DETERMINE Working Document #1 'Policies and actions addressing the social determinants of health inequalities: examples of activity at EU member state level in Europe'

The Institute of Public Health in Ireland (IPH) is a partner in the European project DETERMINE, building on its previous involvement in the Closing the Gap project in 2004-2006. In the first year of the project (2007-2008) 15 DETERMINE partners identified policies and actions that have taken place within countries, and at the EU level, to address Social Determinants of Health Inequalities. These policies and actions were identified via a questionnaire, which also identified structures and tools/mechanisms being used in the country to support a 'health in all policy' approach.

The Social Inclusion of Older People at Local Level: The Role and Contribution of CDBs

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Social Inclusion of Older People at Local Level:The Role and Contribution of the CDBs - Conference Proceedings

This is a publication of The National Council on Ageing and Older People The Conference took place on October 3, 2005 . It attracted almost 250 delegates from across the statutory, voluntary and private sectors, and from every county. The Conference provided the opportunity for delegates to focus on the issue of social inclusion of older people at local level and the challenges it presents. It also gave us the opportunity to examine the issue in the context of work done at the international and national levels as well as work done at local level. Read the Report (PDF, 317kb)

Food and Nutritional Care in Hospitals. Guidelines for Preventing Under-Nutrition in Acute Hospitals

Food and Nutritional Care in Hospitals. Guidelines for Preventing Under-Nutrition in Acute Hospitals Click here to download PDF 1.3mb

A Fitter Future for All - Framework launched

Obesity is a modern lifestyle epidemic that is threatening our health and well-being.This was the key message delivered by Health Minister Edwin Poots at the launch of The Framework for Preventing and Addressing Overweight and Obesity in Northern Ireland 2012-2022: 'A Fitter Future for All'.This ten year strategy will seek to improve the health and wellbeing of people throughout their entire life, from newborns to seniors.Minister Poots said: "We need to face the issue of obesity head on. It's an issue that will require commitment and action from across all sectors, including other government departments and agencies. It is therefore my intention to invest more than £7 million towards tackling the problem of obesity over the next three years."The negative impact on health caused by obesity cannot be over stated. Being obese increases the risk of developing serious illnesses such as heart disease, stroke, some cancers and type 2 diabetes."It is a significant challenge facing modern society and if we don't tackle it now we are storing up a multitude of problems for ourselves in the future."The Minister continued: "More and more of our children and young people are becoming overweight or obese and are putting themselves at risk of developing a range of health problems in their later years."Evidence shows that it is more likely that an obese child will become an obese adult. This in turn will lead to a greater strain on our health and social care services, with more people requiring treatment for obesity related illnesses and specialist care."The proposed framework looks to address a number of key issues, including:-increasing levels of breastfeeding;increasing knowledge and skills about food and its preparationencouraging participation in physical activity;promoting walking and cycling; making sure how we live and where we live encourages and supports healthy eating and physical activity;encouraging and supporting more community involvement with these issues; and;continuation of reformulation of processed foods.The Minister added: "In Northern Ireland 59% of adults are either overweight (36%) or obese (23%). Another worrying statistic is that 8% of children aged 2-15 years were assessed as being obese. These figures demonstrate the scale of the problem and the enormous challenge we are facing."The new framework sets challenging targets. To date we have focussed on simply trying to stop the rise in the levels of obesity, however under A Fitter Future For All we are seeking to actually reduce the level of obesity by 4% and overweight and obesity by 3% among adults. In addition, we are seeking a 3% reduction of obesity and 2% reduction of overweight and obesity among our children and young people." "Meeting these targets will require changes in our lifestyles and behaviours. Most importantly, individuals need to be given the opportunity to make decisions that will benefit their own health and wellbeing".Referring to the 'Give It A Go!' initiative, to increase awareness of the range of nutritional and physical activity initiatives in the southern area, the Minister said: "The Give It A Go! Initiative is a great example of how collaborative work can make such a positive contribution to peoples' lives by providing opportunities for learning, participation in physical activity and for social interaction."Tackling obesity and seeing positive results throughout the life course of the entire population will take time but I strongly believe that the actions set out in this framework will inspire and enable people to improve their diets and be more active."Encouraging people to consider the framework and adopt a healthier lifestyle, the Minister concluded: "Government cannot tackle obesity on its own. We can encourage and promote healthy eating and physical activity but as a society, we must take more individual responsibility for our own health outcomes."Dr Tracy Owen, Consultant in Public Health Medicine with the PHA, said: "The PHA is already working with partner organisations across many of the areas included in the framework 'A Fitter Future for All' and is addressing issues such as developing people's skills and knowledge about healthier eating along with encouraging participation in physical activity. The framework gives us the opportunity to raise awareness of this important area and strengthen action."As the Minister has mentioned, a good example of this coordinated action is the PHA supported initiative Give it a Go! which is providing people in the Southern area with the opportunity to learn about food through supermarket tours and Cook it! classes and to get active through walks, spinning classes and many other activities, all of which are free. These taster sessions are aimed at raising awareness of healthier lifestyles which will ultimately make changes in behaviour more likely."These changes, no matter how small, can help people to lose weight, maintain a healthy weight and bring big benefits to their general health. Importantly, we have developed this joint programme by working closely with our partners, particularly local councils."

