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Caldeira TCM, Vandevijvere S, Swinburn B, Mackay S, Claro RM. Differences in the cost and environmental impact between the current diet in Brazil and healthy and sustainable diets: a modeling study. Nutr J 2024; 23:71. [PMID: 38982483 PMCID: PMC11234630 DOI: 10.1186/s12937-024-00973-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/26/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND While healthy and sustainable diets benefit human and planetary health, their monetary cost has a direct impact on consumer food choices. This study aimed to identify the cost and environmental impact of the current Brazilian diet (CBD) and compare it with healthy and sustainable diets. METHODS Data from the Brazilian Household Budget Survey 2017/18 and the Footprints of Foods and Culinary Preparations Consumed in Brazil database were used for a modeling study comparing the cost of healthy and sustainable diets (based on the Brazilian Dietary Guidelines (BDG) diet and the EAT-Lancet diet) versus the CBD. The DIETCOST program generated multiple food baskets for each scenario (Montecarlo simulations). Nutritional quality, cost, and environmental impact measures (carbon footprint (CF) and water footprint (WF)) were estimated for all diets and compared by ANOVA. Simple linear regressions used standardized environmental impacts measures to estimate differentials in costs and environmental impacts among diets scenarios. RESULTS We observed significant differences in costs/1000 kcal. The BDG diet was cheaper (BRL$4.9 (95%IC:4.8;4.9) ≈ USD$1.5) than the CBD (BRL$5.6 (95%IC:5.6;5.7) ≈ USD$1.8) and the EAT-Lancet diet (BRL$6.1 (95%IC:6.0;6.1) ≈ USD$1.9). Ultra-processed foods (UPF) and red meat contributed the most to the CBD cost/1000 kcal, while fruits and vegetables made the lowest contribution to CBD. Red meat, sugary drinks, and UPF were the main contributors to the environmental impacts of the CBD. The environmental impact/1000 kcal of the CBD was nearly double (CF:3.1 kg(95%IC: 3.0;3.1); WF:2,705 L 95%IC:2,671;2,739)) the cost of the BDG diet (CF:1.4 kg (95%IC:1.4;1.4); WF:1,542 L (95%IC:1,524;1,561)) and EAT-Lancet diet (CF:1.1 kg (95%IC:1.0;1.1); WF:1,448 L (95%IC:1,428;1,469)). A one standard deviation increase in standardized CF corresponded to an increase of BRL$0.48 in the cost of the CBD, similar to standardized WF (BRL$0.56). A similar relationship between the environmental impact and the cost of the BDG (CF: BRL$0.20; WF: BRL$0.33) and EAT-Lancet (CF: BRL$0.04; WF: BRL$0.18) was found, but with a less pronounced effect. CONCLUSIONS The BDG diet was cost-effective, while the EAT-Lancet diet was slightly pricier than the CBD. The CBD presented almost double the CF and WF compared to the BDG and EAT-Lancet diets. The lower cost in each diet was associated with lower environmental impact, particularly for the BDG and EAT-Lancet diets. Multisectoral public policies must be applied to guide individuals and societies towards healthier and more sustainable eating patterns.
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Affiliation(s)
- Thaís Cristina Marquezine Caldeira
- Postgraduate Program in Public Health, Medical School, Federal University of Minas Gerais, Avenue Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, 30130-100, Brazil.
| | | | - Boyd Swinburn
- Faculty of Medical and Health Sciences, Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Sally Mackay
- Faculty of Medical and Health Sciences, Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Rafael Moreira Claro
- Nutrition Department, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Le Bouthillier M, Veilleux S, Loignon J, Turcotte M, Trudel L, Provencher V. Knowledge mobilization between the food industry and public health nutrition scientists: findings from a case study. BMC Nutr 2024; 10:81. [PMID: 38845063 PMCID: PMC11155086 DOI: 10.1186/s40795-024-00889-z] [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: 08/30/2023] [Accepted: 05/28/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Improving the nutritional quality of the food supply increases access to nutritious foods, which improves dietary habits and population health. Yet, knowledge mobilization initiatives between public health nutrition researchers and food industries are often not adequately considered and understood. This study explored what elements related to this specific context need to be recognized so that researchers can better mobilize nutrition science knowledge with the food industry to promote the nutritional improvement of food products. METHOD A case study qualitative approach was selected to answer the research question, using semi-structured interviews as the data collection technique. Québec baking industry actors were shown a mock-up of an online mobilization platform sharing the results of the Food Quality Observatory that describes the nutritional quality of breads offered in Québec, Canada. They were asked to think aloud as they explored the web platform and were interviewed. Two coders analyzed the data using an inductive approach and thematic content analysis, starting with individual open coding, and then put forward their analyses and drafted the final themes. RESULTS The final data consisted of 10 semi-structured interviews conducted between October 2019 and August 2020. Four main themes were identified: the industry's context, the knowledge mobilization initiative, the product-related matters stemming from the information shared and the motivation within the industry. Within each theme, sub-themes were highlighted and related to the industries' motivation to improve their products' nutritional quality. This study also specified key considerations for changes to the sodium and fiber content in bread. CONCLUSION Other steps beyond using simple language and a website format could be taken to better mobilize scientific knowledge with food industries, such as providing more consumer information, using an integrated knowledge mobilization approach that includes a consideration of ethics, working with communication professionals, collaborating with food science experts, and providing resources to act on shared information. Legislation such as the front-of-pack regulations could accelerate the pace of collaboration between researchers and industry. Overall, establishing a prior relationship with industries could help gain a better understanding of the themes highlighted in this study. Future research could build on this case study to provide more insights and solidify these findings. CLASSIFICATION CODES Public Health, Public Private, Policy Making, Research Institutions, Use of Knowledge.
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Affiliation(s)
- Marie Le Bouthillier
- Centre NUTRISS-Nutrition, Santé et Société, Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, 2440, Hochelaga Boulevard, Pavillon des services, office 2729-L Qc, Quebec, QC, G1V 0A6, Canada
- École de Nutrition, Université Laval, 2440, Hochelaga Boulevard, Pavillon des services, office 2729-L Qc, Quebec, QC, G1V 0A6, Canada
| | - Sophie Veilleux
- Centre NUTRISS-Nutrition, Santé et Société, Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, 2440, Hochelaga Boulevard, Pavillon des services, office 2729-L Qc, Quebec, QC, G1V 0A6, Canada
- Faculté des sciences de l'administration, Université Laval, Quebec, QC, G1V 0A6, Canada
- Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, 2440, Hochelaga Boulevard, Pavillon des services, office 2729-L Qc, Quebec, QC, G1V 0A6, Canada
| | - Jeanne Loignon
- Centre NUTRISS-Nutrition, Santé et Société, Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, 2440, Hochelaga Boulevard, Pavillon des services, office 2729-L Qc, Quebec, QC, G1V 0A6, Canada
- Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, 2440, Hochelaga Boulevard, Pavillon des services, office 2729-L Qc, Quebec, QC, G1V 0A6, Canada
| | - Mylène Turcotte
- Centre NUTRISS-Nutrition, Santé et Société, Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, 2440, Hochelaga Boulevard, Pavillon des services, office 2729-L Qc, Quebec, QC, G1V 0A6, Canada
| | - Laurélie Trudel
- Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, 2440, Hochelaga Boulevard, Pavillon des services, office 2729-L Qc, Quebec, QC, G1V 0A6, Canada
| | - Véronique Provencher
- Centre NUTRISS-Nutrition, Santé et Société, Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, 2440, Hochelaga Boulevard, Pavillon des services, office 2729-L Qc, Quebec, QC, G1V 0A6, Canada.
- École de Nutrition, Université Laval, 2440, Hochelaga Boulevard, Pavillon des services, office 2729-L Qc, Quebec, QC, G1V 0A6, Canada.
- Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, 2440, Hochelaga Boulevard, Pavillon des services, office 2729-L Qc, Quebec, QC, G1V 0A6, Canada.
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Eisenkraft Klein D, Shawanda A. Bridging the commercial determinants of Indigenous health and the legacies of colonization: A critical analysis. Glob Health Promot 2024; 31:15-22. [PMID: 37522186 PMCID: PMC11363465 DOI: 10.1177/17579759231187614] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/23/2023] [Indexed: 08/01/2023]
Abstract
To date, there has been scarce effort to consider the intertwining of colonization and the commercial determinants of Indigenous health. This is a vital omission, and one that this paper proposes to address. We propose how four losses of tradition borne out of colonialism are intertwined with four respective commercial determinants of Indigenous health: 1) loss of traditional diets and the ultra-processed food industry; 2) loss of traditional ceremony and the tobacco industry; 3) loss of traditional knowledge and the infant formula industry; and 4) loss of traditional support networks and the alcohol industry. Building on Indigenous efforts to decolonize spaces and assert control over their own lives, we argue that analyzing the mechanisms through which industry activities intersect with colonial legacies will improve broader understandings of Indigenous health disparities.
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Affiliation(s)
| | - Amy Shawanda
- Waakebiness Institute for Indigenous Health, Dalla Lana School of Public Health, University of Toronto, Canada
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Fox NJ. Capitalism and the 'commercial determinants of health': A more-than-human micropolitics. Soc Sci Med 2024; 350:116925. [PMID: 38718438 DOI: 10.1016/j.socscimed.2024.116925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/26/2023] [Accepted: 04/25/2024] [Indexed: 05/21/2024]
Abstract
This paper argues that studies of the 'commercial determinants of health' (CDoH) need to acknowledge fully the part the capitalist mode of commodity production and exchange plays in producing negative health outcomes. This proposition is supported by recourse to a recent development in political economy that has established a more-than-human, relational and monist (or 'flat') ontology of capitalism, in place of the more conventional neo-Marxist perspective. This ontology reveals a dynamic to capitalism that operates beyond human intentionality, driven by the supply of, and demand for the capacities of commodities. This dynamic determines the production and consumption of all commodities, some among which (such as tobacco, alcohol and processed foods) contribute to ill-health. A case study of food consumption reveals how these supply and demand affects drive 'unhealthy' food choices by consumers. Ways to undermine this more-than-human dynamic are offered as an innovative approach to addressing the effects of commerce and capitalism upon health.
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Affiliation(s)
- Nick J Fox
- Department of Behavioural and Social Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK.
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Ferreira SRG, Macotela Y, Velloso LA, Mori MA. Determinants of obesity in Latin America. Nat Metab 2024; 6:409-432. [PMID: 38438626 DOI: 10.1038/s42255-024-00977-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/04/2024] [Indexed: 03/06/2024]
Abstract
Obesity rates are increasing almost everywhere in the world, although the pace and timing for this increase differ when populations from developed and developing countries are compared. The sharp and more recent increase in obesity rates in many Latin American countries is an example of that and results from regional characteristics that emerge from interactions between multiple factors. Aware of the complexity of enumerating these factors, we highlight eight main determinants (the physical environment, food exposure, economic and political interest, social inequity, limited access to scientific knowledge, culture, contextual behaviour and genetics) and discuss how they impact obesity rates in Latin American countries. We propose that initiatives aimed at understanding obesity and hampering obesity growth in Latin America should involve multidisciplinary, global approaches that consider these determinants to build more effective public policy and strategies, accounting for regional differences and disease complexity at the individual and systemic levels.
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Affiliation(s)
| | - Yazmín Macotela
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, UNAM Campus-Juriquilla, Querétaro, Mexico
| | - Licio A Velloso
- Obesity and Comorbidities Research Center, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, Brazil
| | - Marcelo A Mori
- Institute of Biology, Universidade Estadual de Campinas, Campinas, Brazil.
