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Blanchard L, Ray S, Law C, Vega-Sala MJ, Bidonde J, Bridge G, Egan M, Petticrew M, Rutter H, Knai C. The effectiveness, cost-effectiveness and policy processes of regulatory, voluntary and partnership policies to improve food environments: an evidence synthesis. PUBLIC HEALTH RESEARCH 2024; 12:1-173. [PMID: 39323285 DOI: 10.3310/jywp4049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024] Open
Abstract
Background Dietary factors are among the largest and costliest drivers of chronic diseases in England. As a response, the government implements a range of population interventions to promote healthy diets by targeting food environments. Objectives This study aimed to conduct a systematic review of the effectiveness, cost-effectiveness and policy process of real-world evaluations of national and state policies on improving food environments, with a focus on whether they were regulatory, voluntary or partnership approaches. Data sources Fourteen relevant English-language databases were searched in November 2020 for studies published between 2010 and 2020. Methods Six separate evidence reviews were conducted to assess the evidence of effectiveness, cost-effectiveness and policy processes of policies to improve food environments. Results A total of 483 primary research evaluations and 14 evidence syntheses were included. The study reveals considerable geographic, methodological and other imbalances across the literature, with, for example, 81% of publications focusing only on 12 countries. The systematic reviews also reveal the effectiveness and cost-effectiveness of reviewed regulatory approaches designed to improve health, consumer behaviour and food environment outcomes while public-private partnerships and voluntary approaches to improve diets via reformulation, advertising and promotion restrictions or other changes to the environment were limited in their effectiveness and cost-effectiveness. The study also revealed key enabling and impeding factors across regulatory, voluntary and public-private partnership approaches. Conclusion From the available evidence reviewed, this study finds that regulatory approaches appear most effective at improving the food environment, and voluntary agreements and partnerships have limited effectiveness. These findings should be carefully considered in future public health policy development, as should the findings of geographic imbalance in the evidence and inadequate representation of equity dimensions across the policy evaluations. We find that food policies are at times driven by factors other than the evidence and shaped by compromise and pragmatism. Food policy should be first and foremost designed and driven by the evidence of greatest effectiveness to improve food environments for healthier diets. Limitations This was a complex evidence synthesis due to its scope and some policy evaluations may have been missed as the literature searches did not include specific policy names. The literature was limited to studies published in English from 2010 to 2020, potentially missing studies of interest. Future work Priorities include the need for guidance for appraising risk of bias and quality of non-clinical studies, for reporting policy characteristics in evaluations, for supporting evaluations of real-world policies equitably across geographic regions, for capturing equity dimensions in policy evaluations, and for guideline development for quality and risk of bias of policy evaluations. Study registration This study is registered as PROSPERO CRD42020170963. Funding This award project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR128607) and is published in full in Public Health Research; Vol. 12, No. 8. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Laurence Blanchard
- London School of Hygiene & Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | - Stephanie Ray
- London School of Hygiene & Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | - Cherry Law
- University of Reading, School of Agriculture, Policy and Development, Reading, UK
| | | | - Julia Bidonde
- National Institute of Public Health, Department of Reviews and Health Technology Assessments, Oslo, Norway
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan University of Saskatchewan, Saskatoon, Canada
| | - Gemma Bridge
- University of Leeds, Leeds, UK
- York St John University, York Business School, York, UK
| | - Matt Egan
- London School of Hygiene & Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | - Mark Petticrew
- London School of Hygiene & Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | - Harry Rutter
- University of Bath, Department of Social and Policy Sciences, Bath, UK
| | - Cécile Knai
- London School of Hygiene & Tropical Medicine, Faculty of Public Health and Policy, London, UK
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Lingiardi N, Arribas A, Arriola I, Godoy E, Reinheimer MA. Reformulation of snacks offered to children and adolescents at school kiosks: is this strategy enough or just the tip of the iceberg? Int J Food Sci Nutr 2024:1-14. [PMID: 39206473 DOI: 10.1080/09637486.2024.2396481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 07/10/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
Several studies have reported high overweight and obesity incidence among schoolchildren and adolescents, who mostly consume packaged snacks with critical nutrients exceeding the criteria of international profiling systems during school breaks. Then, the objectives of this work were to reformulate a snack consumed by Argentinian schoolchildren and adolescents (aged 6-13 years) to decrease its critical nutrient contents and to determine if this product would still be accepted. Chocolate chip vanilla cookies were selected for reformulation considering each recommended cut-off point for critical nutrients, since a prohibition of products with warning octagons being offered at schools would come into effect in Argentina. These cookies received good acceptability scores (above 3 of 5 points) and would be consumed by 8 of 10 schoolchildren in a sample of 200 participants. These findings underscore the importance of legislation promoting awareness of healthier eating habits and increasing the availability of healthier food options in schools.
