Towards an impactful intervention in a food retail setting - insights from transition management

Issue

Socioeconomic inequalities in diet and health form a persistent public health problem. Environmental, non-agentic interventions are most likely to be equitable, but have to be implemented in a wider system with interests other than health promotion.

Description of the Problem

The Supreme Nudge project (2017-2022) implements a health promotion intervention (niche experiment) in a supermarket setting (regime context). As a sufficiently impactful intervention is likely to conflict with interests of the setting, the Transition Management (TM) framework is used to guide design and implementation. Following the four steps in this cyclical model, we explore the context of the food retail system and identify key players; develop coalitions, shared visions and transition agendas; mobilize actors and implement the intervention; and evaluate, monitor and learn from the intervention. Interviews and focus groups were held to address these steps.

Results

The Dutch supermarket context consists of multiple chains that, after several price wars, are shifting competition from price to corporate social responsibility goals, including health promotion. Together with key supermarket players, a shared vision was defined: making healthy dietary choices easier while striving for neutral business outcomes. Transition paths towards this vision, including their barriers and facilitators, were explored. Additional actors were mobilized to adapt and refine intervention components, and the intervention will be implemented mid-2020. The intervention will be monitored and evaluated to facilitate upscaling.

Lessons

Applying the TM framework facilitated the development of coalitions and a shared vision, the co-creation of intervention components and identification of transition paths. This is likely to also benefit implementation and upscaling of the intervention. Applying the TM framework will also be useful for transferring successful interventions to other contexts.

Key messages

Implementing a health promotion in a food retail setting is challenging because of the conflicting interests. The Transition Management framework can facilitate successful implementation through creating a shared vision and foreseen transition paths.

Socioeconomic inequalities in diabetes mellitus across Europe at the beginning of the 21st century

AIMS/HYPOTHESIS

The aim of this study was to determine and quantify socioeconomic position (SEP) inequalities in diabetes mellitus in different areas of Europe, at the turn of the century, for men and women.

METHODS

We analysed data from ten representative national health surveys and 13 mortality registers. For national health surveys the dependent variable was the presence of diabetes by self-report and for mortality registers it was death from diabetes. Educational level (SEP), age and sex were independent variables, and age-adjusted prevalence ratios (PRs) and risk ratios (RRs) were calculated.

RESULTS

In the overall study population, low SEP was related to a higher prevalence of diabetes, for example men who attained a level of education equivalent to lower secondary school or less had a PR of 1.6 (95% CI 1.4-1.9) compared with those who attained tertiary level education, whereas the corresponding value in women was 2.2 (95% CI 1.9-2.7). Moreover, in all countries, having a disadvantaged SEP is related to a higher rate of mortality from diabetes and a linear relationship is observed. Eastern European countries have higher relative inequalities in mortality by SEP. According to our data, the RR of dying from diabetes for women with low a SEP is 3.4 (95% CI 2.6-4.6), while in men it is 2.0 (95% CI 1.7-2.4).

CONCLUSIONS/INTERPRETATION

In Europe, educational attainment and diabetes are inversely related, in terms of both morbidity and mortality rates. This underlines the importance of targeting interventions towards low SEP groups. Access and use of healthcare services by people with diabetes also need to be improved.

Dietary intakes of adults in the Netherlands by childhood and adulthood socioeconomic position

OBJECTIVE

To determine whether there are socioeconomic differences in the intakes of total fat, fatty acids and fruit among adults in the Netherlands using childhood (parental) and participant's own socioeconomic position (SEP). Furthermore, to quantify the independent effects of childhood and adulthood SEP on dietary behavior in adulthood.

DESIGN

Cross-sectional study among participants in the GLOBE study.

SUBJECTS

A total of 2512 men and women, aged 25-78 y, living in a region in the southeast Netherlands.

METHODS

Dietary intakes were collected by an interviewer-administered quantitative food frequency questionnaire. Average daily intakes of total energy, total, saturated, monounsaturated, polyunsaturated fat and fruit were calculated. The highest educational level was used to classify the participant's adulthood SEP. Parental indicators (mother's education and father's occupation when participants were 12 y of age) were used to classify childhood SEP.

RESULTS

Males with lower levels of education had moderately higher energy intakes than their more educated counterparts, but did not differ in their intakes of total fat, fatty acids and fruit. Among females, the least educated groups had marginally higher intakes of total and monounsaturated fat than the most educated group, and were less likely to consume fruit. For most of these significant differences, the participant's own education demonstrated independent effects that were consistent with chronic disease inequalities. A small residual effect of mother's education was also demonstrated for intakes of some nutrients for males and females, and for fruit consumption among females. However, the effect size of mother's education was rather small and not always consistent with disease inequalities.

CONCLUSIONS

The results imply that socioeconomic disparities in intakes of some dietary factors may contribute to inequalities in chronic disease. Adulthood SEP potentially has a more direct influence on dietary intake inequalities than childhood SEP.

National infant mortality rates in relation to gross national product and distribution of income

We examined the relation between infant mortality rates, gross national product, and income distribution. Our findings support the hypothesis that average measures of population health are influenced by the distribution of income within societies.