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Malamatenios O, Campbell JL, Schofield G, Zinn C. The Human Interference Scoring System (HISS): A New Tool for Quantifying Food Quality Based on Its Level of Processing. Nutrients 2024; 16:536. [PMID: 38398860 PMCID: PMC10892936 DOI: 10.3390/nu16040536] [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: 11/29/2023] [Revised: 01/17/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
The Human Interference Scoring System (HISS) is a novel food-based diet-quality-classification system based on the existing NOVA method. HISS involves food and fluid allocation into categories from digital imagery based on food processing levels, followed by meal plan analysis using food-servings quantification. The primary purpose of this work was to evaluate the reliability of HISS. Trained nutrition professionals analyzed digital photographs from five hypothetical 24 h food recalls and categorized foods into one of four HISS categories. A secondary purpose was to assess the nutrient composition of the food recalls and other selected foods from the HISS categories. Participants effectively categorized foods into HISS categories, with only minor discrepancies noted. High inter-rater reliability was observed in the outer HISS categories: unprocessed and ultra-processed foods. Ultra-processed items consistently displayed elevated energy, carbohydrates, and sugar compared to unprocessed foods, while unprocessed foods exhibited notably higher dietary fiber. This study introduces the HISS as a potentially useful tool for quantifying a food-quality-based system using digital-photography-based assessments. Its high inter-rater reliability and ability to capture relationships between food processing levels and nutrient composition make it a promising method for assessing dietary habits and food quality.
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Affiliation(s)
| | | | | | - Caryn Zinn
- Human Potential Centre, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland 1142, New Zealand
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Norov B, Cristobal-Maramag C, Van Minh H, Long KQ, Huse O, Nkoroi A, Luvsanjamba M, Phuong DH, Kupka R, Lobstein T, Jewell J, Castro MC, Oliver N, Watson F. Prevention of childhood overweight and obesity in Mongolia, the Philippines and Vietnam: identifying priority actions. Health Promot Int 2023; 38:daad187. [PMID: 38156876 PMCID: PMC10756053 DOI: 10.1093/heapro/daad187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Low- and middle-income countries are increasingly faced with a triple burden of malnutrition: endemic underweight, micronutrient deficiencies and rising prevalence of overweight. This study aimed to address existing knowledge gaps and to identify priority policy options in Mongolia, the Philippines and Vietnam. A landscape analysis approach was adopted using methods set out in a UNICEF global toolkit. Quantitative and qualitative data were compiled from a range of global and national sources on childhood overweight and obesity, risk factors and policy responses. Key informant interviews and validation workshops were undertaken with key food and nutrition stakeholders from government and non-government organizations to identify priority policy options for the prevention of overweight and obesity among children. Overweight and obesity among children are increasing in all three countries. Associated risk factors are related to maternal nutrition, birthweight, breastfeeding, as well as diets and physical activity shaped by increasingly obesogenic environments. Key informants identified undefined policy approaches, poor community understanding and food and beverage industry influence as barriers to addressing overweight and obesity. Key policy priorities include restricting the marketing of unhealthy food and beverages, unhealthy food and beverage taxation, introduction of front-of-pack nutrition labels and improving school nutrition environments. Mongolia, the Philippines and Vietnam are all facing an increasing burden of childhood overweight and obesity. Despite differing national contexts, similar environmental factors are driving this rise. A suite of evidence-based policies can effectively be introduced to address obesogenic environments.
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Affiliation(s)
- Bolormaa Norov
- Nutrition Department, National Center for Public Health, Peace Ave 46, Ulaanbaatar 13381, Mongolia
| | - Cherry Cristobal-Maramag
- Health and Nutrition Unit, Nutrition Center of the Philippines, Launchpad Coworking 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, The Philippines
| | - Hoang Van Minh
- Hanoi University of Public Health, 1A Đ. Đức Thắng, Đông Ngạc, Bắc Từ Liêm, Hà Nội, Vietnam
| | - Khương Quỳnh Long
- Hanoi University of Public Health, 1A Đ. Đức Thắng, Đông Ngạc, Bắc Từ Liêm, Hà Nội, Vietnam
| | - Oliver Huse
- Deakin University, Geelong Australia, Global Obesity Centre for Preventive Health and Nutrition, Institute for Health Transformation, 1 Gheringhap St 3220
- East Asia and Pacific Regional Office, UNICEF, 19 Pra Athit Rd, Chana Songkhram, Pra Nakhon, Bangkok 10200, Thailand
| | - Alice Nkoroi
- Philippines Country Office, UNICEF, 14th Floor, North Tower, Rockwell Business Center Sheridan, Sheridan Street corner United Street, Highway Hills, Mandaluyong City 1550, Philippines
| | - Munkhjargal Luvsanjamba
- Mongolia Country Office, UNICEF, UN House, United Nations street-14, Ulaanbaatar 14201, Mongolia
| | - Do Hong Phuong
- Vietnam Country Office, UNICEF, The Green One UN House, 304 Kim Ma, Ba Dinh District, Hanoi, Vietnam
| | - Roland Kupka
- East Asia and Pacific Regional Office, UNICEF, 19 Pra Athit Rd, Chana Songkhram, Pra Nakhon, Bangkok 10200, Thailand
| | - Tim Lobstein
- Policy Section, World Obesity Federation, 5th Floor, 38 Chancery Lane, London, WC2A 1EN, UK
- The Boden Initiative, University of Sydney, John Hopkins Dr, Camperdown, Sydney, 2050, NSW, Australia
| | - Jo Jewell
- Nutrition Section, UNICEF, 3 United Nations Plaza, New York, NY 10017, USA
| | - Mary Christine Castro
- Health and Nutrition Unit, Nutrition Center of the Philippines, Launchpad Coworking 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, The Philippines
| | - Nikka Oliver
- Health and Nutrition Unit, Nutrition Center of the Philippines, Launchpad Coworking 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, The Philippines
| | - Fiona Watson
- East Asia and Pacific Regional Office, UNICEF, 19 Pra Athit Rd, Chana Songkhram, Pra Nakhon, Bangkok 10200, Thailand
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Walls H, Pries A, Chotivichien S, Huynh P, Fahmida U, Blankenship J. Health first, convenience second: Caregiver perspectives of commercially produced complementary foods in five Southeast Asian capital cities. MATERNAL & CHILD NUTRITION 2023; 19 Suppl 2:e13600. [PMID: 38062001 PMCID: PMC10719061 DOI: 10.1111/mcn.13600] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 10/17/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023]
Abstract
Caregivers in low- and middle-income countries increasingly feed commercially produced complementary foods (CPCF) to older infants and young children-shaped by factors including industry promotion. The dynamics of CPCF consumption and caregiver knowledge, attitudes and behaviours regarding complementary feeding practices are poorly understood in these settings. We examined how caregiver knowledge/attitudes/behaviours about CPCF shape the feeding of older infants and young children in the capital cities of five countries in Southeast Asia (Bangkok, Hanoi, Jakarta, Kuala Lumpur, Manila). An online, web-based, cross-sectional panel survey was conducted among mothers of a child aged 6-23 months. One hundred participants were included in each of the five capital cities. Questionnaires were undertaken in the official language of each city. Data were analysed in Stata (version 17.0), using χ2 tests to examine difference between variables of interest. All mothers purchased CPCF for their youngest child aged 6-23 months at the time of survey. CPCF were commonly fed to children at least once per day, and in many of the five cities at most or every feeding. While factors such as convenience and affordability influenced CPCF purchase, mothers primarily purchased CPCF for nutritional reasons. The most common source of feeding information was health care professionals, followed by social media. CPCF are ubiquitous in the diets of older infants and young children of educated middle-upper socioeconomic status mothers in capital cities of Southeast Asia, with perceived healthiness a key driver in selecting CPCF. A strong governmental regulatory response to industry marketing/promotion will be critical to addressing CPCF appropriateness, including health and nutritional claim use.
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Affiliation(s)
- Helen Walls
- London School of Hygiene & Tropical Medicine, Faculty of Public Health & PolicyLondonUK
- Helen Keller InternationalNew YorkNew YorkUSA
| | | | | | | | - Umi Fahmida
- Department of Nutrition, Faculty of MedicineUniversitas Indonesia–Dr. Cipto Mangunkusumo General HospitalDepokIndonesia
- Southeast Asian Ministers of Education Organization Regional Centre for Food and Nutrition (SEAMEO RECFON)Pusat Kajian Gizi Regional Universitas IndonesiaJakartaIndonesia
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Bankole E, Harris N, Rutherford S, Wiseman N. A systematic review of the adolescent-directed marketing strategies of transnational fast food companies in low- and middle-income countries. Obes Sci Pract 2023; 9:670-680. [PMID: 38090687 PMCID: PMC10712404 DOI: 10.1002/osp4.676] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 04/06/2023] [Accepted: 04/16/2023] [Indexed: 06/10/2024] Open
Abstract
Introduction Fast food consumption is associated with excessive intake of energy-dense foods; a major determinant of childhood obesity. The lack of data on the marketing strategies used to promote fast food to adolescents in low and middle-income countries (LMICs) acts as a barrier to global efforts to reduce the marketing of unhealthy foods to young people around the world. Objectives This systematic review aimed to identify the adolescent-directed marketing strategies of transnational fast food corporations in LMICs. Methods A systematic search of eight scientific databases (PubMed, CINAHL, Medline, Embase, ProQuest, PsycInfo, Scopus and Google Scholar) was conducted. Following PRISMA guidelines, primary research articles written in English were included if they were published between 1 January 2010 and 30 December 2022, and reported any adolescent-directed marketing activity undertaken by a transnational fast food company operating in a LMIC. Articles were excluded if they were not peer reviewed. The quality of the included articles was assessed using a condensed version of the Consolidated Criteria for Reporting Qualitative Research tool. Results Twelve articles met the eligibility criteria and were included in this review. A narrative synthesis of these articles revealed that the most documented strategies used to promote fast food to adolescents in LMICs were the use of incentives or premium offers, product appeals, promotional characters and brand familiarity. These strategies were mostly observed on social media, suggesting that there are serious concerns about adolescent exposure to fast food via social media in developing settings, especially as contextual differences in the nature of such marketing were identified. Discussion The promotion of fast food to adolescents in LMICs is contextual in nature, with the nature of marketing strategies employed by transnational fast food corporations varying greatly across cultural and socio-economic contexts. These findings are crucial for the development of guidelines and regulations restricting the marketing of fast food to adolescents in lower income settings, contributing to global efforts to reduce adolescent exposure to unhealthy food promotion.
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Affiliation(s)
- Elijah Bankole
- Public HealthSchool of Medicine and DentistryGriffith UniversityGold CoastQueenslandAustralia
| | - Neil Harris
- Public HealthSchool of Medicine and DentistryGriffith UniversityGold CoastQueenslandAustralia
| | - Shannon Rutherford
- Public HealthSchool of Medicine and DentistryGriffith UniversityGold CoastQueenslandAustralia
| | - Nicola Wiseman
- Public HealthSchool of Medicine and DentistryGriffith UniversityGold CoastQueenslandAustralia
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Barnett-Naghshineh O, Warmington S, Altink H, Govia I, Morrissey K, Smith MJ, Thurstan RH, Unwin N, Guell C. Situating commercial determinants of health in their historical context: a qualitative study of sugar-sweetened beverages in Jamaica. Global Health 2023; 19:69. [PMID: 37700357 PMCID: PMC10498565 DOI: 10.1186/s12992-023-00962-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/07/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are the leading cause of mortality across the Caribbean and similar regions. Structural determinants include a marked increase in the dependency on food imports, and the proliferation of processed foods, including sugar-sweetened beverages (SSBs). We focused on Jamaica as a case study and the health challenge of SSBs, and situated contemporary actions, experiences and policies within their historical context to investigate underlying drivers of commercial determinants of health and attempts to counter them. We asked: how can a historical perspective of the drivers of high level SSB consumption in Jamaica contribute to an enhanced understanding of the context of public health policies aimed at reducing their intake? METHODS An ethnographic approach with remote data collection included online semi-structured interviews and workshops with 22 local experts and practitioners of health, agriculture and nutrition in Jamaica and attending relevant regional public webinars on SSBs and NCD action in the Caribbean. Our analysis was situated within a review of historical studies of Caribbean food economies with focus on the twentieth century. Jamaican and UK-based researchers collected and ethnographically analysed the data, and discussed findings with the wider transdisciplinary team. RESULTS We emphasise three key areas in which historical events have shaped contextual factors of SSB consumption. Trade privileged sugar as a cash crop over food production during Jamaica's long colonial history, and trade deregulation since the 1980s through structural adjustment opened markets to transnational companies. These changes increased Jamaican receptiveness to the mass advertisement and marketing of these companies, whilst long-standing power imbalances hampered taxation and regulation in contemporary public health actions. Civil society efforts were important for promoting structural changes to curb overconsumption of SSBs and decentring such entrenched power relations. CONCLUSION The contemporary challenge of SSBs in Jamaica is a poignant case study of commercial determinants of health and the important context of global market-driven economies and the involvement of private sector interests in public health policies and governance. Historically contextualising these determinants is paramount to making sense of the sugar ecology in Jamaica today and can help elucidate entrenched power dynamics and their key actors.
