N° 12 • May 2007 • “SOCIAL MARKETING” EGEA 2007 STATEMENT Overcoming the socioeconomic and gender gap in fruit and vegetable intake European action to increase fruit and vegetable consumption
Why is it so difficult for most people to reach the dailyrecommendation for fruit and vegetables? In Sweden, less than
To address the growing challenge of chronic diseases - cancer, coronaryheart disease and obesity - on health, the economy and development,
20 percent of the adult population reaches the intake goal of 500
EGEA 2007 adopted the following statement, following valuable input
grams per day, and less than 10 percent of children reach their
goal of 400 grams. A universal pattern can be observed across
northern Europe: Intake is lower in men compared to women, in
people on low incomes and in those with lower education
compared to higher socioeconomic groups. Is it a matter of low
and the WHO Regional Office for Europe.
availability? Is the perceived high cost of fruits and vegetables
Increasing fruit and vegetable consumption is an important part of
preventing desired change? Are other, less healthy foods and
comprehensive prevention of chronic diseases. Currently only aminority of European citizens eat the daily recommended amount of
beverages too readily available and too cheap? Or is it a matter of
lack of knowledge, skills or widespread taste preferences for
The WHO European Charter on counteracting obesity sets goals for
curbing the epidemic and reversing the trend in children and
The answer to these questions should guide us in the search of
adolescents by 2015. It recommends increasing consumption of fruitand vegetables.
effective measures to increase consumption in all groups in the
The German government has given, during its Presidency, commitment
to increase fruit and vegetable intake by 2010, so that 20% more
Among higher socioeconomic groups, targeted promotional
people are consuming at least 5 portions of fruit and vegetable eachday; and that by 2010, an extra 30% of catering (such as
activities and health counselling is probably an adequate strategy
kindergartens, schools, cafeterias and old people’s homes) serve
to reduce the gender gap in consumption. However, in order to
healthy meals, which include fruit and vegetables.
overcome the socioeconomic gap, additional instruments are
The 2007 EGEA conference "The Role of Fruit and Vegetables in the
needed. Social marketing employing traditional marketing
Fight Against Obesity" has identified a number of effective and
elements - product, price, place and promotion - could be a way
innovative solutions to increase consumption of fruit and vegetables.
forward. One proven approach to increasing consumption is
Among these effective solutions, three main areas of action should begiven priority:
establishment of free or subsidised fruit and vegetable schemes
• Increase access to and availability of fruit and vegetables in
in schools and work places. However, this might not be enough to
prevent obesity and chronic diseases. Governments,
• Improve information on the health benefits of fruit and
municipalities and employers need to consider whether free or
vegetables and increase advertising for fruit and vegetables.
subsidised fruit and vegetable schemes should be made
• Reduce social inequalities in fruit and vegetable consumption.
