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Abstract
Context Policy-specific actions to improve food environments will support healthy population diets. Objective To identify cited barriers and facilitators to food environment policy (FEP) processes reported in the literature, exploring these according to the nature of the policy (voluntary or mandatory) and country development status. Data sources A systematic search was conducted of 10 academic and 7 grey-literature databases, national websites, and manual searches of publication references. Data extraction Data on government-led FEPs, barriers, and facilitators from key informants were collected. Data synthesis The constant-comparison approach generated core themes for barriers and facilitators. The appraisal tool developed by Hawker et al. was adopted to determine the quality of qualitative and quantitative studies. Results A total of 142 eligible studies were identified. Industry resistance or disincentive was the most cited barrier in policy development. Technical challenges were most frequently a barrier for policy implementation. Frequently cited facilitators included resource availability or maximization, strategies in policy process, and stakeholder partnership or support. Conclusions The findings from this study will strategically inform health-reform stakeholders about key elements of public health policy processes. More evidence is required from countries with human development indices ranging from low to high and on voluntary policies. Systematic Review Registration PROSPERO registration no. CRD42018115034.
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Affiliation(s)
- SeeHoe Ng
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Heather Yeatman
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Bridget Kelly
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sreelakshmi Sankaranarayanan
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Tilakavati Karupaiah
- T. Karupaiah, School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, 47500 Subang Jaya, Selangor, Malaysia. E-mail:
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Baker P, Brown AD, Wingrove K, Allender S, Walls H, Cullerton K, Lee A, Demaio A, Lawrence M. Generating political commitment for ending malnutrition in all its forms: A system dynamics approach for strengthening nutrition actor networks. Obes Rev 2019; 20 Suppl 2:30-44. [PMID: 31245905 DOI: 10.1111/obr.12871] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/07/2019] [Accepted: 03/29/2019] [Indexed: 12/01/2022]
Abstract
Generating political commitment for ending all forms of malnutrition represents a key challenge for the global nutrition community. Without commitment, the policies, programs, and resources needed to improve nutrition are unlikely to be adopted, effectively implemented, nor sustained. One essential driver of commitment is nutrition actor network (NAN) effectiveness, the web of individuals and organizations operating within a given country who share a common interest in improving nutrition and who act collectively to do so. To inform new thinking and action towards strengthening NAN effectiveness, we use a systems dynamics theoretical approach and literature review to build initial causal loop diagrams (CLDs) of political commitment and NAN effectiveness and a qualitative group model building (GMB) method involving an expert workshop to strengthen model validity. First, a "nutrition commitment system" CLD demonstrates how five interrelated forms of commitment-rhetorical, institutional, operational, embedded, and system-wide-can dynamically reinforce or diminish one another over time. Second, we present CLDs demonstrating factors shaping NAN effectiveness organized into three categories: actor features, resources, and capacities; framing strategies, evidence, and norms; and institutional, political, and societal contexts. Together, these models generate hypotheses on how political commitment and NAN effectiveness could be strengthened in future and may provide potential starting points for country-specific conversations for doing so.
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Affiliation(s)
- Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Andrew D Brown
- Global Obesity Centre, Deakin University, Geelong, Australia
| | - Kate Wingrove
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Steve Allender
- Global Obesity Centre, Deakin University, Geelong, Australia
| | - Helen Walls
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Amanda Lee
- School of Public Health, The University of Queensland, Brisbane, Australia
| | | | - Mark Lawrence
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
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Baker P, Hawkes C, Wingrove K, Demaio AR, Parkhurst J, Thow AM, Walls H. What drives political commitment for nutrition? A review and framework synthesis to inform the United Nations Decade of Action on Nutrition. BMJ Glob Health 2018; 3:e000485. [PMID: 29527338 PMCID: PMC5841521 DOI: 10.1136/bmjgh-2017-000485] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 01/10/2018] [Accepted: 01/10/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Generating country-level political commitment will be critical to driving forward action throughout the United Nations Decade of Action on Nutrition (2016-2025). In this review of the empirical nutrition policy literature, we ask: what factors generate, sustain and constrain political commitment for nutrition, how and under what circumstances? Our aim is to inform strategic 'commitment-building' actions. METHOD We adopted a framework synthesis method and realist review protocol. An initial framework was derived from relevant theory and then populated with empirical evidence to test and modify it. Five steps were undertaken: initial theoretical framework development; search for relevant empirical literature; study selection and quality appraisal; data extraction, analysis and synthesis and framework modification. RESULTS 75 studies were included. We identified 18 factors that drive commitment, organised into five categories: actors; institutions; political and societal contexts; knowledge, evidence and framing; and, capacities and resources. Irrespective of country-context, effective nutrition actor networks, strong leadership, civil society mobilisation, supportive political administrations, societal change and focusing events, cohesive and resonant framing, and robust data systems and available evidence were commitment drivers. Low-income and middle-income country studies also frequently reported international actors, empowered institutions, vertical coordination and capacities and resources. In upper-middle-income and high-income country studies, private sector interference frequently undermined commitment. CONCLUSION Political commitment is not something that simply exists or emerges accidentally; it can be created and strengthened over time through strategic action. Successfully generating commitment will likely require a core set of actions with some context-dependent adaptations. Ultimately, it will necessitate strategic actions by cohesive, resourced and strongly led nutrition actor networks that are responsive to the multifactorial, multilevel and dynamic political systems in which they operate and attempt to influence. Accelerating the formation and effectiveness of such networks over the Nutrition Decade should be a core task for all actors involved.