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Affiliation(s)
| | - Sheray Warmington
- Epidemiology Research Unit, Caribbean Institute for Health Research (CAIHR), The University of the West Indies, Mona, Kingston, 7, Jamaica
| | - Henrice Altink
- Department of History and Interdisciplinary Global Development Centre, University of York, Heslington, York, YO10 5DD, UK
| | - Ishtar Govia
- Epidemiology Research Unit, Caribbean Institute for Health Research (CAIHR), The University of the West Indies, Mona, Kingston, 7, Jamaica
- Institute for Global Health, University College London, London, WC1N 1EH, UK
| | - Karyn Morrissey
- Climate and Energy Policy, Department of Technology, Management and Economics, Technical University Denmark, Kgs. Lyngby, 2800, Denmark
| | - Matthew J Smith
- Department of History, University College London, London, WC1E 6BT, UK
| | - Ruth H Thurstan
- Centre for Ecology and Conservation, University of Exeter, Penryn, TR10 9FE, UK
| | - Nigel Unwin
- European Centre for Environment and Human Health, University of Exeter, Penryn, TR10 9FE, UK
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, CB2 0SL, UK
| | - Cornelia Guell
- European Centre for Environment and Human Health, University of Exeter, Penryn, TR10 9FE, UK.
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11
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Hertwig R. The real cause of our complicity: The preoccupation with human weakness. Behav Brain Sci 2023; 46:e161. [PMID: 37646278 DOI: 10.1017/s0140525x23000936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Chater & Loewenstein offer an incisive criticism of how behavioral sciences and public policy have become complicit with corporations in blaming public health and societal problems on individual weaknesses, thus deflecting support away from systemic reforms. However, their analysis stops short of holding the field to account in one important respect: its preoccupation with human irrationality and weakness.
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Affiliation(s)
- Ralph Hertwig
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany. ; https://www.mpib-berlin.mpg.de/staff/ralph-hertwig
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12
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Valicente VM, Peng CH, Pacheco KN, Lin L, Kielb EI, Dawoodani E, Abdollahi A, Mattes RD. Ultraprocessed Foods and Obesity Risk: A Critical Review of Reported Mechanisms. Adv Nutr 2023; 14:718-738. [PMID: 37080461 PMCID: PMC10334162 DOI: 10.1016/j.advnut.2023.04.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/02/2023] [Accepted: 04/14/2023] [Indexed: 04/22/2023] Open
Abstract
Epidemiologic evidence supports a positive association between ultraprocessed food (UPF) consumption and body mass index. This has led to recommendations to avoid UPFs despite very limited evidence establishing causality. Many mechanisms have been proposed, and this review critically aimed to evaluate selected possibilities for specificity, clarity, and consistency related to food choice (i.e., low cost, shelf-life, food packaging, hyperpalatability, and stimulation of hunger/suppression of fullness); food composition (i.e., macronutrients, food texture, added sugar, fat and salt, energy density, low-calorie sweeteners, and additives); and digestive processes (i.e., oral processing/eating rate, gastric emptying time, gastrointestinal transit time, and microbiome). For some purported mechanisms (e.g., fiber content, texture, gastric emptying, and intestinal transit time), data directly contrasting the effects of UPF and non-UPF intake on the indices of appetite, food intake, and adiposity are available and do not support a unique contribution of UPFs. In other instances, data are not available (e.g., microbiome and food additives) or are insufficient (e.g., packaging, food cost, shelf-life, macronutrient intake, and appetite stimulation) to judge the benefits versus the risks of UPF avoidance. There are yet other evoked mechanisms in which the preponderance of evidence indicates ingredients in UPFs actually moderate body weight (e.g., low-calorie sweetener use for weight management; beverage consumption as it dilutes energy density; and higher fat content because it reduces glycemic responses). Because avoidance of UPFs holds potential adverse effects (e.g., reduced diet quality, increased risk of food poisoning, and food wastage), it is imprudent to make recommendations regarding their role in diets before causality and plausible mechanisms have been verified.
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Affiliation(s)
- Vinicius M Valicente
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Ching-Hsuan Peng
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN, United States
| | - Kathryn N Pacheco
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Luotao Lin
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Elizabeth I Kielb
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN, United States
| | - Elina Dawoodani
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Afsoun Abdollahi
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Richard D Mattes
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States.
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13
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Wang J, Zhang X. The big food view and human health from the prospect of bio-manufacturing and future food. Front Nutr 2023; 10:1160743. [PMID: 37360295 PMCID: PMC10286865 DOI: 10.3389/fnut.2023.1160743] [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: 02/07/2023] [Accepted: 04/11/2023] [Indexed: 06/28/2023] Open
Abstract
The "big food view" has attracted widespread attention due to the view of sustainable nutrition and human health as part of sustainable development. The "big food view" starts from better meeting the people's needs for a better life. While ensuring the supply of grain, the effective supply of meat, vegetables, fruits, aquatic products and other foods also should be guaranteed. Using cell factories to replace the traditional food acquisition methods, establishing a new model of sustainable food manufacturing, will greatly reduce the demand for resources in food production, and improve the controllability of food production and manufacturing, and effectively avoid potential food safety and health risks. Cell factories can provide key technologies and supporting methods for the biological manufacturing of important food components, functional food ingredients and important functional nutritional factors, realizing a safer, nutritious, healthy and sustainable way of food acquisition. The combination of cell factory technology and other technologies meets the people's new dietary demand, and also supports that sustainable nutrition and human health as part of sustainable development. This paper focuses on the big food view and human health from the prospect of bio-manufacturing and future food, which aims to better meet people's dietary needs for increasingly diversified, refined, nutritious and ecological food through diversified food manufacturing.
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Affiliation(s)
- Jing Wang
- China Rural Technology Development Center, Beijing, China
| | - Xin Zhang
- China Rural Technology Development Center, Beijing, China
- Department of Food Science and Engineering, Ningbo University, Ningbo, China
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14
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Jawad A, Mulligan C, Savona N, L'Abbé MR. Qualitative analysis of front-of package labeling policy interactions between stakeholders and Health Canada. Front Public Health 2023; 11:982908. [PMID: 37089483 PMCID: PMC10115994 DOI: 10.3389/fpubh.2023.982908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 03/10/2023] [Indexed: 04/08/2023] Open
Abstract
Background Front-of-package labelling regulations proposed by Health Canada in their Healthy Eating Strategy (2016) were finally passed in 2022, but remain unimplemented. This study analyzed interactions that occurred between stakeholders and government related to this policy proposal to identify key themes and policy implications. Methods A qualitative framework analysis was conducted on publicly available documents for stakeholder correspondences related to front-of-package that occurred between 2016 and 2019 in Health Canada's Meetings and Correspondence on Healthy Eating database. Five sequential steps were applied: familiarization, identifying a thematic framework, indexing, charting, and mapping and interpretation. A complex systems (i.e., a dynamic system with multiple interconnecting components) lens was incorporated in the final step to deepen the analysis. Results Hundred and seventy-three documents were included, the majority from industry stakeholders (n = 108, 62.4%). Three overarching themes were identified: industry trying to control the agenda and resist regulation; questioning the evidence supporting the policy and its impact on the agri-food industry; and dismissing the need and effectiveness of the policy. Incorporating a complex system lens found industry and non-industry stakeholders held markedly different perspectives on how cohesive the system defined by the front-of-package labelling policy was, and the policy impact on its stability. Economic and opportunity costs were the main trade-offs, and symbol misinterpretation considered an unintended consequence by industry. Finally, some stakeholders argued for wider policy scope incorporating more products, while others requested a narrower approach through exemptions. Conclusion Interactions with industry stakeholders on health food policy proposals require careful consideration, given it may suit their interests to generate delays and policy discordance. Explicitly setting out the principles of engagement and actively encouraging non-industry stakeholder representation provides a more balanced approach to policy consultation and development.
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Affiliation(s)
- Aalaa Jawad
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Christine Mulligan
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Natalie Savona
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mary R. L'Abbé
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
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15
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Gaucher-Holm A, Wood B, Sacks G, Vanderlee L. The structure of the Canadian packaged food and non-alcoholic beverage manufacturing and grocery retailing sectors through a public health lens. Global Health 2023; 19:18. [PMID: 36906536 PMCID: PMC10008568 DOI: 10.1186/s12992-023-00917-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/28/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Corporate power has been recognized as an important influence on food environments and population health more broadly. Understanding the structure of national food and beverage markets can provide important insight into the power held by leading corporations. This study aimed to descriptively analyze the structure of the Canadian food and beverage manufacturing and grocery retailing sectors as of 2020/21. METHODS Packaged food manufacturers, non-alcoholic beverage manufacturers and grocery retailers with ≥ 1% market share in 2020/21 in Canada as per Euromonitor International were identified and characterized. Proportion of market share held by public vs private, multinational vs national, and foreign multinational companies was assessed for the 3 sectors. The concentration of 14 packaged food, 8 non-alcoholic beverage and 5 grocery retailing markets was assessed using the Herfindahl-Hirschman Index (HHI) and the four firm concentration ratio (CR4) (HHI > 1800 and CR4 > 60 suggest high market concentration). Company ownership structure was also assessed, including common ownership of public companies by three of the largest global asset managers using data from Refinitiv Eikon, a financial market database. RESULTS The Canadian non-alcoholic beverage manufacturing sector, and, to a lesser extent, the packaged food manufacturing sector were dominated by foreign multinational companies, in contrast with the grocery retailing sector which was dominated by national companies. Market concentration varied across sectors and markets but was substantially greater within the retailing (median CR4 = 84; median HHI = 2405) and non-alcoholic beverage sectors (median CR4 = 72; median HHI = 1995) compared to the packaged food sector (median CR4 = 51; median HHI = 932). There was considerable evidence of common ownership across sectors. Overall, the Vanguard Group Inc owned at least 1% of shares in 95% of publicly listed companies, Blackrock Institutional Trust Company 71%, and State Street Global Advisors (US) 43%. CONCLUSIONS The Canadian packaged food and non-alcoholic beverage manufacturing and grocery retailing sectors include several consolidated markets, with a high degree of common ownership by major investors. Findings suggest that a small number of large corporations, particularly in the retailing sector, have extensive power to influence Canadian food environments; their policies and practices warrant substantial attention as part of efforts to improve population diets in Canada.
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Affiliation(s)
- Alexa Gaucher-Holm
- École de nutrition, Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, 2425 rue de l'Agriculture, Québec, QC, G1V 0A6, Canada
| | - Benjamin Wood
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Gary Sacks
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Lana Vanderlee
- École de nutrition, Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, 2425 rue de l'Agriculture, Québec, QC, G1V 0A6, Canada.
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16
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The role of trade in pacific food security and nutrition. GLOBAL FOOD SECURITY 2023. [DOI: 10.1016/j.gfs.2022.100670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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17
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Sharma S, Matheson A, Lambrick D, Faulkner J, Lounsbury DW, Vaidya A, Page R. Dietary practices, physical activity and social determinants of non-communicable diseases in Nepal: A systemic analysis. PLoS One 2023; 18:e0281355. [PMID: 36745612 PMCID: PMC9901760 DOI: 10.1371/journal.pone.0281355] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 01/20/2023] [Indexed: 02/07/2023] Open
Abstract
Unhealthy dietary habits and physical inactivity are major risk factors of non-communicable diseases (NCDs) globally. The objective of this paper was to describe the role of dietary practices and physical activity in the interaction of the social determinants of NCDs in Nepal, a developing economy. The study was a qualitative study design involving two districts in Nepal, whereby data was collected via key informant interviews (n = 63) and focus group discussions (n = 12). Thematic analysis of the qualitative data was performed, and a causal loop diagram was built to illustrate the dynamic interactions of the social determinants of NCDs based on the themes. The study also involved sense-making sessions with policy level and local stakeholders. Four key interacting themes emerged from the study describing current dietary and physical activity practices, influence of junk food, role of health system and socio-economic factors as root causes. While the current dietary and physical activity-related practices within communities were unhealthy, the broader determinants such as socio-economic circumstances and gender further fuelled such practices. The health system has potential to play a more effective role in the prevention of the behavioural and social determinants of NCDs.
