The Joint Programming Initiative on a Healthy Diet for a Healthy Life (JPI HDHL), involved 28 research institutes from seven European countries and New Zealand combined their expertise to form the Policy Evaluation Network (PEN). PEN, true to its vision, has improved knowledge, tools and capacity among its network and beyond to identify, evaluate and benchmark policies designed to directly or indirectly address physical inactivity, unhealthy diets and sedentary behaviour while accounting for existing health inequities.  

Through a series of consortium-wide activities, network meetings, presentations at (inter)national conferences and capacity building workshops with policy makers PEN has met, and indeed exceeded, its deliverables. PEN has published the first EU Food Environment Policy Index (Food-EPI) for Europe, and the first Physical Activity Environment Policy Index (PA-EPI).  PEN has developed a set of Selected Instruments for Multilevel PoLicy and impact Evaluation (SIMPLE) modules for physical activity and diet, and created an expert-led Methodologic Competence Platform to guide and sustain the data harmonization process across Europe long term.  PEN scientists have created simulation models, applied multiple research designs and used innovative online research methods –during COVID-19 restrictions– to deliver 50+ peer-reviewed publications. These include meta-, systematic- and narrative-reviews advancing, synthesizing and consolidating state-of-the-art evidence on policy determinants, frameworks, tools and research methods.  PEN has advanced our understanding of the unintended effects of policy interventions on persons with low income, and as part of its Early Career Network provided mentorship and prompted changes within JPI programmes to support early career professionals.  The Policy Symposium on NCDs prevention in Brussels (June 2022), organised by PEN, the H2020 projects CO-CREATE and STOP, and the Joint Action Best-ReMaP, culminated in a Call To Action outlining key policy, research and funding priorities necessary to prevent obesity.  In summary, PEN has provided a comprehensive roadmap for policy improvement for health promotion and prevention of non-communicable diseases, including obesity. 

WP1 Policy mapping and EPI development

Launch of Food-EPI reports in each partner country and at the EU level. Engagement with key stakeholders and policy makers, and extensive print and broadcast media coverage

Launch of the 11-country Food-EPI results in collaboration with STOP partners at the Policy Symposium in Brussels in Jun. 2022.

Over 70 academic experts from 20 countries, and 40 policymakers from four PEN countries engaged in an online consultation to advance PA-EPI development

A new PA-EPI was developed and disseminated through peer-review publication (N=1), online symposia at international conferences (N=3) and workshops (N=3)

PA-EPI tool was formally launched at the Policy Symposium in Brussels in Jun. 2022. The first PA-EPI was fully implemented in Ireland and formally launched in Aug. 2022.

WP2 Monitoring and surveillance

Key indicators for EU health monitoring for dietary, physical and sedentary behaviours were prioritized by policy-makers and researchers with the ultimate aim to embed policy evaluation measures in existing surveillance systems across the European Union

A searchable online catalogue with key indicators was compiled to provide an opportunity for key stakeholders to view available European indicators that can be employed to evaluate national level, public and private policy actions which influence diet, physical activity and sedentary behaviour

A set of unified questionnaire modules (SIMPLE modules) were developed and published to enable the measurement of variables that describe relevant key policy indicators for dietary, physical and sedentary behaviours and equity

A Methodologic Competence Platform, composed of experts from surveillance and monitoring systems, epidemiology and public health research was established to guide and sustain the harmonization process beyond the concluded PEN project.

WP3 Estimation and simulation of policy impact

A scoping review on the application of the GRADE system to support health policy making (e.g. guidelines) and policy evaluation (e.g. systematic reviews evaluating policy interventions) was developed and published (https://doi.org/10.1186/s13012-020-00984-2)

WP3 organized two very successful workshops on methods for impact evaluation in Munich and Rimini, involving internationally recognized scholars as contributors, and gathering more than 150 attendants in total

Project outputs were published in a variety of journals including Implement Sci, Adv Nutr, Eur J Epidemiol, Transport Res Part A. Several other works are currently under review

A set of methodological recommendations were delivered to improve impact evaluation through experimental methods, quasi-experimental methods on observational data, and simulation models and demonstrated through a series of applications, including nutrition labelling in France, the Catalunya soft drink tax, the Cycling May campaign in Gdansk, agricultural sugar price transmission in Italy, Vitamin D fortification in Europe

An article drawing the final methodological recommendations from the PEN project was produced and accepted for the PEN Special Issue, Eur J Public Health (forthcoming), exploring complementarities and synergies between quasi-experimental methods using observational data and simulation models to predict longer term health effect and their distribution.