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Affiliation(s)
- Nadia Lingiardi
- Facultad de Química, Universidad del Centro Educativo Latinoamericano (UCEL), Rosario, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Rosario, Argentina
| | - Alberto Arribas
- Facultad de Química, Universidad del Centro Educativo Latinoamericano (UCEL), Rosario, Argentina
- Asociación Supersaludable, Rosario, Argentina
| | - Ileana Arriola
- Facultad de Química, Universidad del Centro Educativo Latinoamericano (UCEL), Rosario, Argentina
- Asociación Supersaludable, Rosario, Argentina
| | - Ezequiel Godoy
- Facultad Regional Rosario (UTN), Universidad Tecnológica Nacional, Rosario, Argentina
| | - María Agustina Reinheimer
- Facultad de Química, Universidad del Centro Educativo Latinoamericano (UCEL), Rosario, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Rosario, Argentina
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3
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Wopereis TM, Dijkstra C, Wierda JJ, Rongen FC, Poelman MP. Systems thinking for local food environments: a participatory approach identifying leverage points and actions for healthy and sustainable transformations. Health Res Policy Syst 2024; 22:101. [PMID: 39135050 PMCID: PMC11318250 DOI: 10.1186/s12961-024-01199-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 07/29/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Current local food environments encourage poor diets, posing a significant threat to public and planetary health. Acknowledging and addressing its inherent complexity is vital to making meaningful improvements to the food environment. Using a participatory approach with local stakeholders, this study aims to gain insight into the factors and mechanisms underlying the local food environment and to identify leverage points and system-based actions to foster healthy and sustainable local food environments. METHODS A systems-thinking approach was used in a Dutch municipality in 2022. Two group model building (GMB) workshops were held with community stakeholders (e.g. local policymakers, retailers and residents). During the first workshop (June 2022), factors and mechanisms influencing the local food environment were identified and visualized through a causal loop diagram (CLD). During the second workshop, leverage points and system-based actions to improve food environments were identified by the stakeholders. Four months after (October 2022), an action-implementation meeting was organized to stimulate the implementation of selected actions. Progress was monitored through brief telephone interviews 6 and 12 months after the second workshop. RESULTS The CLD visualises the factors and mechanisms influencing the local food environment from the point of view of the community stakeholders. The CLD consists of 46 factors shaping the local food environment, which were categorized into four identified subsystems: societal factors, individual, socio-economic factors, commercial factors and political factors. Eight leverage points were identified within the CLD, for example, 'lobby from food industry', 'governmental food policies' and 'e-commerce and platform economy'. Stakeholders formulated 20 actions targeting the identified leverage points. During the action-implementation meeting, long-term plans were created for five actions. After 1 year, only one participant (policy advisory role) remained actively engaged in three of these actions. CONCLUSIONS This study yields insight into the numerous factors and mechanisms underlying the local food environment and identified system-based actions as perceived by local stakeholders to improve this food environment locally. The CLD offers stakeholders valuable insights on employing a systems approach when enhancing food environments. More research is necessary, especially into the long-term processes and effects of implementing system-oriented actions to improve local food environments.
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Affiliation(s)
- Tamika M Wopereis
- Chair Group Consumption and Healthy Lifestyles, Department of Social Sciences, Wageningen University, Wageningen, 6706 KN, The Netherlands
| | - Coosje Dijkstra
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Joline J Wierda
- Chair Group Consumption and Healthy Lifestyles, Department of Social Sciences, Wageningen University, Wageningen, 6706 KN, The Netherlands
| | - Frédérique C Rongen
- Chair Group Consumption and Healthy Lifestyles, Department of Social Sciences, Wageningen University, Wageningen, 6706 KN, The Netherlands
| | - Maartje P Poelman
- Chair Group Consumption and Healthy Lifestyles, Department of Social Sciences, Wageningen University, Wageningen, 6706 KN, The Netherlands.
