Gaining health : analysis of policy development in European ...

Society of Nutrition and Foods, which brought together
top academics with an interest in the issue, there was little
practical policy action. It is suggested (26) that this was
partly because the lobby group did not have a clearly defined
strategy and did not employ available epidemiological
material to convince policy-makers, but also that there was
a dearth of people with training in nutrition. In addition,
mortality from nutrition-related causes was comparatively
low at that time and Greeks were obviously still benefiting
from their Mediterranean diet. Greek experts were actively
involved in raising the issue of the Mediterranean diet in
international research circles.
Surveys carried out in the late 1990s indicated that the
pattern of nutrition in Greece was moving away somewhat
from the traditional Mediterranean diet, although a very
high intake of fruit and vegetables was still reported. Data
on cause of death were also being improved in the sense
that the categories “old age” and “unknown causes”, which
had covered 20% of all deaths, were practically eliminated
(27). Gradually, a convincing body of evidence was being
collected indicating that Greeks were increasingly burdened
by nutrition-related diseases.
In 1994, Greece joined the joint WHO/EU study entitled
European Prospective Investigation into Cancer and Nutrition
(EPIC), in which 22 research centres from 9 countries
take part. In Greece, about 28 000 adult volunteers have
been recruited, representing a broad range of socioeconomic
groups. Apart from self-administered questionnaires
or telephone interviews regarding 24-hour dietary recall,
this includes the use of blood samples and medical files in a
longitudinal study.
In 1999, a core group of nutrition experts moved from the
School of Public Health to the new Public Health Nutrition
and Nutritional Epidemiology Unit, created in the Department
of Hygiene and Epidemiology of the University of Athens
Medical School. This unit became a WHO collaborating
centre for nutrition and, with the prestige of the university
behind them, a small band of dedicated nutritionists under
the leadership of Antonia Trichopoulou continued to push
for action to deal with the observed changing eating and
morbidity patterns.
In 1999, partly as a result of their pressure, the Hellenic
Food Authority was established and became operational in
May 2001. This is a governmental organization, supervised
by the Ministry of Development and based in Athens. A
number of regional branches were foreseen but have not
yet been developed. The principal aim of the Food Authority
is to ensure that food produced, distributed and
marketed in Greece meets high standards of food safety
and hygiene and that the relevant legislation is enforced. It
also has a division for nutrition policy, and is advised by a
Committee for Nutrition Policy and other relevant experts.
The fortuitous appointment of the Professor of Epidemiology
and Hygiene at Athens University as President of the
Supreme Scientific Health Council meant that the University
was asked to prepare food-based dietary guidelines
for adults in Greece. Through collaborative action by the
Ministry of Health and Social Welfare, the Ministry of Agriculture,
the Ministry of National Education and Religious
Affairs and the Ministry of Development, with input from
a number of related NGOs, these guidelines, based on the
Mediterranean diet with its high use of olive oil, fruit and
vegetables, were quickly developed and accepted by the
Supreme Scientific Health Council (28).
In 2003, the Committee for Nutrition Policy proposed
a draft nutrition policy to the then Minister for Health
and Welfare. This was well-received by the Minister, who
defined the field of nutrition as being one of the significant
factors that contribute not only to longer life expectancy
but simultaneously to avoidance of illness and a better quality
of life. However, before this could be finalized, general
elections brought in a new government. According to the
Chapter 4
113
Case studies: policy development in countries for tackling noncommunicable diseases