conditional upon removal of unhealthy snacks from schoolcanteens, vending machines and cafeterias, i.e. heighteningbarriers for unhealthy foods and beverages competing with fruitand vegetables. In this way, environments truly supportive to
fourth edition
HEALTH AND CONSUMER PROTECTION DIRECTORATE-GENERAL
AGRICULTURE AND RURAL DEVELOPMENT DIRECTORATE-GENERAL
Liselotte Schäfer Elinder
Stockholm Centre for Public Health, Sweden
IFAVA Board of Directors IFAVA Committees J. Badham • South Africa • 5-a-Day for better health TRUST L. Damiens • France • “La moitié” • Aprifel C. Doyle • USA • American Cancer Society P. Dudley • New Zealand • 5+ a day T.Yoshimura • Japan • Japan Vegetable & Fruit Meister Association J. Badham • South Africa S. Barnat • France J. Badham • South Africa R. Lemaire • Canada • 5 to 10 a day L. Damiens • France L. Damiens • France P. Dudley • New Zealand E. Pivonka • USA • 5 A Day P. Dudley • New Zealand K. Hoy • USA R. Lemaire • Canada C. Rowley • Australia • Go for 2&5® • Horticulture Australia R. Lemaire • Canada E. Pivonka • USA C. Rowley • Australia S. Tøttenborg • Denmark • 6 a day R. Pederson • Denmark T. Yoshimura • Japan IFAVA Contact info HEAD OFFICE International Fruit And Vegetable Alliance CHAIRMAN: VICE CHAIRMAN: INFORMATION OFFICER: c/o Canadian Produce Marketing Association 9 Corvus Court
E-mail: [email protected] E-mail: [email protected]Ottawa, ON K2E 7Z4 Canada International Fruit and Vegetable AllianceThe public policy of generic food marketing for fruits and vegetables — Parke Wilde —
Director, Food Policy and Applied Nutrition, Friedman School of Nutrition Science and Policy, Tufts University, Boston, USA
The economics of food marketing are very different for branded
majority of the commodity’s producers, managed jointly by a
products (such as Coca-Cola) and generic products (such as most
producer board and the U.S. Department of Agriculture
spinach sold in bulk). The producer of a branded product has a
(USDA), and funded through mandatory assessments on the
strong incentive to advertise. By contrast, the producer of a
producers. The federal government enforces the collection of
generic product knows that any voluntary advertising expenditure
the mandatory assessments, approves the advertising and
will benefit competitors. In economic jargon, the competitors will
marketing programs, and defends checkoff communication incourt as the federal government’s own message -- in legal
Of course, there are some branded fruit and vegetable products
jargon, as its own “government speech”(1).
(such as Dole packaged spinach, to continue the spinach
Using the federal government’s powers of taxation, these
example). However, at least in the United States, it is clear that
checkoff programs collected more than $600 million from
product branding -- and hence voluntary advertising -- is much
producers in 2004. The checkoff promotions sometimes put the
less prevalent in the fruit and vegetable industries than in other
federal government in the awkward position of undermining the
segments of the food market. This disparity leads to a concern
more scientifically deliberate nutrition messages of the Dietary
that private-sector incentives favor the advertising of
Guidelines for Americans, which are intended as the
comparatively unhealthy foods and penalize the advertising of
government’s authoritative statement on nutrition
communication. For example, the Guidelines related to obesity
Producers of unbranded food products have sought government
prevention do not focus on particular nutrients, as in the “low-
assistance in solving the “free rider” problem in marketing
carb” fad diets favored by the meat industry or the “high-
generic food products. In the case of fruits and vegetables,
calcium” fad diets favored by the dairy industry. Instead, the
producer organizations, nutrition foundations, and the federal
Guidelines focus on overall calorie balance within the context of a
government all perceive the merit in generic marketing and
healthy diet that is high in fruits, vegetables, and low fat dairy:
promotion. One result has been the “5-a-day” and later “5-to-9-a-day” program, which is a public/private partnership that
• To maintain body weight in a healthy range, balance
encourages consumers to increase their daily servings of all fruits
calories from foods and beverages with calories expended.
and vegetables, regardless of the brand. In addition to this
• To prevent gradual weight gain over time, make small
national partnership, some regional fruit and vegetable marketing
decreases in food and beverage calories and increase physical
orders include mandatory producer contributions to a marketing
However, these fruit and vegetable promotion programs are only
By contrast, the federal government’s pork checkoff program
a very small part of the U.S. federal government’s interventions to
relies on a low-carb dietary message, “Counting carbs? Pork’s
help food producers solve their “free rider” problem and promote
perfect.” The federal government’s dairy checkoff program used
their generic products. For example, the contribution to the “5-
weight loss as a central theme in the last couple years: “3-a-Day.