Fruit and Vegetables

This review showed that, based on the balance of current scientific evidence, organic fruit and vegetables are no safer or more nutritious than conventionally produced varieties.

Healthy lunchboxes

Good food habits set early in childhood can last a lifetime. Lunches provide around one third of our daily nutritional needs, so it’s important to put some thought and planning into them. Here are some tips on how to prepare a healthy lunchbox. Sevensteps to creatinghealthy, varied and interestinglunchboxes Include a wide variety of foods - starchy foods, protein, dairy, and fruit and vegetables Try to offer different foods every day - no one wants to be eating a ham sandwich five days a week! Vary the types of bread e.g. pitta bread, bagels, wholemeal rolls - - keep a stock in the freezer Cook extra rice/pasta in the evening - these can make interesting salads Theme your lunchbox on a different country, e.g. Italian - try a pasta salad, Mexican fill flour tortillas Home-made soup (in a Thermos flask) is great for cold days, while salads are light and refreshing for warmer weather. Both are packed with essential vitamins and minerals Fluids are important for children - up to 6 cups of fluid should be encouraged daily. Milk and water are the best options. Straws and brightly coloured drinks bottles can make rehydrating more interesting!

Fruit and vegetables

You’ve probably noticed that people are getting more and more into their health these days: going to the gym, buying fancy ‘functional foods’ packed with extra vitamins, calcium, and so on. That’s all great, but what people may not realise is that some of the most ordinary foods are actually quite extraordinary. Genuine ‘superfoods’, in fact. Fruit and vegetables are superfoods. Why? Because they contain awhole lot of different vitamins and minerals, they’re low in fat and calories and also have some fibre. All that, and flavour and colour for your meals as well.

Food Behaviours: Healthy Eating on the island of Ireland

In the past, safefood’s consumer focused reviews (CFRs) have focused on key food chains including chicken, finfish, fruit and vegetables, milk, beef and pork. The reviews aimed to address consumer concerns surrounding food safety, production methods and nutritional issues related to key foods, with a view to communicating directly to consumers on those issues. More recently, there has been a shift in emphasis by safefood to address broader issues of consumer concern, such as food origin. The aim of the current CFR is different from previous reports. Instead of addressing key consumer food concerns, it focuses on understanding consumer food behaviour. Its primary aim is to inform the research, policies and practices of all those working towards changing consumer food safety and dietary behaviour on the island of Ireland and to ensure that communication with consumers is both evidence-based and effective.

What's in your Chinese Takeaway?

