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Dogbe W, Akaichi F, Rungapamestry V, Revoredo-Giha C. Effectiveness of implemented global dietary interventions: a scoping review of fiscal policies. BMC Public Health 2024; 24:2552. [PMID: 39300446 DOI: 10.1186/s12889-024-19988-4] [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: 05/22/2024] [Accepted: 09/04/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Although the World Health Organisation (WHO) has proposed the use of fiscal policies to mitigate consumption externalities such as overweight and obesity-related diseases, very little is known about the impacts of the different types and framing of national and/or regional fiscal policies that have been implemented over the years. There is the need to provide up-to-date evidence on the impact of fiscal policies that have been enacted and implemented across the globe. METHODS We conducted a scoping review of all implemented government fiscal policies in the food and drinks sector to identify the different types of fiscal policies that exist and the scope of their impact on consumers as well as the food environment. Electronic databases such as the Web of Science and Google Scholar were used to search for appropriate literature on the topic. A total of 4,191 articles were retrieved and 127 were synthesized and charted for emerging themes. RESULTS The results from this review were synthesized in MS Excel following Arksey & O'Malley (2005). Emerging themes were identified across different countries/settings for synthesis. The results confirms that fiscal policies improve consumers' health; increase the prices of foods that are high in fats, sugar, and salt; increase government revenue; and shift consumption and purchases towards healthier and untaxed foods. CONCLUSION Governments already have the optimum tool required to effect changes in consumer behaviour and the food environment.
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Affiliation(s)
- Wisdom Dogbe
- The Rowett Institute, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Faical Akaichi
- Scotland's Rural College (SRUC), Peter Wilson Building, King's Buildings, West Mains Road, Edinburgh, EH9 3JG, UK
| | | | - Cesar Revoredo-Giha
- Scotland's Rural College (SRUC), Peter Wilson Building, King's Buildings, West Mains Road, Edinburgh, EH9 3JG, UK
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Lee AJ, Herron LM, Rainow S, Wells L, Kenny I, Kenny L, Wells I, Kavanagh M, Bryce S, Balmer L. Improving economic access to healthy diets in first nations communities in high-income, colonised countries: a systematic scoping review. Nutr J 2024; 23:10. [PMID: 38225569 PMCID: PMC10790425 DOI: 10.1186/s12937-023-00895-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 11/23/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Affordability of healthy food is a key determinant of the diet-related health of First Nations Peoples. This systematic scoping review was commissioned by the Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women's Council (NPYWC) in Central Australia to identify interventions to improve economic access to healthy food in First Nations communities in selected high-income, colonised countries. METHODS Eight databases and 22 websites were searched to identify studies of interventions and policies to improve economic access to healthy food in First Nations communities in Australia, Canada, the United States or New Zealand from 1996 to May 2022. Data from full text of articles meeting inclusion criteria were extracted to a spreadsheet. Results were collated by descriptive synthesis. Findings were examined with members of the NPYWC Anangu research team at a co-design workshop. RESULTS Thirty-five publications met criteria for inclusion, mostly set in Australia (37%) or the US (31%). Interventions (n = 21) were broadly categorised as price discounts on healthy food sold in communities (n = 7); direct subsidies to retail stores, suppliers and producers (n = 2); free healthy food and/or food vouchers provided to community members (n = 7); increased financial support to community members (n = 1); and other government strategies (n = 4). Promising initiatives were: providing a box of food and vouchers for fresh produce; prescriptions for fresh produce; provision/promotion of subsidised healthy meals and snacks in community stores; direct funds transfer for food for children; offering discounted healthy foods from a mobile van; and programs increasing access to traditional foods. Providing subsidies directly to retail stores, suppliers and producers was least effective. Identified enablers of effective programs included community co-design and empowerment; optimal promotion of the program; and targeting a wide range of healthy foods, particularly traditional foods where possible. Common barriers in the least successful programs included inadequate study duration; inadequate subsidies; lack of supporting resources and infrastructure for cooking, food preparation and storage; and imposition of the program on communities. CONCLUSIONS The review identified 21 initiatives aimed at increasing affordability of healthy foods in First Nations communities, of which six were deemed promising. Five reflected the voices and experiences of members of the NPYWC Anangu research team and will be considered by communities for trial in Central Australia. Findings also highlight potential approaches to improve economic access to healthy foods in First Nations communities in other high-income colonised countries. TRIAL REGISTRATION PROSPERO CRD42022328326.