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Hoyle LP, Ryde GC, Coulter J, Rollason J. Supporting health and wellbeing in health care employees: a documentary review of organizational policies, strategies and frameworks. Front Sports Act Living 2024; 6:1308603. [PMID: 38873228 PMCID: PMC11169735 DOI: 10.3389/fspor.2024.1308603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 05/14/2024] [Indexed: 06/15/2024] Open
Abstract
Background Health care workers are crucial for a productive and thriving health care system, yet the health and lifestyle behaviour of key groups within this workforce (for example nurses and healthcare assistants/support workers) is typically poor. The extent of health and wellbeing documents that guide action towards improving their health and wellbeing is unknown. Using one health care system, NHS Scotland, as an example, the aim of this study was to assess the number of NHS health boards with workplace documents focused on health and wellbeing of employees, the quality of these documents and the extent to which they reference lifestyle behaviours, namely physical activity. Methods Documentary analysis was undertaken on employee health and wellbeing policies (and wider documents). These were sourced through online searches on Google search engine and Freedom of Information Requests sent to all 14 Scottish NHS Health Boards. Titles and content were assessed for relevance to employee health and wellbeing. Content analysis was used to analyse the included documents against eight predefined codes. Results Thirteen documents were retrieved with 11 of the 14 Health Boards having at least one relevant document. The content varied greatly between documents with regards to how many reported the eight codes and the quality of content within these. Nine documents mentioned physical activity but mainly in relation to current activities rather than in the context of a future healthy workforce. Conclusions Despite the importance of a healthy, health care workforce, more work is needed to ensure high level documents are able to support these efforts, especially with reference to lifestyle behaviours.
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Affiliation(s)
- Louise Patricia Hoyle
- Faculty of Health Science and Sport, University of Stirling, Stirling, United Kingdom
| | - Gemma Cathrine Ryde
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | | | - Jennie Rollason
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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5
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Hagenaars LL, Schmidt LA, Groeniger JO, Bekker MPM, Ter Ellen F, de Leeuw E, van Lenthe FJ, Oude Hengel KM, Stronks K. Why we struggle to make progress in obesity prevention and how we might overcome policy inertia: Lessons from the complexity and political sciences. Obes Rev 2024; 25:e13705. [PMID: 38424004 DOI: 10.1111/obr.13705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 12/18/2023] [Accepted: 01/18/2024] [Indexed: 03/02/2024]
Abstract
Despite evidence for the effectiveness of policies that target obesogenic environments, their adoption remains deficient. Using methods and concepts from complexity and political science (Stock-and-Flow analysis and Punctuated Equilibrium Theory) and a qualitative literature review, we developed system maps to identify feedback loops that hinder policymaking on mitigating obesogenic environments and feedback loops that could trigger and sustain policy change. We found numerous self-reinforcing feedback loops that buttress the assumption that obesity is an individual problem, strengthening the biomedical and commercial weight-loss sectors' claim to "ownership" over solutions. That is, improvements in therapies for individuals with obesity reinforces policymakers' reluctance to target obesogenic environments. Random events that focus attention on obesity (e.g., celebrities dismissing soda) could disrupt this cycle, when actors from outside the medical and weight-loss sector (e.g., anti-weight stigma activists) successfully reframe obesity as a societal problem, which requires robust and politically relevant engagement with affected communities prior to such events taking place. Sustained prioritization of policies targeting obesogenic environments requires shared problem ownership of affected communities and nonhealth government sectors, by emphasizing cobenefits of policies that target obesogenic environments (e.g., ultraprocessed food taxation for raising revenue) and solutions that are meaningful for affected communities.
