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Awareness campaigns and policy change efforts in Nordic and Baltic countries tackle alcohol consumption and tobacco use in order to improve public health. However, there is another significant public health challenge, accounting for one fourth of the cardiovascular disease burden and almost one third of the diabetes and kidney disease burden. That is an unhealthy diet.
A new study on diet-related risks in the Nordic and Baltic countries was published in February this year. The study found that, despite significant improvements in recent decades, Estonia, Latvia, and Lithuania still rank among the highest of the countries studied in terms of both deaths and disability-adjusted life years. Tagli Pitsi, an Estonian nutritional researcher at Tallinn University of Technology who took part in the study, emphasises that cardiovascular diseases are still the main cause of death in the Baltic states. She states that, “In addition to nutritional reasons, we have a socio-economic and healthcare system legacy that has not been fully balanced by improved prevention and early treatment options. Unfortunately, decision-makers still do not understand the importance of prevention.”
But not only are the Baltic states the ones with problematic eating patterns. The study uncovered that leading dietary risks among the observed indicators included high intake of processed meat and low intake of fruits and whole grains. The consumption of processed meat was highest in the Baltic states and fruit consumption was also lowest in these countries, signalling clear risk. However, the Baltic states also stood out positively with having the highest whole grain consumption. In Iceland, Sweden and Norway, on the other hand, whole grain consumption was the lowest. This shows that no single country consistently performs better across all dietary risk factors.
Reasons for problematic dietary patterns vary, starting from traditions and culture and ending with food availability. And indeed, walking into a grocery store in Estonia, the meat and processed meat aisle takes up a considerable amount of the store. Pitsi also stresses that an important factor in people opting for processed meats and unhealthy options is the availability of these products.
The research article emphasises how socioeconomic factors also play a significant role, as obesity is more prevalent within socially disadvantaged groups as there are constraints on access to nutritious diets. Pitsi points out how socioeconomically disadvantaged groups often have more stress, less time, and fewer resources to plan and prepare meals, and they also have fewer opportunities for physical activity and healthcare services. Nutritionally poor processed food is readily available, which again encourages unhealthy food choices. Pitsi stresses that a lower educational level may additionally be associated with lower nutritional literacy.
It is not only purchasing power which limits access to health-promoting foods as cultural heritage, social norms, and family traditions also play a part. When a person from a very early age has eaten in a certain way, it is difficult to try to change eating habits later on. In Estonia, for example, the provision of school and kindergarten food is regulated by the state, which helps children and young people make better food choices. But healthy choices should be made more available elsewhere as well.
The article highlights that education and awareness-raising campaigns are simply not enough to change people’s eating patterns. If a person knows that processed meats and high sodium intake is a risk for health, yet all that is affordable and quick to grab are burger patties or nuggets, then there is a stark contrast in what the national guidelines are saying and what they are actually doing to make healthy food choices more accessible. The article emphasises how consumer-oriented interventions include front-of-pack labelling, subsidies for health-promoting foods, and taxes or bans on unhealthy food choices, marketing regulations, etc.
Pitsi stresses that for instance measures taken to reduce tobacco consumption are excellent examples. Smoking tax increases, advertising restrictions, smoke-free zones, banning smoking indoors, and awareness campaigns have worked together to bring down smoking. But lowering alcohol and tobacco use is more clear-cut, as taxes can be implemented, alcohol and smoking prohibited in public places, etc.
Unlike tobacco or alcohol, high sodium intake or processed meat consumption cannot simply be banned in public places, you cannot make eating an apple a day obligatory for everyone. Amsterdam is set to become the first capital city to ban advertising meat. But is it a good example? Pitsi says that very strict prohibitions and orders can cause the opposite reaction in people’s behaviour. Rather, she suggests ‘’nudging’’ as food environments must be regulated to nudge people to make better decisions more easily. ‘’Interventions must take place at multiple levels of the ecological model, such as the individual, environment, and policy level,’’ says Pitsi.
This is what the article emphasises – it is the policymakers and food production system who must implement effective interventions. Pitsi stresses that disease prevention is easier and cheaper than dealing with the consequences later. While there have been some successful measures taken, such as the EU regulation on the maximum amount of trans fatty acids in products, which ensures that they are not consumed in quantities that are harmful to health, there is still a lot that has to be done.
This article is written by Annette Maria Hermaküla. This article was funded by the European Regional Development Fund through Estonian Research Council.
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