The acceptability to stakeholders of mandatory nutritional labelling in France and the UK--findings from the PorGrow project.

BACKGROUND: Implementing a European Union (EU)-wide mandatory nutrition labelling scheme has been advocated as part a multi-pronged strategy to tackle obesity. The type of scheme needs to be acceptable to all key stakeholders. This study explored stakeholders' viewpoints of labelling in two contrasting food cultures (France and the UK) to see whether attitudes were influenced by sectoral interests and/or national context. METHODS: Using Multi Criteria Mapping, a decision analysis tool that assesses stakeholder viewpoints, quantitative and qualitative data were gathered during tape-recorded interviews. In France and the UK, 21 comparable stakeholders appraised nutritional labelling with criteria of their own choosing (i.e. feasibility, societal benefits, social acceptability, efficacy in addressing obesity, additional health benefits) and three criteria relating to cost (to industry; public sector; individuals). When scoring, interviewees provided both optimistic (best case) and pessimistic (worst case) judgements. RESULTS: Overall, mandatory nutritional labelling was appraised least favourably in France. Labelling performed worse under optimistic (best case) scenarios in France, for five out of eight sets of criteria. French stakeholders viewed labelling as expensive, having fewer benefits to society and as being marginally less effective than UK stakeholders did. However, French interviewees thought implementing labelling was feasible and would provide additional health benefits. British and French stakeholders made similar quantitative judgements on how socially acceptable mandatory labelling would be. CONCLUSIONS: There is agreement between some stakeholder groups in the two different countries, especially food chain operators. However, cultural differences emerged that could influence the impact of an EU-wide mandatory labelling scheme in both countries.

Methodology for obtaining stakeholder assessments of obesity policy options in the PorGrow project.

The Policy Options for Responding to the Growing Challenge of Obesity Research Project (PorGrow) study provided a unique opportunity to develop a large-scale application of a semi-quantitative technique for exploring interviewees' views on options to tackle obesity, using multi-criteria mapping. This 'heuristic' approach utilizes the advantages of a structured interviews framework by predefining a set of options for appraisal, while leaving interviewees free to select their own criteria for making their judgements. Additional information can be gleaned from the interview transcripts and related materials to set the appraisals in their policy context, and allowing interviewees to express their views on the options presented and their own appraisals. The PorGrow study team agreed a predefined set of 20 options for appraisal, and interviewed sets of stakeholders representing more than 20 aspects of policy development in each of the nine participating countries. The details of the methodology adopted are set out in this paper.

The PorGrow project: overall cross-national results, comparisons and implications.

European policymakers need more information on policy responses to obesity that stakeholders judge effective and acceptable. The Policy Options for Responding to the Growing Challenge of Obesity Research Project gathered such intelligence by interviewing key stakeholder groups in nine countries. Interviews used an innovative multi-criteria mapping (MCM) methodology that gathers quantitative and qualitative information on the stakeholders' perceptions and judgements. Aggregating across all participants, a comprehensive portfolio of policy measures, integrated into a coherent programme, would be well-supported by broad coalitions of stakeholders. Those portfolios should include measures (i) to provide improved educations in schools and to the general adult population; (ii) measures to improve access to and incentives for physical activity; (iii) measures to improve information about both foods and physical activity and (iv) changes to the supply of and demand for foodstuffs. There was little support for fiscal measures and technological 'fixes'; they were judged ineffective and unacceptable. Significant differences were found across European regions, and across different stakeholder perspectives, but not across genders. There is a strong case for improved monitoring of body mass index levels, dietary habits and physical activity. An MCM study can effectively cover several countries, rather than being confined to just one, and generate both national and cross-national policy analyses and proposals.

Policy options for responding to the growing challenge from obesity in the United Kingdom.

The aim of this study was to map and analyse how key stakeholders evaluated options for dealing with the rising incidence of obesity in the UK, as part of a wider cross-national study in nine European countries. Multi-criteria mapping was used to capture the ways in which different policy options were evaluated by a variety of key stakeholders. 'Positive societal benefits' was among the criteria most often selected by participants to assess the options and was generally considered more important than costs. Of the seven pre-defined options that all participants appraised, those related to increasing opportunities for physical activity received the highest rankings, and fiscal measures the lowest. Educational measures fared best among the remaining 13 discretionary options while technological measures performed poorly. No one option, or group of options, was considered sufficient to address the obesity problem. Rather, a general consensus was evident in support of mutually reinforcing measures related to education, information, healthier food and physical activity. Although obesity policies are currently emerging in these different areas in the UK, there is a need for them to be better coordinated, and for improved surveillance to estimate their effectiveness in reversing the trend in obesity.

Context for the PorGrow study: Europe's obesity crisis.

The Policy Options for Responding to the Growing Challenge of Obesity Research Project (PorGrow) study was conducted at a time when the prevalence levels of overweight and obesity among both adults and children had been rising for over a decade in most countries in Europe. The reasons are assumed to be related to changes in dietary patterns and in patterns of physical activity, and may be linked to economic as well as socio-environmental influences on behaviour. Inequalities in the distribution of obesity across different socio-economic groups are also apparent. The demographic and secular trends have led to increasing concern among policymakers over the costs of obesity-related disease to the health services and to the economy generally. In response, a series of policy initiatives have been considered among the countries participating in the PorGrow study.

Lead toxicity and public health policy.

Senior UK scientists have recently acknowledged that lead exerts neurotoxic effects at blood lead levels even as low as 10 micrograms/dL. The implications of these findings for public policy are outlined, especially in relation to contamination of drinking water, soil and household dust. Estimates of the proportion of 6 year old children with elevated blood lead levels for several locations are also provided.

Plagiarism or protecting public health?

Is milk produced using recombinant bovine growth hormone hazardous to animal health? Despite wide publicity, the controversy remains unresolved. Rapid publication of all available data is essential if progress is to be made.