Background

1. Capacity Development in Nutrition in Central and Eastern EuropeMirjana Pavlovic, Fre Pepping, Arne Oshaug andthe participants from CEE countries Joint meeting of SCN Working Groups on“Capacity Development” and “Nutrition, Ethics and Human Rights” 15th March 2006Geneva , Switzerland Report from the inaugural meeting of the Network on Capacity Development nutrition in CEE countries

2. Background • Regional networks already exist in Asia, Latin America, the Middle East and Southern Africa. • Thus the network in Central and Eastern Europe is the newest network facilitated by the UNU Food and Nutrition Programme and by SCN. • The inaugural meeting took place in Budapest on the13-14 February 2006, at the FAO SEUR Office.

3. Participating countries The meeting was attended by participants from 10 countries: • Bosnia and Herzegovina, Bulgaria, CzechRepublic, FYR Macedonia, Hungary, The Netherlands, Norway, Romania, Serbia and Montenegro and Slovakia.

4. Lajos Biro, HU Katarina Chudikova, SK Zlatka Dimitrovska, MK Veselka Duleva, BG Aida Filipovic, BIH Mirjana Pavlovic, SCG Jana Parizkova, CZ Camelia Parvan, RO Facilitators Fre Pepping, NL Arne Oshaug, NO Participants FAO provided support staff and engaged somewhat in the discussion

5. Objectives The objectives of the meeting were to: • Formally initiate the Network on Capacity Development for the CEE countries within the capacity development initiatives of SCN, UNU and other European research and training institution. • Present and discuss the profile of challenges identified by participants. • Identify follow-up activities in order to facilitate the initiatives of the Network in the field of capacity development in the CEE region. • Identify strategic elements to meet the capacity development plans of institutions and individuals in the region. • Prepare a presentation of needs and strategies to be presented at the 33rd session of SCN in Geneva, March 2006.

6. Some results

7. The main characteristics of nutrition and life style in CEE countries Foods and meal pattern • Irregular meal pattern • Low intake of certain food groups - particularly fruits and vegetable, milk products and fish • High intake of total fat (in particular saturated), sugar, and salt • Low intake of vitamins: folate/folic acid, and minerals e.g. calcium, iron, iodine (except in countries having programmes on salt iodisation) (Relevant for some countries) • High level of alcohol intake in some countries • Low breastfeeding rates.

8. The main characteristics of nutrition and life style in CEE countries (cont.) Nutritional and life style related public health problems • High prevalence of NCD – hypertension, atherosclerosis, CHD, CVI, certain cancers, diabetes mellitus, etc. • High level of overweight and obesity. • Dyslipidaemia. • Low level of Haemoglobin, although some data are lacking. • Generally low level physical activity, in particular in urban areas. • Increasing osteoporosis in both genders, in particular with increased age. • Eating disorders in certain groups may increase, in particular in younger girls. • Consumption mega doses of minerals and vitamins; lack of information about risk of mega doses. • High level of smoking.

9. National nutrition action plans Food based dietary guidelines RDA National food database Nutrition information center Training of professionals on academic level Education and promotion (for the public) Bulgaria 2005, Macedonia 2004, Bosnia (draft waiting approving), Hungary 2004, Slovak Republic 1999, Rumania (draft waiting approving), Czech Republic (approved), Serbia & Montenegro (none). Bulgaria, Macedonia, Bosnia, Hungary, Slovak Republic, Czech Republic. Bulgaria, Macedonia, Hungary, Slovak Republic, Rumania, Czech Republic. Bulgaria, Hungary , Slovak Republic, Rumania, Czech Republic, Serbia & Montenegro. Not formalized. Modest in many countries, few countries have special education of nutritionists. Mostly part of national action plans for food and nutrition. Overview of challenges in CEE countries

10. Is it adequate nutrition education and training of professionals in CEE countries? The gap in capacity in nutrition education is major challenge. Those challenges included: • inadequate/insufficient • knowledge of nutrition among medical specialists. • international training in modern nutritional epidemiology. • international training in modern clinical nutrition. • training of nutrition in schools and universities. • knowledge of nutrition in the population. • education and curricula of nutrition in medical faculties e.g. incorporated in hygiene. Nutrition is now considered to be a part of specialization in hygiene. • knowledge of nutrition among health professionals working with the population. • Nutrition is only a part of other trainings (mentioned earlier). • Lack of ‘pure’ nutrition education at academic level. • Lack of in-service training of nutrition. • Lack of methodological approaches and software for data collection, assessment and analyses.

11. Political dimensions-Governmental level (resistance or neglect of addressing nutrition issues) • Engagement of ministries and public agencies in food, dietary and nutrition related issues is lacking due to lack of funds (official explanation). • Lack of a national nutrition strategy, or action plan (e.g. based on WHO Global Strategy on Diet and Physical Activity, or Food and Nutrition Action Plan for Europe), except Hungary and Bulgaria. • Lack of contact and collaboration between responsible ministries (e.g. Ministry of Health, Agriculture, Education, and Research) and institutions working in the field of nutrition (except for Bulgaria and Hungary). • Lack of coordinated activities at national and regional level in nutrition and nutritional status monitoring (except Bulgaria and Macedonia).

