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to change their behaviour themselves encouraging them to do so by showing the achievement of peers. Empower- ment does not have to take place in the community, but in this case it has been linked to a local commitment, in particular through the use of local peer role models.
Attainment
Campaigns are initiated and imple- mented with the final goal not only to get the message ‘across’, but also to change behaviour. These success factors have thus been summarised as those that take place at the individual level. One important aspect seems to be the messaging or framing approach observed in a number of the cam- paigns in that a clear, simple and posi- tive message was found. One example is Belgian ‘Veggie Day’ which does not propose a negative message about avoiding meat, but about increasing consumption of vegetables. Another important aspect of this message ap- proach is to avoid focusing on health as the main objective, but to place the message in a broader context also showing other benefits.
The ‘Fuel Zone’ campaign aimed to make school canteen food interesting and appealing and not to focus on the pupils’ health. In the “School Fruit Fyn” project it was believed that the main factor in creating a lasting effect in a health campaign is to place the mes- sage in an everyday context conse- quently making healthy living a natural everyday thing. Focus should be on the social aspect of eating and the effect on the body of what one eats. Spokes- people from both campaigns claim that an overzealous focus on health is perceived as paternalistic and will result in disassociation.
The notion of seduction is linked to this. Instead of making people feel compelled to making a choice – for example as a result of guilt – it is impor- tant to habituate people to the healthy alternative, thus making them ‘long’ for it. If a healthy lifestyle is perceived as a pressure, one effect may be that a lot of people fail to live healthily or simply resist following what they perceive is an authority dictate. Instead, it is much more effective to ‘seduce’ people to live healthily by making them experi- ence that healthy food is not boring but attractive and by habituating them to eat it. This strategy was used by both ‘School Fruit Fyn’ and ‘Fuel Zone’. A number of respondents mention structural changes as one of the key elements to creating real change in
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people's behaviour because informa- tion campaigns raise awareness about the campaign itself, but do not neces- sarily succeed in changing people's behaviour. Structural changes may, for example, include minimising the avail- ability of unhealthy alternatives and to make healthy options more attractive and widespread. The result would be that it’s easier and more attractive to choose the healthy alternative. Free choice is thus minimised, but the great- est effect results when people perceive that they are not missing out on any- thing, or if they don’t feel that they are forced into doing something, as the representative of ‘Wholegrain’ states.
National differences
The empirical base is too small to draw any conclusions about national characteristics or differences in how public campaigns for healthier eating are conducted. However, the examples provide an opportunity to report on some interesting observations, which the researchers made, regarding their subjective perception of cultural differ- ences highlighted in the examples. In the French school milk program, a private dairy company is behind the promotion of a free milk program in all public schools, and this scheme gives the dairy producer a clear competitive advantage. This seems to hint at a cen- tralised France, where the boundary between public and private companies is fuzzy. The German campaign is by far the most informative of the campaigns selected and the success is substantially based on the public institution enjoying great recognition and respect. From a neighbouring country’s perspective, this seems to match with the perception that authorities and hierarchies are of great importance in Germany. The British campaigns appear to be most unorthodox, an excellent example being the ‘Fuel Zone’ campaign’s co- operation with Coca-Cola which was designed to attract pupils to the school canteen. In addition, the concept of social marketing seems to have been used to a much greater extent. It ap- pears as if Great Britain is under greater influence from the US than is the case on the European continent. Another as- pect observed in the British campaigns is that they are explicitly targeted at vulnerable groups, which was not that much of an issue in the continental campaigns. This might hint at a pro- nounced existence of social classes in the British society.
In the Danish context, the ‘School Fruit Fyn’ is interesting as the success, among
other things, seems to depend on a local democratic dimension, meaning collaboration between a central organi- sation and the local authorities and lay people. This matches with the possibly Danish characteristic or self-perception of an especially equal society. These observations underline that, despite some of the success factors being shared across borders, it is still nec- essary to bear in mind that the cultural differences existing within the EU play a role when it comes to understanding, assessing and planning future health campaigns.
Conclusion
Historically, extensive public cam- paigns have received great focus and are still used to some extent. But, as shown above, they are more effective if they are supported by other actions, of which several have been described drawing from the examples. As the model shows, there are three main phases of public health cam- paigns which the success factors can be attributed to: The first is the initial phase depending on capturing current trends and fitting the campaign into the overall macro environment, but also considering promising partners as, for example, relevant and adequate private companies in public-private- partnerships.
The next phase is the implementation, as, for example, putting social marketing to good practice, but especially linking with and within the social community and empowering the citizens within their communities. Communication is essen- tial but can have various forms. Large- scale information campaigns, which often in the past were the only healthy eating campaigns conducted by the public sector, might work but they are not necessarily appropriate. The last phase is attainment – how
to reach citizens with the message, but also actually make people change their eating habits. An important factor here is that the message is simple, posi- tive and clear, underlines more short- term benefits alongside the long-term benefit of good health, but it can also be crucial to focus on creating struc- tural changes.
References 1 Kuipers, Yoline, EuroHealthNet (2009) p6-8. Focusing on obesity through a health equity lens. A collection of innovative ap- proaches and promising practices by health promotion bodies in Europe to counteract obesity and improve health equity 2 Kuipers, Yoline, EuroHealthNet (2009) s6. Focusing on obesity through a health equity lens. A collection of innovative ap- proaches and promising practices by health promotion bodies in Europe to counteract obesity and improve health equity
http://www.iotf.org/database/documents/TrendsEuropean- adultsthroughtimeMay09.pdf 3 Mazzocchi, M, Traill, WB (2005). Nutrition, health and economic policies in Europe. Food Economics - Acta Agriculturae Scandi- navica, Section C, 2:138-149
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