A review of studies by this working group documented that high fruit and vegetable intake is associated with lower prevalence of many Non-Communicable Diseases (NCD). This association is particularly well-founded for certain cancers (3, 11). The report estimates that an increase in fruit and vegetables intake to 600 grams daily will reduce the risk of cancer and Ischemic Heart Disease by 15 – 30% (3). In relation to the current daily intake of 280 grams/day, a two fold increase in consumption is necessary.
A variety of campaigns, and general information have contributed to increasing the level of health knowledge in Denmark, resulting in 99% of the adult population are aware that fruit and vegetables are healthy (4). Other studies show that especially those responsible for meal planning and preparation in families with children are motivated to prepare food with more fruit and vegetables (4,5). The 1995 national dietary survey and analysis of data from Denmark's Statistical Bureau, suggest that knowledge and motivation are not sufficient to increase fruit and vegetable intake in Denmark.

Figure A. Consumption of fruit and vegetables in Denmark from 1986 - 1996. (source: Denmarks Statistical Bureau)
The projects main aim is developing and testing concepts and methods, which make it easier for individual consumers to acquire and eat more fruit and vegetables. This project is in compliance with 3 food policy initiatives issued by government agencies during the last year.
The Danish Cancer Society and The Danish Food and Veterinary Agency, have worked actively to identify and analyze barriers to increasing fruit and vegetable intake. The 1995 report "Is it possible to eat more carbohydrates", (4) suggested that the most widespread and significant barrier, is the populations' misconception that they already consume an adequate amount fruit and vegetables. This finding is the main reason for publication of specific recommendations for daily intake of fruit and vegetables. A number of later studies confirmed these findings (sources or delete).
Another important barrier is time available for meal preparation. The 1995 national dietary survey (5) found that time was the most important barrier for persons who do not eat as healthy as they would like to. Time was also listed as a decisive factor in a recent analysis of the population's use of recipes (8). Finally, a telephone survey undertaken by the Danish Cancer Society and the Produce Marketing Association confirmed that time is an important factor, finding that time was the next most important barrier. Perhaps it is lack of time that explains individual preference of fruit to vegetables in both England and Denmark (6, 7). The majority of vegetables are time intensive to prepare, while fruit generally can be eaten immediately without preparation. The fruit and vegetable industry in USA has recognized this, and has marketed and successfully sold a variety fruit and vegetable convenience foods for a number of years - making eating more fruit and vegetables easier.
The third and very significant barrier which this project builds on, is lack of access to fruit and vegetables. That is, the assumption that people will eat more fruit and vegetables, if access to these healthy choices is made easier. Analysis of American school childrens' intake of fruit and vegetables, showed clearly that intake on weekdays and during the weekend was substantially different, and can largely be attributed to an extensive net of cantinas that ensure students' access to fruit and vegetables every day. In a project financed by the British Ministry of Agriculture (MAFF) (6), interventions studies an increased fruit and vegetable intake from 324 to 557 grams/day. The methods that subjects found most useful, were all related to practical ways to increase access to fruit and vegetables in their everyday lives.
Finally, a recently published American study (13) shows that access is decisive for the magnitude of intake. In this study, parents were interviewed about the availability of 10 fruits and 10 vegetables in the household, and access by determining how readily consumable the fruit and vegetables were. The results showed that the degree of preparation influenced intake, e.g. carrots are first accessible by children when they are peeled, cut and placed in the front of the refrigerator.
Cooperation with the retail trade sector has a great potential for increasing purchases of fruit and vegetables significantly - and consequently intake, making the retail trade a particularly effective intervention point. Fruit and vegetables purchases in Denmark can be categorized as impulse purchases. In this context, supermarkets can have a great effect on fruit and vegetable purchases, because the decision to purchase fruit and vegetables is likely to take place in the retail outlet.
Retail outlets are also important as an intervention area, because this is where the greatest part of marketing for fruit and vegetables takes place. The Retail sector has abundant experience with sales promotion activities, and fruit and vegetables are a high markup product category with a good profit growth potential for the retail sector. Consequently the retail sector will be a motivated and important collaborative partner. Cooperation with the retail sector also offers the possibility of daily collection inexpensive, precise Point of Sales data for specific products or product groups, making measurement of the effect of eventual interventions in the retail outlets relatively easy.