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Affiliation(s)
- Luc L Hagenaars
- Department of Public Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, USA
| | - Laura A Schmidt
- Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, USA
| | - Joost Oude Groeniger
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Erasmus School of Social and Behavioural Sciences, Erasmus MC, Rotterdam, The Netherlands
| | - Marleen P M Bekker
- Health and Society Group, Wageningen University & Research, Wageningen, The Netherlands
| | - Fleur Ter Ellen
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Evelyne de Leeuw
- Urban Health and Policy, University of New South Wales, Sydney, Australia
- École de Santé Publique, Université de Montréal, Montréal, Canada
| | - Frank J van Lenthe
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, The Netherlands
| | - Karen M Oude Hengel
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Work Health Technology, Netherlands Organisation for Applied Scientific Research TNO, The Hague, The Netherlands
| | - Karien Stronks
- Department of Public Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
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Mollet SD, Manton DJ, Wollgast J, Toebes B. A Right to Health-Based Approach to Dental Caries: Toward a Comprehensive Control Strategy. Caries Res 2024; 58:444-453. [PMID: 38565094 PMCID: PMC11313044 DOI: 10.1159/000538459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 03/17/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Health is a matter of human rights, and dental caries is the most common noncommunicable disease globally. Consequently, dental caries is a matter of human rights and its control, particularly prevention, must be a priority. Although largely preventable, this is too often neglected, both in the literature of human rights and health law, and in dental research. The right to oral health has recently been acknowledged by the World Health Organization (WHO), but it is insufficiently clear what this right entails. SUMMARY This article introduces a right to health-based narrative in the context of dental caries. The right to health is stipulated in human rights treaties, including the International Covenant on Economic, Social and Cultural Rights (ICESCR) and the Convention on the Rights of the Child (CRC). States that are parties to these treaties, which are virtually all States globally, are mandated to ensure the enjoyment of individuals' right to the highest attainable standard of health, including oral health. KEY MESSAGES Dental caries is a matter of human rights. States have binding obligations to address dental caries: they require the regulation of the healthcare system, i.e., the traditional focus on operative care, but also put the regulation of other risk factors on an equal footing, such as the regulation of the living environment and access to fluoride. A right to health-based approach to dental caries thus offers a comprehensive approach to dental caries control, particularly prevention.
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Affiliation(s)
- S Dominique Mollet
- Faculty of Law, University of Groningen, Groningen, The Netherlands
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - David John Manton
- University Medical Centre Groningen, Centre for Dentistry and Oral Hygiene, Groningen, The Netherlands
- Pediatric Dentistry, Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Jan Wollgast
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Brigit Toebes
- Faculty of Law, University of Groningen, Groningen, The Netherlands
- Aletta Jacobs School of Public Health, University of Groningen, Groningen, The Netherlands
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Vandevijvere S, De Pauw R, Djojosoeparto S, Gorasso V, Guariguata L, Løvhaug AL, Mialon M, Van Dam I, von Philipsborn P. Upstream Determinants of Overweight and Obesity in Europe. Curr Obes Rep 2023; 12:417-428. [PMID: 37594616 DOI: 10.1007/s13679-023-00524-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE OF REVIEW To review the upstream determinants of overweight and obesity in Europe, including food and built environments, and political, commercial, and socioeconomic determinants. RECENT FINDINGS Overweight and obesity affect 60% of European adults, and one in three children, and are more common in individuals with low compared to high socioeconomic position (SEP). Individuals in low SEP groups are more exposed to unhealthy built and food environments, including higher exposure to unhealthy food marketing. Industries influencing the food system have much economic power, resulting in ignoring or silencing the role of ultra-processed foods and commercial practices in weight gain. Overall, effective policies to address overweight and obesity have been insufficiently implemented by governments. To accelerate implementation, strengthened political commitment is essential. Policies must also focus on the upstream, structural, and systemic drivers of overweight and obesity; be comprehensive; and target socioeconomic inequalities in diets and physical activity.
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Affiliation(s)
- Stefanie Vandevijvere
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium.
| | - Robby De Pauw
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Sanne Djojosoeparto
- Consumption and Healthy Lifestyles Chair Group, Wageningen University and Research, Wageningen, The Netherlands
| | - Vanessa Gorasso
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Leonor Guariguata
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Anne Lene Løvhaug
- Department of Nursing and Health Promotion, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | | | - Iris Van Dam
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Peter von Philipsborn
- Pettenkofer School of Public Health, Ludwig-Maximilians-Universität München, Munich, Germany
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Volf K, Kelly L, Van Hoye A, García Bengoechea E, MacPhail A, Woods CB. Assessing the implementation of physical activity-promoting public policies in the Republic of Ireland: a study using the Physical Activity Environment Policy Index (PA-EPI). Health Res Policy Syst 2023; 21:63. [PMID: 37365610 DOI: 10.1186/s12961-023-01013-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/03/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Government policy can promote physical activity (PA) as part of a multilevel systems-based approach. The Physical Activity Environment Policy Index (PA-EPI) is a monitoring framework which assesses the implementation of government policy by drawing on the experience of national stakeholders. This study is the first to assess the extent of policy implementation in the Republic of Ireland using the PA-EPI tool, and to provide information on how policy implementation can be improved, with the intention of maximizing its impact on population levels of PA. METHODS This mixed-methods research study, comprising eight steps, was carried out in 2022. Information documenting the evidence for implementation of PA policy, across all 45 PA-EPI indicators, was collected via systematic document analysis, and validated via survey and interview with government officials. Thirty-two nongovernment stakeholders rated this evidence on a five-point Likert scale. Aggregated scores were reviewed by stakeholders who collectively identified and prioritized critical implementation gaps. RESULTS Of the 45 PA-EPI indicators, one received an implementation rating of 'none/very little', 25 received a rating of 'low' and 19 received a 'medium' rating. No indicator was rated as fully implemented. The indicators that received the highest level of implementation related to sustained mass media campaigns promoting PA and PA monitoring. Ten priority recommendations were developed. CONCLUSIONS This study reveals substantial implementation gaps for PA policy in the Republic of Ireland. It provides recommendations for policy action to address these gaps. In time, studies utilizing the PA-EPI will enable cross-country comparison and benchmarking of PA policy implementation, incentivizing improved PA policy creation and implementation.
