Harald Roderick Rutter

• Mackenbach, Joreintje D & Rutter, Harry (2026). Beyond the binary: towards obesity prevention and treatment as a continuum. European Journal of Public Health. ISSN 1101-1262. 36(4). doi: 10.1093/eurpub/ckag112. Full text in Research Archive
• Karlsen, Tom Hemming; Hutchinson, Sharon J.; Zelber-Sagi, Shira; Carrieri, Patrizia; Negro, Francesco & Lim, Aaron G. [Show all 48 contributors for this article] (2026). Implementing sustainable liver health in Europe: a second EASL–Lancet Commission. The Lancet. ISSN 0140-6736. 407(10541), p. 1825–1890. doi: 10.1016/S0140-6736(26)00138-8. Full text in Research Archive
• Osorio, Natalie Garzon; Vik, Frøydis Nordgård; Hillesund, Elisabet Rudjord; Helland, Sissel Heidi; Love, Penelope & Abel, Marianne Hope [Show all 12 contributors for this article] (2026). A Formative Evaluation of Parental Perceptions Related to Acceptability, Appropriateness, Feasibility, and Reported Use of an e-Learning Resource Targeting Diet in the First 1000 Days: Survey Study. JMIR Formative Research. 10, p. 1–13. doi: 10.2196/84277. Full text in Research Archive Show summary

  Background In October 2022, the Nutrition Now (NN) e-learning resource was implemented within Maternal and Child Healthcare centers and Early Childhood Education and Care centers of a southern Norwegian municipality. The e-learning resource targets expectant parents, parents of children aged 0‐2 years, and Early Childhood Education and Care staff, aiming to promote healthy dietary behaviors during the first 1000 days of life. Objective This study aimed to explore parental perceptions related to the acceptability, appropriateness, feasibility, and reported use of the NN e-learning resource among parents. Methods From October 2022 to May 2023, expecting parents and parents of children aged 0‐2 years were recruited from 2 Norwegian municipalities, one intervention group receiving access to the NN e-learning resource, and one control. Participants in the intervention group received a web-based follow-up questionnaire 7 months after gaining access to the NN e-learning resource. Data were analyzed using descriptive statistics. Results Of the 179 participants in the NN study intervention group, 48 completed the web-based follow-up questionnaire administered 7 months after enrollment. Parents rated the e-learning resource positively on items assessing whether they liked and appreciated the resource, perceived it as an appropriate source of information, and found it doable and easy to use. Most respondents reported visiting the resource (38/48, 79%), although only 21% (10/48) reported frequent visits. Less than half of the participants answering the web-based follow-up questionnaire reported having watched the theme films (20/48, 42%), the recipe films (17/48, 35%), or making food using recipes provided in the e-learning resource (20/48, 42%). Conclusions Parents rated the NN e-learning resource positively but reported limited use. These findings point to the need for strategies that enhance engagement with self-guided digital interventions among expectant parents and parents of young children. Future efforts should focus on identifying how to maximize potential adoption of the e-learning resource and evaluate its impact to promote healthy dietary behaviors during the first 1000 days of life.

• Rutter, Harald Roderick; Wabnitz, Katharina; Nambiar, Devaki; Garde, Amandine; Benton, Tim G & Heymann, David L [Show all 19 contributors for this article] (2025). The Lancet Commission on improving population health post-COVID-19. The Lancet. ISSN 0140-6736. 407(10525), p. 267–308. doi: 10.1016/s0140-6736(25)02061-6. Full text in Research Archive Show summary