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Affiliation(s)
- Amanda J Lee
- School of Public Health, The University of Queensland, 288 Herston Rd, Herston, QLD, 4029, Australia.
| | - Lisa-Maree Herron
- School of Public Health, The University of Queensland, 288 Herston Rd, Herston, QLD, 4029, Australia
| | - Stephan Rainow
- Nganampa Health Council, 3 Wilkinson St, Alice Springs, NT, 0871, Australia
| | - Lisa Wells
- Anangu research team, Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women's Council, 3 Wilkinson St, Alice Springs, NT, 0871, Australia
| | - Ingrid Kenny
- Anangu research team, Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women's Council, 3 Wilkinson St, Alice Springs, NT, 0871, Australia
| | - Leon Kenny
- Anangu research team, Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women's Council, 3 Wilkinson St, Alice Springs, NT, 0871, Australia
| | - Imogen Wells
- Anangu research team, Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women's Council, 3 Wilkinson St, Alice Springs, NT, 0871, Australia
| | - Margaret Kavanagh
- Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women's Council, 3 Wilkinson St, Alice Springs, NT, 0871, Australia
| | - Suzanne Bryce
- Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women's Council, 3 Wilkinson St, Alice Springs, NT, 0871, Australia
| | - Liza Balmer
- Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women's Council, 3 Wilkinson St, Alice Springs, NT, 0871, Australia
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Eberly LA, Shultz K, Merino M, Brueckner MY, Benally E, Tennison A, Biggs S, Hardie L, Tian Y, Nathan AS, Khatana SAM, Shea JA, Lewis E, Bukhman G, Shin S, Groeneveld PW. Cardiovascular Disease Burden and Outcomes Among American Indian and Alaska Native Medicare Beneficiaries. JAMA Netw Open 2023; 6:e2334923. [PMID: 37738051 PMCID: PMC10517375 DOI: 10.1001/jamanetworkopen.2023.34923] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/17/2023] [Indexed: 09/23/2023] Open
Abstract
Importance American Indian and Alaska Native persons face significant health disparities; however, data regarding the burden of cardiovascular disease in the current era is limited. Objective To determine the incidence and prevalence of cardiovascular disease, the burden of comorbid conditions, including cardiovascular disease risk factors, and associated mortality among American Indian and Alaska Native patients with Medicare insurance. Design, Setting, and Participants This was a population-based cohort study conducted from January 2015 to December 2019 using Medicare administrative data. Participants included American Indian and Alaska Native Medicare beneficiaries 65 years and older enrolled in both Medicare part A and B fee-for-service Medicare. Statistical analyses were performed from November 2022 to April 2023. Main Outcomes and Measures The annual incidence, prevalence, and mortality associated with coronary artery disease (CAD), heart failure (HF), atrial fibrillation/flutter (AF), and cerebrovascular disease (stroke or transient ischemic attack [TIA]). Results Among 220 598 American Indian and Alaska Native Medicare beneficiaries, the median (IQR) age was 72.5 (68.5-79.0) years, 127 402 were female (57.8%), 78 438 (38.8%) came from communities in the most economically distressed quintile in the Distressed Communities Index. In the cohort, 44.8% of patients (98 833) were diagnosed with diabetes, 61.3% (135 124) were diagnosed with hyperlipidemia, and 72.2% (159 365) were diagnosed with hypertension during the study period. The prevalence of CAD was 38.6% (61 125 patients) in 2015 and 36.7% (68 130 patients) in 2019 (P < .001). The incidence of acute myocardial infarction increased from 6.9 per 1000 person-years in 2015 to 7.7 per 1000 patient-years in 2019 (percentage change, 4.79%; P < .001). The prevalence of HF was 22.9% (36 288 patients) in 2015 and 21.4% (39 857 patients) in 2019 (P < .001). The incidence of HF increased from 26.1 per 1000 person-years in 2015 to 27.0 per 1000 person-years in 2019 (percentage change, 4.08%; P < .001). AF had a stable prevalence of 9% during the study period (2015: 9.4% [14 899 patients] vs 2019: 9.3% [25 175 patients]). The incidence of stroke or TIA decreased slightly throughout the study period (12.7 per 1000 person-years in 2015 and 12.1 per 1000 person-years in 2019; percentage change, 5.08; P = .004). Fifty percent of patients (110 244) had at least 1 severe cardiovascular condition (CAD, HF, AF, or cerebrovascular disease), and the overall mortality rate for the cohort was 19.8% (43 589 patients). Conclusions and Relevance In this large cohort study of American Indian and Alaska Native patients with Medicare insurance in the US, results suggest a significant burden of cardiovascular disease and cardiometabolic risk factors. These results highlight the critical need for future efforts to prioritize the cardiovascular health of this population.