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Affiliation(s)
- Sudesh Sharma
- DIYASU Community Development Centre, Biratnagar, Morang, Nepal,Massey University, Wellington, Wellington Region, New Zealand,* E-mail:
| | - Anna Matheson
- Victoria University of Wellington, Wellington, Wellington Region, New Zealand
| | | | - James Faulkner
- University of Winchester, Winchester, Hampshire, United Kingdom
| | - David W. Lounsbury
- Albert Einstein College of Medicine, Bronx, New York, United States of America
| | | | - Rachel Page
- Massey University, Wellington, Wellington Region, New Zealand
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18
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Seale E, de Groh M, Greene-Finestone L. Fast food consumption in adults living in Canada: alternative measurement methods, consumption choices, and correlates. Appl Physiol Nutr Metab 2023; 48:163-171. [PMID: 36322952 DOI: 10.1139/apnm-2022-0252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Global industries and technological advancements have contributed to the proliferation of fast food (FF) establishments and ultraprocessed food, associated with poorer diet quality and health outcomes. To investigate FF as an indicator, we compared alternative methods to capture self-reported FF consumption and examined associated socio-demographic factors. We conducted a secondary analysis of the 2014-2015 Foodbook study, a cross-sectional survey on foods consumed by Canadians during the previous week. An embedded randomized design compared alternative FF intake questions of varying details. A total of 6062 participants aged 18+ were included, representing 24.7 million Canadian adults. Approximately 48% consumed FF in the past week, and of FF consumers, average frequency was twice. Asking broadly about FF intake without examples resulted in significantly lower reported FF intake compared with the two more detailed questions; the latter two were not significantly different. Burgers, pizza, and submarines/sandwiches were most commonly consumed. Men, younger age, higher BMI, women in central Canada (versus territorial regions), and men with income $30 000-$80 000 (versus >$80 000) were associated with higher FF consumption. Consumption of FF is common among Canadians; some associated factors are gender-specific. Further research examining FF as an indicator, and individual and societal implications of FF consumption, is recommended to inform programs and policies.
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Affiliation(s)
- Emily Seale
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON K1A 0K9, Canada
| | - Margaret de Groh
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON K1A 0K9, Canada
| | - Linda Greene-Finestone
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON K1A 0K9, Canada
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19
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Koios D, Machado P, Lacy-Nichols J. Representations of Ultra-Processed Foods: A Global Analysis of How Dietary Guidelines Refer to Levels of Food Processing. Int J Health Policy Manag 2022; 11:2588-2599. [PMID: 35184508 PMCID: PMC9818109 DOI: 10.34172/ijhpm.2022.6443] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/15/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND As evidence grows about negative health impacts of ultra-processed foods (UPFs), nutrient-centred advice is contested, and food-based dietary guidelines are increasingly utilised. Previous analyses of dietary guidelines evaluated their potential impact on health and sustainability, but little research has been conducted to examine how the concept of UPFs is reflected in dietary advice for consumers. This paper systematically analyses whether and how UPFs are represented in dietary guidelines internationally. METHODS Based on a systematic online search, the consumer-targeted key messages of 106 dietary guidelines were identified and a qualitative content analysis was conducted. A coding framework was developed to classify messages as 'eat more' or 'eat less' according to the language used (eg, 'choose' vs 'avoid') and to differentiate between a focus on nutrients or food processing. Specific foods mentioned in 'eat less' guidelines were classified according to their level of processing using the NOVA framework. RESULTS 99% of guidelines utilised some type of nutrient-based message, either promoting 'positive' nutrients (eg, vitamins) or discouraging the consumption of 'negative' nutrients (mainly salt, sugar and fat). Explicit references to food processing were present in 45% of 'eat less' guidelines and 5% of 'eat more' guidelines. Implicit references (eg, promoting 'raw' or discouraging 'packaged' foods) were found in 43% of 'eat less' and 75% of 'eat more' guidelines. 53% of the specific foods referred to in 'eat less' advice were UPFs. CONCLUSION Overall, nutrient-based messages were more common than messages about processing levels. The majority of discouraged foods were UPFs, however some minimally processed foods were discouraged, which points to tensions and contradictions between nutrient- and processing-based dietary advice. As dietary guidelines begin to include advice about food processing, it is important to consider both consumer understanding of the terms used and their capacity to act on the advice.
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Affiliation(s)
- Daniela Koios
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Priscila Machado
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
| | - Jennifer Lacy-Nichols
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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20
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Huse O, Reeve E, Bell C, Sacks G, Baker P, Wood B, Backholer K. Strategies used by the soft drink industry to grow and sustain sales: a case-study of The Coca-Cola Company in East Asia. BMJ Glob Health 2022; 7:e010386. [PMID: 36593644 PMCID: PMC9730366 DOI: 10.1136/bmjgh-2022-010386] [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: 08/10/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The market and non-market activities of the food and beverage industry contribute to unhealthy and unsustainable dietary patterns, increasingly in low-income and middle-income countries (LMICs). We aimed to describe how The Coca-Cola Company (TCCC), as the world market leader in the sugar-sweetened beverage sector, operationalises their activities in LMICs in East Asia, among the world's most highly populated yet under-researched countries, to illustrate the ways in which these activities may negatively influence health outcomes. METHODS We adopted a theoretically-guided qualitative research design and documentary analysis method. Data sources included: industry documents and web pages, marketing case studies obtained from the World Advertising Research Centre, media reports, global trade summaries and websites of industry associations. To guide data analysis, we synthesised a conceptual framework from existing commercial determinants of health literature, to describe ways in which the market and non-market activities of TCCC influence health. RESULTS TCCC leverages subsidiary companies and investments in international networks to expand its supply chains. The company engages in frequent political activities to minimise the implementation of nutrition policies that may impact profits. The company markets products, particularly on digital and mobile devices, often targeting children, adolescents and mothers, and undertakes public relations activities related to human rights, environmental sustainability and community and economic supports, and these public relations activities are often integrated into marketing campaigns. The identified activities of TCCC are frequently in direct contrast to efforts to improve the healthfulness of population diets in East Asia LMICs. CONCLUSIONS A public health analysis of the market and non-market activities of corporations active in unhealthy commodity industries needs to be broad in scope to cover the diverse set of strategies used to increase their market power and influence. Governments should consider a suite of policy options to attenuate these commercial determinants of unhealthy diets.
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Affiliation(s)
- Oliver Huse
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation. Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Erica Reeve
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation. Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Colin Bell
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation. Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Gary Sacks
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation. Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Victoria, Australia
| | - Benjamin Wood
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation. Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Kathryn Backholer
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation. Faculty of Health, Deakin University, Geelong, Victoria, Australia
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21
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Simple solutions for complex problems? What is missing in agriculture for nutrition interventions. Food Secur 2022. [DOI: 10.1007/s12571-022-01324-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Within the nutritionism paradigm, in this article we critically review the marketization and medicalization logics which aim to address the pressing issue of malnutrition in low- and middle-income countries. Drawing from political economy and food system transformation discourses, we are using the popular intervention types of nutrition-sensitive value chains (marketization logic) and biofortification exemplified through orange-fleshed sweet potato (medicalization logic) to assess their outcomes and underlying logics. We demonstrate that there is insufficient evidence of the positive impact of these interventions on nutritional outcomes, and that their underlying theories of change and impact logics do not deal with the inherent complexity of nutritional challenges. We show that nutrition-sensitive value chain approaches are unable to leverage or enhance the functioning of value chains to improve nutritional outcomes, especially in light of the disproportionate power of some food companies. We further demonstrate that orange-fleshed sweet potato interventions and biofortification more broadly adopt a narrow approach to malnutrition, disregarding the interactions between food components and broader value chain and food system dynamics. We argue that both intervention types focus solely on increasing the intake of specific nutrients without incorporating their embeddedness in the wider food systems and the relevant political-economic and social relations that influence the production and consumption of food. We conclude that the systemic nature of malnutrition requires to be understood and addressed as part of the food system transformation challenge in order to move towards solving it. To do so, new evaluation frameworks along with new approaches to solutions are necessary that support multiple and diverse development pathways, which are able to acknowledge the social, political-economic, and environmental factors and drivers of malnutrition and poverty.
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22
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Electoral campaign contributions: an obstacle to sugary drink industry regulation in Brazil? Public Health Nutr 2022; 25:3215-3224. [PMID: 34955113 PMCID: PMC9991833 DOI: 10.1017/s1368980021005036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess corporate electoral campaign contributions from industries related to sugary drinks production and the characteristics of the elected officials financed by the sector. DESIGN Cross-sectional analysis of electoral campaign contributions from corporations related to sugary drinks production (sugary drink industries and sugary drink input industries) to candidates to the Chamber of Deputies, Brazil. SETTING Elections to the 55th Congress (2015-2019), held in October 2014. PARTICIPANTS Candidates to the Chamber of Deputies, Brazil. RESULTS Forty-nine companies or corporate groups that produce sugary drinks and fifty-two corporations that produce inputs for sugary drinks manufacturing contributed to electoral campaigns of candidates in the 2014 Election. Contributions from this industry sector represented 7·3 % of all corporate contributions and helped finance 11·7 % of the candidates and 46·2 % of the elected officials. The transnationals Ambev and Coca-Cola were the first and second biggest donors, respectively. Revenues mediated by political parties, from sugary drink industries and from corporate members of some industry associations (Abir, Unica and CitrusBR), were more prevalent. Among elected officials, a significant association was found between being financed by the sector and representing the south-east region, having higher education level and referring themselves as being professional politicians. In the multivariate model, financed candidates were 27 % more likely to be elected. CONCLUSIONS Corporations related to sugary drinks production have contributed to the electoral campaigns of almost half of the Federal Deputies in Brazil in 2014. This possibly facilitates access to decision-makers and could help buy influence on legislative proposals, including health-related food policies.
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Zaltz DA, Bisi LE, Ruskin G, Hoe C. How independent is the international food information council from the food and beverage industry? A content analysis of internal industry documents. Global Health 2022; 18:91. [PMID: 36309701 PMCID: PMC9618198 DOI: 10.1186/s12992-022-00884-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 10/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The International Food Information Council (IFIC) and its partner foundation (IFIC Foundation) widely disseminate nutrition information and participate in relevant policymaking processes. Prior research has established a connection between IFIC and large food and beverage companies, representing a potential conflict of interest. The authors reviewed public records documents to investigate the connection between IFIC and industry, and to describe how IFIC communicates policy-relevant information about nutrition science to the public. METHODS The research team collected communications between IFIC and members of the research and policymaking communities by using state and federal transparency laws. The team analyzed the content of these documents with a commercial determinants of health framework while allowing for new themes to emerge, guided by the broad analytic questions of how and why does IFIC communicate nutrition information to policymakers and the broader public? RESULTS IFIC employs self-designed research and media outreach to disseminate nutrition information. Communications from IFIC and its affiliates related to nutrition information fell within major themes of manufacturing doubt and preference shaping. CONCLUSIONS IFIC uses media outlets to preemptively counter information about the negative health impacts of added sugars and ultra-processed foods, and promotes a personal-responsibility narrative about dietary intake and health. IFIC and its affiliates disseminate a narrow subset of nutrition and health information consistent with corporate interests and in opposition to public health policies associated with improved population health.
