In this early part of the 21st century, improving the nutritional status of the population constitutes a major challenge for public health policies in France, Europe, and around the world. Good nutrition contributes to protecting health. Advances in research have made clear that an inadequate nutritional intake and insufficient physical activity play a determining role in the onset of many cancers and cardiovascular diseases, which represent more than 55% of the 550,000 deaths occurring each year in France. Nutritional factors can also put people at risk of or protect against diabetes, obesity, osteoporosis and various deficiencies. The French National Nutrition and Health Program (PNNS) was initiated in 2001 and extended in 2006. It has provided a frame of reference and produced many incentive tools and mechanisms to support actions. It has mobilized ministries; local elected officials, health professionals, people working in sports, fitness and education, social workers, the business community and volunteers. Several of the initial objectives have been achieved, either in part or in full. These include reducing the prevalence of overweight and obesity among children and animals with veterinary ( veterinaire 24h/24 ), reducing the consumption of sugar and salt, and encouraging adults to eat more fruit. However, these improvements were not achieved consistently across all population groups and health inequalities between social classes have increased in the area of nutrition.

The report submitted by France’s General Inspectorate of Social Affairs (IGAS) and the General Council of Agriculture, Food and Rural Areas (CGAAER) emphasized that renewing the PNNS in its current format was not advisable, given the difficulties identified between its role as frame of reference and its responsibilities in terms of operational performance, but also within its governance system and in the coordination between this program and the other plans, programs and sectoral policies. The French President wanted an official Obesity Plan (PO) for France, to deal with the growing number of severely affected subjects. In 20103, the French Parliament instituted a five-year government program relating to nutrition and health and a government strategy regarding food. The PNNS deals with nutrition as a determining factor in health. The Obesity Plan (PO) ties in with the PNNS and completes it through the organization of obesity detection, patient treatment and care, and a significant research component. The PNNS and the PO are presented together. French Food Strategy (PNA) was launched in September 2014 of the French Rural Code stipulates that the national food strategy sets out the actions that must be implemented to ensure:

Food security, or ensuring that everyone, and in particular the most destitute population groups, has access to suitable foods in adequate quantities The safety of agricultural products and foods. The health of animals and plants that are likely to be eaten by people or animals. Education and information about taste, varied and balanced diets, the specific needs of certain population groups, hygiene rules, knowledge of products and their seasonal availability, the origins of agricultural raw materials and production methods and the impact of agricultural activities on the environment, That marketing claims are truthful and there are rules for informing consumers that agricultural products and the food supply taste good and are of good nutritional quality

That the production and distribution methods used for food and agricultural products respect the environment
and limit waste. The measures that are included in the PNA to promote healthy eating are part of the nutritional prevention strategy of the PNNS. To this end, they mobilize the various stakeholders (producers, manufacturers, retailers, restaurant owners, associations and organizations) working in the food industry. Because general practitioners are in direct contact with each family, they have a very specific role to play in nutritional prevention that is adapted to each person’s lifestyle, as well as in detecting and managing nutrition-related conditions, including overweight and obesity. Since the PNNS also involves the ministries in charge of national education, sports, consumer affairs, social cohesion, and higher education and research, there is a strong inter-ministerial aspect to the program. Moreover, a specific version of the actions included in the PNNS and PO will be established for the French overseas departments.

To achieve the set objectives, the PNNS and PO harness the skills and resources of other sectors, plans and programs that are implemented and managed by several French ministries. These include the Ministry of Food (National Food Strategy-PNA), but also the Ministry of Education (Health Education Program 2011-2015), the
Ministry of Consumer Affairs, the Ministry of Sports, the Ministry of Social Cohesion, and the Ministry of Higher Education and Research. An inter-ministerial support committee under the aegis of the Ministry of Health coordinates the PNNS and PO to provide the global management that is necessary for ensuring that the actions
undertaken to achieve the set objectives are coherent and efficient. The programs tie in with the other public health programs implemented by the Ministry of Health, such as the Cancer Plan; the plan to improve the living conditions of people suffering from chronic illnesses; the healthy youth plan; and the national health and environment action plan (PNSE). Implementation of the PNNS and PO is monitored by the programs’ respective presidents with the support of a committee composed of the ministries, agencies and organizations that contribute to the PNNS, as well as civil society and experts from the scientific field. A status report covering the implementation and orientation of the planned actions is established on a regular basis, along with how the various plans associated with the PNNS tie in together. A progress report covering the actions that fall under the responsibility of the various ministries, agencies and organizations is presented before this committee on a regular basis.