to-9-a-day” program from the federal government’s National
Milk-cheese-yogurt. Burn more fat, lose weight”(1). Far from
Institutes of Health was merely $3.6 million in 2001. More
adhering to the Dietary Guidelines’ emphasis on lowfat dairy
recently, the federal participation in the program has been
products, the dairy checkoff advertisements commonly promote
administered by the Centers for Disease Control (CDC), but it is
milk and cheese without reference to fat content, and they
not clear how much money CDC commits to this effort (multiple
sometimes promote products that are high in fat and saturated
email requests to the CDC’s program and public information
fat, as in the checkoff program’s recent collaboration with Pizza
offices over several weeks could not turn up a specific dollar
Hut to promote a three-cheese stuffed crust pizza or its
collaboration with Wendy’s to promote the Wild Mountain BaconCheeseburger.
By contrast, the federal government offers much greater help tothe powerful meat and dairy industries through the federal
Observers of nutrition policy in the United States have some hope
generic commodity promotion programs, known as “checkoff”
that the upcoming 2007 Farm Bill, which reauthorizes a wide
programs. As recently summarized in a longer perspective
array of agricultural and food programs, will be more favorable to
fruit and vegetable production and promotion than such bills
The advertising campaigns from the checkoff programs
have been in the past. At the same time, the political calculation
include: “Beef. It’s What’s for Dinner,” “Ahh, the Power of
that favored meat and dairy promotion at the expense of the
Cheese,” “Pork. The Other White Meat,” “Got Milk?,” and the
Dietary Guidelines in past years has not fundamentally changed. “Milk Mustache” campaign. These campaigns are so familiar
It remains to be seen whether U.S. public policy can support
that many readers will recognize the slogans immediately
nutrition objectives through fruit and vegetable promotion on a
and be surprised only to hear that they are federally
scale that would noticeably compete with other subsidy programs
in the agriculture budget or with other food products in the
The programs are established by Congress, approved by a
REFERENCES1. Wilde P. Federal Communication about Obesity in the Dietary
2. U.S. Department of Health and Human Services and U.S. Department
Guidelines and Checkoff Programs. Obesity. 2006;14: 967-973.
of Agriculture. Dietary Guidelines for Americans, 2005 (6th Edition). Washington, DC: U.S. Department of Health and Human Services and U.S. Department of Agriculture; 2005. The interplay of 5 A Day Campaigns with food-based dietary guideline promotion — Ingrid Keller —
Food Policy Centre, City University, London, UK
The Plan of Action endorsed at the International Conference on
In Germany, the FBDG are chiefly promoted by the BMVEL and its
Nutrition in 1992 called on governments to provide to the public
agencies, which are a member of or sponsor of the 5 A Day
“qualitative and/or quantitative dietary guidelines”1.
association. As in Chile, the 5 Am Tag message is part of the FBDG;
Subsequently, many countries developed food-based dietary
hence, message and logo are included in government sponsored
guidelines (FBDG). Fruit and vegetables are an important
nutrition information, which gives a consistent picture.
component of a healthy diet, and their sufficient daily
In New Zealand there is no real interplay with the national
consumption could help prevent certain chronic diseases. To
government (exception: fruits in schools project), which is
increase the consumption of fruit and vegetables in the
conscious that 5+ADay is industry lead. However, the message
population, several countries have programmes that promote fruit
and number "5" is included in the government sponsored FBDG;
and vegetables, often under the slogan "5 A Day". This article
hence there is no conflict in the messages, even though they are
looks at the implementation of FBDG in Chile, Germany, New
Zealand and South Africa and its interplay with the 5 A Day
In South Africa, there is reluctance from the side of the national
programme in each country. Most of the information comes from
government to interact directly with the 5 A Day Trust, even
though the fruit and vegetable message is part of the FBDG.
Each of these countries has a specific FBDG regarding fruit and
However, 5 A Day is not seen as hindering the implementation of
FBDG or that it could "threaten" an overall healthy diet approach- FBDG and 5 A Day are complementary; and promoting all FBDG
Chile Eat 2 plates of vegetables and 3 fruits every day2
through the entry-points 5 A Day uses may be beneficial.
