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Research for food and health in Europe: themes,needs and proposalsMcCarthy et al.

McCarthy et al. Health Research Policy and Systems 2011, 9:37http://www.health-policy-systems.com/content/9/1/37 (29 September 2011)

RESEARCH Open Access

Research for food and health in Europe: themes,needs and proposalsMark McCarthy1*, Amina Aitsi-Selmi1, Diána Bánáti2, Lynn Frewer3, Vasant Hirani1, Tim Lobstein4, Brian McKenna5,Zenab Mulla6, Giulia Rabozzi7, Raluca Sfetcu8 and Rachel Newton9

Abstract

Background: Diet, in addition to tobacco, alcohol and physical exercise, is a major factor contributing to chronicdiseases in Europe. There is a pressing need for multidisciplinary research to promote healthier food choices andbetter diets. Food and Health Research in Europe (FAHRE) is a collaborative project commissioned by the EuropeanUnion. Among its tasks is the description of national research systems for food and health and, in work reportedhere, the identification of strengths and gaps in the European research base.

Methods: A typology of nine research themes was developed, spanning food, society, health and researchstructures. Experts were selected through the FAHRE partners, with balance for individual characteristics, andreported using a standardised template.

Results: Countries usually commission research on food, and on health, separately: few countries have combinedresearch strategies or programmes. Food and health are also strongly independent fields within the EuropeanCommission’s research programmes. Research programmes have supported food and bio-technology, food safety,epidemiological research, and nutritional surveillance; but there has been less research into personal behaviour andvery little on environmental influences on food choices - in the retail and marketing industries, policy, andregulation. The research is mainly sited within universities and research institutes: there is relatively little publishedresearch contribution from industry.

Discussion: National food policies, based on epidemiological evidence and endorsed by the World HealthOrganisation, recommend major changes in food intake to meet the challenge of chronic diseases. Biomedicaland biotechnology research, in areas such as ‘nutrio-genomics’, ‘individualised’ diets, ‘functional’ foods and‘nutri-pharmaceuticals’ appear likely to yield less health benefit, and less return on public investment, thanresearch on population-level interventions to influence dietary patterns: for example policies to reducepopulation consumption of trans fats, saturated fats, salt and energy density. Research should now addresshow macro-diets, rather than micro-nutritional content, can be improved for beneficial impacts on health, andshould evaluate the impact of market changes and policy interventions, including regulation, to improvepublic health.

Conclusions: European and national research on food and health should have social as well as commercialbenefits. Strategies and policies should be developed between ministries of health and national research fundingagencies. Collaboration between member states in the European Union can yield better innovation and greatercompetitive advantage.

* Correspondence: [email protected] of Epidemiology and Public Health, University College London,London, UKFull list of author information is available at the end of the article

McCarthy et al. Health Research Policy and Systems 2011, 9:37http://www.health-policy-systems.com/content/9/1/37

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Background’A major issue for public research is targeting preven-tion of diet-related diseases. The major chronic diseasesare caused substantially through poor diets. Moreover,the dramatic rise in overweight and obesity is also pre-dominantly due to worsening diet across the EU. Thesetrends will have a negative impact on life expectancy inthe EU and reduce quality of life.’ [1]In Europe, four proximal behavioural factors - diet,

tobacco, lack of physical exercise and alcohol - aremajor contributary causes of chronic diseases [2]. TheWorld Health Organisation has sought to raise aware-ness and develop policy on food-related health chal-lenges in European Member States through capacitybuilding, monitoring trends, and reporting on servicesand strategies. WHO proposes that: “Research shouldsupport a better understanding of the role of nutrition,food safety and lifestyle factors in disease development,provide information on risk factors and determinantsthroughout the whole food supply chain, and strengthenthe evidence base for, and the health impact of, inter-ventions and policies.” [3]Support for agriculture has been a cornerstone of pol-

icy for European integration since the Treaty of Romein 1957. The food sector is the second largest manufac-turing sector in Europe, currently with a turnover ofover €800 bn and 4 million employees [1], and the foodretail and catering sector together is as large. ‘Health’, incontrast, is a relative newcomer for European policy.Public health (disease prevention and health promotion)was recognised within the EU Treaty in 1992, but healthservices are the primary responsibility of member states.Agriculture, food and health are significant themes inthe European Union’s current Seventh FrameworkResearch Programme (FP7). Food and health have beenconsidered together within the Food theme of FP7, butthe research supported has been mainly for productionof food, including biotechnology, and its microbiologicaland chemical safety [4]. Health itself is a major theme inFP7, but almost all the funding has been directed to bio-technology and biomedicine, and very little to broadersocial research for health [5].In the year 2000, the EU’s Lisbon Strategy proposed

coordination and increased competition within the Eur-opean Research Area to promote economic and socialimprovement. In the EU’s Sixth Framework ResearchProgramme (2002-2006) a European Technology Plat-form ‘Food for Life’ was created for food industryresearch, and the Platform’s report [6] contributed tothe inclusion of the sub-theme ‘Food and Health’ withinthe Knowledge-Based Bio-Economy theme of theSeventh Framework Research Programme (2007-2013)The European Commission has also developed Joint

Programming Initiatives for coordination of researchprogrammes between member states, and in 2009 thetopic ‘Healthy Food for a Healthy Life’ was chosen asone of the first of these new instruments [7]. The Eur-opean Union now has a new overarching strategy forthe period 2014-2020, with seven Flagship themes, andresearch is incorporated within the theme of Innovationfor economic and social improvement [8].FAHRE (Food and Health Research in Europe) [9] is a

collaborative project created in response to a call fromthe European Union’s food and health research pro-gramme for 2009. The call sought to deepen knowledgeof national research on food and health and contributeto planning and coordination of future research, FAHREhas four activities: to map national food and healthresearch and research structures; to determine strengthsand gaps at European level; to develop proposals forimproved European performance in food and healthresearch; and to disseminate the findings in support ofthe European Research Area. These were phasedsequentially, so that first there was mapping in memberstates, next there was analysis and synthesis to Europeanlevel, then development of proposals and finally dissemi-nation to targeted and more general audiences. FAHREhas seven partners contributing to these activities, withthe first two activities also supported by informationfrom specialist experts. The present review combinesthe expert analyses undertaken for FAHRE’s secondactivity.