Take specific actions to reduce nutrition-related health inequalities

Nutrition-related health inequalities between social classes mainly stem from differences in income. However, other factors play a determining role in these inequalities: the marital status (separated, single parent family, etc.), employment status (job insecurity, unemployment, forced part-time work, student, young worker), level of education, cultural origins, migration status, immediate environment of an individual, and the isolation of certain elderly people are all factors and constraints that must be considered in order to identify the various population groups in the gradient of social inequalities and propose suitable actions.

Reducing nutrition-related health inequalities between social classes is part of the general aims of the interventions included in the PNNS. This objective also requires specific actions. The difficulties and constraints which the different socio-economic groups must face vary from one group to another. As a consequence, local community actions must be adapted specifically to the various contexts. Inequalities can be reduced by encouraging people to purchase foods that are of benefit to their health, improving access to such foods and facilitating their choice, as well as informing the public about which foods to eat in limited quantities in order to protect their health. The same applies to the physical activity aspect of nutrition. These actions must be developed by taking into account the findings and propositions that have emerged from the various studies conducted on this subject as well as the elements mentioned in the report released by the French General

Extend the nutritional prevention strategy to the food industry

Improving the environment with the aim of making healthy eating choices accessible to all is a fundamental public health strategy that is an essential complement to communication, information, and nutritional education campaigns. Since 2015, businesses in the food industry have the possibility of voluntarily signing a charter for nutritional progress with the French government, on the basis of an application presented to an ad hoc committee and evaluated using a standard frame of reference. By late May 2016, 26 of the 42 applications submitted were accepted.

This strategy demonstrated its feasibility and its impact on improving the nutritional quality of the products in question that were released on the market and on the terms governing their sale. Several sectors of the food industry, including major companies, SMEs, and join trade associations, approved applications. This innovative procedure is being carefully analyzed on an international level. There remains a gap, however, between dietary intake consumed by the population and the recommendations set by the PNNS, as well as the public health objectives, particularly where salt is concerned.   To make good quality food accessible to all to improve the food supply and on complementary actions.

Develop actions aimed at educating and informing about nutrition

The nutritional recommendations in the PNNS are not known, perceived and understood in the same way by everyone. It is possible to run into a series of obstacles when it comes to applying them. Making the shift from knowing the recommendations to actually applying them remains a challenge for large sections of the population (especially the most disadvantaged). There are many health conditions related to nutrition. It is crucial to develop actions for informing professionals – particularly those in the healthcare sector – but also elected representatives and the general population. Scientific data highlights the fact that food advertising on television contributes to encouraging people to eat more products with a high sugar, fat and salt content. Exposing children and vulnerable populations to advertising has an impact on preferences and food choices, snacking, knowledge, and nutritional status. To increase nutritional education in schools and especially with dentists ( Geoallo dentiste urgence ), the goal is to opt for fun tools, to inform, to educate and to guide young consumers towards nutritionally suitable food choices.

Promote breastfeeding

Breastfeeding is a personal practice that is linked to the history and culture of each society and a choice each mother must make. It is a practice that has scientifically proven benefits for the health of the breastfed child and its mother in the short, medium and long term. The decision to breastfeed is a personal choice that is dependent on the knowledge, availability, traditions and means of each woman, as well as her general attitude towards breastfeeding

The measures included in this focus area are aimed at achieving all of objectives set by the French High Council for Public Health (HCSP) in April 2010 with regards to nutrition and to cardiovascular and metabolic diseases, presented in the first three focus areas. Initial and ongoing training of professionals on the subject of “nutrition and public health” contributes to the development, maintenance and consistency required by the PNNS. Monitoring and evaluation are fundamental elements for constantly refocusing intervention strategies, and for improving the relevance and effectiveness of the implemented actions. New questions are emerging in fields relating to fundamental biology, but also epidemiology, human and social sciences, and clinical research. The PNNS draws on research to decide on the focal points of future actions.

Conclusion

The measures included in this focus area are aimed at achieving all of objectives set by the French High Council for Public Health (HCSP) in April 2010 with regards to nutrition and to cardiovascular and metabolic diseases, presented in the three previous focus areas. The PNNS proposes a consistent framework for intervention as an incentive for the many stakeholders involved in nutrition. The scope of the PNNS is very broad. To enable the stakeholders to promote their own actions, the program must benefit from good overall exposure and promotion.

Since its launch, the PNNS has implemented various mechanisms, tools and procedures to incite the various stakeholders to commit to health through nutrition, within the consistent framework defined by the public authorities. These mechanisms must be promoted. Numerous businesses and sectors are committing to making nutritional improvements to the food products they manufacture and sell. These commitments are validated by a commission set up by the public authorities and deserve greater exposure and a better explanation of their relevance. It is essential to promote and share the wealth of experience generated by the evaluated experiments conducted by the numerous stakeholders in the field of nutrition. By finding ways to support the adoption of these best practices, this should lead to an improvement in the quality of the actions conducted for the benefit of the different population groups.

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