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A History of the European Nutrition for Health Alliance

Summary of activities
The European Nutrition for Health Alliance was established 2005 to raise awareness of the importance and urgency of undernutrition and appropriate nutritional care as well as to build an agenda at EU and member state level 2005-2010 Raising Awareness Key achievements and activities included: Roundtable resulting in Malnutrition among older people in the community: Policy Recommendations for Change report Prague Declaration to acknowledge and address malnutrition Inclusion of malnutrition as a priority issue in Together for Health European Parliament Health Strategy 2008-13 and European Parliament White Paper on Nutrition, Overweight and Obesity (June 2008) Health and Economic Impact of Malnutrition in Europe Study Belgian European Parliament event and Belgian EU Presidency Conference

2011-13 Nutritional Screening and Follow up Care Campaign Key achievements and activities included: Polish declaration on the fight against malnutrition 1st country to commit to routine nutritional screening and follow up Signing of Memorandum of Understanding signed between ENHA and the European patient groups leading to two successful conferences Implementation of policy on appropriate nutritional care including screening. In 2012 work began in Belgium and in 2013 in Ireland. Co-ordinator and Chair of undernutrition group for the European Innovation Partnership on Active & Healthy Ageing Action group A3 on Frailty and Functional Decline Co-ordinator of screening group for the European Innovation Partnership on Active & Healthy Ageing Action group A3 on Frailty and Functional Decline Strategic advisor and observer to WHO Euro and to raise the profile of undernutrition in this vital policy area

Introduction The European Nutrition for Health Alliance was established in 2005 to raise awareness of the importance and urgency of undernutrition and appropriate nutritional care as well as to build an agenda at EU and member state level The aim of the organisations early work was to raise awareness of the issue of malnutrition and Create momentum for change through the development of partnerships and co-branding. support implementation of nutritional screening across Europe This document charts the annual activity of the European Nutrition for Health Alliance (ENHA) outlining the work conducted, its aims and outcomes as well as the evolution of the organisation from its inception to the present day. Founding members: European Society for Clinical Nutrition and Metabolism (ESPEN), European Union Geriatric Medicine Society (EUGMS), European Hospital and Healthcare Federation (HOPE), European Nurse Directors Association, International Longevity Centre-UK

Establishment and raising awareness 2005-2010 2006 UK/EU Presidency ENHAs first event was held in the UK in 2006, following on from successful partnership with ILC-UK in 2005. The UK held the Presidency of the EU during this time and the British Association for Parental and Enteral Nutrition (BAPEN) was very active in tackling undernutrition compared to other countries, making it an ideal starting point to raise the profile of ENHA and its members. As a result in partnership with the ILC-UK and the British Association for Parenteral and Enteral Nutrition and in collaboration with Associate Parliamentary Food & Health Forum a round table event was held at the House of Lords, leading to the report Malnutrition among older people in the community: Policy Recommendations for Change. (http://www.europeannutrition.org/index.php/events/malnutrition_among_older_people_in_the_community_policy_reco mmendations_for) 2007 Prague Conference and Declaration This declaration was the culmination of collaborative work between ENHA and its members resulting in a joint Press Release from Medical Nutrition International Industry, the European Society for Clinical Nutrition and Metabolism (ESPEN) & ENHA. The release highlighted the work of the large scale collaborative study Nutrition Day and the high prevalence of malnutrition in found in hospitals across Europe. At the annual ESPEN conference in 2007, the group signed a declaration to: Acknowledge malnutrition Recognise malnutrition Affirm access to proper nutritional care as a fundamental human right Offer political direction & support 2

Provide coherent reimbursement policies Develop nutrition care plans for all health care settings and promote the implementation of existing solutions.

2008 Air, Water, Nutrition Its a Basic Need Campaign The aim of this campaign was to highlight awareness of malnutrition and the vital importance of good nutrition in maintaining good health. It also aimed to raise the profile of ENHAs work and garner further support for our activities across Europe.

2008-2010 Health and Economic Impact of Malnutrition in Europe Study As a part of ENHAs work to raise awareness it was noted that there was a lack of research into the costs associated with malnutrition across different care settings. As such this study was developed to consider the prevalence, health and economic impact of malnutrition in care homes, hospitals and the community. Results where available were published in peer review publications (Clinical Nutrition see http://download.journals.elsevierhealth.com/pdfs/journals/02615614/PIIS0261561411001488.pdf) and have since been extensively used to support ENHAs work and by other organisations across Europe.

2008 Malnutrition amendments in key European Parliament documents Together for Health European Parliament Health Strategy 2008-13 As a result of extensive work, lobbying and discussion with MEPs conducted by ENHA and its members, It was unanimously agreed to include amendments proposed by ENHA whereby malnutrition be stated as a key target area for policy development and work within the EU in the next 5 years. ENHA had previously highlighted the prevalence of malnutrition in hospitals and care homes. This amendment gave malnutrition equal weighting to other key public health challenges in Europe such as cancer, diabetes, cardiovascular disease, mental health and obesity. European Parliament White Paper on Nutrition, Overweight and Obesity (June 2008) As a part of the consultation process on this paper, ENHA wrote to the Members of the European Parliament to ask them to: Urge the Commission to make malnutrition alongside obesity a key priority in the fields of nutrition and health incorporating wherever possible into EU funded research initiatives and EU level partnerships ENHA went on to request several amendments including highlighting malnutrition and its associated cost which was almost equal to that of obesity. The work drew attention to the problem of malnutrition and defined it as well as highlighting the burden for the individual and society. It called on the Commission to devote greater attention to the problem of malnutrition, especially in older people.

