesity and all dietary disorders are defined the following programme: it involved 6,000 children who played with increasing more and more among consisted of a training period for teachers, food. The Municipality of Milan advanced children, school is an important setting for then a national contest for schools entitled the project “+ Fruit + Vegetables” whose educating children concerning healthy “The language of food: history of nutrition target is to make students aware that diets and for giving them the ability to look in Italy from the origins to our times”. eating fruit and vegetables is healthy. at advertisements with a critical eye. ALT Finally, MIUR, in association with (Italian Association for the Fight Against Federalimentare (Italian Federation of The District Council of Bologna, Emilia Thrombosis (Associazione per la Lotta alla the Food-processing Industry), a member Romagna, adopted the same policy. The Trombosi-Onlus)), which coordinates the of the Platform on Childhood Obesity, projects “Eating together” and “Snack European project “Children, Obesity and published “Guidelines to a healthy with taste” convert breakfast, snack time Associated Avoidable Chronic Diseases” in lifestyle” which underlines the relationship and canteen meals into learning times for Italy, initiated the Platform on Childhood between nutrition, physical activity and children. Obesity, which includes medical associations, health, offering a model for health scientific societies, institutions, consumers, education to all people (teachers, students, The Regional Authority of Lazio financed food industry representatives and advertising families, etc.) interested in promoting a the project “Being familiar with taste” companies. healthy lifestyle. The Moratti Law gives which touches on different subjects from schools a certain amount of autonomy in nutrition to agriculture, from lifestyle to The Platform soon faced a difficulty: there organising all these activities, although local tradition. Another interesting project 17 are many different institutions (School, funds are restricted. Furthermore the for a primary school in Rome was “A Health and Agriculture Ministries) dealing regional authorities, the districts, the healthy lifestyle, why not?” This educational with nutritional education. That is the municipalities and local health corporations programme consisted of several lessons on 1. Kelleher, C., Nic Gabhainn, S., Friel, S., Corrigan, H., Nolan, G., Sixsmith, J., Walsh, O. & Cooke, M. (2003) National Health and Lifestyles Surveys. Centre for Health Promotion Studies, reason why there are a great many projects, go a long way towards projects of nutrition held by doctors for selected National University of Ireland, Galway. promoted by different public and private nutritional education at school. With a students; once educated, the students 2. Woods, C.B., Nelson, N., O’Gorman, D., Kearney, J., & Moyna, N. (2005) The Take Part Study: Physical Activity Research for Teenagers. Centre for Sports Science and Health, Dublin City University. agents, different in targets, methods, great many projects (some of them very held lessons for all their schoolmates. 3. Woods, C.B., Foley, E., O’Gorman, D., Kearney, J., & Moyna, N. (2004) The Take Part Study: Physical Activity Research for Teenagers. Centre for Sports Science and Health, Dublin resources, etc. and not always coordinated effective), it is important to establish joint City University. to cover the field and avoid duplication of coordination, which would probably 4. Irish Universities Nutritional Alliance. (2005). National Children’s Food Survey. www.iuna.ie. efforts. increase effectiveness. 5. de Roiste, A. & Dineen, J. (2005). Young People's Views about Opportunities, Barriers and Supports to Recreation and Leisure: A Research Report by Cork Institute of Technology on behalf of the National Children's Office. Dublin: Brunswick Press. 6. Leslie, E., Owen, N., Salmon, J., Bauman, A., Sallis, J. F., & Kai Lo, S. (1999). “Insufficiently active Australian college students: perceived personal, social and environmental influences.” Preventive Medicine 28, 20-27. 7. Romero, A. J. (2005). “Low-income neighbourhood barriers and resources for adolescents' physical activity.” Journal of Adolescent Health 36, 253-259. HeartMatters HeartMatters 18 News from the Netherlands By Karen van Reenen, Netherlands Heart Foundation