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Affiliation(s)
- Daniel A Zaltz
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
| | - Lauren E Bisi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Gary Ruskin
- U.S. Right To Know, 4096 Piedmont Ave. #963, Oakland, CA, 94611, USA
| | - Connie Hoe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
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Phulkerd S, Collin J, Ngqangashe Y, Thow AM, Schram A, Huckel Schneider C, Friel S. How commercial actors used different types of power to influence policy on restricting food marketing: a qualitative study with policy actors in Thailand. BMJ Open 2022; 12:e063539. [PMID: 36229148 PMCID: PMC9562312 DOI: 10.1136/bmjopen-2022-063539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES There is limited research focused explicitly on understanding how commercial actors use different forms of power to influence policy decision making in Thailand. This study aimed to identify how the food industry has used structural, instrumental and discursive power to influence policy on restricting food marketing in Thailand. STUDY DESIGN Qualitative study using in-depth semistructured interviews SETTINGS: Thailand. PARTICIPANTS The interviews were conducted with 20 participants (of a total of 29 invited actors) from government, civil society, technical experts, international organisation and the food and advertising industry. Interview data were identified in the transcripts and analysed using abductive methods. RESULTS Non-commercial actors perceived the commercial actors' structural power (its economic influence and structurally privileged position) as central to understanding the government having not implemented policy to restrict food marketing. The commercial actors' instrumental power was observed through sponsorship, campaign and lobbying activities. Discursive power was used by the industry to shift responsibility away from the food companies and onto their customers, by focusing their messaging on freedom of consumer choice and consumer health literacy. CONCLUSIONS This study examined different types of power that commercial actors were perceived to use to influence policy to restrict food marketing in Thailand. The study showed arguments and institutional processes used to enhance commercial actors' ability to shape the policy decision for nutrition, public opinion and the broader regulatory environment. The findings help governments and other stakeholders to anticipate industry efforts to counter policy. The findings also suggest the need for governance structures that counter industry power, including comprehensive monitoring and enforcement in policy implementation.
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Affiliation(s)
- Sirinya Phulkerd
- Institute for Population and Social Research, Mahidol University, Salaya, Thailand
| | - Jeff Collin
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Yandisa Ngqangashe
- Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ashley Schram
- Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Carmen Huckel Schneider
- Menzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sharon Friel
- Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
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Targeted formulation of plant-based protein-foods: Supporting the food system’s transformation in the context of human health, environmental sustainability and consumer trends. Trends Food Sci Technol 2022. [DOI: 10.1016/j.tifs.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Ndebele P, Krisko P, Bari I, Paichadze N, Hyder AA. Evaluating industry attempts to influence public health: Applying an ethical framework in understanding commercial determinants of health. Front Public Health 2022; 10:976898. [PMID: 36203686 PMCID: PMC9530268 DOI: 10.3389/fpubh.2022.976898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/26/2022] [Indexed: 01/25/2023] Open
Abstract
Objectives This paper explores industry influence on public health using a specific case study and applies an established ethical framework based on eleven principles to explore Commercial Determinants of Health (CDoH). It demonstrates an application of these principles to evaluate the ethical integrity of industry strategies and practices and their impacts on public health. Methods Using eleven a priori, deductive, ethical principles as codes, this paper conducted an in-depth analysis of 19 e-mail chains and accompanying documents made publicly available through the Freedom of Information Act (FOIA) from U.S. Right to Know (USRTK) sent between Coca-Cola representatives, lobbyists, academics, and the International Life Sciences Institute (ILSI), founded by former Coca-Cola executives. Results The three principles violated most frequently amongst the documents were consumer sovereignty (n = 22), evidence-informed actions (n = 21), and transparency (n = 20). Similarly, codes that featured most regularly across documents were transparency (13 out of 19 documents), consumer sovereignty (13 out of 19 documents), evidence-informed actions (9 out of 19 documents), and social justice and equity (9 out of 19 documents). All eleven principles were applied at least four times throughout the documents; however, responsiveness (z = 12), moral responsibility (z = 16), and holism (z = 30) were the least relevant to the data set. Conclusions This case study of Coca-Cola demonstrates the usefulness of this ethics framework in reviewing actions of corporate actors in the promotion of products that are harmful to human health. It shows that the industry at times has low ethical integrity in their various strategies and practices to promote their products despite the negative impacts of these products on public health.
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Abstract
Policy Points The commercial determinants of health (CDoH) concept, which currently focuses on markets that harm health, should be expanded to refer to the interface between commerce and health, which can sometimes have positive public health consequences. The regulatory stances framework helps us classify public health preferences for regulating specific markets related to CDoH, based on the intended effects of regulations on market size. The regulatory stances a jurisdiction can adopt can be classified as ranging from prohibitionist through contractionist, permissive, and expansionist, to universalist. The regulatory stances framework increases the usefulness of the CDoH concept by expanding the conversation beyond negative determinants of health and providing a fuller view of the tools at the disposal of society to alter markets and improve health. CONTEXT The effects of commerce on the public health are omnipresent. The commercial determinants of health (CDoH) represent a burgeoning area of scholarly debate and activist policymaking to redress markets that adversely affect public health. The CDoH debate is a logical extension of the tobacco control movement, but, to its detriment, the CDoH conversation remains primarily focused policies and proposals that are analogous to historical tobacco control strategies. METHODS This paper argues that for the CDoH to develop further and broaden its appeal, it should expand to cover markets with conditional and positive impacts on health. To explain and order this conversation, a comparative framework for regulatory policy is introduced: the regulatory stances. The regulatory stances classify a regulatory policy based on the intended effect of policy on the size of a market in the future relative to the present. FINDINGS Some markets that interface between commerce and health do not inherently harm health. Regulatory policy toward these markets should be different in intent than regulatory policy for markets with negative health effects. CONCLUSIONS By using the regulatory stances framework to encompass markets that have positive or conditional effects on health as well as those that have adverse health effects, the CDoH conversation can shift away from the exclusive focus on strategies to shrink markets with adverse health impacts to consider a wider array of policy options.
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Affiliation(s)
- ALEX C. LIBER
- Georgetown University Lombardi Comprehensive Cancer Center
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Mukanu MM, Delobelle P, Thow AM, Mchiza ZJR. Determinants of dietary patterns in school going adolescents in Urban Zambia. Front Nutr 2022; 9:956109. [PMID: 36091242 PMCID: PMC9452662 DOI: 10.3389/fnut.2022.956109] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background Understanding dietary patterns in a population is critical for decision making. This study aimed to identify the prevailing dietary patterns and their associated individual and school environment factors among school going adolescents in Lusaka, Zambia. Method A cross-sectional study involving 404 Grade 10 pupils from 10 secondary schools in Lusaka district was conducted. A 108-item unquantified Food Frequency Questionnaire (FFQ) was used to assess the learner's food intake practices. Principal component analysis (PCA) was used to derive dietary patterns from the 108 food items. In addition, a mapping of food vendors and types of food sold was conducted in the same 10 schools using a semi-structured observation checklist. Bivariate and multivariate multilevel regression was used to analyse the individual and school level determinants of the adolescent dietary patterns. Results The average age of learners was 16.1 years (SD 1.4 years); 234 (58%) were female while 170 (42%) male. “Snacking,” “vegetarian,” “health conscious,” and “traditional” dietary patterns accounting for 54.5% of variability in learner's diets were identified using PCA. At individual level, having weekly pocket money was significantly associated with snacking (p ≤ 0.0001). Self-identified poverty was associated with snacking (p ≤ 0.0001), vegetarian (p = 0.009) and traditional (p = 0.009) dietary patterns. School level factors like a school tuckshop (similar to canteen) that sells fast foods or a kantemba (semi-permanent makeshift store) within the school vicinity (p = 0.023) were significantly associated with a snacking dietary pattern. School tuckshop selling nshima (a thick maize based porridge) was significantly associated with vegetarian (p = 0.007), health conscious (p = 0.02) and traditional dietary patterns (p=0.01) while a tuckshop with fruit significantly predicted traditional (p ≤ 0.0001), vegetarian (p = 0.041), and snacking (p = 0.002), dietary patterns. Having a supermarket or fast food restaurants in the school vicinity did not significantly influence any dietary pattern. Conclusion Both individual behavioral and school environment level factors were found to be significant determinants of the four dietary patterns identified in this study.
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Affiliation(s)
- Mulenga Mary Mukanu
- School of Public Health, University of the Western Cape, Cape Town, South Africa
- *Correspondence: Mulenga Mary Mukanu
| | - Peter Delobelle
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
- Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium
| | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, University of Sydney, Camperdown, NSW, Australia
| | - Zandile June-Rose Mchiza
- School of Public Health, University of the Western Cape, Cape Town, South Africa
- Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
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Romano E, Ma R, Vancampfort D, Smith L, Firth J, Solmi M, Veronese N, Stubbs B, Koyanagi A. The association of cannabis use with fast-food consumption, overweight, and obesity among adolescents aged 12-15 years from 28 countries. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2114388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Eugenia Romano
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
| | - Ruimin Ma
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Center KU Leuven, KU Leuven, Kortenberg, Belgium
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Joseph Firth
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, Ontario, USA
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
- Physiotherapy Department, South London and Maudsley National Health Services Foundation Trust, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, Barcelona, Spain
- ICREA, Barcelona, Spain
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Millar SR, Navarro P, Harrington JM, Perry IJ, Phillips CM. Associations between the Nutrient Profiling System Underlying the Nutri-Score Nutrition Label and Biomarkers of Chronic Low-Grade Inflammation: A Cross-Sectional Analysis of a Middle- to Older-Aged Population. Nutrients 2022; 14:nu14153122. [PMID: 35956304 PMCID: PMC9370507 DOI: 10.3390/nu14153122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023] Open
Abstract
Low-grade systemic inflammation is associated with a range of conditions. Diet may modulate inflammation and public health strategies are needed to guide consumers’ dietary choices and help prevent diet-related disease. The Food Standards Agency nutrient profiling system (FSAm-NPS) constitutes the basis of the five-colour front-of-pack Nutri-Score labelling system. No study to date has examined FSAm-NPS dietary index associations with biomarkers of inflammation. Therefore, our objective was to test relationships between the FSAm-NPS and a range of inflammatory biomarkers in a cross-sectional sample of 2006 men and women aged 46–73 years. Individual participant FSAm-NPS scores were derived from food frequency questionnaires. Pro-inflammatory cytokine, adipocytokine, acute-phase response protein, coagulation factor and white blood cell count concentrations were determined. Correlation and linear regression analyses were used to examine FSAm-NPS relationships with biomarker levels. In crude and adjusted analyses, higher FSAm-NPS scores, reflecting poorer nutritional quality, were consistently and positively associated with biomarkers. In fully adjusted models, significant associations with concentrations of complement component 3, c-reactive protein, interleukin 6, tumour necrosis factor alpha, resistin, white blood cell count, neutrophils, eosinophils and the neutrophil-to-lymphocyte ratio persisted. These results suggest that dietary quality, determined by Nutri-Score rating, is associated with inflammatory biomarkers related to health.
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Affiliation(s)
- Seán R. Millar
- HRB Centre for Health and Diet Research, School of Public Health, University College Cork, T12 XF62 Cork, Ireland; (J.M.H.); (I.J.P.); (C.M.P.)
- Correspondence:
| | - Pilar Navarro
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin 4, Ireland;
| | - Janas M. Harrington
- HRB Centre for Health and Diet Research, School of Public Health, University College Cork, T12 XF62 Cork, Ireland; (J.M.H.); (I.J.P.); (C.M.P.)
| | - Ivan J. Perry
- HRB Centre for Health and Diet Research, School of Public Health, University College Cork, T12 XF62 Cork, Ireland; (J.M.H.); (I.J.P.); (C.M.P.)
| | - Catherine M. Phillips
- HRB Centre for Health and Diet Research, School of Public Health, University College Cork, T12 XF62 Cork, Ireland; (J.M.H.); (I.J.P.); (C.M.P.)