  An increasing number of national and international commitments have failed to reduce three intimately interconnected major global threats to population health: non-communicable diseases, outbreaks of infectious diseases, and environmental degradation. Non-communicable diseases cause more than 43 million deaths globally every year, of which 18 million are of people younger than 70 years. More than 70% of these deaths occur in low-income and middle-income countries (LMICs). To date, the official number of COVID-19 cases globally is more than 775 million, with more than 7 million deaths, although the absolute figures are likely to be far higher due to under-reporting. Environmental degradation is unravelling complex ecosystems, setting the world on a path to mass extinction, with the climate crisis creating an existential threat to human survival. The Lancet Commission on improving population health post-COVID-19 was established to draw attention to the interactions between these three threats, the frequently shared structural factors underpinning them, and the opportunities for synergistic actions to address them. Having identified that the three systems of physical environment and transport, agriculture and food, and energy, underpin the three primary threats to population health, the Commissioners agreed upon three aims for the Commission to generate and synthesise evidence on actions needed to achieve: (1) healthy and sustainable physical environment and transport systems; (2) healthy and sustainable agriculture and food systems; and (3) healthy and sustainable energy systems. These aims were used to create a framework to agree a set of objectives via a two-stage survey and modified Delphi exercise that resulted in a final list of ten objectives which were clustered under each of the three aims. In addition, we conducted supporting work: a rapid review of the evidence on drivers of, and policy levers for addressing, the three threats of non-communicable diseases (NCDs), communicable disease, and environmental degradation; an expert elicitation exercise using semi-structured interviews with 26 international experts to identify potential actions; and two pieces of economic modelling on the impact of carbon pricing on agriculture and land use, as well as land use and transport. By synthesising evidence obtained from each of these sources we identified a set of recommendations for actions to take place within and, in many cases, across the three systems of physical environment and transport, agriculture and land use, and energy. Equity is a central concern of our Commission, and all actions were considered in terms of their potential effects on inequalities, as well as risks of other harmful unintended consequences. Where this was the case, we identified potential ways in which any such harms could be mitigated. We identified that these three threats to population health are caused by many shared and interacting factors. For example, the clearance of vast areas of land globally to support high levels of palm oil production reduces the capacity of the land to retain carbon, and excessive consumption of ultraprocessed foods containing palm oil contributes to non-communicable diseases (such as obesity and type 2 diabetes), which are major risk factors for morbidity and mortality from infectious diseases, including COVID-19. Simultaneously, the destruction of ecosystems and the loss of habitats increase the likelihood of interactions between wild animals and humans, which in turn increase the risk of new zoonotic diseases transferring from animals to humans. Simultaneously, global heating drives an increase in disease vectors, such as those for malaria and dengue, and air pollution creates an epidemic of respiratory disease. The drivers of these threats are underpinned by political systems that prioritise economic growth over population health and the natural environment, undermining economies through increased health-care costs and reduced human productivity. Across these threats, people with the lowest income experience the greatest harms. Reducing these threats requires a global shift in the behaviour of populations, including eating healthier and more sustainable diets, drinking less or no alcohol, not smoking, and increasing levels of physical activity. These behaviours are largely cued, reinforced, and maintained by physical, economic, digital, and social environments over which individuals have little control. Exhorting individuals to change their behaviour is therefore an ineffective strategy for the magnitude and scale of change that is required. Changing these behaviours necessitates changing the environments that shape them, requiring action largely by governments and business actors to transform the conditions that determine population health. Achieving the necessary political action in the face of growing political populism and geopolitical instability globally is a major challenge. There are, however, some positive signs, including: increases in the affordability of public transport in cities around the world; restrictions on advertising and marketing of ultra-processed foods coupled with mandatory warning labels led by countries in Latin America; and increases in renewable energy generation globally. However, these changes are not occurring at either the large scale or the rapid speed that is needed. This Commission provides a set of recommendations that, if implemented, could have a major impact on increasing both the scale and speed of action necessary to address some of the greatest threats to population health.