Germany Fruits and vegetables: take 5 a day3
FBDG give positive and negative messages regarding a total diet. New Zealand Eat plenty of vegetables and fruits4
“5 A Day” only gives a positive message. Some informantspointed out that it is "easier" to give those positive messages to
South Africa Eat plenty of fruits and vegetables every day5
the population than the negative "eat less" ones. However, for abalanced diet, the 5 A Day message needs to be combined with
The role of 5 A Day programme in dietary
the "instead of" message. Hence, the "bad news" needs to be part
of the nutrition information given to the population as well as atthe policy level. Policy makers should support fruit and vegetable
In Chile, the 5 A Day programme contributes to FBDG
promotion, but they should also focus on the "eat less" / "instead
dissemination. The activities of the public sector and the 5 A Day
programme are coordinated and the same messages and
While not all governments endorse the 5 A Day programme, the
materials are given to the public. The German 5 Am Tag
informants concurred that these programmes are complementary
association communicates mainly its own message, however
to FBDG implementation and not counterproductive.
without leaving out other important factors of a healthy diet. Governmental representatives agree that 5 Am Tag is part of the
Additionally, nutrition education, as a rather "top-down"
FBDG promotion, since they co-sponsor 5 Am Tag and the FBDG
approach, is often not complemented by community involvement
specifically include the “Take 5” message.
and/or environmental changes and FBDG are not taken into
In New Zealand, from the governmental point of view the 5+ADay
account by other public policies. 5 A Day programmes, if set-up as
programme has no specific role in the implementation of the
public-private partnerships, can have policy impact and are well
FBDG. All interviewees agreed that 5+ADay is complementary to
situated to complement education with environmental changes.
FBDG promotion. In South Africa, a better coordination and
Such set-up may be conducive for overall FBDG implementation
collaboration with the public side has recently started and it is felt
that 5 A Day can be the “voice” for the fruit and vegetableguideline.
The interplay of governmental FBDGimplementation and 5 A Day programmes
In Chile, INTA, an academic institution, promotes the FBDG and 5Al Día, which gives credibility to the programme in the populationand for government collaboration. As a "neutral party", INTAachieved a multi-sectoral dialogue and buy-in. As the 5 Al Díamessage is included in the new FBDG, the programme gives anopportunity to use its channels to communicate all FBDG to thepublic, therefore diversifying the "traditional" communicationchannels.
REFERENCES1. WHO/FAO, Technical Report Series 880, 1998.
4. Ministry of Health New Zealand, 2003.
2. Instituto Nacional de Tecnologia de Alimentos y Nutricion / Ministerio
5. Vorster et al., S African J Clin Nutr. 2001;14 (3) (Suppl.):S3-6.
3. Deutsche Gesellschaft für Ernährung, 2004. Social Marketing Strategies to Enhance Fruit and Vegetable Consumption — Jennifer Scott, PhD - Tom Beall, M.H.S.A. —
Social Marketing campaigns are similar to product marketing
is called “Fruits and Veggies: More Matters” and is designed to
campaigns in that they are trying to change the attitudes and
drive up adult consumption towards the goal of 9 to 11 servings
behaviors of target audiences. However, they differ in that they
(4.5-5.5 cups) of fruits and vegetables per day. In many ways,
are generally not offering a product/service for purchase. This
the new PBH campaign exemplifies the best practices detailed
means that the “payoff” or reward for consumer compliance is
much less tangible, it offers much less immediate gratification,
1. Specifically targeted Gen X moms (women aged between
and may even involve personal sacrifices and changes to deeply-
25 and 42 who have children under 18 years living at
ingrained habitual behaviors. For this reason, Social Marketing
home), and campaign messages and mediums are
campaigns are required to epitomize the best practices
designed to impact this group. This targeting is based on
associated with conventional marketing campaigns, and are also
the understanding that these Moms are: highly engaged in
required to effectively tap into unmet needs, existing social
their families’ health; active information-seekers;
drivers and core values to be persuasive.