Experiences, especially in the USA, show that increased collaboration between health organizations, the fruit and vegetable branch and the retail sector can result in increased sales (10).
This project's collaborative partners have a common belief that there is a large and previously unexploited potential to establish wide reaching cooperation between growers, the food industry, governmental agencies and non governmental organizations to achieve the projects objectives. In the project a synergetic effect should be created, by establishing of new collaborative relationships between authorities, organizations and industry*.
The project will be divided into three areas of intervention named: Retail Trade; Objective-directed supply and cross cutting activities.
Project organization is established in cooperation between the Ministry of Food, Agriculture and Fisheries, the Danish Food and Veterinary Agency, the Danish Cancer Society, Produce Marketing Association, and representatives of fruit and vegetable working councils together with the Fruit and Vegetable Processing Association.
A more detailed description of project organization will be presented in a separate framework agreement for the project "6 a day". In the framework, the total project is described as an umbrella organization for two projects - the development project described and the campaign project. The campaign project is primarily coordination and implementation of fruit and vegetable information campaigns under the slogan "6 a day". The development project is expected completed in april 2004.
All project employees will be physically located 6 a day project secretariat in the Danish Cancer Societies premises - with the purpose of promoting inspiration and synergy between the development and campaign projects.
Overall Management of the project will be undertaken by the Danish Cancer Society´s Morten Strunge Meyer, Produce Research Associations' Torben Bo Toft Christensen tbc@landbrug.dk and Ellen Trolle etr@vfd from the Danish Veterinary and Food Agency.
For more information about specific projects, please contact:
Retail Sector Projects:Anders Krøyer ak@6aday.com
Direct Supply Projects: Hanne Vig Flyger hav@6aday.com
Summary of Projects
The individual projects in this intervention area are evaluated where possible by measurement of changes in sales of fruit and vegetables or changes in consumer groups intake of fruit and vegetables.
Projects under cross cutting issues are aimed at developing standard methods and methodologies that allow comparison of results between the different projects. Operating costs of sales promotion activities, interventions etc. will be approximated, and be used in evaluating by cost-benefit analysis, and the most advantageous initiatives for future application in fruit and vegetable promotion activities will be identified.
An important part of all the individual projects is dissemination of results, primarily in the form of data showing the effect of the various interventions. However, it is equally important that experiences and materials related to the practical tasks and processes from the various projects are widely available to the whole retail sector. A high level of competition, especially for consumables in Denmark has contributed to, that in Denmark the retail sector has not chosen to collaborate on a common and generic marketing of fruit and vegetables as seen in Norway and Sweden. Experiences of cooperation and collaboration are expected to motivate the Danish retailers, wholesalers, and producers to actively, objectively and with a shared economic responsibility to establish a common generic marketing strategy for fruit and vegetables.
One way of achieving increased intake of fruit and vegetables, is through the fruit and vegetables "industry's" creation of convenience products, which require less preparation or are readily eatable. Production and sale of such products is extensive in the USA. According to previous studies, Danish consumers believe that the quality fruit and vegetable convenience foods is poorer than unprocessed products (1). Such products, although several have been test marketed, have failed to succeed in Denmark. This can also be attributed to a producers and product developers lack of knowledge concerning consumer attitudes to convenience products.
Successful marketing of convenience products in Denmark requires a detailed analysis of consumer attitudes and barriers to such products.
This project should create baseline knowledge of consumer attitudes to 4 different convenience products: portioned fruit, ready to eat salads, frozen vegetables and fruit juice.
It is assumed that retail outlets that have products of a particularly good quality and a large assortment of fruit and vegetables will sell more than outlets with a low quality and limited assortment. Additionally, it is believed that consumer information on variety, taste and good practical use will increase sales, and repeat purchases.
Documentation of the effect that higher quality, more aesthetic presentation and larger assortment has individually and/or has on the consumers' intake of fruit and vegetables. Additionally, the effect of more information on variety, taste and practical use lead to increased sales and repeat purchases.
Improvement of quality and assortment is documented, and practical experiments are designed so that variation caused by: season, consumer purchase from a variety of outlets, price reductions and marketing can be controlled.