MethodsThe initial task was to determine the themes covered by‘food and health’: the range is indicated in Figure 1.Agricultural research has a long tradition - for example,as well as genetic husbandry, it was important for envir-onmental experiments, and in developing statistical ana-lysis - but agriculture’s direct effects on dietary healthare not well understood. Converting food into food pro-ducts (processing) creates issues of content, taste andsafety, while the retail and catering industries are con-cerned with supply and choice. In different ways, pri-mary production, processing and retail industries affectconsumer choice and are subject to forms of policy andregulation. Food impacts on the population and its con-stituent groups, and understanding of its effects onhealth and disease have come both through population(epidemiology) as well as laboratory studies. Clinicalresearch (patients with diseases) addresses some condi-tions where there are evident precipitating causes, suchas allergies, while laboratory research is investigating themechanisms at tissue, cell and molecular level. Added tothis, studies seek to connect genetic characteristics withfood exposures and intervening factors.


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Another objective was to span research employing thenatural sciences, including biology and chemistry, theclinical sciences based on diseases, and the socialsciences placing the human in social structures andenvironments. These were identified for the definitionfor food and health research adopted by the project, butit was understood that multiple disciplines are increas-ingly used across the thematic sectors.’Food and health research’ for this report refers to

research about the production, marketing, choice, regu-lation and policy for food as it affects health, and themechanisms and control of diet-related diseases, nutri-tion and obesity. It covers positive and negative impactsof food on health as well as issues related to under andover consumption of food (undernutrition and obesity).It draws on a wide range of disciplines including psy-chological, social, management and political sciences,laboratory sciences, clinical medicine, environment andepidemiology, and is undertaken by public, independentand industry organisations.FAHRE commissioned experts to report on the nine

themes forming a spectrum across food, society andhealth, joining both core disciplines and multidisciplin-ary approaches. An earlier typology had been developedby the Joint Technology Platform, Food for Life [7]. Inaddition, for the first activity of FAHRE, a typology offour categories had been developed to classify research

programmes. These two further typologies are given inTable 1 to show their overlap and similarities - an esti-mate of validity for the categories chosen.

Work of the expertsSince ‘food and health’ is a complex field, there is noimmediate source to identify experts; and a balance wassought, including geography, gender, experience andemployer, as well as field and discipline. The partners inFAHRE were contacted for their suggestions, and asearch of the internet was made for relevant organisa-tions. From these enquiries, curriculum vitae werereceived from potential experts, and the final nine wereselected from a short-list with FAHRE partners.An initial meeting between FAHRE partners led to the

development of a template to guide the work of eachexpert. The template fields included research structuresand programmes at national and European levels, andthe implications of strengths and gaps for future propo-sals. The experts came together on two occasions, firstto assess and improve the template, and on a secondoccasion to review progress, and assess barriers in find-ing results. The experts were asked to use only second-ary information. This included the information onnational structures and programmes described in theFAHRE country reports. Experts were also asked to usetheir professional knowledge and data available on the

Figure 1 FAHRE food and health research typology.


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internet to characterise European level activities for theirtheme. The thematic reports were returned to the leadauthor who made a synthesis which was the basis of thepresent review. Details, including webpage URLs andreferences, are given in the primary reports [10-18].

ResultsSupport at national levelFood processing research funding varies greatly fromcountry to country, with higher levels of it in west Europeand less in the east. There is very little evidence of jointspecific funding for this topic anywhere in Europe. Foodprocessing research appears reasonably well funded atEU level, although within larger Food and Health pro-jects. There are research facilities and infrastructure inboth western and eastern European countries, with sig-nificant facilities in both regions, although these are age-ing in the eastern countries. In almost all countries, theindustry has projects on food technology diagnosticmethods, whereas enforcement programmes are plannedby public entities, universities and public research insti-tutes and sometime endorsed by private actors.The country reports indicated little research on food and

health regulation. Some countries had no strategies or

national policies for food and health, while others withstrategies did not build on the results of food and healthpolicy research - for example, national reports on thehealth status of the population did not indicate an impacton food and health policies. Governmental and publicinstitutions with an important role in food and health pol-icy were mostly not linked to policy research, and thereare very few foresight studies and programmes, whichwould serve as a good basis for policy planning. In thearea of consumers, existing food and health research ismainly in the older EU member states: capacity and cap-ability building is particularly required in Eastern Europe.Research into consumer behaviour and health insuffi-ciently addresses other potential determinants of consu-mer decision-making (including economic factors,sustainable production, environmental factors and ethicalconcerns). There is a substantial volume of research rele-vant to obesity currently being conducted in most coun-tries, and some research on obesity control was related topolicy. Six (Denmark, Italy, Latvia, Netherlands, Portugaland Switzerland) of nineteen country reports indicatedEuropean collaborative work: five countries are collaborat-ing on an international scale, and four acknowledged plansto do so, or the importance of this type of collaboration.

Table 1 Comparison of fields identified by FAHRE thematic areas experts, by FAHRE country reports and by JointProgramming Initiative (JPI) interim report

FAHRE Researchthematic areas

FAHRE Country Report Programme research fields JPI interim report

Food production andproductsFood safety

Production field: design of food (components...), itspreparation (processes...), its manufacturing and also homecooking matters linked to health and disease, interfacebetween industry and the scientific sector.

Diet and food production:Establish reliable data on consumer food preferences andacceptance in order to develop new food products and toredesign how foods are produced.Enable redesign and optimisation of food processing andpackaging.Foods must always be safe and should be produced in asustainable way.

