**Equitable Access to Healthy Diets: Nutrition-Based Interventions of the Healthy Life Project and Trends in Dietary Risk Factors in the Republic of Moldova**

#### **Ala Curteanu1,2, Constantin Rîmis1, Meike Zuske3,4, Cristina Rotaru1 , Carolyn Blake3,4, Leah Bohle3,4, Florence Sécula3,4, and Helen Prytherch3,4**

1Healthy Life Project: Reducing the Burden of Non-Communicable Diseases in Moldova, Chisinau, Moldova 2Mother and Child Institute, Chisinau, Moldova

3Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland 4University of Basel, Basel, Switzerland

Global transformation processes are affecting human life and the shape of our planet. Rural areas are decaying while cities are expanding, and the gap between rich and poor is widening. Against these challenges, there is an increase in non-communicable diseases (NCDs) linked to dietary risk factors. We place special focus on the nutrition-based interventions of the Healthy Life Project, established in the Republic of Moldova in 2017, to combat NCDs and improve population health. The project has built capacities in public health, health promotion, and risk reduction: local government and community-led actions linked to nationwide campaigns addressing the high levels of salt and trans fat consumption, reducing sugar intake, and promoting intake of fruit and vegetables. The exchange has been facilitated between supermarkets, food producers, and public health experts to influence national regulations on salt levels. To measure trends related to dietary and other risk factors, a controlled trend study using the Knowledge, Attitudes, and Practices survey method was conducted in 2017 and 2020. Data were collected in 10 intervention and 10 control districts. A total of 930 and 945 respondents participated in the surveys in 2017 and 2020, respectively. More respondents consumed industrially produced foods and salty snacks, as well as sugary foods and drinks only occasionally or never (from 69% in 2017 to 74% in 2020, as well as from 37% in 2017 to 43% in 2020, respectively). Knowledge about the harms of trans fats was higher in women (85% compared to 71% in men) and in respondents between 45 and 69 years of age (80% compared to 77% in younger participants).

The consumption of fruits and vegetables increased (from 64% in 2017 to 71% in 2020 and from 68% in 2017 to 80% in 2020, respectively). In 2020, nearly 30% of respondents had no access to fruits and vegetables in all seasons, especially in the older age group and in participants with an NCD. Although some positive trends are identifiable, the question of equitable access to healthy food becomes pivotal. Strategies to promote and strengthen local markets, as well as innovations of delivery to vulnerable groups, need to be developed.

#### SwissTPH

**Swiss Tropical and Public Health Institute Schwe zerisches Tropen- und Public Health-lnstitut lnstitutTropicalet de Sante Pubtique Suisse**

#### Authors

Ala Curteanu1,2, Constantin Rîmis1, Meike Zuske3,4, Cristina Rotaru1, Carolyn Blake3,4, Leah Bohle3,4, Florence Secula3,4, and Helen Prytherch3,4

1Healthy Life Project: Reducing the Burden of Non-Communicable Diseases in Moldova, Chisinau, Moldova

2 Mother and Child Institute, Chisinau, Moldova

3 Swiss Tropical and Public Health Institute, Allschwil, Switzerland

4 University of Basel, Switzerland

#### Introduction

Global transformation processes are affecting human life and the shape of our planet. Rural areas are decaying while cities are expanding. and the gap between rich and poor is widening. Against these challenges. there is an increase in non-communicable diseases (NCDs) linked to dietary risk factors. We place special focus on the nutrition-based interventions of the Healthy Life Project. established in the Republic of Moldova in 2017 to combat NCDs and improve population health.

### Methods

The project has built capacities in public health, health promotion and risk reduction:

Local government and community-led actions linked to nationwide campaigns addressing the high levels of salt and trans fat consumption, reduce sugar intake and promote intake of fruit and vegetables.

Exchange has been facilitated between central authorities. supermarkets. food producers and public health experts. to influence national regulations on salt and trans fat levels.

Educational activities to promote healthy food in the Health Promotion Schools. during the local level awareness campaigns on reducing consumption of salt and trans fats. were implemented.

To measure trends related to dietary and other risk factors, a controlled trend study using the Knowledge, Attitudes and Practices survey method was conducted in 2017 and 2020. Data was collected in IO intervention and IO control districts 930 and 945 respondents participated in the surveys in 2017 and 2020 respectively.

Proportion of respondents consuming fruits and vegetables daily and proportion of respondents with no access to fresh fruits and vegetables

*Example 2: Healthy food choices campaign. 2020.*

#### Results

More respondents consumed industrially produced foods and salty snacks. as well as sugary foods and drinks only occasionally or never (from 69% in 2017 to 7 4% in 2020. as well as from 37% in 2017 to 43% in 2020, respectively). Knowledge about the harms of trans fats was higher in women (85% compared to 71% in men). and in respondents between 45-69 years of age (80% compared to 77% in younger participants) The consumption of fruits and vegetables increased (from 64% in 2017 to 71% in 2020, and from 68% in 2017 to BO % in 2020, respectively) (Figure 1). In 2020, nearly 30% of respondents had no access to fruits and vegetables in all seasons (Figure 1). especially in the older age group and in participants with an NCO.

#### Conclusion

Although some positive trends are identifiable. the question of equitable access to healthy food becomes pivotal. Strategies to promote and strengthen local markets. as well as innovations of delivery to vulnerable groups. need to be developed.

*Figure 1. Selected results of the Knowledge, Attitudes and Practice surveys 2017 and 2020.*

*Example 1: Video spot of the salt reduction campaign, 2019.*