• Lian, Henrik; Øverby, Nina Cecilie; Vik, Frøydis Nordgård; Medin, Anine Christine; Osorio, Natalie Garzon & Helle, Christine [Show all 12 contributors for this article] (2025). Implementation strategies: lessons learned during an e-learning intervention to improve dietary behaviors and feeding practices in early childhood education and care. BMC Nutrition. 11(1). doi: 10.1186/s40795-024-00990-3. Full text in Research Archive Show summary

  Background Early Childhood Education and Care (ECEC) centers play an important role in fostering healthy dietary habits. The Nutrition Now project focusing on improving dietary habits during the first 1000 days of life. Central to the project is the implementation of an e-learning resource aimed at promoting feeding practices among staff and healthy dietary behaviours for children aged 0–3 years in ECEC. Implementing new interventions often presents challenges. This study explores ECEC staff views and experiences with selected strategies for implementing an e-learning resource in ECEC centers in a municipality in Southern Norway. Methods The study is a part of the Nutrition Now study, a hybrid type 1 non-randomized controlled trial. The implementation process followed the Dynamic Integrated Evaluation Model (DIEM). Implementation strategies were selected from the Expert Recommendations for Implementing Change (ERIC) project and included identify and prepare champions, conduct educational meetings, distribute educational materials, create a learning collaborative, and remind clinicians. ECEC teachers from participating ECEC centers in the intervention municipality were recruited as champions. Brief (5–7 min minutes), semi-structured phone interviews, covering key points, were conducted with the champions 8 times, evenly distributed over six months. The interviews were analysed using qualitative thematic analysis. Results In total, 29 of the invited ECEC centers (53%) participated, and 260 brief interviews (88%) were conducted with champions (n=37). An evaluation of the feedback from the champions suggests that the five selected implementation strategies were acceptable. Five main themes were developed by qualitative analysis: 1) Being a champion resembles what I already do. 2) Educational meetings are fine but take time. I prefer when peers share experiences. 3) Newsletters were helpful and reminded me, but I do not always have enough time to read. 4) Evaluations have increased my awareness, and we do them informally and formally. 5) The regular phone calls reminded me I could receive support and express my opinion Conclusion This study’s findings suggest that several implementation strategies are acceptable for stakeholders in an ECEC e-learning healthy eating intervention. However, time constraints among champions may hinder deep engagement. These results provide valuable insights into how the selected implementation strategies may function in practice and how they are perceived and experienced by the ECECs staff. Trial registration Trial registration on June 6, 2022: ISRCTN10694967.

• Vigsnes, Kristine Løkås; Kiland, Charlotte; Rutter, Harry & Abildsnes, Eirik (2025). Raising complex public health challenges on local government agendas: a Norwegian case study. Health Research Policy and Systems. 23(1). doi: 10.1186/s12961-025-01347-3. Full text in Research Archive Show summary

  Background Public health challenges, ranging from noncommunicable disease prevention to pandemic preparedness, involve both policymaking and the handling of complexity at local, national or global level. The complexity of public health challenges arises from uncertain knowledge, hidden mechanisms, differing conceptual models and multiple stakeholders, making it difficult to identify and agree on problem definitions and potential solutions. This case study aims to provide insights into how complex public health challenges are addressed within local government agendas. We use theories of policy entrepreneurs and agenda setting to explore the processes behind the agenda setting of a public health programme for work inclusion. Methods We conducted an in-depth case study in a local government context. Data from interviews with key informants and political documents were triangulated and analysed using deductive thematic content analysis, framed within Kingdon’s agenda-setting theory and theories of policy entrepreneurs. Results We identified problem framing, the involvement of multiple actors, and turbulent surroundings as influential factors for agenda setting of complex public health challenges in local government. We further identified the significance of the level of influence of policy entrepreneurs’ positions, their coalitions and maintaining agenda control as core mechanisms for enabling agenda setting. We found that strategic manoeuvres of policy entrepreneurs were crucial to handle and manoeuvre complexity within the multiple streams described by Kingdon. Conclusions This article contributes knowledge of how complex public health problems receive attention and how these issues are shaped and defined, placed on governmental agendas, and paired with solutions. The article contributes important insights for understanding policy responses to complex public health problems and how policy entrepreneurs strategically manoeuvre within the streams of policy development to create windows of opportunity and maintain agenda control. This is important knowledge to support agenda setting for public health challenges and to realize policies to improve public health.