Fat Seducers, an educational evening

Conclusions programme for parents It is still not easy to introduce nutritional education at school because of the television programme was broadcast in primary school age really need. Rather different institutions dealing with it. Another October 2005. Later on, schools could than leaving programmes up to the order a videotape or DVD from Teleac schools, the NHF decided to use the obstacle is the incompleteness of NOT so they could organise their own brochure “Fat Seducers” as a starting point educational programmes and documents parents evenings. for a Parents Evening Programme that for teachers. More coordination between would be organised by NHF’s free-lance institutional agents and end users is desirable Parents evenings in schools health educators. in order to develop rigorous and effective Following the structure of the previous The brochure “Fat Seducers” was sent to programmes concerning nutritional National Parents Evening programmes, all the primary schools and day care education. NHF also drafted a brochure that contained centres in The Netherlands in September everything schools needed to organise 2005. After a large audience watched the parents evenings themselves. Items such as television programme in October, a number an invitation letter for parents, a description of newspapers and television magazines of the evening for the school’s newsletter, featured articles about the subject. More what schools have to do to prepare for than 150 DVD/videotapes were ordered the evening and a list of utilities are included by schools and day care centres. The The Netherlands Heart Foundation (NHF) is in the brochure. Internet site for the National Parents Evening an active partner in the Childhood Obesity was accessed by 1220 visitors. Of the large project, which was initiated by EHN in In addition to the theoretical information, number of visitors to the website 2004. In the first phase a survey was carried very practical instructions are part of the www.hartvoorschool.nl it is not easy to out on the nature and amount of food programme. For example, photographs of distinguish between regular visitors and marketing to children. NHF also asked two children’s products are shown and people people specifically interested in “Fat graduate students at the Vrije Universiteit are asked to fill in a form on what they Seducers“. Amsterdam to carry out research on would buy, what the food marketing and children. They conducted a claim or advertisement on In 2005 about survey on food marketing and regulation, the package is and what 17 parents and a survey on food marketing and their reason for buying it evenings on “Fat parenting, and presented their results at would be. People were Seducers” were an invitational conference on food also asked questions organised. The In Campania the Naples Local Health Some consumers organisations proposed marketing and children in March 2005. concerning the calorie evaluation forms NHF Corporation implements a project based educational programmes concerning the content of products and received, showed that how long children would people think it is an on nutritional diseases (obesity but also theme of healthy nutrition. Among these is Televised nutrition information have to exercise to burn important subject. For spring diabetes, bulimia and anorexia) in order to COOP’s (National Consortium of When Teleac/NOT, the educational public these calories. All 2006, another 33 parents evenings promote healthy eating habits. In Naples Consumers Cooperatives and a member broadcaster in the Netherlands decided to products in the are planned, and more will follow. as well some schools implemented the of the Platform) “Educational programme dedicate a part of the television project were looked NHF developed a flyer offering projects “Let’s nourish health”, “Mens sana for students” that has been attended by programming of their annual National at and supervised by information on both the parents the other partners. The brochure evenings and the television in corpore sano” and “Four-leaf Project”, more than 1.7 million students in the last 20 Parents Evening to food marketing and children, they turned to NHF for help. also advised working with a broadcast, and mailed the flyer, inviting students to healthy nutrition. years. In 2005 Altroconsumo (a member of Together with the Nutrition Centre health educator from the NHF as well as a newsletter, to the schools in In Sicily the regional authority implemented the Platform), a major consumer (Voedingscentrum), the Consumer or an expert from one of the the NHF network. a nutritional education project that association, carried out a food campaign Organisation (Consumentenbond) and parent’s organisations to involved more than 25,000 students last characterised by several articles in its three parents organisations (VOO, NKO, organise such a parents Education while waiting for a ban on evening. advertising to children year. A project promoted by the CONI magazines and by a photography contest Ouders en Coo), NHF wrote an educational programme aimed at parents (Italian National Olympic Committee) of for pupils under 16. The contest’s theme “A with children in primary schools. More help for teaching Experts at the Netherlands Heart Foundation Caltanissetta is particularly interesting: healthy dish” was interpreted by students nutrition in schools believe that the influence of food marketing “10,000 steps and more against obesity” in various ways, and they also attended 19 The television programme NHF and its to children is huge and that it is necessary inviting students to adopt a healthy diet some lessons on nutritional education. partners devised, “Fat Seducers”, consists While preparing the brochure it became to have a ban on advertising of unhealthy clear that some schools might need further food to children. Meanwhile NHF also and regular physical activity. of a talk show with parents, and several short film clips on subjects such as the assistance with the difficult subject of considers it very important to educate and ubiquitous food marketing aimed at nutrition, advertising and claims. Pilot influence parents because they need to children, food claims on packages, and research involving family visits showed that know how best to look after their children’s the different appealing techniques parents were keen on getting advice on health. marketers use to sell their products. The the amount of food that children of

