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

Chapter 4
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2.5.2. Nutrition
Some 39% of adults are overweight and 18% are obese.
About 2000 premature deaths per year are estimated as being
due to obesity, with an annual cost to the state of €4 billion
(30). The Survey of Lifestyle, Attitudes and Nutrition
carried out in 1998 and 2002 gave ample evidence of the
emerging problems, as did the survey of Health Behaviour in
School-aged Children, and obesity is considered to be one of
the fastest developing health problems in Ireland (31).
Ireland administers a Food Frequency Questionnaire
supplemented by a dietary record for schoolchildren. This
shows rather mixed results, with an increase in fat intake
since 1998 but a decline in carbohydrate intake. A recent
survey indicated that just over half of schoolchildren eat
sweets at least once a day and one third have fizzy drinks
and potato crisps. Although the majority of children are
involved in some exercise outside school, boys exercise
more than girls and exercise decreases with increasing age,
particularly for girls. The growing number of overweight and
obese children is of particular concern.
There has been no lack of interest from the public health
sector. Health promotion interventions dealing with nutrition
have been ongoing in Ireland since 1991 (15). One of
the key components has been the establishment of community
nutrition services at regional level. A strategy for the
then health boards to promote physical activity was also
developed in 1997 (32). Reviewing action in health promotion
for nutrition in 1997, the National Nutrition Surveillance
Centre pointed to the need for greater focus on
socially disadvantaged groups.
The National Health Promotion Strategy 2000–2005 (15)
deals with both nutrition and physical activity. The objectives
of the Strategy are linked to policies for heart health,
cancer, children and young people, as well as the specific
policy recommendations for food and nutrition for older
people (33).
One problem so far has been the lack of essential collaboration
with other sectors. Facilities in schools for physical
exercise are said to be woefully inadequate, many schools
not even having a playground, so that by the time children
are 10–12 years old they are not used to exercising. Walking
to school and playing on housing estates are said to be
a thing of the past, a change that has taken place in the last
few years owing to parents’ real or imagined fears of letting
children out alone. Few of the rather narrow country roads
are safe for walking and cycling. There are very few public
indoor facilities for physical activity, despite the inclement
weather in Ireland. Private and voluntary facilities tend to be
used by middle-class children whose parents take them to
participate.
To promote intersectoral action, the Government launched
a national obesity campaign covering the period 2003–
2006. In addition to the health sector, stakeholders included
physical activity coordinators, NGOs, supermarket chains,
caterers, cafes, restaurants and hotels, schools, workplaces
and the media.
As part of the campaign, in March 2004 a National Taskforce
on Obesity was set up with representation of civil
society, the food and drinks industry, sports associations
and the Irish Heart Foundation. Following considerable consultation,
the Taskforce reported early in 2005 in Obesity:
the policy challenges (34). The Taskforce felt that to date
nutrition policy had concentrated mostly on actions within
the remit of the DoHC, such as implementing dietary
guidelines. Although important, it was felt that in the face of
changes in the availability of food and patterns of eating and
more sedentary life and work styles, the time had come to
look at the totality of policies that influence what people eat
and their opportunities for engaging in physical activity.
The proposed actions take a population approach for adults
and children, together with weight reduction management
for the severely overweight. While recognizing that people
Case studies: policy development in countries for tackling noncommunicable diseases