• Osorio, Natalie Garzon; Vik, Frøydis Nordgård; Helle, Christine; Hillesund, Elisabet Rudjord; Øverby, Nina Cecilie & Helland, Sissel Heidi [Show all 15 contributors for this article] (2024). Implementing an early-life nutrition intervention through primary healthcare: staff perspectives. BMC Health Services Research. 24(1). doi: 10.1186/s12913-024-11582-z. Full text in Research Archive Show summary

  Background: Nutrition interventions targeting early childhood can be cost-effective and may provide lifelong, intergenerational benefits. From October 2022 to April 2023 the Nutrition Now (NN) e-learning resource was implemented within Early Childhood Education and Care centres and the Maternal and Child Healthcare Centre (MCHC) in a southern Norwegian municipality. As part of the NN project, the present study aims to explore the MCHC staff’s experiences with implementing the NN resource, to gain insights into measures important to scale up digital early-life nutrition interventions. Methods: Three group interviews were conducted among public health nurses and midwives alongside one individual interview with the department leader of a MCHC in May 2023. An inductive thematic analysis, as described by Braun and Clarke, was conducted to generate the key themes and subthemes regarding the implementation process of NN within the MCHC. Results: Three main themes were generated: [1] Important resource but not always utilized; [2] Parents are interested but had issues with access; and [3] Staff and stakeholder buy-in and commitment needed from the start. Overall, the staff viewed the NN resource as a potential tool for promoting diet-related topics and believed it could support the guidance they were already providing parents. However, few staff members fully familiarized themselves with the resource. While staff perceived parents as positive when informed about NN, they believed issues such as access challenges, competing platforms, and time constraints reduced parental engagement. Lastly, staff suggested improvements for NN’s implementation, including enhanced training, better planning, assigning champions, and lowering the threshold for access. Conclusion: The findings of this study suggest that the real-world implementation of digital evidence-based health behaviour interventions is feasible but would be enhanced by employing strategies focusing on engagement and utilization.

• Klepp, Knut Inge; Helleve, Arnfinn; Fismen, Anne-Siri & Rutter, Harald Roderick (2022). Improving the health of adolescents: the Nordic countries can help fill the evidence gap. Scandinavian Journal of Public Health. ISSN 1403-4948. 50(7), p. 887–891. doi: 10.1177/14034948221124675. Full text in Research Archive Show summary

  While in the Nordic countries we have well-developed welfare policies and several structural, statutory measures in place aiming to promote public health, studies from these countries are often absent from systematic reviews of research literature assessing the effects of policy measures designed to promote health. Using adolescent health promotion and efforts related to primary prevention of obesity as an example, this short commentary aims to illustrate the paucity of well-designed studies investigating the effects of public health policies affecting adolescents. This paper argues that the Nordic research community is in a good position to help fill this gap, and to contribute more widely to the international literature on evaluation of policy interventions.

• Andersen, Lars Bo; Riiser, Amund; Rutter, Harald Roderick; Goenka, Shifalika; Nordengen, Solveig & Solbraa, Ane (2018). Trends in cycling and cycle related injuries and a calculation of prevented morbidity and mortality. Journal of Transport and Health. ISSN 2214-1405. 9, p. 217–225. doi: 10.1016/j.jth.2018.02.009. Full text in Research Archive Show summary

  The objectives were to describe trends in cycling and cycle related injuries in Denmark overall and in the four largest Danish cities to see if changes in cycling trips and injuries were associated. Further, we compared number of prevented deaths, type 2 diabetes (T2D), cardiovascular diseases (CVD) and cancers with registered injuries. We analyzed cycling trends over past 17 years in Denmark based on national statistics from 56 electronic counters as an ecological study. Cycle related injuries were collected by Statistics Denmark from hospital records. We also calculated the annual prevented disease and mortality accrued from the health benefits of physical activity in cycling based on relative risk (RR) of cycling derived from population studies, number of cyclists, and number of death, T2D, CVD and cancers in Denmark. Since 1998 till 2015, cycling has increased by 10% in the whole country; the cycling related injuries however, have gradually declined and were only 45% in 2015 as compared to 1998 level. In Copenhagen specifically, cycling even increased more than 30% since 1998 while cycling related injuries decreased during the same period to one third. Diseases prevented in Denmark by cycling were annually 3328 T2D cases, 5742 CVD cases and 2076 cancer cases and prevented deaths were 6190. In comparison, in 2015, 26 cyclists were killed in the traffic, 512 were seriously injured and 297 experienced light injuries in the whole country. In conclusion, in Denmark, the number of cycling trips have steadily increased over the past 17 years while cycling related injuries show a concomitant decline. Intuitively one might expect cycle related injuries to increase with increased cycling, but a decrease was observed in injuries. Health benefits of cycling calculated from cohort studies were 21 times higher than risk of injuries and for mortality alone the ratio was 238.

