Abstract P409: Assessing public health nutrition policies using a novel framework across 30 European countries: Lessons for the USA?
Authors: Lloyd-Williams Ffion , Bromley Helen , Orton Lois , Hawkes Corinna , Taylor-Robinson David , O'Flaherty Martin , McGill Rory , Anwar Elspeth , Hyseni Lirije , Guzman Castillo Maria , Rayner Mike , Capewell Simon 
Published: July 2021

Background:
Countries across Europe have introduced a wide variety of policies to improve nutrition. However, the sheer diversity of interventions is potentially bewildering. We therefore aimed to map existing public health nutrition policies and identify their perceived effectiveness, in order to inform future evidence-based diet strategies.

Methods:
Mapping exercise: We created a public health nutrition policy database for 30 European countries (EU 27 plus Iceland, Norway and Switzerland), by summarising policy documents, grey literature, web searches and advice from topic experts. National nutrition policies were then classified using the marketing “4Ps” approach: Product (reformulation, elimination, new healthier products); Price (taxes, subsidies); Promotion (advertising, food labelling and health education) and Place (schools, workplaces, etc.) Policy interviews: We interviewed 71 senior policy-makers, public health nutrition policy experts and academics from 14 of the 30 countries, eliciting their views on diverse current and possible nutrition strategies.

Results Product:
Voluntary reformulation of foods, (especially salt, sugar and total fat) is widespread but with questionable impact. Denmark, Austria, Iceland and Switzerland have trans fats bans. Twelve countries regulate maximum salt content in specific foods.

Price:
EU School Fruit Scheme subsidies are almost universal, with variable implementation. Taxes are uncommon. However, Finland, France, Hungary and Latvia have implemented ‘sugar taxes’ on sugary foods and sugar-sweetened beverages. Finland, Hungary and Portugal also tax salty products.

Promotion:
Dialogue, recommendations, nutrition guidelines, information and education campaigns are widespread (all 30 countries). Labelling information is widespread, but variable. Restrictions on marketing to children are widespread but mostly voluntary.

Place:
Interventions reducing the availability of unhealthy foods were most commonly found in schools and workplace canteens (e.g. vending machines). Comparative effectiveness: Interviewees generally considered mandatory reformulation more effective than voluntary, and regulation and fiscal interventions much more effective than information strategies, but politically much more challenging.

Implications:
Public health nutrition policies in Europe appear diverse, dynamic, complex and bewildering. However, the “4Ps” framework potentially offers a structured and comprehensive categorisation.

Most European countries are active in nutrition policy. However, exemplars are few, including Finland, Norway, Iceland, Denmark, Hungary, Portugal and the UK. Do these offer any useful lessons for US states addressing similar challenges?
In conclusion, fiscal and regulatory nutrition policies appear potentially powerful and should be considered across Europe, and perhaps across the US?