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Affiliation(s)
- Lauren A. Eberly
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia
- Penn Cardiovascular Center for Health Equity and Social Justice, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Kaitlyn Shultz
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Maricruz Merino
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
| | | | - Ernest Benally
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
| | - Ada Tennison
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
| | - Sabor Biggs
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
| | - Lakotah Hardie
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
| | - Ye Tian
- Division of Pulmonary and Critical Care, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - Ashwin S. Nathan
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Sameed Ahmed M. Khatana
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Judy A. Shea
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia
| | - Eldrin Lewis
- Division of Cardiovascular Medicine, Stanford University Medical Center, Palo Alto, California
| | - Gene Bukhman
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Global Health and Social Medicine, Program in Global Noncommunicable Diseases and Social Change, Harvard Medical School, Boston, Massachusetts
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Sonya Shin
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Peter W. Groeneveld
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Curley C, Eddie R, Tallis K, Lane TS, Yazzie D, Sanderson PR, Lorts C, Shin S, Behrens TK, George C, Antone-Nez R, Ashley C, de Heer HD. The Navajo Nation Healthy Diné Nation Act: Community Support of a 2% Tax on Unhealthy Foods. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:622-632. [PMID: 37253351 PMCID: PMC10363222 DOI: 10.1097/phh.0000000000001753] [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: 06/01/2023]
Abstract
CONTEXT The Healthy Diné Nation Act (HDNA) of 2014 included a 2% tax on foods of little-to-no-nutritious value ("junk foods") on the Navajo Nation. The law was the first ever in the United States and any Indigenous nation worldwide with a population at a high risk for common nutrition-related conditions. To date, research on community support for food tax legislation among Indigenous nations is entirely lacking. OBJECTIVE To assess the extent of support for the HDNA and factors associated with support including sociodemographic variables, knowledge of the HDNA, nutrition intake, and pricing preferences. DESIGN Cross-sectional survey. SETTING The Navajo Nation. PARTICIPANTS A total of 234 Navajo Nation community members across 21 communities. OUTCOME MEASURES The percentage of participants who were supportive of the HDNA. RESULTS Participants were 97% Navajo, on average middle-aged, 67% reported an income below $25 000 annually, and 69.7% were female. Half of the respondents said they "support" (37.4%) or "strongly support" (13.0%) the tax, while another 35% of people said they were neutral or somewhat supportive; 15% did not support the tax. Participants with higher income ( P = .025) and education ( P = .026) and understanding of the legislation ( P < .001 for "very well" vs "not at all") had increased odds of greater support, as did people who believed that the HDNA would make Navajo people healthier (vs not, P < .001). Age, gender, language, and reported nutrition intake (healthy or unhealthy) were not associated with HDNA support, but participants willing to pay 5% or 12%-15% higher prices for fast food and soda had increased odds of greater support ( P values range from .023 to <.001). CONCLUSIONS The majority of Navajo community members surveyed were moderately supportive of the Navajo Nation tax on unhealthy foods. Higher income and education and understanding of the law were associated with greater support, but nutrition intake was not.
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Affiliation(s)
- Caleigh Curley
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Regina Eddie
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Kristen Tallis
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Taylor S. Lane
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Del Yazzie
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Priscilla R. Sanderson
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Cori Lorts
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Sonya Shin
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Timothy K. Behrens
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Carmen George
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Ramona Antone-Nez
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Christine Ashley
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Hendrik D. de Heer
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
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Barry LE, Kee F, Woodside J, Clarke M, Cawley J, Doherty E, Crealey GE, Duggan J, O'Neill C. An umbrella review of the effectiveness of fiscal and pricing policies on food and non-alcoholic beverages to improve health. Obes Rev 2023:e13570. [PMID: 37095626 DOI: 10.1111/obr.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 02/03/2023] [Accepted: 04/06/2023] [Indexed: 04/26/2023]
Abstract
Poor quality diets represent major risk factors for the global burden of disease. Modeling studies indicate a potential for diet-related fiscal and pricing policies (FPs) to improve health. There is real-world evidence (RWE) that such policies can change behavior; however, the evidence regarding health is less clear. We conducted an umbrella review of the effectiveness of FPs on food and non-alcoholic beverages in influencing health or intermediate outcomes like consumption. We considered FPs applied to an entire population within a jurisdiction and included four systematic reviews in our final sample. Quality appraisal, an examination of excluded reviews, and a literature review of recent primary studies assessed the robustness of our results. Taxes and, to some extent, subsidies are effective in changing consumption of taxed/subsidized items; however, substitution is likely to occur. There is a lack of RWE supporting the effectiveness of FPs in improving health but this does not mean that they are ineffective. FPs may be important for improving health but their design is critical. Poorly designed FPs may fail to improve health and could reduce support for such policies or be used to support their repeal. More high-quality RWE on the impact of FPs on health is needed.