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Affiliation(s)
- Kevin Volf
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland.
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland.
| | - Liam Kelly
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Aurelie Van Hoye
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Enrique García Bengoechea
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Research and Innovation Unit, Sport Ireland, Dublin, Ireland
| | - Ann MacPhail
- Office of the Vice President Research, University of Limerick, Limerick, Ireland
- Physical Education, Physical Activity and Youth Sport (PEPAYS) Ireland Research Centre, University of Limerick, Limerick, Ireland
| | - Catherine B Woods
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
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Pineda E, Poelman MP, Aaspõllu A, Bica M, Bouzas C, Carrano E, De Miguel-Etayo P, Djojosoeparto S, Blenkuš MG, Graca P, Geffert K, Hebestreit A, Helldan A, Henjum S, Huseby CS, Gregório MJ, Kamphuis C, Laatikainen T, Løvhaug AL, Leydon C, Luszczynska A, Mäki P, Martínez JA, Raulio S, Romaniuk P, Roos G, Salvador C, Sassi F, Silano M, Sotlar I, Specchia ML, de Arriaga MT, Terragni L, Torheim LE, Tur JA, von Philipsborn P, Harrington JM, Vandevijvere S. Policy implementation and priorities to create healthy food environments using the Healthy Food Environment Policy Index (Food-EPI): A pooled level analysis across eleven European countries. Lancet Reg Health Eur 2022; 23:100522. [PMID: 36405402 PMCID: PMC9673115 DOI: 10.1016/j.lanepe.2022.100522] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Food environments have been recognised as highly influential on population diets. Government policies have great potential to create healthy food environments to promote healthy diets. This study aimed to evaluate food environment policy implementation in European countries and identify priority actions for governments to create healthy food environments. Methods The Healthy Food Environment Policy Index (Food-EPI) was used to evaluate the level of food environment policy and infrastructure support implementation in Estonia, Finland, Germany, Ireland, Italy, the Netherlands, Norway, Poland, Portugal, Slovenia, and Spain in 2019–2021. Evidence of implementation of food environment policies was compiled in each country and validated by government officials. National experts evaluated the implementation of policies and identified priority recommendations. Findings Finland had the highest proportion (32%, n = 7/22) of policies shaping food environments with a “high” level of implementation. Slovenia and Poland had the highest proportion of policies rated at very low implementation (42%, n = 10/24 and 36%, n = 9/25 respectively). Policies regarding food provision, promotion, retail, funding, monitoring, and health in all policies were identified as the most important gaps across the European countries. Experts recommended immediate action on setting standards for nutrients of concern in processed foods, improvement of school food environments, fruit and vegetable subsidies, unhealthy food and beverage taxation, and restrictions on unhealthy food marketing to children. Interpretation Immediate implementation of policies and infrastructure support that prioritize action towards healthy food environments is urgently required to tackle the burden of obesity and diet-related non-communicable diseases in Europe. Funding This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 774548 and from the Joint Programming Initiative “A Healthy Diet for a Healthy Life”.
