The regulatory governance conditions that lead to food policies achieving improvements in population nutrition outcomes: a qualitative comparative analysis

Legal and regulatory instruments for NCD prevention: a scoping review and descriptive analysis of evaluations in OECD countries

CONTEXT

Public health law is an important tool in non-communicable disease (NCD) prevention. There are different approaches available for achieving policy objectives, including government, co-, quasi- and self-regulation. However, it is often unclear what legal design features drive successes or failures in particular contexts. This scoping review undertakes a descriptive analysis, exploring the design characteristics of legal instruments that have been used for NCD prevention and implemented and evaluated in OECD countries.

METHODS

A scoping review was conducted across four health and legal databases (Scopus, EMBASE, MEDLINE, HeinOnline), identifying study characteristics, legal characteristics and regulatory approaches, and reported outcomes. Included studies focused on regulation of tobacco, alcohol, unhealthy foods and beverages, and environmental pollutants.

FINDINGS

We identified 111 relevant studies evaluating 126 legal instruments. Evaluation measures most commonly assessed implementation, compliance and changes to the built and lived environment. Few studies evaluated health or economic outcomes. When examining the design and governance mechanisms of the included legal instruments, government regulation was most commonly evaluated (n = 90) and most likely to be reported effective (64%). Self-regulation (n = 27) and quasi-regulation (n = 5) were almost always reported to be ineffective (93% and 100% respectively). There were few co-regulated instruments evaluated (n = 4) with mixed effectiveness. When examining public health risks, food and beverages including alcohol were more likely to be self- or quasi-regulated and reported as ineffective more often. In comparison, tobacco and environmental pollutants were more likely to have government mandated regulation. Many evaluations lacked critical information on regulatory design. Monitoring and enforcement of regulations was inconsistently reported, making it difficult to draw linkages to outcomes and reported effectiveness.

CONCLUSIONS

Food and alcohol regulation has tended to be less successful in part due to the strong reliance on self- and quasi-regulation. More work should be done in understanding how government regulation can be extended to these areas. Public health law evaluations are important for supporting government decision-making but must provide more detail of the design and implementation features of the instruments being evaluated - critical information for policy-makers.

Regulatory governance pathways to improve the efficacy of Australian food policies

BACKGROUND

Effective regulatory governance, which entails the actors, processes and contexts within which policies are developed, designed and implemented, is crucial for food policies to improve food environments, consumer behaviour and diet-related health.

OBJECTIVE

To critically assess Australian food policies for the presence of necessary and sufficient regulatory governance conditions that have been shown to effect positive nutrition outcomes from food policies.

METHODS

We assessed the Australian National Association of Advertisers (AANA) Food and Beverage Advertising Code, Health Star Rating Front of Pack labelling system and Sodium reformulation under the Healthy Food Partnership (HFP). The policies were analysed for the presence/absence of five regulatory governance conditions - the extent of industry involvement, regulatory design, instrument design, monitoring and enforcement.

RESULTS

All three policies lack one or more regulatory governance conditions crucial for policy success. Each policy has high industry involvement, an absence of government-led policy-making underpinned by legislation and lacks comprehensive enforcement. Except for the Health Star Rating system, the policies did not have comprehensive monitoring - a necessary condition for policy success.

PUBLIC HEALTH IMPLICATIONS

The efficacy of these three policies can be enhanced by minimising industry involvement, improving government oversight and improving monitoring systems.