HeartMatters HeartMatters 20 News from Norway News from Slovenia by Carina Alm, Norwegian Health Association by Asst. M.Sc Danica Rotar Pavlič, MD, President of the Slovenian Heart Foundation, and Prof. Matjaž Ovsenek, President of the Slovenian Heart Foundation’s Branch office for Škofja Loka, Poljanska and Selška Valley Partnerships in promoting better nutrition Nordic walking – a novelty in recreational Since 2004 the Norwegian Health Foundation (The Tick), from Sweden (The the keyhole on their products, but intend activities offered by the Slovenian Heart Foundation Association has been a member of the Keyhole), from the Finnish Heart to start “carefully” and hope not to Kostforum (Nutrition Forum). This is an Association and from Denmark to present provoke the authorities too much. They alliance working to encourage people to their experiences in labelling healthy also welcome other companies who want is the leading world organisation in this eat a healthier diet and live a healthier products. This was a successful seminar to adopt the keyhole system. field, and Slovenia’s ZNHS (Slovenian life. Kostforum is addressed to industry, with many high level participants. Nordic Walking Association) is a member decision-makers and the general public. Kostforum has considered different traffic organisation. The network consists of five member After the seminar Kostforum was invited to light systems, for example by labelling with organisations (all NGOs): the National Council of Nutrition to present green, yellow or red symbols. Such a A little instruction is necessary • the Norwegian Health Association; their views of the topic. The Council graded labelling system may be highly • the Norwegian Association of Heart and concluded that it regarded some kind of desirable from the point of view of many The participants in the course in Nordic Lung Patients; signposting positively and wished to consumers. However, it is less likely that walking are first familiarised with the basic • the Norwegian Diabetes Association; examine it further. In particular it was producers and retailers are willing to features of walking poles. Special poles • the Norwegian Cancer Society; interested in the effect signposting could cooperate by labelling their products with are used for Nordic walking. Similar to the physical condition, therefore Nordic • the Norwegian Asthma and Allergy have in inspiring food producers to negative symbols in red or even in yellow. In the years 2005 and 2006, the Slovenian poles used for cross-country skiing, but walking is intended for all people, Association. develop new and healthier products. Labelling according to this principle would, Heart Foundation offered its members new shorter, they are made of composite regardless of their age and fitness level. It probably, have to be enforced by law. recreational options. The Foundation is materials and are light, firm and durable. can be practised by beginners engaged Labels for healthy products On 9 February 2006 a working group from The experiences from Australia, Finland especially proud of the novelty, as the Their handle is ergonomically shaped, and in a sport activity for the first time who the Norwegian Ministry of Health and Care and Sweden show that a positive labelling idea arose within the local community the grip makes it possible to engage the would like to gradually activate their body.