WP4 Policy implementation evaluation

We conducted a meta-review to (1) identify determinants that were systematically indicated as occurring during the implementation processes and (2) identify differences in the presence of determinants across reviews versus stakeholder documents on healthy diet/PA/SB policies, reviews/stakeholder documents addressing healthy diet policies versus PA/SB policies targeting any population/setting, and healthy diet/PA/SB policies focusing on school settings (https://doi.org/10.1186/s13012-021-01176-2)

Another meta-review was conducted to investigate the context-related implementation determinants from seven domains (geographical, epidemiological, sociocultural, economic, ethics-related, political, and legal) that were systematically indicated as occurring during the implementation of obesity prevention policies targeting a healthy diet and a physically active lifestyle (https://doi.org/10.1186/s12889-022-13340-4)

Two scoping reviews were conducted to examine implementation processes for sugar-sweetened beverage taxation (https://doi.org/10.1186/s12961-022-00832-3) and public physical activity policies (accepted for publication: PEN Special Issue, Eur J Public Health, forthcoming) in terms of pre-implementation context, taxation instruments used and interactions in the implementation process

A systematic review was conducted that aimed to identify tools used to assess acceptability of policies targeting physical activity and dietary behaviour, and examine if acceptability differs depending on characteristics of the policy and of the respondents (accepted for publication: PEN Special Issue, Eur J Public Health, forthcoming)

Knowledge was synthesised on how implementation of policies promoting healthy diets, physical activity, and reducing sedentary behaviours is evaluated. The findings and lessons learned about policy implementation evaluation gathered within WP4 and WP6 were compiled and presented in nine case reports (submitted to BMC Public Health).

WP5 Equity and diversity of policies

Based on an umbrella review and expert panels, poor dietary intake in low-income groups is presented as an emergent property of a complex adaptive system that sustains a food environment that increases the accessibility, availability, affordability and acceptability of unhealthy foods

An umbrella review suggests that there is enough evidence to state that a reduction of socioeconomic inequalities in diet can be achieved through food taxation, but that evidence for policies related to other aspects of the food environment is still poor

Theories that aim to understand socioeconomic inequalities in health help to understand how broader daily living conditions (social practices, and material conditions that shape experiences of scarcity) may lead to a greater benefit of certain food environment policies for the healthfulness of diets of lower or higher socioeconomic groups

Based on a review of the literature, lower levels of physical activity in ethnic minority groups can be understood as an emergent property of a complex system of individual, social, cultural, economic, environmental and organisational influences. This system can restrict attractive opportunities for physical activity or disempower individuals of the choice to be physically active.

WP6 Policy in practice - Selected case studies

Recommendations to enhance the acceptability, adoption and implementation of an sugar sweetened beverages tax are: (i) address inconsistencies between identified beliefs and scientific literature, (ii) use raised revenue for health initiatives, (iii) communicate transparently about the purpose of the tax, and (iv) generate political priority for solutions supporting implementation (https://doi.org/10.1186/s12966-019-0843-0)

An RCT to investigate effects of different tax schemes on consumer food purchases in a Virtual Supermarket showed that a nutrient profiling tax targeting a wide range of unhealthy foods and beverages (i.e. those with a low nutritional quality) has more beneficial effects on consumer food purchases than taxation of SSB alone (https://doi.org/10.1017/S1368980021004547)

Walking, cycling and using public transport instead of car driving can enhance physical activity levels. Interventions promoting such transport modes are effective in reducing car use, but the effect is small. The effect strongly varies across studies and interventions. (Okraszewska et al. submitted to journal)

The implementation of SUMPs in Danish, Polish and German cities is hampered by complex institutional structures, the dominant role of motorised traffic as well as complexities surrounding the integration of national, regional and local policies. Motorisation rate, modal split, and public transport use can be utilised to assess the influence of SUMPs on physical activity (Okraszewska et al., accepted for the PEN Special Issue, Eur J Public Health, forthcoming)

Positive child perceptions of the value of the intervention and perceived behaviour change were reported as relevant facilitators to implementation. Parents are both supporting the implementation and themselves targets of fruit and vegetables interventions at schools, which could have implications for the design and implementation (https://doi.org/10.1186/s12966-022-01246-8)

WP7 Network coordination and dissemination

The core paper describing the scope and design of PEN was published in Food Policy in 2019 (DOI: 10.1016/j.foodpol.2020.101873)

The consortium undertook a process to agree on a PEN glossary of key terms in the field of policy evaluation for use within the overall PEN project, and potentially beyond. This glossary is available at the project website (https://www.jpi-pen.eu/pen-glossary-of-definitions.html)

The PEN Early Careers Network was established and delivered a successful mentorship programme to facilitate the exchange of guidance, expertise and experiences between project members. The PEN ECN has been taken as model for creating an ECN among the project of the JPI PREPHOBES call. Its activities started in Sept. 2022

16 PEN factsheets were created summarizing main results, conclusions and recommendations of the research areas covered by PEN, with the purpose to disseminate results to key target audiences in order to create long-term sustainable impact of the project results. The factsheets are available at the PEN website (https://www.jpi-pen.eu/outcome/fact-sheets.html)

In collaboration with the Horizon2020 projects CO-CREATE and STOP and the JA Best-ReMap, the Policy Symposium on NCDs prevention took place in Jun. 2022 in Brussels as a major event bringing together policymakers and experts working in nutrition and physical activity, to present and discuss recommendations for optimal policy implementation to promote healthy diets, physical activity and to reduce sedentary behaviour across Europe (https://www.jpi-pen.eu/policy-symposium.html)

A special scientific journal issue including 13 papers presenting final results of PEN is to be published by the Eur J Public Health over autumn 2022 with the title “Creating evidence for public policies to improve dietary and physical activity behaviours in Europe”.