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin 4, Ireland;
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Van Dam I, Vandevijvere S. Benchmarking the nutrition-related commitments and practices of major French food companies. BMC Public Health 2022; 22:1435. [PMID: 35902838 PMCID: PMC9330679 DOI: 10.1186/s12889-022-13780-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022] Open
Abstract
Background This study benchmarked and quantitatively assessed the transparency, specificity and comprehensiveness of nutrition-related commitments and related practices of the major companies within the French food industry. Methods To evaluate the nutrition-related commitments and practices across policy domains such as product reformulation, labelling, marketing, and accessibility, the ‘Business Impact Assessment on Obesity and population-level nutrition’ (BIA-Obesity) was applied. A total of 33 French food companies were selected using Euromonitor 2018 market share data, including major packaged food and non-alcoholic beverage manufacturers (N = 20), quick-service restaurants (N = 7), and supermarkets (N = 6). During 2019-2020 the publicly available commitments were collected for each company, scored according to the BIA-Obesity, and company representatives were provided with the opportunity to complete and verify the collected data. The following performance metrics were included to assess company practices: the median Nutri-Score of product portfolios, the proportion of products with Nutri-Score A or B, the percentage of products (not-)permitted to be marketed to children according to the World Health Organisation Europe nutrient profile model and the proportion of ultra-processed food products as determined by the NOVA-classification. In addition supermarket flyers were collected over a 6-months period to assess the healthiness of product promotions. Correlations between commitments and performance metrics were assessed applying the Spearman’s rank correlation coefficient. Results Among the selected food companies, 13 companies verified and completed the publicly available data (response rate = 39%). Overall BIA-Obesity scores for company commitments varied between 2 and 74% with a median score of 28%. Scores for packaged food and non-alcoholic beverage manufacturers were higher than those for supermarkets and quick-service restaurants. The median proportion of foods with Nutri-Score A or B within product portfolios was 38% (range = 1-95%), while the median proportion of non-permitted products was 84% (range = 7-100%) and the median proportion of ultra-processed food products 63% (range = 5-100%). Stronger company commitments did not translate into better performance metrics. Conclusions There is room for significant improvement of both company commitments and performance. Current food industry action does not meet recommended best practices. The French government is urged to regulate food industry practices to create healthier food environments. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13780-y.
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Affiliation(s)
- Iris Van Dam
- Sciensano, Service of Lifestyle and chronic diseases, Brussels, Belgium.,Université Paris-Saclay, INRAE, UR ALISS, 94205, Ivry-sur-Seine, France
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Kliemann N, Al Nahas A, Vamos EP, Touvier M, Kesse-Guyot E, Gunter MJ, Millett C, Huybrechts I. Ultra-processed foods and cancer risk: from global food systems to individual exposures and mechanisms. Br J Cancer 2022; 127:14-20. [PMID: 35236935 PMCID: PMC9276654 DOI: 10.1038/s41416-022-01749-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 01/28/2022] [Accepted: 02/09/2022] [Indexed: 12/21/2022] Open
Abstract
Ultra-processed foods (UPFs) have become increasingly dominant globally, contributing to as much as 60% of total daily energy intake in some settings. Epidemiological evidence suggests this worldwide shift in food processing may partly be responsible for the global obesity epidemic and chronic disease burden. However, prospective studies examining the association between UPF consumption and cancer outcomes are limited. Available evidence suggests that UPFs may increase cancer risk via their obesogenic properties as well as through exposure to potentially carcinogenic compounds such as certain food additives and neoformed processing contaminants. We identify priority areas for future research and policy implications, including improved understanding of the potential dual harms of UPFs on the environment and cancer risk. The prevention of cancers related to the consumption of UPFs could be tackled using different strategies, including behaviour change interventions among consumers as well as bolder public health policies needed to improve food environments.
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Affiliation(s)
- Nathalie Kliemann
- Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
| | - Aline Al Nahas
- Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
| | - Eszter P Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Mathilde Touvier
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
| | - Emmanuelle Kesse-Guyot
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
| | - Marc J Gunter
- Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
- National School of Public Health, NOVA University, Lisbon, Portugal
| | - Inge Huybrechts
- Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France.
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Suzuki M, Webb D, Small R. Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-communicable Diseases. Int J Health Policy Manag 2022; 11:1078-1089. [PMID: 33619925 PMCID: PMC9808183 DOI: 10.34172/ijhpm.2020.257] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 12/14/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are increasingly recognized as a significant threat to health and development globally, and United Nations (UN) Member States adopted the Political Declaration of the Third High-level Meeting (HLM) on the prevention and control of NCDs in 2018. The negotiation process for the Declaration included consultations with Member States, intergovernmental organizations (IGOs), and non-state actors such as non-governmental organizations (NGOs) and the private sector. With NCD responses facing charges of inadequacy, it is important to scrutinize the governance process behind relevant high-level global decisions and commitments. METHODS Through a review of 159 documents submitted by stakeholders during the negotiation process, we outline a typology of policy positions advocated by various stakeholders in the development of the Declaration. We document changes in text from the draft to the final version of the Declaration to analyse the extent to which various positions and their proponents were influential. RESULTS NGOs and low- and middle-income countries (LMICs) generally pursued 'stricter' governance of NCD risk factors including stronger regulation of unhealthy products and improved management of conflicts of interest that arise when health-harming industries are involved in health policy-making. The private sector and high-income countries generally opposed greater restrictions on commercial factors. The pattern of changes between the draft and final Declaration indicate that advocated positions tended to be included in the Declaration if there was no clear opponent, whereas opposed positions were either not included or included with ambiguous language. CONCLUSION Many cost-effective policy options to address NCDs, such as taxation of health-harming products, were opposed by high-income countries and the private sector and not well-represented in the Declaration. To ensure robust political commitments and action on NCDs, multi-stakeholder governance for NCDs must consider imbalances in power and influence amongst constituents as well as biases and conflicts in positioning.
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Affiliation(s)
- Mao Suzuki
- Department of Political Science and International Relations, University of Southern California, Los Angeles, CA, USA
- HIV, Health and Development Group, Bureau for Policy and Programme Support, United Nations Development Programme, New York City, NY, USA
| | - Douglas Webb
- HIV, Health and Development Group, Bureau for Policy and Programme Support, United Nations Development Programme, New York City, NY, USA
| | - Roy Small
- HIV, Health and Development Group, Bureau for Policy and Programme Support, United Nations Development Programme, New York City, NY, USA
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Van Dam I, Guillon E, Robinson E, Allais O, Sacks G, Vandevijvere S. Assessment of the Commitments and Performance of the European Food Industry to Improve Population Nutrition. Int J Public Health 2022; 67:1604116. [PMID: 35719734 PMCID: PMC9198223 DOI: 10.3389/ijph.2022.1604116] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: Food companies could play an important role in improving population diets, but often escape accountability through unspecific commitments. This study evaluated nutrition-related commitments and estimated performance of the largest packaged food and non-alcoholic beverage manufacturers, supermarkets and quick-service restaurants (QSR) in Europe. Methods: To quantitatively assess companies’ publicly available commitments in 2020, the “Business Impact Assessment on Obesity and Population Nutrition” was applied. The proportion of sales from ultra-processed and “unhealthy” food categories (product categories not-permitted to be marketed to children) and over time changes in the number of QSR transactions and QSR and supermarket outlets were calculated. Results: Company commitments fell short of best practice recommendations (median overall score of 21%, range: 1%–62%). Food and beverage companies generated 82% (15%–100%) and 58% (1%–100%) sales from ultra-processed and “unhealthy” products, respectively. The number of QSR outlets and transactions substantially increased in Europe since 2011, while QSR commitments to improve population nutrition remained limited. Conclusion: Whilst most companies made some nutrition-related commitments, they did not comply with best practice recommendations. A large proportion of sales was generated from ultra-processed/unhealthy products and QSR outlets increased. Government regulations are urgently needed.
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Affiliation(s)
- Iris Van Dam
- Sciensano, Service of Lifestyle and Chronic Diseases, Brussels, Belgium
- Université Paris-Saclay, INRAE, UR ALISS, Ivry-sur-Seine, France
- *Correspondence: Iris Van Dam,
| | - Emilie Guillon
- Alimentation & Santé, UniLaSalle Campus de Beauvais, Beauvais, France
| | - Ella Robinson
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Olivier Allais
- Université Paris-Saclay, INRAE, UR ALISS, Ivry-sur-Seine, France
| | - Gary Sacks
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
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The Reinforcing Natures of Hyper-Palatable Foods: Behavioral Evidence for Their Reinforcing Properties and the Role of the US Food Industry in Promoting Their Availability. CURRENT ADDICTION REPORTS 2022. [DOI: 10.1007/s40429-022-00417-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gómez EJ. Enhancing our understanding of the commercial determinants of health: Theories, methods, and insights from political science. Soc Sci Med 2022; 301:114931. [PMID: 35358943 DOI: 10.1016/j.socscimed.2022.114931] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 01/21/2022] [Accepted: 03/16/2022] [Indexed: 10/18/2022]
Abstract
Public health researchers concerned with the commercial industry's influence over health policy have contributed to the development of a new field of inquiry, Corporative Political Activity (CPA). While the CPA literature has improved our understanding of the tactics that industries use to influence health policy and outcomes, ironically, this literature appears to have fallen short of thoroughly engaging those social science disciplines focusing on the relationship between industry and government in the policymaking process, such as political science. The purpose of this article is to reveal how political science theory and method can generate new research questions for CPA scholars; propose alternative qualitative methodological approaches to causal inference, with a focus on historical and temporal analysis; and establish adequacy in causal mechanisms. The application of political science theories and methods may assist CPA researchers in their efforts to explain the durability and efficacy of CPA political tactics at the domestic government level, which of these tactics are more important, while providing greater depth into explaining how and why industries continue to obstruct policymaking. The author then propose an alternative political science analytical framework, Political Analysis of Corporate Political Activity (PACPA), that may provide a more thorough understanding of the politics of the commercial sector's policy influence. This framework integrates the political science literature highlighting the political and institutional contexts shaping interest group activities and policymaking influence along with the CPA literature discussing these issues, through a historically-based qualitative case study approach emphasizing the causal mechanisms behind industry's political activities. With respect to methodology, this article relied on an analysis of qualitative documents through a variety of on-line search engines and the author's extensive knowledge of the topic. Select case studies were used as illustrations supporting the author's claims. This research began in November 2020 and concluded in June 2021.
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Affiliation(s)
- Eduardo J Gómez
- Lehigh University, College of Health, STEPS Building, 1 W. Packer Avenue, Room 564, Bethlehem, PA, 18015, USA.
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Van Dam I, Reimes N, Vandevijvere S. Benchmarking the nutrition-related commitments and practices of major Belgian food companies. Int J Behav Nutr Phys Act 2022; 19:43. [PMID: 35392933 PMCID: PMC8991492 DOI: 10.1186/s12966-022-01269-1] [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: 08/30/2021] [Accepted: 03/10/2022] [Indexed: 12/17/2022] Open
Abstract
Background To benchmark and quantitatively assess the transparency, specificity and comprehensiveness of nutrition-related commitments, as well as related practices of the largest Belgian food companies. Methods The ‘Business Impact Assessment on Obesity and population-level nutrition’ (BIA-Obesity) was applied to evaluate nutrition-related commitments and practices concerning product formulation, labelling, promotion and accessibility by the biggest Belgian food and non-alcoholic beverage manufacturers (n = 19), supermarkets (n = 5) and quick-service restaurants (n = 7). Publicly available commitments were collected and company representatives given the opportunity to verify and complete the information (2019–2020). Commitments were scored according to the BIA-Obesity. To assess company practices, the following indicators were calculated: median Nutri-Score of product portfolios, the proportion of products not-permitted to be marketed to children (using the World Health Organisation Regional Office for Europe nutrient profile model), the proportion of ultra-processed food products (using the NOVA-classification) and the proportion of products displaying Nutri-Score on the front-of-pack. Promotions in supermarket flyers were analysed over a one-year period and quick-service restaurant density around schools was calculated. Correlations between commitments and performance indicators were calculated applying the Spearman's rank correlation coefficient. Results Eighteen out of 31 companies participated (56%). Overall BIA-Obesity scores for commitments ranged from 2 to 75% (median = 35%) with notable variation across policy domains and food industries. The proportion of portfolios consisting of A and B Nutri-Score products ranged from 0 to 100% (median = 29%). The median proportion of products not-permitted to be marketed to children was 81% (range = 12%-100%) and the median proportion of ultra-processed foods was 75% (range = 2%-100%) across product portfolios. No significant correlations were observed between the strength of commitments and related performance indicators. Conclusion Food industry actions do not meet recommended best practices. Performance indicators show large potential for improvement across policy domains and industries. Government regulations are urgently needed to improve food industry efforts and ensure that commitments translate into improved practices. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-022-01269-1.
