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How policies can protect the health and life of millions

The covid-19-pandemic may give a different impression, but non-communicable diseases are by far the leading cause of disability and death in Europe. New research shows: These diseases are much better prevented by policies that tackle the environmental drivers of unhealthy behaviours, rather than by advocating for individual behaviour change. The EU-funded Policy Evaluation Network (PEN) aims to identify public policies most likely to sustain healthy lifestyles, for example by making the healthy choice the default choice. It now summarizes its key research findings in a special issue of the European Journal of Public Health.

Wolfgang Ahrens

Professor Wolfgang Ahrens: "The outcomes of PEN show what successful policy action looks like, and how policy action, if implemented in full, has the potential to fundamentally improve the health and well-being of an entire population."

The burden of these diseases is serious: Chronic diseases caused by physical inactivity and poor nutrition such as cardiovascular diseases, diabetes, cancer and respiratory diseases account for 77 per cent of the burden of disease and almost 86 per cent of premature mortality, and these diseases are still on the rise. The main reasons for this trend are well-known: In their daily life many Europeans combine physical inactivity and extended sedentary time with the excessive consumption of energy-dense food and drinks rich in saturated fat, trans-fatty acids, sugar and salt, while eating only low amounts of vegetables, fruits and whole grains.


“The causes of major non-communicable diseases are well-understood since decades, but we see little to no improvement in tackling their root-causes. As we are facing increasing health inequities political action is needed to curb this negative trend”, says Professor Wolfgang Ahrens, who is Deputy Director of the Leibniz Institute for Prevention Research and Epidemiology - BIPS in Bremen, Germany, and Project Coordinator of PEN. “To change the current situation, it is necessary to move beyond individual behaviour change to broader policy and system-oriented approaches. Policy is about changing systems, not people. Public policies include processes activated across multiple sectors to achieve specific outcomes, for example, a reduction in population levels of physical inactivity.  This requires a delicate balance between what is achievable, what is evidence informed and what has political will or ‘buy in’. The outcomes of PEN show what successful policy action looks like, and how policy action, if implemented in full, has the potential to fundamentally improve the health and well-being of an entire population.”


PEN’s vision


As part of the Joint Programming Initiative on a Healthy Diet for a Healthy Life (JPI HDHL), 28 research institutes from seven European countries and New Zealand combined their expertise to form PEN. The network’s vision is to provide Europe with tools to identify, evaluate and benchmark policies designed to directly or indirectly address physical inactivity, unhealthy diets and sedentary behaviour while accounting for existing health inequities. Until now, systematic research of this field across Europe was sparse.


The existing body of evidence on the topic has substantially changed with PEN’s special issue of the European Journal of Public Health. The journal supplement comprises thirteen manuscripts that are output from the PEN project. Topics examined include new theoretical models to advance our understanding of the policy process and its evaluation. It provides an overview of priority public policies and policy areas most likely to sustainably reduce physical inactivity, unhealthy diets and sedentary behaviour. It explores the first steps in a bespoke policy monitoring and health surveillance system for Europe, and a refinement of our knowledge of appropriate research designs and methods for the quantification of policy impact. PEN scientists illustrate how best to evaluate the implementation and impact of policy in order to yield the best results for a healthy life of European citizens. Importantly, PEN has provided recommendations on equity and diversity to ensure that policy actions are inclusive as opposed to exclusive.


A call to action


“Through this supplement, we make a call to action. A call to governments and policymakers from national and local levels to use the newly acquired knowledge to develop, implement and evaluate strong, comprehensive policy solutions that are sustainable, equitable and address the current health challenges effectively”, says Professor Ahrens. He adds: “It is a call to funding agencies at European, national and local levels to continue to prioritize and fund policy research, to build on the work of PEN which has really only begun to understand the potential policy impact on human behaviours and environments. A call to policy researchers to move beyond peer-reviewed publications and to translate their findings into relevant and meaningful advice and advocacy documents for policymakers to use to advance policy action to promote health-for-all citizens across Europe.”


Download the press release.


PEN - Public policies addressing health-related behaviours in Europe


PEN is funded by the Joint Programming Initiative (JPI) “A Healthy Diet for a Healthy Life”, a research and innovation initiative of EU member states and associated countries. The funding agencies supporting this work are: Germany: Federal Ministry of Education and Research (BMBF); Ireland: Health Research Board (HRB); Italy: Ministry of Education, University and Research (MIUR); The Netherlands: The Netherlands Organisation for Health Research and Development (ZonMw); New Zealand: The University of Auckland, School of Population Health; Norway: The Research Council of Norway (RCN); and Poland: National Centre for Research and Development (NCBR).


BIPS - Health research in the service of the people


BIPS is one of the oldest epidemiology institutes in Germany and is one of the leading international institutes in this field. The population is at the centre of our research. We develop effective strategies for the prevention of chronic, non-communicable diseases. The primary goal is to set the course for a healthy life at an early stage. Our research spectrum ranges from method development and the identification of disease causes to intervention and implementation research.


BIPS coordinates the Northwest Cluster of the NAKO Health Study, the largest health study in Germany. It led the IDEFICS/I.Family cohort study, the largest survey of dietary behaviour in European children. Since 2004, BIPS has maintained and expanded the Pharmacoepidemiological Research Database (GePaRD), which contains data from approximately 20 percent of the German general population and is one of the largest of its kind in the world. In September 2016, BIPS was also named a WHO Collaborating Centre for Obesity Prevention, Nutrition and Physical Activity.