Eat more dietary fiber! From a simple message to a complex policy Peter Gry, Gabriel Gulis, Marco Martuzzi, Matt Soeberg, Peter Otorepec, Jarmila Korcova, Elzbieta Grochowska-Niedworok

Health Impact Assessment in New Members states and Accession Countries – HIA-NMAC nEC funded research project, 2 years ( ) n11 partners n WP 1 – Coordination of the project n WP 2 – Capacity building n WP 3 – HIA of CAP - wine production; a case study n WP 4 – HIA of CAP – dietary fiber; a case study n WP 5 – HIA of tourism and recreational water; a case study n WP 6 – Addressing socio-economic determinants of health within HIA n WP 7 – HIA on policies related to vulnerable populations; a case study n WP 8 – Introducing HIA on local level n WP 9 – Dissemination of results

Why focus on dietary fiber? nEpidemiologic studies have shown that dietary fiber is an important part of prevention of: n diabetes n colorectal cancer n gastrointestinal disorders n high cholesterol n heart disease n obesity

Danish context n A daily intake of g dietary fibers for adults is recommended which corresponds to 3g/1000 kJ. n The intake should be covered by a number of different foods: whole grain products, fruits and vegetables, etc. nStudies in DK show that the intake of dietary fiber has declined during the last 20 years: n In the period the average intake of dietary fiber for adults fall from 26,5g/day to 20 g/day. This is due to a decline in the intake of coarse bread and vegetables.

Where do we get fiber from? Example of foods containing dietary fibers: Bread, grain and flourg/ 100 gVegetables, fruits and nutsg/ 100 g Wheat bran40,2Sesame seeds, dried18,0 Rye flower14,8Kidney beans, dried17,8 Rye crisp bread14,5Coconut14,0 Graham flour, whole grain flour11,6Almond9,2 Oatmeal10,1Horse radish7,5 Rye bread, whole grain8,6Curly kale/borecole6,2 Muesli8,6Cauliflower2,2 White bread4,0Tomato1,4

To assess health impacts we need to identify: nA production related policy nDeterminants of health nRisk Factors nHealth outcome

Production chain Farmers Processing Labeling Shop, business External influences?

External influence nA report published in 2004 by the Danish Agricultural Academy described four ways of political intervention in relation to food, obesity and health: n increase knowledge n technological solutions n regulation n economical mechanism

Other (external) influences nDomestic products vs. Imported products nEU/governmental subsidies to farmers nMain legislations/policies in Denmark n Action plan for the Aquatic Environment III n Intervention buying of crop n Voluntary deal regarding straw shortener n Deal regarding payment of grain, peas and rape.

Stakeholder meeting nWe invited three people from the agricultural field. nDiscussed external and internal influences with them nFrom the discussion we got new input: n Taste matter n Difficult to assess the policies found in the pre-screening n Taxation could be a step to increase consumption of products with dietary fiber

Ill health/disease, related to dietary fiber consumption Dietary fiber consumption Information, Culture, Media SES, Education Marked access Health limitation, Food allergies Labelling, Packaging Marked supply International policies National policies Agriculture, CAP Trade, WTO Environment Taxation Determinants Policy Risk factor Health outcome General population General population Consumers Public health Business, marked Media “experts” Producers, Processing Producers Agriculture suppliers Politicians Labelling Physical activity Ethnicity Gender Diet and Lifestyle

Preliminary results nA simple health promotion message (eat more dietary fiber) is much more complex as it sounds nIntervention on policy level needs to identify first the policy to change nHIA, even retrospective and not directly linked to a pending decision is a good method of intervention

Next step Investigate taxation policy in Denmark and consumption of different food products containing dietary fiber during the last 40 years Our assumption is that there is a relationship between increased taxation and trends of decreasing consumption pattern of food products containing high amount of dietary fiber