Sara Capacci

Policies to promote healthy eating in Europe: a structured review of policies and their effectiveness

This review provides a classification of public policies to promote healthier eating as well as a structured mapping of existing measures in Europe. Complete coverage of alternative policy types was ensured by complementing the review with a selection of major interventions from outside Europe. Under the auspices of the Seventh Framework Programmes Eatwell Project, funded by the European Commission, researchers from five countries reviewed a representative selection of policy actions based on scientific papers, policy documents, grey literature, government websites, other policy reviews, and interviews with policy-makers. This work resulted in a list of 129 policy interventions, 121 of which were in Europe. For each type of policy, a critical review of its effectiveness was conducted, based on the evidence currently available. The results of this review indicate a need exists for a more systematic and accurate evaluation of government-level interventions as well as for a stronger focus on actual behavioral change rather than changes in attitude or intentions alone. The currently available evidence is very heterogeneous across policy types and is often incomplete.

Policy interventions to promote healthy eating: A review of what works, what does not, and what is promising

Unhealthy diets can lead to various diseases, which in turn can translate into a bigger burden for the state in the form of health services and lost production. Obesity alone has enormous costs and claims thousands of lives every year. Although diet quality in the European Union has improved across countries, it still falls well short of conformity with the World Health Organization dietary guidelines. In this review, we classify types of policy interventions addressing healthy eating and identify through a literature review what specific policy interventions are better suited to improve diets. Policy interventions are classified into two broad categories: information measures and measures targeting the market environment. Using this classification, we summarize a number of previous systematic reviews, academic papers, and institutional reports and draw some conclusions about their effectiveness. Of the information measures, policy interventions aimed at reducing or banning unhealthy food advertisements generally have had a weak positive effect on improving diets, while public information campaigns have been successful in raising awareness of unhealthy eating but have failed to translate the message into action. Nutritional labeling allows for informed choice. However, informed choice is not necessarily healthier; knowing or being able to read and interpret nutritional labeling on food purchased does not necessarily result in consumption of healthier foods. Interventions targeting the market environment, such as fiscal measures and nutrient, food, and diet standards, are rarer and generally more effective, though more intrusive. Overall, we conclude that measures to support informed choice have a mixed and limited record of success. On the other hand, measures to target the market environment are more intrusive but may be more effective.

Five-a-day, a price to pay: An evaluation of the UK program impact accounting for market forces

We provide an ex-post assessment of the UK 5-a-day information campaign, where the positive effects of information are disentangled from potentially conflicting price dynamics. Using 4 years of data from the Expenditure and Food Survey between 2002 and 2006, we estimate that the 5-a-day program has lifted fruit and vegetable consumption by 0.3 portions, on average. We also provide quantitative evidence of a differentiated impact by income group, ranging from 0.2 to 0.7 portions. All impacts are larger than those observed by simply comparing pre-policy and post-policy intakes.

AN EVALUATION OF THE UK FOOD STANDARDS AGENCY'S SALT CAMPAIGN

Excessive salt intake is linked to cardiovascular disease and several other health problems around the world. The UK Food Standards Agency initiated a campaign at the end of 2004 to reduce salt intake in the population. There is disagreement over whether the campaign was effective in curbing salt intake or not. We provide fresh evidence on the impact of the campaign, by using data on spot urinary sodium readings and socio-demographic variables from the Health Survey for England over 2003-2007 and combining it with food price information from the Expenditure and Food Survey. Aggregating the data into a pseudo-panel, we estimate fixed effects models to examine the trend in salt intake over the period and to deduce the heterogeneous effects of the policy on the intake of socio-demographic groups. Our results are consistent with a previous hypothesis that the campaign reduced salt intakes by approximately 10%. The impact is shown to be stronger among women than among men. Older cohorts of men show a larger response to the salt campaign compared to younger cohorts, while among women, younger cohorts respond more strongly than older cohorts.

Assessment of evaluations made to healthy eating policies in Europe: A review within the EATWELL Project

OBJECTIVE To identify and assess healthy eating policies at national level which have been evaluated in terms of their impact on awareness of healthy eating, food consumption, health outcome or cost/benefit. DESIGN Review of policy documents and their evaluations when available. SETTING European Member States. SUBJECTS One hundred and twenty-one policy documents revised, 107 retained. RESULTS Of the 107 selected interventions, twenty-two had been evaluated for their impact on awareness or knowledge and twenty-seven for their impact on consumption. Furthermore sixteen interventions provided an evaluation of health impact, while three actions specifically measured any cost/benefit ratio. The indicators used in these evaluations were in most cases not comparable. Evaluation was more often found for public information campaigns, regulation of meals at schools/canteens and nutrition education programmes. CONCLUSIONS The study highlights the need not only to develop harmonized and verifiable procedures but also indicators for measuring effectiveness and success and for comparing between interventions and countries. EU policies are recommended to provide a set of indicators that may be measured consistently and regularly in all countries. Furthermore, public information campaigns should be accompanied by other interventions, as evaluations may show an impact on awareness and intention, but rarely on consumption patterns and health outcome.