Sales in participating outlets are measured, and a minimum of 100 households' fruit and vegetable intake is monitored during quality and assortment intervention period. The study will take place in close cooperation with a wholesaler and a number of retail outlets (max. 12) in a naturally defined local area for a period of 6 months.
Establishing and maintaining qualifications
In Denmark, jobs in the fruit and vegetables departments of retail outlets are often associated with low status. Produce employees are often recruited from the street, with little or no training. It is difficult to maintain expertise in the produce departments because typical career paths bring produce workers to other departments or assignments. This is supported by a 1997 survey of retail outlets selling fruit and vegetables in 47 municipalities (2), that concluded that there was a lack of fundamental knowledge of handling, storing, quality and use of individual products in majority outlets, even in the best outlets.
High quality and good presentation in retail outlets leads to increased sales. High quality and presentation relies on, if the outlet has experienced and professional fruit and vegetable employees. Increased education results in more professional employees, which are easier to hold.
Collect knowledge about the need and interest in increasing the education level of fruit and vegetable employees in Denmark, and outline content and educational activities.
Baseline study of existing Danish experiences and practices through interviews with decision-makers, educators and fruit and vegetable buyers and produce department employees. The following 5 themes will be investigated:
There is a large difference between the price that fruit and vegetable growers get and the price which consumers pay in retail outlets. At the same time, price is the most important sales argument in the retail sector.
Lower prices are expected to lead to increased sales of fruit and vegetables.
Collection of documented examples of the effect of price reduction strategies (discount) on sales within the retail sector. Collection of data will be achieve through semi-structured interviews.
Investigation to document the sales promotional effect of long term price reduction, can lead to a sustainable increase in consumers intake of fruit and vegetables. Intervention should be designed so that variations caused by: season, subjects shopping at more than one outlet, discounts that are short term as well as differences in product quality can be controlled for. The intervention study is implemented in cooperation with a wholesaler and a number of retail outlets (supermarkets).
Communication and discussion of results with key actors from fruit and vegetable sector.
In the marketing of coffee, dairy products, wine, etc. sales demonstrations are often held. Sales demonstrations are rarely used for fruit and vegetables or fruit and vegetable products. Sales demonstrations are especially relevant during the introduction of new items. This can be in the form of completely new products or new ways of preparation or use.
The general populations' utilization of fruit and vegetables is limited to a very narrow assortment. Thus, it is relevant to give consumers the chance to taste different products that are currently only sold in smaller amounts. Sales demonstrations are also useful in the demonstration of new, convenience products, giving consumers the chance to judge quality of these new products. The most important barriers to more extensive use of sales demonstrations are the costs. Sales demonstrations normally cost between 2,000 to 3,000 DKK in wages, transport, equipment and materials, with wages representing the largest cost. Possibilities exist in using volunteer, e.g. local associations of the Danish Cancer Society; some of these groups already have experience with demonstrating fruit and vegetables in stores.
Increased use of sales demonstrations for fruit and vegetables products can lead to increased sales. Use of volunteer labor can reduce operation costs, making sales demonstrations profitable for retail business.
Through practical intervention studies to document the effect of sales demonstrations on sales in retail outlets.
Competition for fruit and vegetable sales has mainly been focused on pricing strategies in the form of special discounts, and the use of weekly discount flyers. This project is included to ensure the comparability of the results from following retail trade projects with existing marketing initiatives (strategies).
Collection of Data and Information on the effect that price discount strategies (and discount coupon weeklies) have on sales.
Cooperation is started with 4 interested supermarket chains and approximately 10 food companies. Collection and Analysis of sales data for products at normal price, discounted price and advertised in weekly flyers. The study should be designed so that control of random variations in the sales of products is included. Also, an appraisal is sought, if advertisements and discounts lead to a total increase in sales, or substitution of normal priced goods with discounted products.
During recent talks with fruit and vegetable business representatives and a study tour to USA, a number of sales promotion activities were identified, that aren't investigated as part of the other projects.
Hypothesis
A variety (listed under activities) of sales promotion activities will affect sales of fruit and vegetables.
Aim
To inspire the retail sector to carry out a variety of sales promotion activities, and to document the effect of these activities.