The impact that food prepared outside of the home has on the nutrient intakes of adults, has beenstudied previously on the IOI. It was found that food prepared outside the home contains considerably more dietary fat than food prepared within the home and it is also lower in fibre and micronutrients. safefood has commissioned previous nutritional surveys in the takeaway sector.These surveys revealed that certain foods i.e. potato, chicken, pizzas and burgers prepared outside thehome are high in calories, fat and salt. These surveys also reported that there are majordifferences in portion sizes across takeaway outlets on the IOI. Traditional Asian diets are low in fat and high in fruit, vegetables and fibre. However, thesetraditional meals have been adapted to suit Western palates and, in doing so, different ingredients indifferent quantities are added, possibly increasing their fat and salt content. Recent research hasfound that Chinese is the single most popular style of meal across both takeaways and restaurants(excluding pub restaurants) on the IOI. Given the diversity of Chinese dishes available, this surveywas designed to provide an insight into the energy (calorie), total fat, saturated fat, protein and saltcontent of a range of Chinese meals from various Chinese takeaways, and Chinese restaurants with atakeaway service.

Consumer Focused Review of Fruit and Vegetables

This review provides an update on the fruit and vegetable review conducted in 2007. It collates and considers the information available – academic, regulatory, public health – on the health and food safety implications of fruit and vegetables. It focuses on ready-to-eat (RTE) fresh fruit and vegetables which are consumed raw, whether whole or prepared, and includes products packaged under vacuum or in a modified atmosphere that have not undergone any treatment (chemical, physical or biological) to ensure preservation, other than chilling. The key finding was that 75% of Irish consumers are now able to identify that they should eat five portions of fruit and vegetables a day, but only a third (36%) of consumers say they are doing so. The average intake of fruit and vegetables is currently less than half that recommended, at 2.4 portions per day. Issues to do with cost, shelf life, preparation time and habit were seen by consumers as barriers to buying and consuming more fruit and vegetables. his review provides an update on the fruit and vegetable review conducted in 2007. It collates and considers the information available – academic, regulatory, public health – on the health and food safety implications of fruit and vegetables. - See more at: http://www.safefood.eu/Publications/Research-reports/Consumer-Focused-Review-of-Fruit-and-Vegetables.aspx#sthash.T98zN2UU.dpuf This review provides an update on the fruit and vegetable review conducted in 2007. It collates and considers the information available – academic, regulatory, public health – on the health and food safety implications of fruit and vegetables. It focuses on ready-to-eat (RTE) fresh fruit and vegetables which are consumed raw, whether whole or prepared, and includes products packaged under vacuum or in a modified atmosphere that have not undergone any treatment (chemical, physical or biological) to ensure preservation, other than chilling. The key finding was that 75% of Irish consumers are now able to identify that they should eat five portions of fruit and vegetables a day, but only a third (36%) of consumers say they are doing so. The average intake of fruit and vegetables is currently less than half that recommended, at 2.4 portions per day. Issues to do with cost, shelf life, preparation time and habit were seen by consumers as barriers to buying and consuming more fruit and vegetables. This review provides an update on the fruit and vegetable review conducted in 2007. It collates and considers the information available – academic, regulatory, public health – on the health and food safety implications of fruit and vegetables. It focuses on ready-to-eat (RTE) fresh fruit and vegetables which are consumed raw, whether whole or prepared, and includes products packaged under vacuum or in a modified atmosphere that have not undergone any treatment (chemical, physical or biological) to ensure preservation, other than chilling. The key finding was that 75% of Irish consumers are now able to identify that they should eat five portions of fruit and vegetables a day, but only a third (36%) of consumers say they are doing so. The average intake of fruit and vegetables is currently less than half that recommended, at 2.4 portions per day. Issues to do with cost, shelf life, preparation time and habit were seen by consumers as barriers to buying and consuming more fruit and vegetables. - See more at: http://www.safefood.eu/Publications/Research-reports/Consumer-Focused-Review-of-Fruit-and-Vegetables.aspx#sthash.T98zN2UU.dpuf This review provides an update on the fruit and vegetable review conducted in 2007. It collates and considers the information available – academic, regulatory, public health – on the health and food safety implications of fruit and vegetables. It focuses on ready-to-eat (RTE) fresh fruit and vegetables which are consumed raw, whether whole or prepared, and includes products packaged under vacuum or in a modified atmosphere that have not undergone any treatment (chemical, physical or biological) to ensure preservation, other than chilling. The key finding was that 75% of Irish consumers are now able to identify that they should eat five portions of fruit and vegetables a day, but only a third (36%) of consumers say they are doing so. The average intake of fruit and vegetables is currently less than half that recommended, at 2.4 portions per day. Issues to do with cost, shelf life, preparation time and habit were seen by consumers as barriers to buying and consuming more fruit and vegetables. - See more at: http://www.safefood.eu/Publications/Research-reports/Consumer-Focused-Review-of-Fruit-and-Vegetables.aspx#sthash.T98zN2UU.dpuf This review provides an update on the fruit and vegetable review conducted in 2007. It collates and considers the information available – academic, regulatory, public health – on the health and food safety implications of fruit and vegetables. It focuses on ready-to-eat (RTE) fresh fruit and vegetables which are consumed raw, whether whole or prepared, and includes products packaged under vacuum or in a modified atmosphere that have not undergone any treatment (chemical, physical or biological) to ensure preservation, other than chilling. The key finding was that 75% of Irish consumers are now able to identify that they should eat five portions of fruit and vegetables a day, but only a third (36%) of consumers say they are doing so. The average intake of fruit and vegetables is currently less than half that recommended, at 2.4 portions per day. Issues to do with cost, shelf life, preparation time and habit were seen by consumers as barriers to buying and consuming more fruit and vegetables. - See more at: http://www.safefood.eu/Publications/Research-reports/Consumer-Focused-Review-of-Fruit-and-Vegetables.aspx#sthash.T98zN2UU.dpuf This review provides an update on the fruit and vegetable review conducted in 2007. It collates and considers the information available – academic, regulatory, public health – on the health and food safety implications of fruit and vegetables. - See more at: http://www.safefood.eu/Publications/Research-reports/Consumer-Focused-Review-of-Fruit-and-Vegetables.aspx#sthash.T98zN2UU.dpuf