accessible through a variety of mediums; helping establish
Studies of the effectiveness of public health campaigns over the
habits of a lifetime in their children; and, have a significant
past 50 years in the United States(1; 2; 3) indicate that success is
influence over their partners and their parents. 2. Developed messaging that reaches all Moms with an 1. Conduct formative research to understand the needs
encouraging, motivational way. “Fruits and Veggies - More
and interests of the target and refine the impact of
Matters™” is a relevant rallying call to those moms who
think their families (and they) consume enough fruits and vegetables. For Moms who feel like their families eat too
2. Segment the audience into meaningful sub-groups and
little, “Fruits and Veggies - More Matters™” helps them
develop messages highly relevant to that group. Lack of
begin to address this shortfall without setting an
segmentation and message targeting are thought to be
major factors that have contributed to failed social marketing campaigns(4; 5). 3. Because research showed that most Gen X Moms already
had a good attitude about fruits and vegetables in their
3. Ensure high message exposure in reach (how many
families’ diets, the campaign focuses on providing them
people) and frequency (how many times they receive the
with spurs to action, including: new ways to prepare fruits
message). It is important to realize that there is a
and vegetables; help negotiating different fruit and veggie
minimum level of exposure to a message, below which it
preferences within their family; and assistance in
is unlikely to make an impact on the target audience.
recognizing and managing unhealthy food messages in
4. Use multiple mediums, and generate word-of-mouth
popular culture. Importantly, the campaign uses its
discussion about the campaign among the target group. It
interactive component to get Moms together with other
has been demonstrated that information obtained through
Moms to exchange tips, recipes and to offer each other
word-of-mouth is considered twice as valuable as
information from advertising (Keller Fay Group, 2006).
4. Cultivated various mediums for getting the word out,
5. Mobilize credible and popular third-party groups and
including not only the on-line environment, but earned
individuals in support of the campaign.
media and partnerships that initially include 21,000 retail
The Produce for Better Health Foundation – which, together with
stores, more than 170 products and the U.S. public health
the U.S. Centers for Disease Control and Prevention, is responsible
for the extremely successful “Five-A-Day” campaign in the United
The “Fruits & Veggies -- More Matters™” campaign is also being
States - has just launched a new campaign to increase the
closely measured to ensure that it is having the desired impact
consumption of fruits and vegetables in America. The campaign
and to allow for its message to be strengthened over time.
Snyder, L.B. & Hamilton, M.A2002. A meta-analysis of US health
Flay, B.R. and Sobel, J. L. (1983) The role of mass media in preventing
campaign effects on behavior. In R.C. Hornik (ed) Public Health
adolescent substance abuse. In T.J. Glynn, C.G. Leukefeld, & J. P.
Communication: Evidence for Behavior Change pp352-384
Lundford (Eds.) Preventing Adolescent Drug Abuse NIDA Research
Derzon, J.H. & Lipsey M.W. (2002) A meta-analysis of the effectiveness of
mass communication for changing substance abuse knowledge, attitudes
Myhre S. L. and Flora J.A. (2000) HIV/AIDS communications campaigns:
and behavior. In W. D. Crano and M. Bergoon (Eds) Mass Media and Drug
progress and prospects Journal of Health Communications 5, pp. 29-45.
Noar, S.M. A 10-year retrospective of research in health mass media campaigns: where do we go from here? Journal of Health Communications. 2006; 11(1):21-42.
2.2 Envasado y esterilización DRIO - Instrumento de extracción para injertos óseosEl aparato "DRIO" se suministra NO ESTÉRIL en una bolsa médica NO ADECUADA para laesterilización en autoclave. INSTRUCCIONES DE USO La esterilización debe efectuarse con los procesos habituales y específicos para elementos deacero inoxidable previstos por la Farmacopea Europea. 2.3 Contraind