12. Possible elements of a common strategy for the network and possible actions for improvement of capacity development in CEE countries • Continue/start developing national food and nutrition policies and action plans • Standardize education and training programs in nutrition for medical professionals (undergraduate and postgraduate studies) • Need common training courses for relevant professionals within health, food and nutrition in CEE countries • Need mass media in nutrition, health and lifestyle modification • Need promotion of food and nutrition at all levels (including incorporate nutrition in the curricula of elementary and high schools) • Stimulate school canteens to improve nutrition quality of school meals • Standardisation and collaboration on recommended dietary allowances (RDA) in Europe

13. Possible elements of a common strategy for the network and possible actions for improvement of capacity development in CEE countries (cont.) • Harmonize research, evaluation and monitoring of the nutrition situation in the region • Develop dietary guidelines for different population groups • Collaborate with the food industry to produce healthier products • Conduct specific programs to prevent obesity, non-communicable diseases and micronutrient deficiencies • Get support from the UN, such as the UNU, FAO, UNICEF and WHO to the network • Establish relevant internet web pages/modules for exchange and collaboration between countries in the CEE. • One example is the Food and Nutrition Agro Web Network in CEE Countries (http://agrowebcee.net)

14. Framework for analyzing actors and responsibilities in nutrition in CEE Main responsibility Levels Actors Governmental: Primarily MoH, and MoA, MoT(E), MoST, MoE, MoWSA, MoLD.Policy makers/civil servants, Parliament, local level authorities • Policy development (food security, • nutrition, health, training), decision • making, legislation for protecting and • supporting the human right to adequate food • National plans of actions • Funding • Monitoring and evaluation 1 Institutional: Health and research institutions (including statistical), clinics (medical doctors, public health specialists, dietitians, nurses, food controllers), agriculture extension, hygiene • Implement policies • Providing expertise and advisory function • Evidence base (research) in nutr. • Maintain and develop staffs’ capacity • Adapt strategies to local needs • Monitoring and evaluation • Provide feedback to ministries • International collaboration/networking 2 Educational: Universities, faculties, scientific academies, institutions/ departments, scientists, researchers, professors, primary and secondary, school teachers, kindergarten personnel, catering staff • Implement policies on education • Provide and support staff development • Base education/training on local needs • Evaluate education/training • Provide feedback to ministries • Engage in international collaboration • Publishing education material 3 Community: Farmers, cooperatives, industry/business Mass media (public and private) NGO’s, professional associations Families, individuals • Production of safe healthy foods, responsible • marketing • Promotion of healthy nutrition • Positive role models in healthy eating • patterns and life style • Making informed choices • Promotion of consumers’ rights • Availability of desirable food at acceptable prices • Compliances to legislation 4

15. Framework for capacity development in nutrition in CEE Levels Needs Strategies/activities • Political commitment • Food and nutrition policies • Develop nutritional action plan • Reinforcing scientific evidence for increased awareness • Strengthen capacity building • Support for capacity development • Lobby for political support for needs of • nutrition policy and national action plan • Lobby for funding of national capacity development • Monitor for government accountability • Information/education of politicians/parliamentarians • Requesting increased communication between line • ministries 1 • Adequate human resources (including knowledge) • Most recent equipment, methodology and relevant standards • Adequate facilities and organizational structure • Transforming national policies to needs of various groups • Updated/approximation of legislation on food and nutrition • Terms of reference/job description - updates • Promote staff development by academic education and training in nutr./health (incl. in-service) • Monitoring dietary intake/nutritional health status • Exchange of experience (national/international) • Communication and dissemination of scientific results on nutritional health • Establishing and using food database (software) 2 • Adequate institutional capacity (human resources) • Research equipment, apply recognized methodologies and standards • Adequate facilities and organizational structures • Take account of relevant national policies • Updated/approximation of legislation on food and nutrition • Establish academic institution for nutrition training • Develop curricula at each level of education • Accreditation and certification of higher training activities • Conformity of catering serviced to nutrition demands • Harmonization/approximation of EU requirements of • the educational system according to the Bologna Process • Preparing nutrition training and education material • Establish training courses for professionals with • international collaboration • Promote/update a web-based food and nutrition network • Disseminate research results to users • Research to support FNAP • Develop food database 3 • Scientific based information for food selection • Food based dietary guidelines • Sustainable and adequate food supply • Information for informed individual choice for diets (use of labeling) • Application of legislation for food labeling • Nutrition promotion and education • Collaborate with industry/business on responsible marketing • Specific programmes targeting certain population groups • Contribute articles on nutrition to media 4

16. Planning guidelines for capacity development in nutrition in CEE Challenges/ Problem areas Nutrition Food security (WFS 1996) 1. Governmental 2. Institutional 3. Educational 4. Community Levels Lobby/advocacy for food and nutrition action plans • Engage in monitoring/ • evaluation activities • Promote staff development • Argue for funding food database • Apply intern. accepted • methodologies • Develop project proposals • for EU • Develop project proposals for EU • Engage in food database develop. • Initiate the support the FNAP • Disseminate res. results to users • Raise awareness of EUFIC on the • needs for training materials in • CEE languages • Update a web-based food and • nutrition network • Nutrition promotion • (including media) • Popularize scientific • findings adapted to • local challenges • and food habits Prioritized Strategies/activities For all: Fund raising/networking/communication material Short term Medium/longterm Continuous Duration

17. Some plans • 3rd meeting of core countries (plus 2-3 universities), November 2006 • Presentation of two specific themes, one suggested: ‘the human right to food’ • preparation of 1 or 2 proposals for funding of the Network activities. Goal to finalise Socrates application to be submitted March 2007 • Involvement in new EC-programmes, such as • EuroFIR • Harmony, depends on go/no-go • NuGO • European Federation of the Associations of Dieticians (EFAD) • Increase participation in existing post graduate courses, for example food databases (VELAG), epidemiology (Florence), the right to adequate food (Norway) • 4th meeting of the core countries and universities would be considered for the second half of 2007 depending on go/no-go for Socrates programme(s) for 2006/2007. VLAG can offer: • Regulation of food intake (10 – 13 April 2006) • Management of food safety issues (18 – 22 September 2006) • Nutrition and lifestyle epidemiology (June 2007)

18. Thank you for the attention!