Weigh2go: A Peripatetic Level 1 Weight Management Service

The aim of this intervention is to increase the accessibility of appropriate evidence based support to people who are clinically obese to enable them to make lifestyle changes that will lead to weight loss. Objectives1. Identify patients whose lifestyle put them at risk of obesity and poor health outcomes and provide them with advice and support along with signposting to specific services and activities. 2. Identify patients who are overweight or obese and offer them a structured multi-component programme of support for them to loose weight. 3. Through the use of software collect data to monitor outcomes at individual and practice levels.

A Study of the Epidemiology of AIDS in Ireland and an Evaluation of an AIDS Education Programme in Second-level Schools

Second-level school students have been identified by the Minister for health as a priority group for education on AIDS. An education programme was accordingly initiated in 1988 in Community Care Area 1 in South county Dublin. This report evaluates this education intervention by means of pre- and post- intervention questionnaires. The questionnaire examined knowledge and attitudes of students relevant to AIDS. The results showed that the level of knowledge of students living in this area was high prior to intervention. The education programme succeeded in improving some aspects of knowledge and also influenced some attitudes of the students. A study of the epidemiology of Aids in Ireland reveals that the epidemic is at a relatively early stage with a consequent rapid doubling time of 9-10 months. In comparison with most developed countries Ireland has a high proportion of AIDS cases occurring among intravenous drug abusers and directly related to this a high number of HIV infected children. Examination of the literature reveals that behaviour change has occurred most noticeably among the homosexual/bisexual risk group. There is some evidence that the comprehensive programmes can achieve change in the behaviour of intravenous drug abusers. There are very few reports linking behaviour change among adolescents and young adults to education programmes. Much of the available literature relates to changes in knowledge and attitudes. International recommendations on the nature of the ideal health education intervention on AIDS are reviewed. The importance of a comprehensive health education programme which incorporates AIDS education and which commences early in youth is noted. The role of the community physician in relation to education programmes and other aspects of monitoring and management of the AIDS epidemic is discussed.This resource was contributed by The National Documentation Centre on Drug Use.

