Barriers and opportunities to restricting marketing of unhealthy foods and beverages to children in Nepal: a policy analysis

Protecting children from unhealthy food marketing: a comparative policy analysis in Australia, Fiji and Thailand

Restrictions on marketing of unhealthy foods and beverages to children is a globally recommended policy measure to improve diets and health. The aim of the analysis was to identify opportunities to enable policy learning and shift beliefs of relevant actors, to engender policy progress on restrictions on marketing of unhealthy foods to children. We drew on the Advocacy Coalition Framework to thematically analyse data from qualitative policy interviews conducted Australia (n = 24), Fiji (n = 10) and Thailand (n = 20). In all three countries two clear and opposing advocacy coalitions were evident within the policy subsystem related to regulation of unhealthy food marketing, which we termed the 'strengthen regulation' and 'minimal/self regulation' coalitions. Contributors to policy stasis on this issue were identified as tensions between public health and economic objectives of government, and limited formal and informal spaces for productive dialogue. The analysis also identified opportunities for policy learning that could enable policy progress on restrictions on marketing of unhealthy foods to children as: taking an incremental approach to policy change, defining permitted (rather than restricted) foods, investing in new public health expertise related to emerging marketing approaches and scaling up of monitoring of impacts. The insights from this study are likely to be relevant to many countries seeking to strengthen regulation of marketing to children, in response to recent global recommendations.

Contemporary Approaches for Monitoring Food Marketing to Children to Progress Policy Actions

PURPOSE OF REVIEW

Protecting children from unhealthful food marketing is a global priority policy for improving population diets. Monitoring the nature and extent of children's exposure to this marketing is critical in policy development and implementation. This review summarises contemporary approaches to monitor the nature and extent of food marketing to support policy reform.

RECENT FINDINGS

Monitoring approaches vary depending on the stage of progress of related policy implementation, with resource implications and opportunity costs. Considerations include priority media/settings. marketing techniques assessed, approach to classifying foods, study design and if exposure assessments are based on media content analyses or are estimated or observed based on children's media use. Current evidence is largely limited to high-income countries and focuses on content analyses of TV advertising. Ongoing efforts are needed to support monitoring in low-resource settings and to progress monitoring to better capture children's actual exposures across media and settings.

Public perceptions of responsibility for recommended food policies in seven countries

BACKGROUND

Food policy is important to promote healthy and sustainable diets. However, who is responsible for developing and implementing food policy remains contentious. Therefore, this study aimed to investigate how the public attributes responsibility for food policy to governments, individuals and the private sector.

METHODS

A total of 7559 respondents from seven countries [Australia (n = 1033), Canada (n = 1079), China (n = 1099), India (n = 1086), New Zealand (n = 1090), the UK (n = 1079) and the USA (n = 1093)] completed an online survey assessing perceived responsibility for 11 recommended food policies.

RESULTS

Overall, preferred responsibility for the assessed food policies was primarily attributed to governments (62%), followed by the private sector (49%) and individuals (31%). Respondents from New Zealand expressed the highest support for government responsibility (70%) and those from the USA the lowest (50%). Respondents from the USA and India were most likely to nominate individuals as responsible (both 37%), while those from China were least likely (23%). The private sector had the highest attributed responsibility in New Zealand (55%) and the lowest in China and the USA (both 47%). Support for government responsibility declined with age and was higher among those on higher incomes, with a university degree, and who perceived themselves to consume a healthy diet or be in poor health.

CONCLUSIONS

Across seven diverse countries, results indicate the public considers government should take primary responsibility for the assessed food policies, with modest contribution from the private sector and minority support for individual responsibility.

School Food Environment in Urban Zambia: A Qualitative Analysis of Drivers of Adolescent Food Choices and Their Policy Implications

Identifying context specific points for reforming policy to promote healthier food environments and consumer behavior in critical life stages like adolescence is crucial in addressing the double burden of malnutrition. Using a qualitative study design, we conducted 20 focus group discussions with grade 10 pupils from ten secondary schools in Lusaka. Turner’s framework which conceptualizes the food environment into two domains—the external domain (availability, pricing, vendor and product properties, and marketing and regulation of food) and the internal domain (accessibility, affordability, convenience, and desirability of food)—was used to guide thematic data analysis and results interpretation. Adolescents stated their food choices are largely based on personal preference linked to the need for social acceptability among peers. Adolescents felt their food choice is limited to ‘cheap junk foods’ which are affordable and readily available at school. Healthy foods like fruits were said to be inaccessible and unaffordable by the majority of adolescents. Some adolescents stated they were attracted to certain foods by adverts they see on TV and social media. School food environments in urban Lusaka do not support healthy food choices. Policy reforms are required to increase access to affordable healthy food options in schools, and to curb the indiscriminate marketing of unhealthy foods to adolescents.