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10
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Ahrens W, Brenner H, Flechtner-Mors M, Harrington JM, Hebestreit A, Kamphuis CBM, Kelly L, Laxy M, Luszczynska A, Mazzocchi M, Murrin C, Poelman MP, Steenhuis I, Roos G, Steinacker JM, van Lenthe F, Zeeb H, Zukowska J, Lakerveld J, Woods CB. Dietary behaviour and physical activity policies in Europe: learnings from the Policy Evaluation Network (PEN). Eur J Public Health 2022; 32:iv114-iv125. [PMID: 36444106 PMCID: PMC9706119 DOI: 10.1093/eurpub/ckac148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The European Policy Evaluation Network (PEN), initiated in autumn 2018, aimed at advancing the evidence base for public policies impacting dietary behaviour, physical activity and sedentary behaviours in Europe. This is needed because non-communicable diseases-the leading cause of global mortality-are substantially caused by physical inactivity and unhealthy dietary behaviours, which in turn are driven by upstream factors that have not yet been addressed effectively by prevention approaches. Thus, successful policy interventions are required that target entire populations and tackle the 'causes of the causes'. To advance our knowledge on the effective implementation of policies and their impact in terms of improving health behaviours, PEN focused on five research tasks: (i) Adaptation and implementation of a Food Environment Policy Index (Food-EPI) and development of a Physical Activity Environment Policy Index (PA-EPI); (ii) Mapping of health-related indicators needed for policy evaluation and facilitating a harmonized pan-European approach for surveillance to assess the impact of policy interventions; (iii) Refining quantitative methods to evaluate the impact of public policies; (iv) Identifying key barriers and facilitators of implementation of policies; and (v) Advance understanding the equity impact of the development, implementation and evaluation of policies aimed at promoting physical activity and a healthy diet. Finally, and in order to provide concrete evidence for policymaking, existing exemplary policies, namely sugar-sweetened beverages taxation, active transport policies and school policies on nutrition and physical activity were assessed in consideration of these five tasks. At the end of the PEN project's formal runtime, considerable advancements have been made. Here, we present an overview of the most important learnings and outputs.
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Affiliation(s)
- Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
- Institute of Statistics, University of Bremen, Bremen, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marion Flechtner-Mors
- Division of Sports and Rehabilitation Medicine, Department of Medicine, University Hospital Ulm, Ulm, Germany
| | - Janas M Harrington
- HRB Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
| | - Antje Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Carlijn B M Kamphuis
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands
| | - Liam Kelly
- Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Michael Laxy
- Technical University of Munich, Professorship of Public Health and Prevention, Munich, Germany
| | | | - Mario Mazzocchi
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
| | - Celine Murrin
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, Ireland
| | - Maartje P Poelman
- Chair Group Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, The Netherlands
| | - Ingrid Steenhuis
- Department of Health Sciences, Faculty of Science and Amsterdam Public Health Research Institute De Boelelaan 1085, VU University Amsterdam, Amsterdam, The Netherlands
| | - Gun Roos
- Consumption Research Norway, Oslo Metropolitan University, Oslo, Norway
| | - Jürgen M Steinacker
- Division of Sports and Rehabilitation Medicine, Department of Medicine, University Hospital Ulm, Ulm, Germany
| | - Frank van Lenthe
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Human Geography and Public Health, Utrecht University, Utrecht, The Netherlands
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Joanna Zukowska
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdansk, Poland
| | - Jeroen Lakerveld
- Department of Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Upstream Team, Amsterdam, the Netherlands
| | - Catherine B Woods
- Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
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Woods CB, Kelly L, Volf K, Gelius P, Messing S, Forberger S, Lakerveld J, den Braver NR, Zukowska J, García Bengoechea E. The Physical Activity Environment Policy Index for monitoring government policies and actions to improve physical activity. Eur J Public Health 2022; 32:iv50-iv58. [PMID: 36444111 PMCID: PMC9706113 DOI: 10.1093/eurpub/ckac062] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND A multifaceted response, including government action, is essential to improve population levels of physical activity (PA). This article describes the development process of the 'Physical Activity Environment Policy Index' (PA-EPI) monitoring framework, a tool to assess government policies and actions for creating a healthy PA environment. METHODS An iterative process was undertaken. This involved a review of policy documents from authoritative organizations, a PA policy audit of four European countries, and a systematic review of scientific literature. This was followed by an online consultation with academic experts (N = 101; 20 countries, 72% response rate), and policymakers (N = 40, 4 EU countries). During this process, consensus workshops were conducted, where quantitative and qualitative data, alongside theoretical and pragmatic considerations, were used to inform PA-EPI development. RESULTS The PA-EPI is conceptualized as a two-component 'policy' and 'infrastructure support' framework. The two-components comprise eight policy and seven infrastructure support domains. The policy domains are education, transport, urban design, healthcare, public education (including mass media), sport-for-all, workplaces and community. The infrastructure support domains are leadership, governance, monitoring and intelligence, funding and resources, platforms for interaction, workforce development and health-in-all-policies. Forty-five 'good practice statements' or indicators of ideal good practice within each domain conclude the PA-EPI. A potential eight-step process for conducting the PA-EPI is described. CONCLUSIONS Once pre-tested and piloted in several countries of various sizes and income levels, the PA-EPI good practice statements will evolve into benchmarks established by governments at the forefront of creating and implementing policies to address inactivity.