Regulation, claims, andfood policy for healthConsumer behaviourand what influences it

Policy field: regulation (labeling, salt, sugar and fat contents,claims...) and consumers, which will have an impact on dietand therefore on health. It could also focus on programmesmore economically oriented, linked to marketing,participation, public expression and access.

Lifestyle: Consumer behaviour and food choice.Understanding of consumer behaviour with regard to foodand also to raise consumer understanding of healthy foodsand food consumption patterns.Measuring food purchase and consumption behaviourtaking into account cultural differences, and subsequently,developing reliable models of consumer choice processes.Effective communication strategies with consumers need tobe developed to induce behavioural change directed toimproving consumer health and social responsibility.

Population surveyscauses and controlHealth policy for food,nutrition, diet andobesity

Population field: at human and population level,epidemiologic approaches (including biological, social andpsychological determinants) and observational andinterventional research on behaviours that can explain eatingdisorders leading to chronic diseases.

Horizontal issues: Mapping food cultures in Europe; researchinfrastructures (databases, biobanks, food tables); methods,including foresight, to evaluate national or regionalprogrammes; principles for cross-border funding of research.

Food causing disease -excess, imbalance,sensitivityNutrition micro-elements, malnutrition,gene interactions,

Biomedical field: nutrition and dietary research relating tomolecular and clinical aspects, in the pathways and causes ofdisease, and the mechanisms at different periods of the lifecourse.It could also include food safety, both toxicology andbiological.

Chronic diseases: preventing food-related, chronic diseasesand increasing the quality of life:1) understanding of brain function in relation to diet;2) the effects of diet-gut interaction on intestinal andimmune functions;3) the link between diet and metabolic function (obesityand associated metabolic disorders).


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The majority of countries are undertaking lifestyle andprevention research, or community and population stu-dies and programmes. Finland, Romania, Switzerlandand the UK appear to be leaders in the former category,with Lithuania at the forefront in the latter, and theNetherlands and Italy as big players in both. Prospectiveepidemiological studies and projects are being carriedout in most European countries, particularly UK, Ger-many, Italy and France, but not in Turkey or Romania.Countries with a high level of molecular research suchas nutrigenomics included Switzerland, Netherlands,Lithuania, Ireland, France, Finland, Denmark, UK andCzech Republic. Eight of these are involved in the JointProgramming Initiative and together have manyresearch programmes.

European collaborationCollaborative research in food and health has been sup-ported by the European Commission within various pro-grammes since the Fourth Research FrameworkProgramme (1994-1998). On the food side, the 2011programme includes calls for research in fields includingsatiety control, processed foods with lower salt, fat andsugar content, and food labelling. There has also beenmuch research on food safety, both microbiological andchemical. A large Network of Excellence MoniQA isaiming at validation of methods and standards to ana-lyse foods and food products for safety and quality,while FRISBEE is concerned with food refrigerationinnovations for safety (FP7 €8 million). Consumerresearch is also included in FP7 calls, in projects fundedby the Commission’s Health Programme, and in fore-sight work by the European Commission’s JointResearch Centre.In general, research on industry regulation and policy

is lacking. However, studies of health promotion aresupported by DG Health (e.g. PRO GREENS - Promo-tion of fruit and vegetable consumption among school-children in Europe), while the International Associationfor the Study of Obesity (IASO) leads a study jointlywith the USA on standards for marketing foods andbeverages to children funded through the EuropeanExternal Action Service’s Pilot Projects programme.Europe has led important prospective epidemiological

studies linking nutrition, lifestyle and environment, inchildren, adolescents and older people. Obesity in adultsis addressed by EURO-PREVOB and HOPE projectswhile interventions in children include ENERGY, TOY-BOX and EPODE projects. Population-level monitoringresearch has included European food consumption vali-dation, and the European Nutrition and Health Reportproviding comparisons of nutritional indicators andhealth determinants. Child obesity monitoring is beingundertaken by a network of countries coordinated by

the regional office of the World Health Organizationand co-funded by the European Commission. Clinicalresearch on food-related diseases has included interven-tion studies of single nutrients for diseases includingcoeliac disease, diabetes and allergies; and using a‘whole-food’ approach to address specific disease groups- coeliac disease again, Alzheimers’ disease and mentalhealth. Collaborative biomedical research is investigatingthe foetal origin of degenerative diseases, biologicaleffects of the ‘Mediterranean diet’, and links betweennutrition and genomics.

Major researcher groups and networksFood processing technology research is normally con-centrated in one or two food research institutes anduniversities in each country, whereas there are manyuniversity departments addressing food safety, (foodmicrobiology and chemical contaminants). An unusualnetwork is PAN Europe, bringing together NGO cam-paigning organisations working on hazardous chemicalsand including consumer, public health, and environmen-tal organisations, trade unions, women’s groups andfarmer associations, and the SAFE consortium coordi-nates institutes for science-based food safety policy-set-ting and regulation. Consumer research appearsstrongest in the Scandinavian countries, UK, Belgium,the Netherlands and Switzerland, and is represented atEuropean level through BEUC (European ConsumersOrganisation).Regulation has been a major concern of the European

Food Standards Authority, and equivalent nationalbodies, it is not a primary research interest. DG Healthis concerned with foodstuffs regulation, but mainly ani-mal and plant health, rather than human health. Whilethe European Commission’s Directorate for Health andConsumers coordinates a High Level Group on Nutri-tion and Physical Activity, with representatives frommember state governments, and the European Platformon Diet, Physical Activity and Health, bringing togetherindustry and policy stakeholders, there is no committeeor network focusing on European food and health policyresearch.At population level, EuroFIR (European Food Informa-

tion Resource) Network is a European Network ofExcellence on food composition databanks involvinguniversities, research institutes and SMEs. Significantconcern for dietary policies is made by European healthgroups including the European Heart Network (EHN),and the European CanCer Organisation (ECCO). Thereis growing engagement of molecular scientists, geneti-cists and chemists into biomedical fields, includingmetabolomics and nutrigenetics/nutrigenomics. Theyseek to increase understanding through research andeducation, of professionals and the general public, of the


