There has been a dramatic improvement in the health of European children and adults since 1900. These improvements were remarkable in the first half of the century, with a progressive fall in the death of children and pregnant women and substantial increases in life expectancy. This century's early health changes were not the result of the provision of medical services, the discovery of drugs and antibiotics, or even the increasing capacity to immunise children against an ever greater range of infectious diseases. They resulted from improvements in the diet, in the housing, occupational and social conditions of workers and their families. Since World War II, with modern living conditions, the general year-around availability of a huge variety of foods, expanding immunisation and improving health care through the health services, with modern therapeutic techniques and new drugs, life expectancy continues to increase in many European countries. These are great public health achievements which should not be overlooked by policy makers and indeed the public.

The nutrient targets derived from analysis of the relation between nutrient intake and disease prevalence or other scientific evidence, have to be translated into food-based guidelines in order to be understood by die general population. Furthermore, Food-Based Dietary Guidelines (FBGD) have to be realistic, attainable and culturally acceptable and should also give consideration to relevant social, economic, agricultural and environmental factors affecting food availability and eating patterns. This requires a diorough understanding of the relation between foods, food patterns and nutrient intakes in the population. The aims of Working Party 2 were to propose a framework for strategies in the development of FBDG and to examine existing data for nutrient and food intakes in the EU.

This paper suggests strategies for implementing the EU food based dietary guidelines. Dietary guidelines have been developed and disseminated in many countries across the world. However, the EU guidelines are the first to include a specific section on implementation. The aims of the guidelines are twofold, 1) to provide food based dietary guidelines which can be used as a consistent communication tool and 2) as a springboard to planning, implementing, and evaluating public health nutrition strategies.

The report is not intended to be prescriptive. It aims to build upon a solid evidence base to provide practical and cost effective suggestions for developing public health strategies, which member countries can use and tailor to the social, cultural and health needs of their populations.

Diet and physical activity related diseases impose vast costs on the European economy. However, despite the enormous costs to healthcare systems and in terms of lost productivity, there have been a very few resources allocated in Europe to attempting to prevent these, rather than treating them.

The burden of disease exists in the majority of the population, and not in high-risk groups. The optimal public health strategy is thus to focus on the population as a whole, rather than targeting those with increased risk factors or pre-existing disease. Reviews have been carried out on the health impact effectiveness of various types of intervention to promote healthy eating and physical activity in the population. These conclude that the most effective interventions a) adopt an integrated, multidisciplinary, and comprehensive approach b) involve a complementary range of actions, and c) work at an individual, community, environmental and policy level. Information provision in isolation is not effective, and may exacerbate inequalities in health.

In some countries inequities in diet and physical activity are not only significant contributors to inequalities in health, but are increasing. Effective interventions to address inequities need to tackle the broader determinants of health, including social exclusion, social cohesion, environmental, and structural factors.

One of the most easily transferable frameworks for the development of public health strategies attempts to capture the individual, community, environmental and policy levels, by working through ‘target groups’, ‘settings’, and ‘approaches’. The Working Party has suggested outline strategies for each of the key target groups, setting and approaches which it has identified as having the potential for maximum reach and influence. The key characteristics of effective interventions for each of these is given.

Finally, the evidence base points to the importance of a co-ordinated, multisectoral and population wide strategy. In order to develop and implement such strategies, identifiable structures and mechanisms will be needed at a national level within member states.