One of the Norwegian Health Association’s Services arranged a new seminar on the system such as the Tick or the Keyhole can when a new branch of the foundation upper part of the body in the exercise. They are the ones for whom walking with ^ main tasks the last two years has been same topic. This seminar was part of the be introduced in successful cooperation was established in Skofja Loka. The poles is most recommended. However, working toward the signposting of healthy work in the Nordic Council of Ministers. with the food industry. This is considered a enthusiasts and initiators of new activities Nordic walking is also intended for all products. Until now there has been no Norway is supposed to present its view in more realistic approach at the present have transferred what they practised for people who regularly engage in different system for labelling “healthy products” in the summer of 2006 and the working group stage. In the future negative labelling may decades from their local environment – i.e. sports activities. Even top sportsmen can Norway that is equivalent to the Swedish has a deadline of 1 April 2006 to formulate be considered. walking with poles across hilly, mountainous benefit from intensive walking with poles. “Keyhole System”. The Norwegian Health the official position. The Nordic Council of and also flat terrains. Association has worked through Kostforum Ministers wishes to evaluate the possibilities Government involvement still needed It is known from experience of these to try to put this wish for a healthy eating of a common Nordic health labelling A new twist on an old sport courses and lectures that Nordic walking is symbol on the agenda of decision makers. (signposting) system in the Nordic action In the small Nordic countries we believe a very effective, universal, safe and plan for better health and quality of life that a government-backed scheme would Although ski walking with poles has been accessible health preventive sports activity, Satisfactory food labelling is an important through diet and physical activity. This plan be the best alternative. This could be put known in Slovenia ever since the first cross- The teaching of the Nordic walking suitable for people of all ages. It should not consumer demand and has been a topic is expected to be adopted by the Nordic into practice in close cooperation with country ski races were organised in the technique is an important part of the be forgotten, either, that this is an outdoor for Nordic cooperation since the 1980s. ministers in the summer of 2006. The non-governmental organisations concerned beginning of the last century, it has been course. Although the movement is similar exercise in fresh air and nature, which Norwegian authorities have not made Norwegian Food Safety Authority says that with health. We do not trust purely practised on a massive scale only over the to ordinary walking, with this exercise 90% reduces fatigue, stress and irritability and efforts so far to introduce or implement it is prepared to start with signposting as commercial organisations to be best suited last year. Until now this type of walking with of all muscles are engaged. Nordic increases the feeling of well-being. any signposting system but are waiting for soon as the authorities have made up their to organise such labelling schemes. poles was mainly used by competitors walking is different from ordinary walking a Nordic (or European) strategy for a minds. engaged in cross-country skiing when they with poles, therefore it is important to common label. A survey in Norway last Kostforum endorses the introduction of were training without snow. The poles are master the basic technique, which involves autumn showed that 77% of Norwegian A push from the food industry food labelling in Norway according to a usually slightly shorter than ski poles used in using the poles and dynamically performing consumers are positive regarding labelling model similar to the Swedish Keyhole races and they make it possible to imitate a prolonged alternate step sequence. As of healthy products, 19% didn’t have any ICA Norway and COOP Norway (two of System. We believe it is realistic to do this in rather closely the running otherwise the steps are significantly longer than with opinion and only 4% were against it. the biggest retailer companies) do not close cooperation with the other Nordic performed in classic ski technique. In ordinary walking, the hands are involved in want to wait any longer for the authorities countries to obtain a common labelling Finland, the homeland of cross-country a considerably longer movement amplitude Stimulating action by involving more to make up their minds. They have just system. We hope that a common European skiing, at the turn of the millennium there than in traditional trekking with poles. The partners started to mark the shelves with healthy system can be organised in the future. was a trend toward mass use of ski walking strength of the hands and shoulder girdle is products in their food stores in green (the with poles in all seasons (called Nordic improved, and practitioners of the sport The Kostforum thought this work was keyhole colour). This is exactly how they walking), which was stimulated even more substantially solidify their bottom and back evolving too slowly and put the issue on started in Sweden in the 1980s before the by their strong industry of producing cross- muscles – and the most important factor, the agenda by arranging a seminar last keyhole system was introduced. This country poles. of course, is that the cardiovascular system October for the authorities, NGOs, the initiative is accompanied by a major is strengthened. Norwegian Food Safety Authority and media campaign to teach the consumers Nordic walking is currently the greatest other interested parties. There were invited why and how to use the keyhole system. recreational sports trend in Europe. INWA The intensity of physical exercise can be speakers from the Australian Heart ICA and COOP have further plans to use 21 (International Nordic Walking Association) rather closely adjusted to each person’s