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role of genetic variation and dietary response, and therole of nutrients in gene expression. Other groupingsinclude the Federation of European Nutrition Societies(FENS), and the industry-funded ILSI (Europe, Interna-tional Life Sciences Institute) which coordinates theEURRECA Network of Excellence on micronutrientrequirements in Europe.In the private sector, three global companies have

strong European research presence: Danone, with 500staff at Wageningen, The Netherlands and Palaiseau,France; Unilever, with 2500 staff at Port Sunlight, UK,Colworth, UK and Vlaardingen, the Netherlands; andNestlé at Lausanne, Switzerland. The European FoodInformation Council (EUFIC), representing both proces-sing and retail industries provides information on foodsafety and health for the public and professionals withan interest in food.

Research systems at national levelsERAWATCH country research profiles describe nationalresearch systems, policies, policy support measures,research organisations and key research indicators. Eur-opean research is predominantly planned and financedby Ministries of Science and/or Education, or equivalentcentral body. There is often a policy-making council,sometimes in coordination with sectoral ministries, andministries may also hold research funds directly. Thirdtier organisations often administer and implement. Theresearch performers are the universities and publicresearch institutes, with the private sector providing arelatively small proportion. Many member states arerestructuring the research sector, with smaller MemberStates expanding the numbers of new universities, andlarger states regrouping and consolidating the sector.Modernisation of the research system in several east-

ern member states, particularly the larger ones, remainsa challenge. However, the EU Structural Funds includesubstantial funding for research (and innovation), withan emphasis on supporting industry research as well asthe public sector. Broadly, the European Regional Devel-opment Fund can support capital investments (scienceparks, laboratories), and the European Social Fund sup-ports people (higher training programmes, exchange).National agricultural research has been mapped by the

Standing Committee for Agricultural Research [19].FAHRE has reported structures for food and healthresearch in Europe [9]. Structures for funding healthresearch are presented on the web-page of STEPS(Strengthening Engagement in Public Health Research)[20].

Knowledge needsResearch and innovation in food processing should beboth fundamental and consumer-oriented and address

the need for food products that promote healthy eating,including the growing older population, and migrants.The food industry is devoting many millions of Euros tolaboratory searches for new ‘functional’ ingredients infoods, often present at very low concentrations. RTDissues for food processing include effective extractionsystems, how to place the ‘functional’ ingredients infood, and methods for keeping them intact through theprocessing and distribution process. However, there isno lack of nutrients across the population in general,and the value of these products is not supported by evi-dence. More research is needed to understand whatpopulation groups are consuming such products, howoverall dietary intakes are affected, and therefore whatpublic health benefits these products are achieving.Food safety research addresses food pathogens, control

of virulence and chemical contaminants, and seeks todevelop new systems and methods for control. Currentthemes include new technical methods of heating andnon-thermal microbial inactivation methods (e.g. ohmicheating, pulse electric field, high pressure): non-thermalmechanism better retain nutrients (e.g. vitamins in fruitjuices). Much needed safety research is biological, ortechnical (new food processing and preservation tech-nologies) rather than health research. There should alsobe more research on human perception of risks and riskcommunication.There has been a concerted research effort by the

health sector, and the commercial sector with healthcare interests (including medical equipment, pharmaceu-ticals and treatment solutions), to create products effec-tive for managing obesity, but with limited success. Thishas led researchers to turn their attention towards nonmedical approaches, including food-related health beha-viour and the environment (physical, financial, social,educational, regulatory etc). However, while there areseveral examples of national policy interventions onfood marketing and food composition to improve publichealth in European countries - including the Danishincrease in tax on sugared beverages, the French ban onvending machines in schools, Norwegian subsidies givenfor the distribution of fruit and vegetables, the FinnishAllergy programme with children on specific diets, theUK ban on TV advertising of unhealthy foods to chil-dren and the Swiss legal limit on trans-fatty acids invegetable oils - there has been little evaluative researchrelating regulation to effects, for example through popu-lation surveillance and health impact assessments.There is increasing research on food-related beha-

viour, including experimental interventions (for example,information, or community based programmes targetingimproved dietary choice): the interaction between biolo-gical, psychological and socio-cultural factors is impor-tant for dietary choice. Current consumer research


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tends to relate to a single outcome, such as health, sus-tainable consumption, or production acceptance: simul-taneous comparison of several domains, for exampleincluding the risks and benefits to health, the environ-ment, socio-economic factors, and ethical concerns,would be a relevant future research field.Targets are needed for national food-based dietary

guidelines, with interventions at public and industrylevels to promote healthy eating. Population studies areof crucial value. There should be evaluation of biomar-kers in relation to dietary data, along with studies innutrigenomics. Better measures are also needed in, forexample, quality of life measures which incorporate peo-ples’ experience of life as well as clinical assessments, orthe impact of a specific food-related disease on the eco-nomic functioning of the individual, the household, andhealth care services.Collection of data needs to be maintained over time to

monitor changes both in foods and eating habits.Research can investigate food-based interventions fordiseases: (a) to promote good function e.g. gut absorp-tion, brain function (b) prevention of disease, e.g. Alz-heimer’s disease, some cancers, and metabolicsyndrome, and (c) improving prognosis during disease,e.g. cardiovascular disease. Bringing about behaviouralchange is challenging. Health care professionals haveused ‘motivational interviewing’, financial incentives indieting plans, and cardiovascular genetic risk profiles.However, communicating the results of genetic testsdoes not appear to result in behaviour change, andweight loss is difficult to maintain.Biomedical research at molecular-level research has

focused on micronutrients, both at individual countrylevel and also cross-European and international levels.But while epidemiological studies always find a linkbetween cardiovascular disease and fruit and vegetableintake, randomised controlled trials with vitamin supple-ments and with fruit and vegetables have shown noeffect on cardiovascular disease. The focus has thereforeshifted away from micronutrients towards whole diets/whole foods, for example macronutrients and differentdietary patterns such as Mediterranean and Nordicdiets.