2008 European Parliament working lunch, November Hosted by Alonjzo Peterle, MEP and in collaboration with the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Union Geriatric Medicine Society (EUGMS), this event aimed to raise awareness and provide solutions on ensuring good nutrition in Europe. It was attended by representatives from European Non- governmental organisations, parliamentary groups, EC, industry and academics demonstrating the impact ENHA had had in raising awareness and highlighting the issue of malnutrition in the three years since its formation.

2010 Belgian European Parliament event and Belgian EU Presidency Conference This high profile event reflected a culmination of ENHAs work in awareness raising both among health and social care professionals and on a European level where malnutrition was recognised as a significant issue to be addressed in European health policy. Attendees included MEPs, representatives of the EU Presidency and other member states, EU NGOs, European Professional Societies, Academics and Industry.

Moving forward activities 2011-13 Nutritional Screening and Follow up Care Campaign

The work ENHA undertook between 2005-2010 primarily aimed to raise awareness and develop and ensure the legitimacy of the organisation, garnering support from key organisations and the European Parliament. From 2011, ENHA, adapted its work programme from obtaining high level European political support to working to effect change on the ground through national partners as well as local or regional organisations. As the previous years had ensured that ENHA had obtained political support on a European level (as evidenced by the recognition of malnutrition as an issue and the adoption of amendments into key policy papers), it was appropriate within the dynamic of the organisations growth to develop further strategic steps which would support the organisations goal of shifting from policy and awareness to implementation of practical solutions.

2011 Polish declaration on the fight against malnutrition Poland was the first country to collaborate with ENHA on developing a national nutritional care policy, resulting in a commitment for change and actions which would result in good nutritional care for its citizens. Outlined four key actions to address disease related malnutrition. Screening Awareness Reimbursement Education 2011/12 Focus on Implementing nutrition screening and follow up During this period ENHA focused on operationalizing its work platform and extending its work both in collaboration with key partners and throughout European member states. 4

ENHA developed a plan to action the implementation of nutritional screening and follow up care across EU member states, the aim of which was to include routine screening and monitoring for malnutrition in all care settings. Whilst countries would decide the appropriate methods by which they would develop screening in conjunction with their current work and policy climate, the aim was to continue with raising awareness on a national level and ultimately to ensure the implementation of policy on appropriate nutritional care including screening. In 2012 work began in Belgium as a pilot country. This work was further developed with Ireland the focus for 2013 and leadership in establishing stakeholder groups through ENHA member and partner Medical Nutrition International Industry at a country level. This period also saw a shift in terminology used by ENHA, involving a move away from the use of the word malnutrition (as this term may also include obesity) and adopted use of term undernutrition in line with other key European Organisations working in this area.

2012 Memorandum of Understanding signed between ENHA and the European patient groups EGAN and EPF. This was the first step in defining a framework for mutual co-operation and demonstrates ENHAs continuing commitment to developing new ways of working, establishing new partnerships and collaborative efforts to address undernutrition. Since signing the document ENHA, EGAN & EPF have collaborated on two successful conferences. Brussels 2012 - 1st invitational conference on nutrition for EU patient groups. This conference resulted in a well-received report which further widened the audience and demonstrated the vital link between good nutrition and patient health for a variety of conditions. Dublin 2013 - Patient Perspectives on nutrition The second collaborative conference, which took place during the Irish Presidency of the EU, produced a booklet which has further increased interest in the issue of nutrition among patient groups. It coincided with a Call for Action made by the conference to the Irish Government to recognise its previous commitment to

2012 European Innovation Partnership on Active & Healthy Ageing Action Group A3 Frailty and Functional decline ENHA signed a commitment to join this group in May 2012 and was asked to chair and co-ordinate a group on undernutrition. Since then we have been asked to extend our role and co-ordinate a working group on screening. ENHA has a key role in this partnership as a leader in undernutrition issues and continues to develop work within the programme in line with our agenda.

2012/13 World Health Organisation 5

In 2012 ENHA was invited to advise WHO Europes work on nutrition including consulting on the proposed Food and Nutrition Action Plan. In July 2103 ENHA was asked to attend the WHO Ministerial conference in Vienna. At this conference the Vienna Declaration on Nutrition and Non-communicable diseases in the Context of Health 2020 was signed by the WHO EURO members states. In summary, the Declaration provides the political mandate to develop and later implement the Food and Nutrition Action Plan 2014 2020. The Declaration covers key elements of our agenda as it

includes the mandate to tackle undernutrition, alongside overweight and obesity, in the WHO EURO Food and Nutrition Action Plan 2014 2020 urges to reinforce health systems to promote health and provide services for o Nutritional interventions including counselling and care o Nutritional assessment and intervention procedures o Specific needs for risk groups, especially the needs of the aged population

ENHAs work ensured that undernutrition in Europe was highlighted as both an issue and a priority for inclusion in the Food and Nutrition Action Plan. ENHA continues in its role as a strategic advisor and observer to WHO Euro and to raise the profile of undernutrition in this vital policy area.