Interventions to promote healthy eating habits: evaluation and recommendations.

Although in several EU Member States many public interventions have been running for the prevention and/or management of obesity and other nutrition‐related health conditions, few have yet been formally evaluated. The multidisciplinary team of the EATWELL project will gather benchmark data on healthy eating interventions in EU Member States and review existing information on the effectiveness of interventions using a three‐stage procedure (i) Assessment of the interventions impact on consumer attitudes, consumer behaviour and diets; (ii) The impact of the change in diets on obesity and health and (iii) The value attached by society to these changes, measured in life years gained, cost savings and quality‐adjusted life years. Where evaluations have been inadequate, EATWELL will gather secondary data and analyse them with a multidisciplinary approach incorporating models from the psychology and economics disciplines. Particular attention will be paid to lessons that can be learned from private sector that are transferable to the healthy eating campaigns in the public sector. Through consumer surveys and workshops with other stakeholders, EATWELL will assess the acceptability of the range of potential interventions. Armed with scientific quantitative evaluations of policy interventions and their acceptability to stakeholders, EATWELL expects to recommend more appropriate interventions for Member States and the EU, providing a one‐stop guide to methods and measures in interventions evaluation, and outline data collection priorities for the future.

Eco Labels and Tourism Flows: How Much is a Blue Flag Worth?

The rise in destination accessibility and the emergence of new market segments have increased the competition among tourism destinations, both at national and international level. In order to gain a significant competitive advantage over competitors, destinations increasingly make use of signals that certify and communicate the level of quality provided. While existing research on tourism certifications mostly pertains to quality evaluation, this study exploits quantitative methods to assess the economic impact of destinations’ labels. The analysis considers one of the most popular certification of environmental quality attributed to beaches, the Blue Flag award. It explores the relationship between the certification achievement and inbound tourist flows, focusing on the Italian case study. In fact, given their aim of providing synthetized information on destinations, certification programs particularly affect foreign tourists who suffer more from asymmetric information. Panel data techniques and highly disaggregated data are employed to compare the attractiveness of certified and non-certified provinces, by controlling for several factors potentially confounding the effect of the certification.

Estimation of unobservable selection effects in on-line surveys through propensity score matching: An application to public acceptance of healthy eating policies

The use of model-based propensity scores as matching tools opens the way to the indirect estimation of mode-related measurement effects and selection effects in web surveys, including a component of selection that cannot be traced back to observable characteristics. By matching and comparing respondents from real independent surveys that use the same questionnaire, but different administration modes, it becomes possible to isolate the selection effect induced by unobservable (or unobserved) respondent characteristics. This study applies a stratification matching algorithm to compare a web survey from a proprietary panel with a computer-assisted telephone survey based on random digit-dialing. The experiment is run in two countries (UK and Italy) to check for consistencies across different cultures and different internet penetration rates. The application to the elicitation of support for healthy eating policies indicates large and significant measurement and selection effects. After controlling for differences in the observed characteristics of respondents and the intensity of internet use, findings suggest that web surveys record lower support and higher neutrality. Similarly, after controlling for administration mode and observed respondent characteristics, internet users are less likely to state support compared to non-users. This suggests that unobserved characteristics play a major role, and post-stratification weighting is not a sufficient countermeasure. As demonstrated by the cross-country comparison, rising internet penetration rates are not a guarantee against this type of error, as disparities in these unobserved characteristics are likely to increase at the same time.

There is no such thing as a (gluten-)free lunch: Higher food prices and the cost for coeliac consumers

HIGHLIGHTSUK subsidies on gluten‐free foods for coeliac patients are currently under revision.Gluten‐free food costs on average 90.We estimate the welfare impact of dropping gluten on UK coeliac consumers.A coeliac consumer pays an extra £10 per week to keep the pre‐diagnosis utility level.The gluten‐free diet imposes a greater burden on poor consumers than on rich ones. ABSTRACT A lifelong gluten‐free diet is the only available treatment for coeliac disease at present. However, the high price of gluten‐free substitute foods is likely to generate a welfare loss for consumers who drop gluten from their diet. Using original data on retail prices in four major UK supermarkets and consumption data from the UK Living Cost and Food Survey, we simulate the welfare change associated to a switch to the gluten‐free diet. Within the “Bread and Cereals” category, retail price data show that the average price of gluten‐free products is £1.12/100g relative to £ 0.59/100g of gluten‐containing products. Our estimates indicate that on average in the UK coeliac consumers have to pay an extra £ 10 per week to maintain their utility levels prior to the dietary switch. This correspond to 29% of the weekly food budget. Results by income quartile are suggestive of regressive effects and the welfare loss for low‐income consumers is estimated at 36% of their food budget compared to 24% of high‐income consumers.