Support at European Union levelFood researchThe European Technology Platform (ETP) “Food forLife” is an industry-led, public/private partnership sup-ported by the European Commission DG Research [6].Its Strategic Research Agenda in 2007, and Implementa-tion Action Plan, in 2008, proposing proposed “newprocesses, products and tools that: Improve health, well-

being and longevity, build consumer trust in the foodchain, and derive from sustainable and ethical produc-tion.” The ETP is developing a new workprogrammefrom 2011.The Seventh Framework Programme Agriculture

research theme has included a section “Fork to farm;health and well-being”, with topic subjects including• Consumer, behavioural, societal and cognitive

sciences related to food and feed;• Nutrition and diet-related diseases, including obesity;• Improved quality and safety, both chemical and

microbiological, of food, beverage and feed.Following a process of consultation, in 2010 the Eur-

opean Commission invited Member States to launchJoint Programming Initiatives in three areas [7]. For ‘AHealthy Diet for a Healthy Life’, a temporary secretariathas been established in the Netherlands. The permanentgovernance structure and secretariat is planned fromSeptember/October 2011.Health researchThe Sixth Framework Research Programme (2002-2006)focused medical research within ‘Life Sciences’, and gaveparticularly strong funding to genomics. Broader publichealth research was put into the ‘eighth’ Policy strand.The Health call for the Seventh Framework Programmehas three pillars, covering basic sciences, applied (clini-cal) research and public health/health systems. The pro-grammes have covered major disease areas such ascancer, respiratory and neurological diseases as well ascross-specialty themes such as lifecourse, equity andageing. Food-related diseases are not addressed directly,but food and nutrition are included in research propo-sals both on the causes and management of diseases, instudies of the determinants of health and in populationhealth interventions.The European Commission’s Directorate for Health

and Consumers’ EU Platform for Action on Diet, Physi-cal Activity and Health seeks ‘to pool Europe’s knowl-edge on what works - and what does not - and todisseminate best practice across the European Union’[21]. The composition of the Platform has included offi-cials, industry and civil society organisations. Five fieldsfor action identified by the Platform members are: Con-sumer information, including labelling; Education; Physi-cal activity promotion; Marketing and advertising;Composition of foods, availability of healthy foodoptions and portion sizes.FundingThe European Commission calculates that financial sup-port for research on diet, dietary habits and genetic fac-tors totalled about €101 million for five years (1998-2002) in FP5, approximately €178 million for five years


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(2002-2006) in FP6 and approximately €81 million inthe first four years (2007-2010) of FP7 [1]. In FP6 andFP7 approximately €36 million were allocated to pro-jects on allergies, €81 million to prevention of obesity,of which about half was for prevention of obesity inchildren, and approximately €66 million to identificationof bioactive compounds in food and of the mechanismsgoverning the way they act and to related improved pro-cessing. The nutritional needs of an ageing populationreceived €22 million under FP5. €17 million wereinvested in research projects on consumer needs andbehaviour, in FP6 €21 million and in FP7 so far €11 mil-lion. The 2010 workplan is addressing production offood for the low-income population.Other relevant arrangements for European research

include:

• The EUREKA programme provides co-funding forresearch by large companies, and (in the EUREKAEurostars Programme) by SMEs. EUREKA Umbrellassupport research and development in thematic net-works, including Euro-Agri in fields of biotechnol-ogy, genomics, proteomics and food technology, aswell as quality, safety and traceability.• COST (European Cooperation in Science andTechnology) enables coordination of nationally-funded research on a European level. It supportsnational facilities, institutes, universities and privateindustry to work jointly on Research and Develop-ment in the nine domains, including (but separately)Biomedicine and Molecular Biosciences; Food andAgriculture; and Individuals, Societies, Cultures andHealth.• Research Infrastructures are facilities, resources orservices, including, equipment, computing, softwareand communications, which support the researchcommunity in conducting research. An advisorygroup, the European Strategic Forum for ResearchInfrastructures (ESFRI) advises on priorities, andthere RIs in the health field include networks of clin-ical research centres and high security laboratories.• The European Science Foundation (ESF) providescooperation and collaboration in European researchand development, European science policy andscience strategy. Its Biological and Medical SciencesRoadmap Working Group has proposed researchinfrastructures for food and health research.• SCAR, the Standing Committee on Agriculture andResearch, established by the European CommissionDirectorate, reported on ‘health’ as one of eight‘driving forces’ for agriculture in Europe, focused onfood security [22].

DiscussionThematic research areasProcessingThe European Union strategy for research and innova-tion across all sectors seeks to raise investment to thelevels of USA and Japan through increasing commercialinvestment. In the European food industry does nothave high levels of investment in research, and the lar-ger companies keep their research private for commer-cial reasons, so that investment can only be measured asinputs rather than outputs. Several countries have estab-lished public research organisations to support SMEs,working principally in new product development, safetyand presentation. The marketing and retail industrieshave separate approaches. There has been collaborationwith the pharmaceutical industry on supplements infood, but this will align more with the non-patent indus-try rather than the more-regulated sectors.The larger health agenda requires different initiatives

with industry. In the Directorate for Health and Consu-mers’ European Platform for Nutrition, Physical Activityand Health, industry has described its contributingactivities across areas of food presentation and offer(Table 2). Suggestions were also made for creating net-works for the exchange of research findings and techni-ques, funding professional development in relevantresearch areas, and providing funding for research.Food safety researchMuch funding has been given to food safety over the past15 years, both in the food chain and possible humaninfections such as BSE. More practically, there has beenattention to food handling procedures and standards, andimprovements in sterilising foods for retail consumption.Yet much food remains unsafe to consumers because ofan excess or imbalance of ingredients in the diet. Eur-opean and national food safety agencies need an ‘epide-miological transition’ in food safety research, away fromcontamination and acute disease, and towards ‘safety’that encompasses food that reduces chronic diseases.ConsumersInternationalisation of food supplies, more eating out(and less home-cooking), and growing attention to ‘con-venience’ are all influencing eating habits and deserveclose attention. Research must address the balancebetween commercial opportunity and consumer protec-tion. Food labelling and portion sizes are important onthe retail side. Consumer science can contribute tosocial studies of food causing disease, and the requiredinterventions.Policy and regulation researchA recurrent theme of this review has been the lack ofresearch, including policies and regulations, economic