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Affiliation(s)
- Iris Van Dam
- Sciensano, Service of Lifestyle and Chronic Diseases, Brussels, Belgium.,Université Paris-Saclay, INRAE, UR ALISS, 94205, Ivry-sur-Seine, France
| | - Naomi Reimes
- Rijksinstituut Voor Volksgezondheid en Milieu (RIVM), Bilthoven, Netherlands
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Huse O, Reeve E, Baker P, Hunt D, Bell C, Peeters A, Backholer K. The nutrition transition, food retail transformations, and policy responses to overnutrition in the East Asia region: A descriptive review. Obes Rev 2022; 23:e13412. [PMID: 34981877 DOI: 10.1111/obr.13412] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/15/2021] [Accepted: 11/30/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The East Asia region is facing an increasing burden of overweight, obesity and related noncommunicable diseases, resulting from an ongoing nutrition transition. This study aimed to document the growing burden of overweight and obesity, and the accompanying dietary shifts, in the East Asia region and describe the policy responses to this. METHODS We present noncommunicable disease risk factor collaboration data on trends in the burden of malnutrition, and Euromonitor International data on trends in dietary purchases, in the East Asia region. We searched the NOURISHING and GINA databases to identify food and nutrition policies implemented in these countries. RESULTS There is an ongoing nutrition transition in the East Asia region, notably in upper-middle and lower-middle income countries. The prevalence of overweight, obesity, and accompanying health conditions, purchases of ultra-processed foods and beverages, and purchasing from supermarkets, fast-food and takeaway outlets, and other convenience retailers, are increasing. The policy response to this nutrition transition is limited, with the majority of policies implemented in higher-income countries. CONCLUSIONS East Asian countries are facing a growing burden of malnutrition, due in part to the dietary shifts occurring here. An ecological approach to policy intervention is needed to drive transformative food systems change.
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Affiliation(s)
- Oliver Huse
- Global Obesity Centre, Institute for Health Transformation. Faculty of Health, Deakin University, Geelong, Australia
| | - Erica Reeve
- Global Obesity Centre, Institute for Health Transformation. Faculty of Health, Deakin University, Geelong, Australia
| | - Phillip Baker
- Institute for Physical Activity and Nutrition. Faculty of Health, Deakin University, Geelong, Australia
| | - Daniel Hunt
- Independent Researcher and Freelance Public Health Consultant, Bath, UK
| | - Colin Bell
- Global Obesity Centre, Institute for Health Transformation. Faculty of Health, Deakin University, Geelong, Australia
| | - Anna Peeters
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Kathryn Backholer
- Global Obesity Centre, Institute for Health Transformation. Faculty of Health, Deakin University, Geelong, Australia
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Abstract
Veganism is the subject of an increasingly diverse body of social scientific research, yet it remains relatively understudied in geography. Meanwhile, contemporary cultural commentaries note how veganism has gone mainstream, with critics warning of veganism's corporate nature - expressed in the rise of what we term 'Big Veganism'. We argue that food geographers are well placed to examine these trends. We first review vegan studies work beyond geography that examines and critiques the mainstreaming of veganism. We focus on literature that explores multiple contested modes of veganism, veganism as praxis in place and the rise of corporate veganism as useful foundations for geographers to build on, particularly in light of currently unfolding developments in vegan cultures and practice. Taking this work forward, we identify four conceptual traditions from research in food geographies - following foodways, alternative food networks and the cultural and material politics of eating - to develop a 'vegan food geographies' programme that aims to advance critical geographic work on veganism and the emerging implications of its contemporary mainstreaming.
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Affiliation(s)
- Alexandra E Sexton
- Alexandra E Sexton, Department of Geography,
University of Sheffield, Winter Street, Sheffield S3 7ND, UK.
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40
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State your interests. NATURE FOOD 2022; 3:89. [PMID: 37117968 DOI: 10.1038/s43016-022-00474-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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41
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Mackay S, Gerritsen S, Sing F, Vandevijvere S, Swinburn B. Implementing healthy food environment policies in New Zealand: nine years of inaction. Health Res Policy Syst 2022; 20:8. [PMID: 35033119 PMCID: PMC8760574 DOI: 10.1186/s12961-021-00809-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/16/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The INFORMAS [International Network for Food and Obesity/Non-communicable Diseases (NCDs) Research, Monitoring and Action Support] Healthy Food Environment Policy Index (Food-EPI) was developed to evaluate the degree of implementation of widely recommended food environment policies by national governments against international best practice, and has been applied in New Zealand in 2014, 2017 and 2020. This paper outlines the 2020 Food-EPI process and compares policy implementation and recommendations with the 2014 and 2017 Food-EPI. METHODS In March-April 2020, a national panel of over 50 public health experts participated in Food-EPI. Experts rated the extent of implementation of 47 "good practice" policy and infrastructure support indicators compared to international best practice, using an extensive evidence document verified by government officials. Experts then proposed and prioritized concrete actions needed to address the critical implementation gaps identified. Progress on policy implementation and recommendations made over the three Food-EPIs was compared. RESULTS In 2020, 60% of the indicators were rated as having "low" or "very little, if any" implementation compared to international benchmarks: less progress than 2017 (47%) and similar to 2014 (61%). Of the nine priority actions proposed in 2014, there was only noticeable action on one (Health Star Ratings). The majority of actions were therefore proposed again in 2017 and 2020. In 2020 the proposed actions were broader, reflecting the need for multisectoral action to improve the food environment, and the need for a mandatory approach in all policy areas. CONCLUSIONS There has been little to no progress in the past three terms of government (9 years) on the implementation of policies and infrastructure support for healthy food environments, with implementation overall regressing between 2017 and 2020. The proposed actions in 2020 have reflected a growing movement to locate nutrition within the wider context of planetary health and with recognition of the social determinants of health and nutrition, resulting in recommendations that will require the involvement of many government entities to overcome the existing policy inertia. The increase in food insecurity due to COVID-19 lockdowns may provide the impetus to stimulate action on food polices.
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Affiliation(s)
- Sally Mackay
- Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, 1023, New Zealand.
| | - Sarah Gerritsen
- Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, 1023, New Zealand
- Centre for Longitudinal Research He Ara Ki Mua, School of Population Health, University of Auckland, Auckland, 1743, New Zealand
| | - Fiona Sing
- Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, 1023, New Zealand
| | - Stefanie Vandevijvere
- Sciensano (Scientific Institute of Public Health), Epidemiology and Public Health, J.Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Boyd Swinburn
- Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, 1023, New Zealand
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42
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SOHAIB M, NAEEM M, ALI A, IQBAL S, AMJAD A, NAUMAN K, AHMAD S, RAZA M, SAAD BIN JUNAID M, UMAIR RIAZ M. Nutritional and safety evaluation of various liquid and powdered tea whiteners available in Pakistan. FOOD SCIENCE AND TECHNOLOGY 2022. [DOI: 10.1590/fst.04921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
| | | | - Ahmad ALI
- University of Veterinary & Animal Sciences, Pakistan
| | | | | | - Kashif NAUMAN
- University of Veterinary & Animal Sciences, Pakistan
| | - Shahzad AHMAD
- University of Veterinary & Animal Sciences, Pakistan
| | - Mohsin RAZA
- University of Veterinary & Animal Sciences, Pakistan
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43
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Popkin BM, Ng SW. The nutrition transition to a stage of high obesity and noncommunicable disease prevalence dominated by ultra-processed foods is not inevitable. Obes Rev 2022; 23:e13366. [PMID: 34632692 PMCID: PMC8639733 DOI: 10.1111/obr.13366] [Citation(s) in RCA: 119] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/24/2021] [Accepted: 09/05/2021] [Indexed: 12/18/2022]
Abstract
The Nutrition Transition model is presented with the nature and pace of change in key stages varying by location and subpopulations. At present, all high-income and many low- and middle-income countries are in a stage of the transition where nutrition-related noncommunicable diseases including obesity, type 2 diabetes, and hypertension are dominating adult morbidity and mortality and are very high or growing rapidly in prevalence. Some countries still have key subpopulations facing hunger and undernutrition defined by stunting or extreme thinness among adults. We call these double burden of malnutrition countries. All low- and middle-income countries face rapid growth in consumption of ultra-processed food and beverages, but it is not inevitable that these countries will reach the same high levels of consumption seen in high-income countries, with all the negative impacts of this diet on health. With great political and civil society commitment to adoption of policies shown in other countries to have improved dietary choices and social norms around foods, we can arrest and even reverse the rapid shift to diets dominated by a stage of high ultra-processed food intake and increasing prevalence of nutrition-related noncommunicable diseases.
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Affiliation(s)
- Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
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44
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Pandey AR, Aryal KK, Shrestha N, Sharma D, Maskey J, Dhimal M. Burden of Diabetes Mellitus in Nepal: An Analysis of Global Burden of Disease Study 2019. J Diabetes Res 2022; 2022:4701796. [PMID: 36582811 PMCID: PMC9794432 DOI: 10.1155/2022/4701796] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 12/03/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022] Open
Abstract
Globally, the number of people living with diabetes mellitus (DM) increased by 62% between 1990 and 2019, affecting 463 million people in 2019, and is projected to increase further by 51% by 2045. The increasing burden of DM that requires chronic care could have a considerable cost implication in the health system, particularly in resource constraint settings like Nepal. In this context, this study attempts to present the burden of DM in terms of prevalence, mortality, and disability adjusted life years (DALYs). The study is based on the Global Burden of Disease Study 2019, a multinational collaborative research, led by the Institute for Health Metrics and Evaluations. In the study, the overall prevalence of DM was estimated using DisMod MR-2.1, a Bayesian metaregression model. DALYs were estimated summing years of life lost due to premature death and years lived with disability. There were a total of 1,412,180 prevalent cases of DM, 3,474 deaths and 189,727 DALYs, due to DM in 2019. All-age prevalence rate and the age-standardized prevalence rate of DM stood at 4,642.83 (95% uncertainty interval (UI): 4,178.58-5,137.74) and 5,735.58 (95% UI: 5,168.74-6327.73) cases per 100,000 population, respectively, in 2019. In 2019, 1.8% (95% UI: 1.54, 2.07) of total deaths were from DM, which is a more than three-fold increase from the proportion of deaths attributed in 1990 (0.43%, 95% UI: 0.36, 0.5) with most of these deaths being from DM type 2. In 2019, a total of 189,727 disability adjusted life years (DALYs) were attributable to DM of which 105,950 DALYs were among males, and the remaining 83,777 DALYs were among females. Overall, between 1990 and 2019, the DALYs, attributable to Type 1 and 2 DM combined and for Type 2 DM only, have increased gradually across both sexes. However, the DALYs per 100,000 attributable to DM have slightly reduced across both sexes in that time. There is a high burden of DM in Nepal in 2019 with a steep increase in the proportion of deaths attributable to DM in Nepal which could pose a serious challenge to the health system. Primary prevention of DM requires collaborative efforts from multiple sectors. Meanwhile, the current federal structure could be an opportunity for integrated, locally tailored public health and clinical interventions for the prevention of the disease and its consequences.