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Affiliation(s)
- Phillip Baker
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Corinna Hawkes
- Centre for Food Policy, City University London, London, UK
| | - Kate Wingrove
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Alessandro Rhyl Demaio
- Department of Nutrition for Health and Development, World Health Organisation, Geneva, Switzerland
| | - Justin Parkhurst
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Anne Marie Thow
- Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia
| | - Helen Walls
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Leverhulme Centre for Integrated Research on Agriculture and Health, London, UK
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Dinour LM, Pole A. Potato Chips, Cookies, and Candy Oh My! Public Commentary on Proposed Rules Regulating Competitive Foods. HEALTH EDUCATION & BEHAVIOR 2017; 44:867-875. [PMID: 28382838 DOI: 10.1177/1090198117699509] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Healthy, Hunger-Free Kids Act of 2010 authorizes the U.S. Department of Agriculture (USDA) to establish nutritional standards for all foods sold in schools participating in federally funded meal programs. These foods, known as competitive foods, are commonly found in school cafeterias, vending machines, fundraisers, and snack bars and are associated with unhealthy dietary patterns. However, little is known about the regulatory process and opportunities for public participation to improve school food. AIMS This study investigates public commentary on the USDA's proposed rules governing competitive foods in schools. METHODS On February 8, 2013, the USDA's Food and Nutrition Service solicited public comments via Regulations.gov. A corpus of 247,871 public comments was obtained. Duplicate and near-duplicate comments were removed resulting in 3,032 unique comments. Two researchers content analyzed 10% of the sample, removing nonrelevant comments ( n = 249). RESULTS A majority of commenters are women, and mention their affiliation. Comments tend to be short, and exhibit low levels of complexity. An overwhelming majority of comments expressed concerns about the public health of youth vis-à-vis the new rule, whereas a small but vocal minority opposed the rule for financial and labor reasons and/or opposition to further government regulation. DISCUSSION Commentary on proposed rules should be specific, avoiding off-topic remarks. Commenters should be strategic, include their credentials, and provide a rationale for their position. CONCLUSION The rules governing competitive foods are poised to reverse the childhood obesity epidemic, and public commentary may shape these rules.
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Golden SD, McLeroy KR, Green LW, Earp JAL, Lieberman LD. Upending the social ecological model to guide health promotion efforts toward policy and environmental change. HEALTH EDUCATION & BEHAVIOR 2016; 42:8S-14S. [PMID: 25829123 DOI: 10.1177/1090198115575098] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Efforts to change policies and the environments in which people live, work, and play have gained increasing attention over the past several decades. Yet health promotion frameworks that illustrate the complex processes that produce health-enhancing structural changes are limited. Building on the experiences of health educators, community activists, and community-based researchers described in this supplement and elsewhere, as well as several political, social, and behavioral science theories, we propose a new framework to organize our thinking about producing policy, environmental, and other structural changes. We build on the social ecological model, a framework widely employed in public health research and practice, by turning it inside out, placing health-related and other social policies and environments at the center, and conceptualizing the ways in which individuals, their social networks, and organized groups produce a community context that fosters healthy policy and environmental development. We conclude by describing how health promotion practitioners and researchers can foster structural change by (1) conveying the health and social relevance of policy and environmental change initiatives, (2) building partnerships to support them, and (3) promoting more equitable distributions of the resources necessary for people to meet their daily needs, control their lives, and freely participate in the public sphere.
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Affiliation(s)
- Shelley D Golden
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Jo Anne L Earp
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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Allegrante JP. Policy and environmental approaches in health promotion: what is the state of the evidence? HEALTH EDUCATION & BEHAVIOR 2016; 42:5S-7S. [PMID: 25829119 DOI: 10.1177/1090198115575097] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- John P Allegrante
- Teachers College and the Mailman School of Public Health, Columbia University, New York, NY, USA
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