Activities
Which of the listed activities will be realized, is dependant on market-related conditions and interest of the retail sector. The role of this project, is not to actually undertake these activities, but is limited to the role of idea bank, sparring partner along with assistance in planning and evaluating interventions such as these.
Summary of Individual Projects
Fruit and Vegetables in Schools
In Norway, Holland and USA, fruit and vegetable subscription programs have proven successful. School children are given a piece of fruit, a vegetable or juice every day. In the USA, it has been documented that school meal programs have significant effect on students fruit and vegetable intake. In Norway, the National Nutrition Council is working on finishing the concept with the intention establishing a nationwide fruit and vegetable subscription program. A well functioning nationwide school milk program already exists with EU funding.
Hypothesis
By offering parents the possibility to subscribe to daily fruit, vegetable or juice for their children at school, students' total fruit and vegetable consumption can be increased.
Aim
To develop, test and document the effect of fruit and vegetable subscription program aimed at grade school students.
Activities
A number of innovative direct marketing initiatives have been started by organic fruit and vegetable producers, which target private households. The most common schemes are those, in which private households subscribe to a weekly box or bag of fresh organic produce. None of these initiatives have been evaluated in respect to their effect on fruit and vegetable consumption.
Fruit and vegetable subscription schemes increase fruit and vegetable intake, and lead to consumption of a wider variety of fruit and vegetables among participating households.
The purpose of this project is to investigate fruit and vegetable subscription schemes are an effective and profitable way of increasing fruit and vegetable intake.
Fruit and Vegetables
at work
Consumption of fruit and vegetables, can according to intervention studies in the USA (4,5), be significantly increased, if access is improved at work sites.
Introduction of fresh fruit and vegetables to employees and in certain cases customers, can increase the total intake of fruit and vegetables.
Develop and test different concepts and models of supplying fruit to work-sites, and estimate motivation of management in small, medium and large enterprises to offer fruit at no cost.
A large part of the Danish population eats at least one of their daily meals away from home. This includes meals eaten in company canteens, hospital, nursing homes as well as home meal services for older people. Public meal services alone serve approximately 1/2 million meals daily, and it is estimated that approximately the same amount is served in company canteens. Due to a lack of studies in this area, little is known about the quantity fruit and vegetables served with or in these meals, or what practical and attitudinal barriers exist to changing existing practices. Possible barriers are lack of time, lack of knowledge, special production limitations, motivation and perception of higher cost. The Danish Cancer Society has carried out a number of campaigns directed at company canteens; evaluations and experiences from these projects will be incorporated in this project.
Communication of practical knowledge (information) on preparation of fruit and vegetables in canteen kitchens and practical guidelines for reorganization of production to include more fruit and vegetables will result in increased fruit and vegetable intake for the general population.
Inspire caterers, in both public and private sectors, to serve fruit and vegetables in amounts that correspond to the recommendation of 600 grams per day by providing them with practical tools, guidelines and eventually knowledge to achieve this.
In the following section, activities will be described that are not included in either the retail or objective-driven supply, but are necessary to carry out these projects.
Summary of Projects
Comparable measurement methods
Cross cutting activities can be charactarized as tools, methods and methodologies necessary to complete the actual development projects.
Comparable measurement methods
Describe and adapt if necessary existing methods to measure dietary intake and sales of fruit and vegetables. These methods should make comparison between projects and activities possible. In addition, coordination of the different activities field work, so that interaction between the different interventions are registered, and economies of scale are exploited through statistical experimental planning. Finally, to develop methods to validate the association between intake data and sales data.
Background
Because of later utilization of the projects results, a variety of evaluation initiatives will be carried out. The results will be as quickly as possible communicated to project interest groups, and later to the whole fruit and vegetable sector. Consequently, establishment of communications channel that ensures timely dissemination of the project results and experiences is necessary.
Aim
The project will primarily be evaluated on the basis of the individual projects. In addition, a midpoint evaluation of all individual projects in 2001, and a crosscutting comparison of the projects results (metaanalysis) together with a final penetration analysis.
Establishment of communication channels composed of the following elements:
The target audience for the newsletter all actors in the fruit and vegetable sector, including involved businesses and organisations, retail trade, relevant educational institutes and other interested parties.