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Affiliation(s)
| | | | | | | | - Jasmine Maskey
- Oxford University Clinical Research Unit, Lalitpur, Nepal
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45
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Dave LA, Hodgkinson SM, Roy NC, Smith NW, McNabb WC. The role of holistic nutritional properties of diets in the assessment of food system and dietary sustainability. Crit Rev Food Sci Nutr 2021:1-21. [PMID: 34933622 DOI: 10.1080/10408398.2021.2012753] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Advancing sustainable diets for nutrition security and sustainable development necessitates clear nutrition metrics for measuring nutritional quality of diets. Food composition, nutrient requirements, and dietary intake are among the most common nutrition metrics used in the current assessment of sustainable diets. Broadly, most studies in the area classify animal-source foods (ASF) as having a substantially higher environmental footprint in comparison to plant-source foods (PSF). As a result, much of the current dietary advice promulgates diets containing higher proportions of PSF. However, this generalization is misleading since most of these studies do not distinguish between the gross and bioavailable nutrient fractions in mixed human diets. The bioavailability of essential nutrients including β-carotene, vitamin B-12, iron, zinc, calcium, and indispensable amino acids varies greatly across different diets. The failure to consider bioavailability in sustainability measurements undermines the complementary role that ASF play in achieving nutrition security in vulnerable populations. This article critically reviews the scientific evidence on the holistic nutritional quality of diets and identifies methodological problems that exist in the way the nutritional quality of diets is measured. Finally, we discuss the importance of developing nutrient bioavailability as a requisite nutrition metric to contextualize the environmental impacts of different diets.
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Affiliation(s)
- Lakshmi A Dave
- Riddet Institute, Massey University, Palmerston North, New Zealand.,Sustainable Nutrition Initiative, Riddet Institute, Massey University, Palmerston North, New Zealand
| | | | - Nicole C Roy
- Riddet Institute, Massey University, Palmerston North, New Zealand.,Department of Human Nutrition, University of Otago, Dunedin, New Zealand.,High-Value Nutrition National Science Challenge, Auckland, New Zealand
| | - Nick W Smith
- Riddet Institute, Massey University, Palmerston North, New Zealand.,Sustainable Nutrition Initiative, Riddet Institute, Massey University, Palmerston North, New Zealand
| | - Warren C McNabb
- Riddet Institute, Massey University, Palmerston North, New Zealand.,Sustainable Nutrition Initiative, Riddet Institute, Massey University, Palmerston North, New Zealand.,High-Value Nutrition National Science Challenge, Auckland, New Zealand
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46
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Lacy-Nichols J, Williams O. "Part of the Solution": Food Corporation Strategies for Regulatory Capture and Legitimacy. Int J Health Policy Manag 2021; 10:845-856. [PMID: 34634883 PMCID: PMC9309978 DOI: 10.34172/ijhpm.2021.111] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 08/21/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND For decades, the food industry has sought to deflect criticisms of its products and block public health legislation through a range of offensive and defensive strategies. More recently, food corporations have moved on to present themselves as "part of the solution" to the health problems their products cause. This strategic approach is characterised by appeasement, co-option and partnership, and involves incremental concessions and attempts to partner with health actors. This paper details how corporate practices have evolved and changed over the past two decades and gives some definition to what this new political economy signifies for the wider behaviours of corporations producing and selling harmful commodities. METHODS This paper draws on public health and political science literature to classify the food industry's "part of the solution" strategy into three broad components: regulatory responses and capture; relationship building; and market strategies. We detail the key characteristics and consequences of each component. RESULTS The three components of the food industry's "part of the solution" strategy all involve elements of appeasement and co-option. They also improve the political environment and resources of the food industry. Regulatory responses offer incremental concessions that seek to maintain corporate influence over governance processes and minimise the threat of regulations; relationship building fosters access to health and government stakeholders, and opportunities to acquire and maintain channels of direct influence; and market strategies to make products and portfolios healthier bolster the market share and revenue of food corporations while improving their public image. CONCLUSION Rather being a signal of lost position and power, the food industry's repositioning as "part of the solution" has created a highly profitable political economy of 'healthy' food production, alongside continued production of unhealthy commodities, a strategy in which it is also less burdensome and conflictual for corporations to exercise political power and influence.
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Affiliation(s)
- Jennifer Lacy-Nichols
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Owain Williams
- School of Politics and International Studies, University of Leeds, Leeds, UK
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47
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Sievert K, Lawrence M, Parker C, Baker P. Understanding the Political Challenge of Red and Processed Meat Reduction for Healthy and Sustainable Food Systems: A Narrative Review of the Literature. Int J Health Policy Manag 2021; 10:793-808. [PMID: 33300762 PMCID: PMC9309962 DOI: 10.34172/ijhpm.2020.238] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/18/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Diets high in red and processed meat (RPM) contribute substantially to environmental degradation, greenhouse gas (GHG) emissions, and the global burden of chronic disease. Recent high-profile reports from international expert bodies have called for a significant reduction in global dietary meat intake, particularly RPM, especially in high-income settings, while acknowledging the importance of animal-sourced foods to population nutrition in many lower-income countries. However, this presents a major yet under-investigated political challenge given strong cultural preferences for meat and the economic importance and power of the meat industry. METHODS A theoretically-guided narrative review was undertaken. The theoretical framework used to guide the review considered the interests, ideas and institutions that constitute food systems in relation to meat reduction; and the instrumental, discursive and structural forms of power that actors deploy in relation to others within the food system. RESULTS High production and consumption levels of RPM are promoted and sustained by a number of factors. Actors with an interest in RPM included business and industry groups, governments, intergovernmental organisations, and civil society. Asymmetries of power between these actors exist, with institutional barriers recognised in the form of government-industry dependence, trade agreement conflicts, and policy incoherence. Industry lobbying, shaping of evidence and knowledge, and highly concentrated markets are key issues. Furthermore, prevailing ideologies like carnism and neoliberalism present embedded difficulties for RPM reduction. The literature noted the power of actors to resist meat reduction efforts exists in varying forms, including the use of lobbying, shaping of evidence and knowledge, and highly concentrated markets. CONCLUSION There are a number of political challenges related to RPM reduction that contribute to policy inertia, and hence are likely to impede the transformation of food systems. Research on policy efforts to reduce RPM production and consumption should incorporate the role of power and political feasibility.
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Affiliation(s)
- Katherine Sievert
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Mark Lawrence
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Christine Parker
- Melbourne Law School, The University of Melbourne, Melbourne, VIC, Australia
| | - Phillip Baker
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
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48
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Pope H, de Frece A, Wells R, Borrelli R, Ajates R, Arnall A, Blake LJ, Dadios N, Hasnain S, Ingram J, Reed K, Sykes R, Whatford L, White R, Collier R, Häsler B. Developing a Functional Food Systems Literacy for Interdisciplinary Dynamic Learning Networks. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2021. [DOI: 10.3389/fsufs.2021.747627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The impact of human activity on the planet cannot be overstated. Food systems are at the centre of a tangled web of interactions affecting all life. They are a complex nexus that directly and indirectly affects, and is affected by, a diverse set of social, environmental and technological phenomena. The complexity and often intractability of these interactions have created a variety of food-related problems that people seek to address in a collaborative and interdisciplinary manner through the adoption of a holistic food systems perspective. However, operationalising a systemic approach to address food system challenges is not a guarantee of success or positive outcomes. This is largely due to the partiality inherent in taking a systems perspective, and the difficulty in communicating these different perspectives among stakeholders. A functional food systems literacy is therefore required to aid people in communicating and collaborating on food system problems within dynamic learning networks. The Interdisciplinary Food Systems Teaching and Learning (IFSTAL) programme has been operating since 2015 as a social learning system to develop a food systems pedagogy with a range of multi-sectoral partners. The findings in this paper arise out of iterative reflexive practice into our teaching approach and delivery methods by former and current staff. In order to foster integrative engagement on food system challenges, we propose and define a functional food systems literacy—a theoretical minimum that can aid diverse stakeholders to explore and intervene in food systems through more effective communication and collaboration. Derived from a reflective analysis of instruments and methods in delivering the IFSTAL programme, we provide a framework that disaggregates functional food systems literacy according to four knowledge types, and includes examples of skills and activities utilised in the IFSTAL programme to support learning in these different domains. We argue that claims to comprehensive food systems knowledge are unrealistic and therefore propose that a functional food systems literacy should focus on providing a means of navigating partial claims to knowledge and uncertainty as well as fostering effective collaboration. We believe that this will enhance the capabilities of stakeholders to work effectively within dynamic learning networks.
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Milsom P, Smith R, Baker P, Walls H. International investment liberalization, transnational corporations and NCD prevention policy non-decisions: a realist review on the political economy of tobacco, alcohol and ultra-processed food. Global Health 2021; 17:134. [PMID: 34819083 PMCID: PMC8611909 DOI: 10.1186/s12992-021-00784-3] [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: 04/16/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Public health concerns relating to international investment liberalization have centred on the potential for investor-state dispute settlement (ISDS)-related regulatory chill. However, the broader political and economic dimensions that shape the relationship between the international investment regime and non-communicable disease (NCD) policy development have been less well explored. This review aimed to synthesise the available evidence using a political economy approach, to understand why, how and under what conditions transnational corporations may use the international investment regime to promote NCD prevention policy non-decisions. MAIN BODY Methods: Mechanisms explaining why/how the international investment regime may be used by transnational health-harmful commodity corporations (THCCs) to encourage NCD prevention policy non-decisions, including regulatory chill, were iteratively developed. Six databases and relevant grey literature was searched, and evidence was extracted, synthesized and mapped against the various proposed explanatory mechanisms. FINDINGS Eighty-nine sources were included. THCCs may be incentivised to use the ISDS mechanism since the costs may be outweighed by the benefits of even just delaying regulatory adoption, particularly since the chilling effect tends to ripple out across jurisdictions. Drivers of regulatory chill may include ambiguity in treaty terms, inconsistency in arbitral rulings, potential arbitrator bias and the high cost of arbitration. Evidence indicates ISDS can delay policy adoption both within the country directly involved but also in other jurisdictions. Additionally, governments are adopting standard assessments of public health regulatory proposals for trade and ISDS risk. Various economic, political and industry-related factors likely interact to increase (or decrease) the ultimate risk of regulatory chill. Some evidence indicates that THCCs take advantage of governments' prioritization of foreign investment over NCD prevention objectives to influence the NCD prevention regulatory environment. CONCLUSIONS While ISDS-related regulatory chill is a real risk under certain conditions, international investment-related NCD prevention policy non-decisions driven by broader political economy dynamics may well be more widespread and impactful on NCD regulatory environments. There is therefore a clear need to expand the research agenda on investment liberalization and NCD policy beyond regulatory chill and engage with theories and approaches from international relations and political science, including political economy and power analyses.
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Affiliation(s)
- Penelope Milsom
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, Kings Cross, London, WC1H 9SH UK
| | - Richard Smith
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia
| | - Helen Walls
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, Kings Cross, London, WC1H 9SH UK
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50
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Yates J, Gillespie S, Savona N, Deeney M, Kadiyala S. Trust and responsibility in food systems transformation. Engaging with Big Food: marriage or mirage? BMJ Glob Health 2021; 6:e007350. [PMID: 34819325 PMCID: PMC8614044 DOI: 10.1136/bmjgh-2021-007350] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022] Open
Abstract
Concentration of power among transnational 'Big Food' companies has contributed to food systems that are unsustainable, unhealthy and inequitable for people and planet. Given these commercial determinants of health, if 'food systems transformation' is to be authentic-more than a passing narrative-then leveraging Big Food is paramount. To this end, researchers, practitioners and policy-makers are increasingly encouraged to engage with these powerful entities. However, given the conflicts of interest at stake, engagement relies on trust and transparency, that all stakeholders take responsibility for their actions and demonstrate commitment to do no harm. Given Big Food's track record in influencing policy, shifting costs and responsibility for their harms-and while profit primarily drives business decision making-we question whether it is logical to expect trust.This analysis explores concepts of responsibility and trust in relation to food systems transformation involving public-private partnerships. Through short cautionary case studies-looking at the United Nations Food Systems Summit, and Big Food's plastic burden-it argues that unless such companies take responsibility for their cross-cutting effects and earn authentic trust through demonstrably doing no harm, their participation in evidence generation and policy processes should be limited to responding to information requests and adhering to regulation. Any involvement in research agenda-setting or formulating policy solutions introduces conflicts of interest, legitimises corporate irresponsibility and jeopardises scientific integrity. Big Food has dynamism and power to address food system problems, but while it contributes to so many of these problems it should follow-not formulate-transformational evidence, policies and regulations.
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Affiliation(s)
- Joe Yates
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Stuart Gillespie
- International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Natalie Savona
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Megan Deeney
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Suneetha Kadiyala
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
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