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Affiliation(s)
- Catherine B Woods
- Department of Physical Education and Sport Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Liam Kelly
- Department of Physical Education and Sport Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Kevin Volf
- Department of Physical Education and Sport Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Peter Gelius
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sven Messing
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Jeroen Lakerveld
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University Amsterdam, Amsterdam Public Health Research institute, Amsterdam, The Netherlands
- Upstream Team, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - Nicolette R den Braver
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University Amsterdam, Amsterdam Public Health Research institute, Amsterdam, The Netherlands
- Upstream Team, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - Joanna Zukowska
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdansk, Poland
| | - Enrique García Bengoechea
- Department of Physical Education and Sport Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
- Research and Innovation Unit, Sport Ireland, Dublin, Ireland
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12
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Kamphuis CBM, Forberger S, Lien N, Rehfuess E, Luszczynska A. Development of a framework to guide research into policies promoting physical activity and healthy diets in the European context: the system-based Policy Evaluation Network (PEN) framework. Eur J Public Health 2022; 32:iv3-iv9. [PMID: 36444110 PMCID: PMC9706121 DOI: 10.1093/eurpub/ckac068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The Policy Evaluation Network (PEN) is a multidisciplinary Pan-European research consortium focussing on policies affecting dietary intake, physical activity and sedentary behaviour. At the start, the PEN consortium expressed the need for an overarching, system-based framework covering the complexities between the different domains of the policy process (design, implementation and outcomes) in order to execute all research activities in a coherent way. This article describes the PEN framework itself and its development process. METHODS A staged approach to the development of a system-based framework was executed between February 2019 and February 2022. We started with a point-of-departure framework, made use of existing models, collected PEN outputs at different project stages (through online meetings, e-mail exchanges and workshops with PEN researchers) and drew updated versions of the framework, which resulted in the system-based PEN framework. RESULTS The system-based PEN framework depicts the policy process as a complex system, visualizing the dynamic interrelations between and within policy domains (i.e. policy design, policy implementation and policy outcomes), the ways they interact with the context, and how to assure a focus on equity in each domain. CONCLUSIONS The system-based PEN framework may guide researchers and professionals involved in the evaluation of health- or sustainability-related policies to consider their evaluation in a comprehensive picture, including domain interactions, contextual influences and equity considerations, as these can have important implications for the scope of their research. The stage-based process as applied for the development of the PEN framework can serve as a template for other research projects wishing to develop their own framework.
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Affiliation(s)
- Carlijn B M Kamphuis
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Aleksandra Luszczynska
- Wroclaw Faculty of Psychology, SWPS University of Social Sciences & Humanities, Wroclaw, Poland
- Melbourne Centre for Behavior Change, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
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13
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De Pauw R, Claessens M, Gorasso V, Drieskens S, Faes C, Devleesschauwer B. Past, present, and future trends of overweight and obesity in Belgium using Bayesian age-period-cohort models. BMC Public Health 2022; 22:1309. [PMID: 35799159 PMCID: PMC9263047 DOI: 10.1186/s12889-022-13685-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/24/2022] [Indexed: 12/15/2022] Open
Abstract
Background Overweight and obesity are one of the most significant risk factors of the twenty-first century related to an increased risk in the occurrence of non-communicable diseases and associated increased healthcare costs. To estimate the future impact of overweight, the current study aimed to project the prevalence of overweight and obesity to the year 2030 in Belgium using a Bayesian age-period-cohort (APC) model, supporting policy planning. Methods Height and weight of 58,369 adults aged 18+ years, collected in six consecutive cross-sectional health interview surveys between 1997 and 2018, were evaluated. Criteria used for overweight and obesity were defined as body mass index (BMI) ≥ 25, and BMI ≥ 30. Past trends and projections were estimated with a Bayesian hierarchical APC model. Results The prevalence of overweight and obesity has increased between 1997 and 2018 in both men and women, whereby the highest prevalence was observed in the middle-aged group. It is likely that a further increase in the prevalence of obesity will be seen by 2030 with a probability of 84.1% for an increase in cases among men and 56.0% for an increase in cases among women. For overweight, it is likely to see an increase in cases in women (57.4%), while a steady state in cases among men is likely. A prevalence of 52.3% [21.2%; 83.2%] for overweight, and 27.6% [9.9%; 57.4%] for obesity will likely be achieved in 2030 among men. Among women, a prevalence of 49,1% [7,3%; 90,9%] for overweight, and 17,2% [2,5%; 61,8%] for obesity is most likely. Conclusions Our projections show that the WHO target to halt obesity by 2025 will most likely not be achieved. There is an urgent necessity for policy makers to implement effective prevent policies and other strategies in people who are at risk for developing overweight and/or obesity. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13685-w.