HeartMatters HeartMatters News from Sweden News from the UK by Ulrica Klettner, Swedish Heart-Lung Foundation by Ian Fannon, British Heart Foundation Women’s hearts in focus in Sweden Childhood obesity in the UK

Women and heart disease is a very topical Publicising the risk factors know,” says Karin Schenck-Gustafsson. But Childhood obesity is high on the agenda subject in Sweden right now. The “Women what is wrong, in her opinion, is the fact in the UK. The Government’s White Paper at heart – Go Red!” campaign is intended A number of events were held around that female patients are not given on public health, published in November to increase knowledge of heart disease in Sweden on International Women’s Day, medication to lower blood lipids, thin the 2004, has set numerous targets for reducing the causes of childhood obesity in England women and raise funds for research into enabling women (and interested men) to blood, counteract heart failure and – from regulating food advertising to the female heart. The campaign is a find out more about women and heart prevent high blood pressure to the same children to making food labelling clearer collaboration between the Swedish Heart- disease and, above all, to listen to talks on extent as men. for consumers. In Scotland, Wales and Lung Foundation, the Swedish Society of how factors such as lifestyle, obesity, Northern Ireland too, major steps are being Cardiologists and the 1.6 Million Club, exercise, smoking and stress affect the Being aware of the differences taken, including the Scottish Executive’s which represents women over 45 in heart. “Hungry for Success” initiative. Sweden. “At present, diagnosis and treatment of “Women essentially have the same risk heart disease is largely based on the male But this is not an issue confined to the halls Karin Schenck-Gustafsson is a consultant and health factors as men,” says Karin perspective, despite the differences of Westminster. It has been thrust into the cardiologist at Karolinska University Hospital Schenck-Gustafsson. “Blood lipid disorders, between the male and female heart. public spotlight over recent years, and and director of the Centre for Gender- high blood pressure, smoking, stress, Women have smaller hearts and narrower particularly so since celebrity chef Jamie Oliver’s influential campaign, “Feed Me Related Medicine at the Karolinska Institute diabetes, obesity and physical inactivity coronary vessels. They have a generally Better”, highlighted the issue of unhealthy Research after the British Heart Foundation’s also focused on communicating to central in Stockholm. She has been interested in increase the risk of heart attacks, while higher pulse throughout their lives and their school meals on national television last (BHF) 2004 campaign about children and and local governments, the food industry, women and heart disease since the late eating plenty of fruit and vegetables and ECG output differs from men’s. Women are year. This led to commitments from the physical activity, “Well Fit!”, showed most schools and parents the need for all to 1980s and it is largely thanks to her that the drinking only small quantities of alcohol also more likely than men to experience English Government to improve nutritional children (62%) thought their mothers were play a part in helping children make campaign has now become a reality in reduce it. There are also risk factors side effects from medicines, as well as standards for school meals. Food chiefly responsible for their health. The healthier choices. Sweden, based on the American model. specific to women, for example high other types of side effect,” says Karin manufacturers and retailers are also under BHF’s “Food4Thought” campaign, launched Sweden is one of the first countries in blood pressure or diabetes during Schenck-Gustafsson. increasing pressure to reduce salt, saturated in November 2005, was intended to shift Implementation Europe to run the campaign, and the idea pregnancy, complications of childbirth During the “Women at heart – Go Red!” fat and sugar contents of their foods. this perception so that children felt more responsible for their own diet, and their Five arms of the BHF mobilised to form is for it to coincide with International and early menopause.” campaign, the Swedish Heart-Lung own health. a project team, overseen by a project Women’s Day on 8 March each year. Foundation is collecting funds which are However, Jamie Oliver’s campaign, The objective was to encourage 11 to 12- manager, and worked together to produce Recognising the signs of heart attack being earmarked for cardiac research although very successful, focused on school meals – whilst most children make year-olds to think about how food affects a cleverly woven campaign, with a total Heart disease, not cancer, is main killer in women relating to women. Karin Schenck- significant food choices outside school, their health and, by doing so, to decrease budget of around £1.6 million. of women Gustafsson would like to see more in-depth spending an average £2 a day on snacks their risk of heart disease, diabetes and Karin Schenck-Gustafsson believes that research into the differences between high in fat, salt and sugar. other serious conditions. The campaign Marketing: An arresting advertising “A survey carried out in autumn 2005 women over 60 who have any of the risk men and women in terms of heart attacks. campaign was devised showing the gory revealed that 70% of Swedes believe factors should pay extra attention to Perhaps there is a need for the gradual ingredients of burgers, hot dogs and cancer to be the most common cause of shortage of breath, dizziness and extreme introduction of new clinical guidelines to chicken nuggets, obscured with a death in women,” explains Karin Schenck- fatigue, all of which can be a sign of a reflect these differences? She would also ‘censored’ stamp. A £1.3 million media Gustafsson. “Most women think they will heart attack. “Women don’t always get like to see research into areas such as plan encompassed posters, online, radio and school exercise books, a radio die of breast cancer, despite the fact that the classic symptoms of chest pain, as is arrhythmia and heart failure. promotion, and roadshows in 12 UK city they are ten times more likely to die of a often the case for men. However, it is centres, with handouts given to children heart attack. It is extremely important to important to remember that some women, The “Women at heart – Go Red!” and parents passing by. All of the marketing raise awareness that many women have particularly older ones, may get the typical campaign has led to many newspapers aimed to drive children to the campaign heart attacks, and that the symptoms are chest pain.” in Sweden highlighting women and heart microsite. often different for women than for men. If disease, and large numbers of articles women don’t think they are vulnerable to It is not only the symptoms which may be being written on risk factors as well as heart attacks and also cannot recognise different in women; in-patient investigations lifestyle and symptoms. the symptoms, then it is hardly surprising if and treatment also differ for men and they don’t seek medical attention. At women. Among other things, it has been present women with heart attacks come observed that Swedish men undergo into hospital later than men, leading to a coronary x-rays and balloon dilatations higher death rate. This is why this more frequently than Swedish women. knowledge is vital!” “Whether this is right or wrong, we don’t 23 24