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and trade issues, behaviours and marketing, to addressthe major public health issues of food and health.National and local food policies and cultures are notsufficiently assessed and recorded for changes and com-mercial or policy interventions. There is lack of under-standing of drivers for food access or choice, andespecially how to change these - with the engagement ofthe whole food industry - towards healthier diets.Importantly, social and policy research must be linkedinto government structures, particularly the ministry ofhealth, so as to integrate with policy and achieve bene-fits for European citizens.EpidemiologyEurope-wide studies provide an important scale to showthe risks and benefits associated with certain diets.There now needs to be more efficient use and updatingof existing studies, investigation of whether biomarkersare valid measures of disease outcome, better methodsof dietary measurement, and linking of longitudinal stu-dies of individuals with changes in policy, marketing,availability and consumption of foods (e.g. using com-mercial consumer data).DiseasesHeart disease, cancer and diabetes all relate to diet. The‘epidemic’ of adult-onset diabetes is largely due to over-eating and consequent overweight. The pharmaceuticalindustry is seeking to develop ‘targeted’ nutrients, alongthe lines of drugs, for controlling disease, but moreeffective means are needed of reducing the incidence ofnew disease. New approaches for food allergies couldassess why the condition appears to be increasingrapidly, and consider clinical trials of withdrawing ingre-dients to reveal causes.Food supplementationBiochemical research has identified increasing detail oncomponents of food, and this has led the food industryinto substantial investment in supplementation of foods.The EFSA has criticised the health claims of such foods,as there is little satisfactory evidence that the

supplements have any health benefit in this form. Thisis now leading research away from micro-nutrientstowards investigating the impacts of macronutrients anddifferent diets.GenomicsThere is very considerable science investment into geno-mics, which has a broad range of potential impacts. Thechronic diseases are associated with multiple gene sites,and the prospect of ‘individualised’ or ‘personalised’diets appears distant as yet, although there may beknowledge gained from certain genetic disorders. Linksare needed with epidemiological studies, with sufficientdescription of exposures.

Research system needsInfrastructuresResearch for food product development requires pilotplant facilities housed in a quasi food factory environ-ment, with drying, freezing, sterilization, membrane pro-cessing, packaging, heat treatment and other equipment.Such equipment is currently available, but there isdebate on the size of pilot plant required to reflect per-formance when scaled up to full industrial productionsize. For food safety research, existing laboratories areable to perform validated analytical techniques and sam-pling plans for priority chemical contaminants, but thereis a need for more rapid methods to apply knowledge,in-line methods for continuous safety management infood processing, and precision/reference techniques forresearch and confirmatory purposes.Social science consumer methodologies depend on

appropriate information and communication technologyinfrastructures for analysis to be applied. Qualitativeapproaches (collection of interview data, running focusgroups, ethnographic analysis) may require recordingequipment or specific environments (for example,rooms with auditory or video recording equipment).Investigating the organoleptic properties of foods andconsumer choices requires the use of sensory panels

Table 2 Areas of industry action in relation to food and health

Industry area Action

Presentation Modifying food product labels and/or labelling policies

Altering nutritional composition - usually levels of fat, sugar or salt

Changing products - reducing less healthy options, introducing healthier options

Altering the amount of a food product understood to be, or provided as, a “portion”

Proposing and/or implementing limits or codes of practice for advertising

Offer Education about nutritional values or healthy diets

Producing and/or distributing information about nutritional values or healthy diets

Promoting health qualities of own products

Changing food purchasing patterns through mechanisms implemented at the point of purchase

Workplace diet and lifestyle (holistic) programmes


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and specific statistical analysis software. A prerequisitefor longitudinal population nutrition and health surveysis sufficient funding for all stages - planning, fieldwork,analysis, interpretation and reporting of the results.Databases need linkage of data with disease and mortal-ity registries. The added value of EU level action lies inthe harmonisation of monitoring and surveillance sys-tems to enable evaluation and effective health impactassessment. In the clinical field, there are few institu-tions focused towards food causes of disease, althoughallergies are a growing area for collaboration. Laboratorystudies, biomarkers and nutrigenomics are being sup-ported in new member states through European regionalgrants.StructuresFew countries in Europe have a strategic approach tofood and health research, and member states know lit-tle about each other’s programmes. There is a need formore and better multidisciplinary and comparativeresearch, particularly in countries with where tradi-tional food and medical research has not sufficientlyincorporated social science approaches. Career pathsfor interdisciplinary scientists should be supported, forexample through greater recognition in national orinstitutional research assessments. There should bemore systematic recording of the relevant researchareas and actions, and better use of national and Eur-opean projects to determine clearly the main researchissues.A Europe-wide consultative forum, physical or virtual,

is needed. Models include the Standing Committee forAgricultural, the committees of the European ScienceFoundation, or the collective actions in ERA-nets. Therealso could be virtual collaborations, in association with ahost institution which could be responsible for commu-nication on relevant research outputs, conferencing,links with policy-makers for knowledge translation, andtraining and capacity building.European universities and research institutions need to

provide world class research to attract students andresearchers; and they need to open up to business andinternational collaboration to access new funds. Techni-cal equipment has been well provided, through Eur-opean and national grant agencies, and there is now aneed for more “soft” approaches, including training,capacity-building, financial incentives, networks. Eur-opean data bases are also needed - of experts across dif-ferent disciplinary fields, of available Europeanequipment, and ‘warehousing’ data sets for secondaryanalysis. There is a lack of postgraduate training andcourses for research scientists across food and healthresearch, requiring investment in social as well as tech-nological sciences, and in university infrastructures aswell as research institutes.

