Obesity

Health4EUKids – WP4: the workshop in Rome (March 2025)

Focus: sustainability and Policy dialogue

On March 27–28 2025, the second in-person meeting of Work Package 4 (WP4) of the European project Health4EUKids took place in Rome, at the Italian National Institute of Health (ISS). The event marked a key moment to assess the project’s progress and define strategies to ensure its sustainability and transferability at the European level.

The two-day meeting brought together all consortium partners from Greece, Malta, Spain, Belgium, Finland, Hungary, Slovenia, Lithuania, Croatia, Poland, Portugal, and Italy, and actively involved the leaders of all Work Packages. Opening remarks were delivered by Giovanni Capelli, Director of the National Centre for Disease Prevention and Health Promotion (CNaPPS) of ISS, alongside the project coordinator Apostolos Vantarakis (University of Patras) and the WP4 coordinators Chiara Cattaneo and Angela Giusti (ISS).

The work of the first day of the workshop

During the first day, the partners presented their plans for the final year of the project (which ends in 2025) relating to the various Work Packages: from the WP on coordination and dissemination to evaluation, and the two groups dedicated to the implementation of the two Best Practices at the heart of the project, “Grünau Moves” and “Smart Family”.

Particular attention was paid to the DELPHI process developed by WP4, a fundamental tool for identifying shared sustainability criteria for the Best Practices implemented. During the meeting, the results of the first round of DELPHI were presented, which involved 34 experts from ten European countries, including members of the advisory committee, project partners and external stakeholders with multidisciplinary expertise in public health, nutrition, health economics, health promotion and policy implementation.

Assessments of both interventions (Grünau Moves and Smart Family) were collected and analyzed using a qualitative questionnaire based on the Dynamic Sustainability Framework. It covered nine thematic areas, including adaptability, governance, financial sustainability, and equity. Key findings highlighted the importance of bottom-up co-design, alignment with local policies, and the need for intersectoral governance structures. Regarding funding, structural EU funds and municipal budgets were found to be effective. Integration into health systems benefited from anchoring the practices to national strategies, such as Spain’s 2022–2030 plan against childhood obesity.

The importance of participatory evaluation and adaptive communication also emerged, suggesting the use of tools such as local dashboards, awareness campaigns and multilingual information materials. Discussions reinforced the value of a flexible yet structured approach, able to adapt to national and local contexts while promoting consistency and replicability across Europe.

Through group work and plenary sessions, participants developed concrete ideas on how to integrate these interventions into National Health Systems.

In the Grünau Moves group, participants highlighted the importance of active community involvement, supported by formal mechanisms such as regulatory frameworks enabling intersectoral health planning tables, involving local authorities, health services, and civil society. Binding protocols between municipalities and local health authorities proved particularly effective in overcoming funding interruptions or political changes. The model is based on shared leadership, with a guiding role for local health services, strengthening alignment with long-term public health goals.

The discussion also underlined the value of leveraging existing local initiatives, promoting bottom-up alignment instead of top-down replacements, an approach that fosters community trust and ownership. However, political variability remains a critical issue: even with legal mandates, administrative turnover can disrupt continuity, underscoring the need for multi-institutional engagement and strong support networks.

On economic sustainability, participants proposed integrating Grünau Moves into ordinary funding streams, such as regional structural funds for public health, and promoting participatory budgeting at the municipal level. Public-private partnerships were rejected as inappropriate for sensitive areas like nutrition. Instead, approaches that reorganize existing resources, such as schools, law enforcement, and health services, were valued. A notable example involved training police officers already engaged in supporting isolated individuals to promote proper hydration and nutrition behaviors at no additional cost.

The strength of the model lies in its adaptability and strong principles of participation, co-design, and inclusion of vulnerable groups, enabling tailoring to local contexts. Engagement strategies vary across regions, from using schools as access points to participatory observation methods. Mediterranean countries noted a cultural affinity with the program due to dietary patterns, but also challenges related to rising healthy food prices, disproportionately affecting vulnerable populations.

In the Smart Family group, the focus was on the challenge of integrating the intervention into healthcare and educational systems and ensuring long-term sustainability. It was clarified that Smart Family is not purely a digital intervention but a methodology to promote a shift in approach among professionals and families. Digital tools (e.g., Smart Family Cards and QR codes) are supportive, but not central to the program. Major barriers identified included low digital literacy and cultural resistance to technology, particularly among vulnerable populations. Proposed solutions included accessible visual materials and simplified platforms to support professionals’ training.

Regarding integration, the need to overcome fragmentation between health, education, and social sectors emerged, proposing Smart Family as a routine part of professionals' work, tied to continuous training programs. Some countries explored aligning the program with existing early childhood, public education, and primary care initiatives.

Scalability challenges included lack of interoperability between information systems and fragmented data responsibility. Solutions included developing common guidelines, tailored approaches for different professional groups, and pilots in diverse local contexts.

In terms of sustainability, reliance on simplistic indicators such as BMI (Body Mass Index) was discouraged. Participants recommended using process-focused metrics, such as parental confidence or family "health climate," and participatory evaluations involving families. The aim is to capture deep, sustainable behavioral changes rather than immediate and potentially misleading results.

The work of the second day of the workshop

The second day focused on Policy Dialogue, another key element to ensure institutional transferability, sustainability, and scalability of the Best Practices. Sessions provided practical tools and shared experiences from Finland, Slovenia, and Lithuania. Rather than mere result dissemination, Policy Dialogue is a structured process designed to engage policymakers, key stakeholders, and representatives from various sectors (not only health) in action-oriented, solution-driven discussions.

As explained by Nella Savolainen (THL, Finland), Policy Dialogue can either initiate a long-term political process or build on existing initiatives. Its value lies in creating a shared space to foster consensus, trust, and ownership, promoting intersectoral dialogue and enhancing transparency and accountability in the implementation of agreed actions.

For Smart Family, objectives may include identifying legislative opportunities, creating intersectoral collaborations (e.g., health, education, social services), involving new stakeholders, or launching innovative decision-making processes. Expected outcomes range from the development of monitoring tools to identifying funding options and promoting behavioral change among key personnel.

Working groups discussed how to structure and activate effective Policy Dialogues in their countries, starting from existing experiences and defining concrete, realistic future actions to support the systemic adoption of the Best Practices.

The meeting concluded with a joint discussion among all partners to define next steps ahead of the project’s conclusion.

The Rome meeting emphasized the importance of collaboration in strengthening partnerships and promoting an integrated European approach to preventing childhood obesity and fostering healthy lifestyles, with particular focus on parental support. As the hosting partner, the ISS reaffirmed its commitment to disseminating and integrating the Best Practices internationally, while facilitating dialogue with other ongoing European projects.

In this context, a session was dedicated to the synergy between the Health4EUKids Best Practices and those promoted under the Joint Action (JA) Prevent Non-Communicable Diseases (JA PreventNCD), with a particular focus on supporting families, young children, and the Baby-Friendly Community and Health Service initiative coordinated by WP6 of the latter project. Through shared participation in both Joint Actions, Italy, Spain, and Greece are developing coordinated actions that bridge the two projects, aiming to enhance integration and ensure long-term sustainability.

This was also the context for an encounter with a group of students from the University of Patras, hosted by ISS during the two-day event, an invaluable opportunity to foster intergenerational dialogue on current research topics, share knowledge, and strengthen focus on training and capacity-building in public health and health promotion.