HeartMatters HeartMatters Online: A campaign microsite, bhf.org.uk/ schools. In addition 605,000 celebrity-backed Evaluation and results have viewed over 1 million pages. Beat times – meaning the campaign should be grabbing, enticing children with the food, was designed to engage and inform student action packs were mailed out. City has been downloaded 23,500 times. well remembered by most of those censored stamp to find out more online. children about food. It hosted a virtual The campaign’s public-facing element ran exposed to it. The teachers’ pack was particularly reality game, Beat City, and offered the Public Affairs: Clear policy calls were for over a month, but the work in schools Education: All 5000 pizza boxes have now imaginative and helped shape the PR opportunity to “peel off the advertising developed for all audiences and a and in lobbying Government and industry been sent to schools, youth groups, Wider impact: tactic of the journalist teasers and policy censored stamp to reveal the full ingredients”, targeted lobbying campaign was devised. continues today, whilst the website still attracts nutritionists and dieticians and all 605,000 pizza delivery. This idea in turn triggering their interest in learning more Letters were sent to Members of thousands of visitors every month. The results action packs to pupils. Feedback from • BBC children’s programme, Blue Peter, communicated the BHF policy message about food choices. Teachers were able Parliament (MPs), local authorities and below show the measurable effects of the teachers has been excellent, with many has contacted the BHF, leading to a that there is no single ‘solution’ to combat to order the resource pack and download food industry leaders. Postcards for children campaign up until the end of February. schools very grateful for an innovative way joint-working opportunity. childhood obesity – that it is everyone’s materials from bhf.org.uk/foodinschools. to send to MPs were included in the teachers’ of introducing nutrition into the classroom. • Cartoons in the Times and Scotsman responsibility. This original tactic backed pack and as e-postcards on the microsite. Marketing: Post-campaign research has used the ads to satirise controversial up the provocative ads with solutions. revealed a big shift in children’s views, with Public Affairs: A Food4Thought Early Day political moves. PR: An omnibus survey of children aged 8- 66% now thinking they are chiefly responsible Motion was signed by 123 MPs – the • Fast food giant McDonald’s responded Finally, the tactic which launched the 14 provided the news angle for the for their own health. About 76% of children highest BHF has achieved. A survey by a to the campaign, taking out national campaign onto an international stage November 7 launch: one in three children thought the campaign told them something leading public affairs agency in January press advertising on November 10, was highly inventive. The idea that don’t know chips are made from important, making 64% want to do more showed 85% recognition of Food4Thought claiming their food to be much healthier children potatoes. A ‘policy pizza’, detailing policy to keep healthy. among MPs. There have been supportive than the adverts portrayed. This was calls to each of the audiences, was letters from 11 MPs or Welsh Assembly exactly the sort of debate the BHF had might not know what chips were made of delivered to Number 10 Downing Street by Online: The microsite received 39,000 visits Ministers (AMs) and 17 local authorities. 65 hoped to create. seemed so improbable the BHF nearly Education: A teachers’ resource pack TV presenter Gabby Logan and two on its first day – a record for the BHF. It e-postcards were sent to MPs by children. • The National Union of Teachers invited omitted the question from the survey. was designed in the shape of a pizza box, school children. Photocalls were organised went on to attract 280,000 visits in November the BHF to talk about the campaign to Journalists lapped it up and it led to wide- containing lesson plans and food-shaped for regional media to cover the roadshows and 150,000 more since. Children spend Food4Thought was welcomed by their members. scale debate about children’s knowledge teaching aids, and sent on request to 5,000 and MP visits to schools. an average 8 minutes on the site, and Education Minister Jane Davidson in the • The chips survey was discussed on of food – meeting the BHF’s main Welsh Assembly. The policy pizza delivery Channel 4’s The F Word – a popular campaign objective. prompted letters from Ministers in the cooking programme by celebrity chef Department of Health and Department for Gordon Ramsay. Education and Skills. Several meetings have been set up with food industry Creativity leaders and the Department of Health has invited BHF to help frame a forthcoming This campaign was skilfully woven obesity campaign. together, with all elements feeding off each other. The ads were attention- 26 PR: The chips story was covered by almost all mainstream national media and most of the mainstream TV networks covered the policy pizza delivery. Cuttings are still coming in, but by mid-January, the total was 514 items of coverage in national, regional, consumer and trade media. Highlights include 16 columns or leader articles, almost all of which were extremely supportive of the campaign’s aims.