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Affiliation(s)
- Robby De Pauw
- Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsmanstraat 14, BE-1050, Brussels, Belgium. .,Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Manu Claessens
- Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsmanstraat 14, BE-1050, Brussels, Belgium
| | - Vanessa Gorasso
- Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsmanstraat 14, BE-1050, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sabine Drieskens
- Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsmanstraat 14, BE-1050, Brussels, Belgium
| | - Christel Faes
- Data Science Institute, the Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Hasselt, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsmanstraat 14, BE-1050, Brussels, Belgium.,Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
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Nutrition policies in Germany: a systematic assessment with the Food Environment Policy Index. Public Health Nutr 2022; 25:1691-1700. [PMID: 34881689 PMCID: PMC9991688 DOI: 10.1017/s1368980021004742] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To systematically assess Germany's nutrition policies, to benchmark them against international best practices and to identify priority policy actions to improve population-level nutrition in Germany. DESIGN We applied the Food Environment Policy Index (Food-EPI), a methodological framework developed by the International Network for Food and Obesity/non-communicable Diseases Research, Monitoring and Action Support (INFORMAS) network. Qualitative content analysis of laws, directives and other documents formed the basis of a multistaged, structured consultation process. SETTING Germany. PARTICIPANTS The expert consultation process included fifty-five experts from academia, public administration and civil society. RESULTS Germany lags behind international best practices in several key policy areas. For eighteen policy indicators, the degree of implementation compared with international best practices was rated as very low, for twenty-one as low, for eight as intermediate and for none as high. In particular, indicators on food taxation, regulation of food marketing as well as retail and food service sector policies were rated as very low to low. Identified priority actions included the binding implementation of nutrition standards for schools and kindergartens, a reform of the value added tax on foods and beverages, a sugar-sweetened beverage tax and stricter regulation of food marketing directed at children. CONCLUSIONS The results show that Germany makes insufficient use of the potential of evidence-informed health-promoting nutrition policies. Adopting international best practices in key policy areas could help to reduce the burden of nutrition-related chronic disease and related inequalities in nutrition and health in Germany. Implementation of relevant policies requires political leadership, a broad societal dialogue and evidence-informed advocacy by civil society, including the scientific community.
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Effectiveness of food environment policies in improving population diets: a review of systematic reviews. Eur J Clin Nutr 2021; 76:637-646. [PMID: 34545213 DOI: 10.1038/s41430-021-01008-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/11/2021] [Accepted: 09/03/2021] [Indexed: 11/09/2022]
Abstract
Unhealthy population diets contribute to the burden of non-communicable diseases. Policies targeting food environments (FE policies) may improve population diets. This review of systematic reviews aims to summarise recent evidence of the effectiveness of FE policies in improving diets. We searched PubMed for systematic reviews published from January 2010 onwards. Eligible FE policies included: nutrition and food labelling, provision of foods in public institutions or specific settings, price, marketing, nutrition quality and portion size, and availability of foods in retail and food service establishments. A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2) instrument was used to assess review quality. Reviews of critically low quality were excluded. Results were narratively reported in text and tables. The search identified 1102 records after removing duplicates. Following screening and quality assessment we included 12 systematic reviews. Two reviews focused on nutrition and food labelling, two on provision of foods in school settings, four on price, none on marketing policies, three on nutrition quality and portion size and one on the availability of foods in retail and food service establishments. Pricing policies (tax/subsidy) appear effective in altering intake and purchase of targeted foods and beverages. FE policies targeting the availability of foods in retail and food establishments, food provision in school settings, product reformulation and the size of portions/packages or items of tableware also appear effective. Overall, policies targeting food environments appear effective in improving population diets. However, there is a need for further high-quality evidence.
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