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• Rutter, Harry (2025). Transforming action on cancer and noncommunicable disease in Europe. Scandinavian Journal of Public Health. ISSN 1403-4948. 53(3), p. 6–7. doi: 10.1177/14034948251393140. Full text in Research Archive
• Karlsen, Tom Hemming; Rutter, Harald Roderick; Carrieri, Patrizia; Zelber-Sagi, Shira; Engebretsen, Eivind & Hutchinson, Sharon [Show all 16 contributors for this article] (2024). The EASL–Lancet Commission on liver health in Europe: prevention, case-finding, and early diagnosis to reduce liver-related mortality. The Lancet. ISSN 0140-6736. 403(10436). doi: 10.1016/S0140-6736(24)00204-6. Full text in Research Archive
• Øverby, Nina Cecilie; Hillesund, Elisabet Rudjord; Helland, Sissel Heidi; Helle, Christine; Wills, Andrew Keith & Lamu, Admassu Nadew [Show all 23 contributors for this article] (2023). Evaluating the effectiveness and implementation of evidence-based early-life nutrition interventions in a community setting a hybrid type 1 non-randomized trial – the Nutrition Now project protocol. Frontiers in Endocrinology. 13. doi: 10.3389/fendo.2022.1071489. Full text in Research Archive Show summary

  Disappointingly few efficacious health interventions are successfully scaled up and implemented in real world settings. This represents an evidence-to-practice gap, with loss of opportunity to improve practice. Aiming to improve nutrition in the first 1000 days of life, we have combined four efficacious dietary interventions into a single adapted digital resource (Nutrition Now) for implementation in a Norwegian community setting. Nutrition Now targets pregnant women and parents of 0–2-year-olds with messages focusing on healthy dietary behaviours. Early childhood education and care (ECEC) staff are provided with pedagogical tools addressing healthy food exposure and child food acceptance. Objectives: a) evaluate the effectiveness of provision of the Nutrition Now resource on child diet and diet-related outcomes, with special attention to the influence of socio-economic position, b) gather information on the effectiveness of the implementation process to inform forthcoming scale-up and c) perform trial- and model-based economic evaluations. This is a hybrid type 1 implementation study, focusing on evaluation of effectiveness. A quasi-experimental design with pre- and post-tests, where one municipality gets access to the resource (n~800), while a matched non-equivalent control municipality (n~800) does not, will be used. Effectiveness will be assessed by examining e.g., diet outcomes, developmental outcomes, and feeding practices. The resource will be implemented in ECEC settings and made available to pregnant women and parents through the Norwegian system of maternal and child health (MCH) care. The implementation process includes iterative adjustments and implementation strategies from the implementation framework Expert Recommendations for Implementing Change (ERIC) informed by dialogues with stakeholders. Implementation outcomes (e.g., acceptability and adoption) will be assessed through questionnaires and interviews with parents, ECEC and MCH staff, with particular attention to ethnic diverse groups. Both within-trial and modelling-based economic evaluation will be performed. Nutrition Now will bridge the existing evidence-to-practice gap through rigorous scientific effectiveness evaluation of municipal scale up and inform subsequent county scale up. The study is the first to implement efficacious nutrition interventions in early life with potential for health improvement using technology to maximise the reach and impact of both parental and MCH dietary guidance and ECEC practice.

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