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Affiliation(s)
- Luke E Barry
- Centre for Public Health, Queen's University Belfast, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, UK
| | - Jayne Woodside
- Centre for Public Health, Queen's University Belfast, UK
| | - Mike Clarke
- Centre for Public Health, Queen's University Belfast, UK
| | - John Cawley
- Brooks School of Public Policy, Cornell University, Ithaca, NY, USA
| | - Edel Doherty
- John E. Cairnes School of Business and Economics, National University of Ireland, Galway, Co. Galway, Ireland
| | - Grainne E Crealey
- John E. Cairnes School of Business and Economics, National University of Ireland, Galway, Co. Galway, Ireland
| | - Jim Duggan
- John E. Cairnes School of Business and Economics, National University of Ireland, Galway, Co. Galway, Ireland
| | - Ciaran O'Neill
- Centre for Public Health, Queen's University Belfast, UK
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Eddie R, Curley C, Yazzie D, Francisco S, Antone-Nez R, Begay GA, Sanderson PR, George C, Shin S, Jumbo-Rintila S, Teufel-Shone N, Baldwin J, de Heer H“D. Practicing Tribal Sovereignty Through a Tribal Health Policy: Implementation of the Healthy Diné Nation Act on the Navajo Nation. Prev Chronic Dis 2022; 19:E78. [PMID: 36417292 PMCID: PMC9717698 DOI: 10.5888/pcd19.220106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The Navajo Nation is a large sovereign tribal nation. After several years of grassroots efforts and overcoming an initial presidential veto, the Navajo Nation passed the Healthy Diné Nation Act (HDNA) in 2014 to promote healthy behaviors in Navajo communities. This was the first such policy in the US and in any sovereign tribal nation worldwide. PURPOSE AND OBJECTIVES The objective of this study was to describe the process, implementation, and evaluation of the HDNA passage and its 2020 reauthorization and the potential for using existing and tribal-specific data to inform tribal policy making. INTERVENTION APPROACH The HDNA included a 2% tax on unhealthy foods sold on the Navajo Nation and waived a 6% sales tax on healthy foods. HDNA-generated funds were allocated to 110 local communities for wellness projects. No funds were allocated for enforcement or compliance. EVALUATION METHODS We assessed HDNA tax revenue and tax-funded wellness projects in 110 chapters over time, by region and community size. The food store environment was assessed for fidelity of HDNA implementation, price changes since pretax levels, and shopper behaviors. HDNA revenue was cross-matched with baseline nutrition behaviors and health status through a Navajo-specific Behavioral Risk Factor Surveillance System survey. RESULTS HDNA revenue decreased modestly annually, and 99% of revenue was disbursed to local chapters, mostly for the built recreational environment, education, equipment, and social events. Stores implemented the 2% tax accurately, and the food store environment improved modestly. Regions with high tax revenue also had high rates of diabetes, but not other chronic conditions. The HDNA was reauthorized in 2020. IMPLICATIONS FOR PUBLIC HEALTH Sovereign tribal nations can drive their own health policy. Program evaluation can use existing data sources, tailored data collection efforts, and tribal-specific surveys to gain insight into feasibility, implementation, and impact.