A Google search in mid-November showed at least 700 UK and 9,200 global websites had mentioned the campaign, including Newsround and Radio 1 websites, which ran reader polls, and numerous ‘blogging’ websites – really helping to create a debate around the 25 campaign. A media analysis shows the PR campaign reached 56% of adults, an average 3.8

HeartMatters Contact

European Heart Network National coordinators Children and Obesity Project

Ms Susanne Løgstrup National coordinator: Austrian Heart Foundation National coordinator: Irish Heart Foundation Director Contact person: Ms Petra Scharf Contact person: Ms Maureen Mulvihill Telephone: +43 1 405 9155 Telephone: +353 1 668 5001 Fax: +43 1 405 9156 Fax: +353 1 668 5896 Rue Montoyer, 31 E-mail: [email protected] E-mail: [email protected] B-1000 Brussels http://www.herzfonds.at http://www.irishheart.ie Belgium National coordinator: Belgian Heart League National coordinator: Italian Association against Telephone: +32 2 512 9174 Contact person: Dr Freddy Van de Casseye Thrombosis (ALT) Fax: +32 2 503 3525 Telephone: +32 2 649 8537 Contact person: Sergio Oliveri E-mail: [email protected] Fax: +32 2 649 2828 Telephone: +39 02 720 11 444 Website: www.ehnheart.org E-mail: [email protected] Fax: +39 02 720 21 776 http://www.liguecardiologique.be E-mail: [email protected] http://www.trombosi.org