ProgrammesMuch food and health research in Europe is conductedin public institutions. The FAHRE country reports showthe volume of work being undertaken and the largenumber of institutions involved. However, there is animbalance in the research being undertaken. Most foodresearch has addressed food processing technologies andsafety, with less on behaviour, regulation and policy.Similarly, on the health side there has been an emphasison biotechnology and medical aspects, and less on pub-lic-health and policy issues. Given national, regional andlocal differences in diets, family structures, and geneticfactors, more attention to collaborative intervention stu-dies between European partners is needed, perhapsjointly funded by national programmes.Much technical research has addressed introducing

micro-nutrient supplements into foods, but the healthbenefits are often not established, and claims in pro-ducts have been challenged by regulatory authorities inboth Europe and USA. Exploration of genetic profilesfor ‘individualised’ diets has also been unsuccessful. Incontrast, there has been less research on the impact ofthe rapid growth of retail supermarkets, or the greateruse of ‘convenience’ foods and ‘24 hour shops’.Research on barriers to adopting healthier diets should

address habits, socio-cultural pressures (e.g. peer grouppressures in adolescence) and access to healthy food, orinformation about healthy eating. Insights from risk-benefit perception and food safety may be relevant.National and regional surveillance of food intake and itsdeterminants remains important. Food composition(including formulation and portion sizes), food market-ing (including labelling, packaging and advertising), foodbehaviour (including factors influencing choice) andfood accessibility (including pricing, supply and location)are particularly poorly researched. Methodologicalresearch should include standardised approaches toassessing the impact (such as quality of life, economicfunctioning of individuals and households, health serviceuse, and perceived wellbeing), survey measurement ofdietary choices, and psychological aspects (nutritionalknowledge, attitudes towards healthy eating, risk-benefitperceptions associated with specific food choices, andstandardized behavioural indicators). Foresight activitiescan be encouraged in order to serve policy-building anddecision-making activities.ImpactsPolicy-related research should take into account theneeds and priorities of inter-governmental agencies(WHO, Council of Europe, OECD), civil society organi-sations and policy-makers. The research should beframed to have maximum impact, presenting clear andrelevant policy options in a lively way that strikes achord with both decision makers and the public while


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not ignoring the complexities and uncertainties thatcharacterise the real world of research. Research priori-ties can be assisted through policy analyses and thedevelopment of more coherent links between policy-makers and the research community. Public health pro-fessional bodies and advocacy organisations monitorpolicy developments and can provide strategic commen-tary on these.A research question of critical importance is what

incentives can be created to help companies move theirsales from less healthful products, and encourage com-panies to invest in the supply of healthy products. Stan-Mark has monitored development of standards formarketing of food and drinks to children across Europe[23]. The wider policy picture also needs research sup-port, from public or public-private funding: for example,research on the most effective use of the public sector’sfood purchasing power, the use of taxation and subsidy,the use of agricultural policies and industrial investmentpolicies, retail planning policies and economic stimula-tion policies - directed towards public health benefits.Conflicts of interest undermine the advancement ofpublic-private partnerships, and possible solutions maybe suggested, such as a blind trust into which industryand foundation support can be placed, or a form ofresearch levy taken from the commercial operators whobenefit from the research.Developing effective translation of research outcomes

into policy must to be prioritised, as well as ways topromote stakeholder and public engagement forresearch governance and policy development. Bridgingthe gap between research and policy translation - imple-mentation research - is largely absent from nationalfunding agendas. There needs to be a full range ofresearch disciplines and applications in national fundingprogrammes as well as EU funded initiatives. Thereshould be a set of “standard operating procedures” fornational data collection relevant to food and health,comparison of achievement across time and space, andmeasuring health impacts, including socio-economicvariations in population health. Methods of evaluatingthe health impacts of policies before they are introducedalso need to be developed and refined. Besides healthimpact assessment other approaches (e.g. regular inter-sectoral health forums, networks etc.) could be adaptedto the specific policy context.CoordinationWHO is linking member states in action plans for dif-ferent nutrition themes, including salt, obesity andschool meals [24]. Nutrition Action Plans have beenagreed by every EU Member State. The European Com-mission’s Joint Programming Initiative [7] will addresscoordination of food and health research between parti-cipating European countries. There is a need for tools to

track and share data and disseminate the results inorder to prevent duplication of efforts and to encouragesynergies.A listing of resources (skills and equipment) should be

made to facilitate research pooling across the Europeanresearch area. There can also be stakeholder involve-ment in the development of research requirement port-folios, including relevant industries, scientific disciplines,and consumer organisations across EU member states.Country financial information is also limited. Few coun-tries identify specific amounts available under certaincalls for research or as budgets awarded for projects,which makes the evaluation of the cost-effectiveness ofresearch very difficult. There is a need to build clearinformation systems containing financial information,and to relate it effectively to fields and sub-fields of foodand health research.The contribution of public-private partnerships needs

more attention. A few global companies have researchdivisions in European counties, providing an importanttechnical base for product development. For smallercompanies, research is often more linked to the solutionof an immediate industrial problem rather than theimplementation of a good research programme. Thevalue of emphasising intellectual property rights andpatents may be questioned in this field. Many compa-nies are developing open innovation approaches toR&D, combining in-house and external resources tomaximize economic value from their intellectual prop-erty, even when it is not directly linked to their corebusiness. They have begun to recognise public researchas a strategic resource. In parallel, research institutionsneed to play a more active role in their relationship withindustry in order to maximize the use of the researchresults. Joint funding for research and training pro-grammes and industry support of university degree pro-grammes that meet industry needs, can be a wayforward.Health-related civil society organisations involved in

food-related issues (heart disease, diabetes, cancers,nutrition etc) can provide valuable contributions on pol-icy needs and the gaps in the evidence base. More effortcould be made to involve them in the development ofresearch funding strategies - including fund-raising.Effective policy translation, with stakeholder and publicengagement, of research into outcomes needs also to beprioritised.