Building Evidence for Dementia Prevention

As was the case in 2010 when the National Institutes of Health issued a consensus statement on the prevention of Alzheimer’s and other dementias, there remains a lack of firm evidence for dementia prevention. Because of the difficulties in studying this phenomenon, no modifiable risk factors for dementia have been definitively established, and no pharmaceutical or nutritional supplements been proven to prevent Alzheimer’s disease or cognitive decline. However, longitudinal observational studies have identified several factors associated with dementia. A recent review article summarizes the current epidemiological evidence about Alzheimer’s and other dementias, and presents three ongoing large scale randomized control trials (RCTs) that focus on preventing dementia. The review argues that there is substantial evidence for many factors that, in combination, might reduce the risk of, or delay the onset of, dementia. Although no specific cure for dementia exists, and no specific pathway between risk factor and disease onset has been identified, several cardiovascular, stress, toxicity, and psychosocial variables have been repeatedly associated with dementia. Protective factors, such as high education, physical exercise, and not smoking cigarettes, have been identified as well. Intervention studies that account for these multiple factors may well identify strategies for preventing or delaying dementia. However, the protective effects and risk factors suggested by observational data have yet to be assessed in RCT research. The role of such factors in reducing or increasing the risk for dementia needs to be more specifically defined. Three ongoing RCT studies in Europe show promise in this area, as they target multiple risk and protective factors by promoting healthy lifestyle changes and medical treatment of vascular diseases. These are: FINGER, a Finnish trial involving 1,200 older adults at risk for dementia. This intervention features nutritional guidance, physical activity, cognitive and social engagement, and medical management of risk factors. Participants were involved in previous, intensive observational studies of vascular health and health behavior, so FINGER will provide a level of relevant information about its research subjects that is normally impossible for clinical RCTs to attain;MAPT, a multicenter study of 1,680 frail older adults in France. This study will compare the efficacy of omega-3 dietary supplementation with a multidomain training intervention that involves physical and cognitive training. The study will include follow-up assessments after five years;PreDIVA, a Dutch study of 3,534 community dwelling participants between 70 and 78 years old, recruited from primary care clinics. This study will compare standard medical care with a multicomponent vascular health intervention. The study will last for six years and measure both dementia and disability outcomes. These studies are an important step in dementia research, using earlier observational studies as the basis for rigorously assessed interventions. Although a cure for dementia has not been identified, this new research may identify preventive strategies against dementia. �� Source: Mangialasche F, Kivipelto M, et al. (2012). Dementia prevention: current epidemiological evidence and future perspective. Alzheimer’s Research and Therapy 4:6.

Nutritional Standards for School Lunches and Other School Food

In September 2005 the Government received recommendations fromthe School Meals Review Panel (SMRP) on school lunches and on a number of wider issues concerning food in schools. In response to that report Turning the Tables the newly-established School Food Trust (SFT) was commissioned to advise Ministers on standards for food in school other than lunch.The DfES consulted widely on the recommendations of the SMRP andon a more limited basis on the advice of the SFT. Reports on the responses to each of those consultations are available at: www.dfes.gov.uk/consultations/conresults.cfm?consultationId=1319Having considered responses to those consultations and taken intoaccount the many representations the Department has received on theseissues from a range of stakeholders, the Secretary of State for Education and Skills has arrived at final decisions on the standards. These standards will apply to school lunches and other food provided in all local authority maintained schools in England.