National coordinator: Danish Heart Foundation Contact person: Ms Dorte Fremm National coordinator: Netherlands Heart Foundation Ms Marleen Kestens Telephone: +45 33 670 040 Contact person: Ms Karen van Reenen European Coordinator Fax: +45 33 931 245 Telephone: +31 70 31 55 624 E-mail: [email protected] Fax: +31 70 34 790 46 http://www.hjerteforeningen.dk E-mail: [email protected] Telephone: +32 2 502 1541 http://www.hartstichting.nl Fax: +32 2 503 3525 E-mail: [email protected] National coordinator: Estonian Heart Foundation Contact person: Ms Monika Tartu National coordinator: Norwegian Council on CVD Telephone: +372 697 7304 Contact person: Ms Elisabeth Fredriksen Fax: +372 654 2574 Telephone: +47 231 200 82 E-mail: [email protected] Fax: +47 231 200 03 The European Heart http://www.sydameliit.ee E-mail: [email protected] Network plays a http://www.nasjonalforeningen.no leading role in the National coordinator: Finnish Heart Association Contact person: Ms Anna-Liisa Rajala National coordinator: Portuguese Heart Foundation prevention and Telephone: +352 44 53 42 Contact person: Dr Luis Negrão Fax: +358 505 207 898 Telephone: +351 21 38 150 00 reduction of E-mail: [email protected] Fax: +351 21 38 733 31 cardiovascular http://www.sydanliitto.fi E-mail: [email protected] http://www.fpcardiologia.pt disease through National coordinator: French Federation of Cardiology advocacy, Contact person: Ms Céline dos Santos National coordinator: Slovenian Heart Foundation networking and Telephone: +33 1 44 90 70 21 Contact person: Dr Danica Rotar Pavlic Fax: +33 1 43 87 98 12 Telephone: +386 1 436 95 62 education so that it E-mail: [email protected] Fax: +386 1 436 12 66 is no longer a major http://www.fedecardio.com E-mail: [email protected] http://www.zasrce.over.net cause of premature

death and disability National coordinator: German Heart Foundation Contact person: Ms Christine Dehn National coordinator: Spanish Heart Foundation^ throughout Europe. Telephone: +49 69 955 128 141 Contact person: Ms Beatriz Juberías Fax: +49 69 955 128 345 Telephone: +34 91 724 2373 E-mail: [email protected] Fax: +34 91 724 2374 http://www.herzstiftung.de E-mail: [email protected] http://www.fundaciondelcorazon.com

National coordinator: Hellenic Heart Foundation Contact person: Dr George Andrikopoulos National coordinator: Swedish Heart-Lung Foundation Telephone: +30 210 640 14 77 Contact person: Ms Janina Blomberg Fax: +30 210 640 14 78 Telephone: + 46 8 566 24 237 E-mail: [email protected] Fax: + 46 8 566 24 229 E-mail: [email protected] http://www.hjart-lungfonden.se National coordinator: Hungarian Heart Foundation Contact person: Dr Andras Nagy Telephone: +36 76 519 502 National coordinator: National Heart Forum Fax: +36 76 482 014 Contact person: Ms Jane Landon E-mail: [email protected] Telephone: + 44 20 7383 76 38 http://www.mnsza.hu Fax: + 44 20 7387 27 99 E-mail: [email protected] http://www.heartforum.org.uk National coordinator: Icelandic Heart Foundation Contact person: Mr Vilmundur Gudnason Telephone: +354 535 1800 Fax: +354 535 1801 E-mail: [email protected] http://www.hjarta.is Front cover courtesy of the World Heart Federation

The European Heart Network acknowledges the financial support received from the European Commission for this project. Neither the European Commission nor any person acting on its behalf is liable for any use made of the information in this publication.

Cover photo: Graphics by www.karakas.be