ConclusionsThis synthesis of FAHRE Thematic Expert’s reports pro-vides information on research programmes, nationalstructures and projects at European level, and gaps andoverlaps for the research. Food is an important cause ofill-health in Europe, but the two research fields of food


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and health are not well linked, at either the national orat European levels. There have been major research pro-grammes on food safety, and epidemiological studiesand population surveys have contributed to understand-ing the trends and causes of disease. However, industryresearch has focused on technology for nutrientenhancement of processed food, while national researchhas failed to invest in social, behavioural and policyresearch on food and ill-health. The findings indicate amove from research on ‘healthy food’, which concen-trates on food products, to research for ‘healthy eating’which is concerned with appropriate intake and redu-cing risks to European citizens.FAHRE has addressed broad needs and gaps in both

research and the structures supporting research. The‘Europe 2020’ strategy of the European Union [8] seeksto build economic and social improvement on the baseof innovation and research. Research on food and healthcan contribute by identifying solutions and supportingfood markets for healthier eating, and thereby extendinghealthy and productive lives. And there should be bene-fits from international cooperation. As one expert pro-posed: “It is not too extreme to suggest that the 27member states and the EU all have the identicalresearch food agendas and, while the FAHRE countryreports have not been detailed at the individual researchproject level (this would have been impossible), knownareas of duplication of effort could be avoided by betterintegration and organisation.”

AcknowledgementsThe work reported in this study was supported by the EuropeanCommission Directorate for Research project number 245278 (Food andHealth Research in Europe). The views of the authors are independent of theEuropean Commission.

Author details1Department of Epidemiology and Public Health, University College London,London, UK. 2Central Food Research Institute, Budapest, Hungary. 3Centre forRural Economy, Newcastle University, Newcastle, UK. 4InternationalAssociation for the Study of Obesity, London, UK. 5Emeritus Professor,University College Dublin, Dublin, Ireland. 6University of Study, Milan, Italy.7Medical Research Council Unit of Lifelong Health and Ageing, London, UK.8Independent consultant, Bucharest, Romania. 9Sociedade Portuguesa deInovação, Porto, Portugal.

Authors’ contributionsMM initiated the study, oversaw the data collection, and wrote and revisedthe final paper; AA-S, DB, VF, VH, TL, BM, ZM, GR, RS contributed equally incollecting data and writing thematic papers, and commented on the finalpaper; RN contributed to the study design, reviewed thematic papers andcommented on the final paper. All authors read and approved the finalmanuscript.

Competing interestsDr Banati declares her interests as:• Chairpersons of EU Agencies, Chair (2011-)• European Food Safety Authority (EFSA), Management Board, member(2006-2010, 2010-2014); Vice-Chair (2006-2008); Chair (2008-2010, 2010-)• European Commission, European Group on Ethics in Science and NewTechnologies (EGE), member (2005-2010)

• European Academy of Nutritional Sciences, member• European Association for Food Safety (EAFS), Executive Board, member(2005-), Vice Chair (2006-2009)• European Programme Planning Committee of the Toxicology Forum,member(2006-2010)• FAO/WHO Codex Alimentarius Task Force on the Safety of Foods Derivedfrom Modern Biotechnology, expert (2005-2008)• ILSI Europe (International Life Sciences Institute), Scientific and AdvisoryCommittee (SAC), member (2003-2006, 2006-2009)• ILSI Europe (International Life Sciences Institute), Board of Directors (2010)• International Academy of Food Science and Technology (IAFoST), Fellow(2010-)• OECD Task Force for the Safety of Novel Foods and Feeds, tag, alelnök(2005-2009)• The University College of Dublin (UCD) Institute of Food and Health,Scientific Advisory Board, member (2009-).Other authors declare they have no conflicts of interest.

Received: 18 April 2011 Accepted: 29 September 2011Published: 29 September 2011

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doi:10.1186/1478-4505-9-37Cite this article as: McCarthy et al.: Research for food and health inEurope: themes, needs and proposals. Health Research Policy and Systems2011 9:37.

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http://www2.spi.pt/fahre/projectresults.asphttp://www2.spi.pt/fahre/projectresults.asphttp://ec.europa.eu/research/agriculture/scar/index_en.cfm?p=3_overviewhttp://ec.europa.eu/research/agriculture/scar/index_en.cfm?p=3_overviewhttp://www.steps-ph.euhttp://ec.europa.eu/research/agriculture/scar/pdf/scar_foresight_health_en.pdfhttp://ec.europa.eu/research/agriculture/scar/pdf/scar_foresight_health_en.pdfhttp://www.iaso.org/policy/euprojects/stanmarkproject/http://tinyurl.com/6xzx6vv

AbstractBackgroundMethodsResultsDiscussionConclusions

BackgroundMethodsWork of the experts

ResultsSupport at national levelEuropean collaborationMajor researcher groups and networksResearch systems at national levelsKnowledge needsSupport at European Union levelFood researchHealth researchFunding

DiscussionThematic research areasProcessingFood safety researchConsumersPolicy and regulation researchEpidemiologyDiseasesFood supplementationGenomics

Research system needsInfrastructuresStructuresProgrammesImpactsCoordination

ConclusionsAcknowledgementsAuthor detailsAuthors' contributionsCompeting interestsReferences

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