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

Chapter 4
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information was not successful, however, owing to a lack of
consensus on the link between television food advertising
and obesity.
Each region was asked to establish a committee on nutrition
to coordinate the implementation of the national nutrition
policy, and to ensure the presence of healthy nutrition
in the PRSP (see section 2.5). Resources for the work of
the committee are ensured by the Regional Authority on
Health and Social Affairs (DRASS). Moreover, the Government
strongly supports cooperation among cities, to
reinforce local initiatives and actions on healthy nutrition.
In February 2007, the Minister of Health, together with the
association of mayors in France, announced a charter of
cities active in the nutrition programme. The charter aims
to foster the mutual responsibility of communes and the
state for giving high priority to nutrition in the programmes
of the communes. Typically, communes are involved in improving
the quality of food in school canteens and hospitals
and creating greater opportunities for physical activity. In
return, they are allowed to use the logo of the national
programme.
PNNS is often considered the most effective and successful
public health programme In France, and among international
experts to be an exceptionally well-designed and
well-implemented strategy. The reasons for success are
various: there is strong political will for PNNS and committed
leadership in the Ministry, in INSERM and in other
research institutes; it works at interministerial level and has
clear, coherent objectives that agree with those of current
and former programmes (such as the Cancer Plan); it is
based on scientific evidence and supervision; and it involves
various partners and stakeholders by creating a broad
forum, a strong voice and a focus on the issue. Cooperation
with the private sector is a key element of the programme,
as the regulation of market supply is one of its main aims.
In general, businesses are interested in participating in the
nutrition programme and thereby creating a positive public
image. In addition, the Ministry sets out a clear framework
and ethical guidelines for cooperation and for allowing use
of the well-known PNNS logo.
A challenge for PNNS is to create and maintain good cooperation
with other programmes. PNNS cannot and should
not deal with all the nutritional problems of the French
population. Experts express concerns about the sustainability
of the programme because of limited financial resources
and recent cut-backs that it has had to face.
2.8.3. Alcohol
France is world famous for its wine production and is one
of the world’s leading wine exporters, as well as the third
largest exporter of spirits in Europe. In terms of alcohol
consumption, France is characterized as having a “wet”
culture, whereby daily light drinking is the norm, alcohol is
linked to meals and wine has always been a part of everyday
life.
After the Second World War, alcohol consumption rose
significantly and reached its peak in the 1950s. In the last 50
years, per capita alcohol consumption has fallen by about
40% (from 19 litres of pure alcohol per capita per year in
1950 to 10.5 litres in 2000) (22) because of the decline in
wine consumption, the change in consumption patterns and
the rural-to-urban shift in the population. Nevertheless, per
capita alcohol consumption in France is higher than the EU
average and alcohol-related harm gives cause for serious
concern. A government alcohol strategy from 2001 (23)
stressed that alcohol consumption is responsible for 14% of
total mortality among males and 3% among females, with
strong regional and socioeconomic differences.
Recognizing the relevance of alcohol-related problems in
France for the first time, in 1954 the Government established
the High Committee for the Study of and Information
on Alcoholism, charged with making recommendations
for policy-makers; it was incorporated into the HCSP in
1991. A major result of the work of Committee was the
Case studies: policy development in countries for tackling noncommunicable diseases