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Affiliation(s)
- Regina Eddie
- School of Nursing, Northern Arizona University, Flagstaff, Arizona
| | - Caleigh Curley
- Department of Health Sciences, Northern Arizona University, Flagstaff, Arizona,Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Del Yazzie
- Navajo Epidemiology Center, Navajo Department of Health, Window Rock, Arizona
| | - Simental Francisco
- Navajo Epidemiology Center, Navajo Department of Health, Window Rock, Arizona
| | - Ramona Antone-Nez
- Navajo Epidemiology Center, Navajo Department of Health, Window Rock, Arizona
| | | | | | | | - Sonya Shin
- Brigham and Women’s Hospital, Boston, Massachusetts
| | | | | | - Julie Baldwin
- Department of Health Sciences, Northern Arizona University, Flagstaff, Arizona
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Etsitty SO, John B, Greenfield A, Alsburg R, Egge M, Sandman S, George C, Curley C, Curley C, De Heer HD, Begay G, Jumbo-Rintila S, Ashley ME, Yazzie D, Antone-Nez R, Shin SS, Bancroft C. Implementation of Indigenous Food Tax Policies in Stores on Navajo Nation. Health Promot Pract 2022; 23:76S-85S. [PMID: 36374598 PMCID: PMC10767710 DOI: 10.1177/15248399221112964] [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: 10/13/2023]
Abstract
In 2014, the Navajo Nation Healthy Diné Nation Act (HDNA) was enacted and permanently approved in 2020; HDNA places a 2% surtax on unhealthy foods and beverages, while other 2014 legislation exempted healthy food items from the 6% regular sales tax. Little is known about Navajo Nation store manager/owner perspectives toward the HDNA and how best to support stores to implement the legislation. Purposive sampling was used to ensure a balanced sample of correct HDNA implementers, incorrect HDNA implementers, and stores which made healthy store changes over the past 6 years. Three community-based interviewers collected surveys by phone or in-person. Frequency of closed-ended questions was quantified, and open-ended responses were coded using thematic analysis. Of 29 identified sample stores, 20 were interviewed to reach saturation. Eleven of 20 stores made changes improving their healthy food environments. Barriers included lack of equipment (6/20) and low consumer demand (5/20). Facilitators included consumer awareness and increased produce supply options (5/20). Sixteen of 20 stores supported HDNA continuation. Facilitators to HDNA implementation included orientation and informational materials (6/20) and promotion of tax-free items (5/20). Barriers included confusion about the tax (6/20) and tax exemption (5/20). Suggestions for support included printed materials (6/20) and store training (5/20). HDNA benefits included greater awareness of healthy choices among staff (7/20) and customer-community members (2/20). Most managers and owners expressed receiving support for healthy store changes and HDNA, but also identified a need for added resources and support. Findings inform legislative action to promote timely and appropriate uptake of HDNA, and support equitable, healthy food systems.
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Affiliation(s)
| | - Brianna John
- Northern Arizona University, Flagstaff, AZ, USA
- Community Outreach and Patient Empowerment, Gallup, NM, USA
- Brigham and Women’s Hospital, Boston, MA, USA
| | - Alex Greenfield
- Northern Arizona University, Flagstaff, AZ, USA
- Brigham and Women’s Hospital, Boston, MA, USA
| | - Robert Alsburg
- Northern Arizona University, Flagstaff, AZ, USA
- Brigham and Women’s Hospital, Boston, MA, USA
| | - Malyssa Egge
- Northern Arizona University, Flagstaff, AZ, USA
- Community Outreach and Patient Empowerment, Gallup, NM, USA
| | - Sharon Sandman
- Northern Arizona University, Flagstaff, AZ, USA
- Community Outreach and Patient Empowerment, Gallup, NM, USA
| | - Carmen George
- Northern Arizona University, Flagstaff, AZ, USA
- Brigham and Women’s Hospital, Boston, MA, USA
| | - Cameron Curley
- Northern Arizona University, Flagstaff, AZ, USA
- Brigham and Women’s Hospital, Boston, MA, USA
| | - Caleigh Curley
- Northern Arizona University, Flagstaff, AZ, USA
- University of Arizona, Tucson, AZ, USA
| | | | | | | | | | - Del Yazzie
- Navajo Epidemiology Center, Window Rock, AZ, USA
| | | | - Sonya Sunhi Shin
- Community Outreach and Patient Empowerment, Gallup, NM, USA
- Brigham and Women’s Hospital, Boston, MA, USA
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Bennion N, Redelfs AH, Spruance L, Benally S, Sloan-Aagard C. Driving Distance and Food Accessibility: A Geospatial Analysis of the Food Environment in the Navajo Nation and Border Towns. Front Nutr 2022; 9:904119. [PMID: 35873433 PMCID: PMC9301304 DOI: 10.3389/fnut.2022.904119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
The Navajo Nation, an area home to approximately 173,000 people in the southwest United States, experiences the highest rates of food insecurity in the United States and is classified as a food desert. The present study assessed the accessibility to food outlets (grocery stores, convenience stores, and restaurants) as measured by driving time on the Navajo Nation and in selected surrounding border towns. Food outlets located in neighboring border towns were examined using network analysis tools in ArcGIS Pro to calculate driving distance and examine the potential impact of driving time within the Navajo Nation on accessibility to nutritious foods. There were 14 grocery stores, 21 convenience stores, and 65 restaurants identified in the Navajo Nation using Mergent Intellect, a proprietary database, as compared to border towns which had a total of 542 grocery stores, 762 convenience stores, and 3,329 restaurants equaling a ratio of about 50:1 (grocery, 39:1; convenience, 36:1; restaurants, 51:1) when comparing food outlets nearby versus on the Navajo Nation. This ecological study presents a visual representation of driving time and food accessibility, revealing geographic areas within the Navajo Nation where access to border town food stores is sparse, and food insecurity may be elevated.
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