The Department of Health in WA led the development of the "Eat Well WA-Fruit and Vegetable Strategy" (EWWAFV) to advise on and coordinate activities to improve access and increase consumption of fruit and vegetables. A framework with a systematic approach to planning the provision of public health interventions was used [29
]. The approach ensured that a comprehensive range of intervention types were considered and the capacity to carry out the interventions. The following steps were used:
1. Identify the determinants of health
2. Assess the risks and benefits posed by each determinant to identify what should be addressed
3. Identify intervention options and appraise them
4. Decide on the portfolio of interventions
5. Implement the portfolio
6. Evaluate the portfolio [29
Literature and program reviews identified health determinants and their risk/benefits. Based on these, two health determinants were chosen:
• access to fruit and vegetables
• consumption of at least 300 g (2 servings) fruit and 375 g vegetable (5 servings) daily [35
A comprehensive approach to intervention planning covers policy, program interventions, and the infrastructure required to support them. The full range of intervention types were considered to decide appropriate actions. Types included public policy development, legislation and regulation, resource allocation, engineering and technical interventions, incentives (financial and other), service development and delivery, education (including skills development), communication (including social marketing), collaboration/partnership building (community and intersectoral), community and organisational development (including organisational policy) [29
]. The Department of Health outlined the types of interventions that could be considered using available evidence and the intervention recommendations from a national case study [16
]. Next, stakeholders were consulted to capture other possible interventions. Involvement of both the government and non-government sector would be crucial for effective action in implementing strategies [36
Two distinct management portfolios were defined, which related to access and consumption of fruit and vegetables. These recognised that better access to fruit and vegetables is likely to assist in increasing consumption, while increasing consumption has implications for improving access. Portfolio one addressed the access to fruit and vegetables health determinant with the management objective "to increase and sustain access to high quality, safe, affordable vegetables and fruit". Portfolio two addressed the health determinant relating to consumption with the objective "to increase consumption of fruit and vegetables by people in WA to meet or exceed recommendations".
A steering group with representatives from relevant sectors was formed to lead the development of the strategy and select priorities for action. Members represented the retail, hospitality, catering, education, horticulture, agricultural and transport sectors, environmental health, regional health, produce retailers, fruit growers, vegetable industry, non-government health organisations, and consumers. Members were asked to weight the relative importance of interventions using the available evidence and their knowledge and professional judgement. The group assigned a score out of 10 to each intervention for its expected performance against specific criteria including: effectiveness, equity, feasibility, acceptability, timing and sustainability.
Lead agency custodians for management of the selected interventions were identified. Custodians were expected to be responsible for the overall management and communication between partnering organisations to implement the particular intervention. Partners required to support the implementation were enlisted. In addition specific actions, costs, and performance indicators or measures were identified and confirmed by the steering group. Key stakeholders from government departments, non-government organisations and the fruit and vegetable industry were invited to form a Steering Committee and an EWWAFV strategy workshop was held to initiate the process. Participants from relevant sectors were invited – government (health, agriculture, education, industry, training and transport), non-government health agencies, the fruit industry (from gate to plate), Foodbank WA, hospitality, and training, and horticulture industries. Attendees were asked to nominate to be part of a committee to oversee the development of a ten-year strategy and implementation plan. The committee reviewed interventions in the two management portfolios, their suggestions were added and priorities for action determined.