Implementation of healthy food environment policies to prevent nutrition-related non-communicable diseases in Ghana: National experts’ assessment of government action

Nutrition-related non-communicable diseases (NR-NCDs) are a global health problem, increasingly recognised as driven by unhealthy food environments. Yet little is known about government action to implement food environment-relevant policies, particularly in low-and lower-middle income countries. This study assessed government action, implementation gaps, and priorities to improve the food environment in Ghana. Using the Healthy Food-Environment Policy Index (Food-EPI), a panel comprising government and independent experts (n = 19) rated government action to improve the healthiness of food environment in Ghana against international best practices and according to steps within a policy cycle. Forty-three good practice indicators of food environment policy and infrastructure support were used, with ratings informed by systematically collected evidence of action validated by government officials. Following the rating exercise, the expert panel proposed and prioritized actions for government implementation. Three-quarters of all good practice indicators were rated at ‘low’/‘very little’ implementation. Restricting the marketing of breast milk substitutes was the only indicator rated “very high”. Of ten policy actions prioritized for implementation, restricting unhealthy food marketing in children’s settings and in the media were ranked the highest priority. Providing sufficient funds for nationally-relevant research on nutrition and NCDs was the highest priority infrastructure-support action. Other priority infrastructure-support actions related to leadership, monitoring and evaluation. This study identified gaps in Ghana’s implementation of internationally-recommended policies to promote healthy food environments. National stakeholders recommended actions, which will require legislation and leadership. The findings provide a baseline for measuring government progress towards implementing effective policies to prevent NR-NCDs.     

Improving the food environment in kindergartens and schools: An overview of policies and policy opportunities in Europe

Childhood obesity and unhealthy nutrition are high on the European policy agenda because of their association with chronic diseases and due to the related social and economic burden. In 2014, the EU Action Plan on Childhood Obesity 2014–2020 was launched with an overarching goal to halt the rise of overweight and obesity in children by the year 2020. To facilitate the implementation of the Action Plan, the Directorate-General for Health and Food Safety of the European Commission provided support to bring together 25 Member States plus Norway for a Joint Action on Nutrition and Physical Activity (JANPA). The current paper is based on the results of JANPA and presents the explored policy options to improve children's nutrition by targeting the food environment in and around kindergartens and schools. We conclude that for effective actions countries need to combine various mutually reinforcing policies in parallel, including the provision of healthy foods, lowering the availability of unhealthy foods, restricting marketing, and promoting education. Success will depend on the coherence of messages and on the engagement of a wide range of stakeholders and sectors. Evaluation should be carefully designed, using indicators of progress towards the goal of improving diet and reducing obesity in children.     

Baseline results from the Eat,Play, Live trial: A randomized controlled trial within a natural experiment examining the role of nutrition policy and capacity building in improving food environments in recreation and sport facilities

Canadian provincial governments have introduced voluntary nutrition guidelines for recreation and sport facilities to promote healthy dietary patterns in children. This paper presents baseline data from the Eat, Play, Live (EPL) randomized controlled trial to examine whether facilities in guideline provinces had greater capacity, more nutrition policies, and healthier food environments than facilities in a province without guidelines. Facility capacity, policy development, and food environment quality were measured and compared in guideline (GF; n = 32) and no guideline facilities (NoGF; n = 17) using ANOVA and Chi-square statistics. Healthfulness of vending and concession items were rated as Do Not Sell (least nutritious), Sell Sometimes or Sell Most (most nutritious). Facility capacity scores did not differ between GF and NoGF. A higher proportion of GF had facility-specific nutrition policies compared to NoGF. GF vending machines had healthier profiles than NoGF; including a lower proportion of Do Not Sell snacks and beverages, and a higher proportion of Sell Sometimes snacks and beverages and Sell Most beverages. GF concessions had healthier profiles than NoGF; with a lower proportion of Do Not Sell snacks and beverages, a higher proportion of Sell Sometimes snacks and Sell Most beverages, and higher food environment summary scores. Recreation and sport facilities in guideline provinces had more nutrition policies and healthier food environments than facilities in a province without guidelines. However, food environments were unhealthy regardless of guideline status which may promote correspondingly unhealthy dietary patterns among children.Clinical trials registration (retrospectively registered): ISRCTN14669997 Jul 3 2018.     

Indigenous Shawi communities and national food security support: Right direction,but not enough

Food insecurity is a major challenge facing Peru’s Indigenous Shawi communities, who receive food support through national level programs. There is limited research, however, on how national food and social programming support is perceived, received and used among Indigenous communities. We address this research gap by characterizing the preferred diet and coping mechanisms among Shawi Indigenous households, and investigating community perspectives on the national food program and national social supports. We used a mixed methods approach, including a quantitative survey among eleven Shawi communities in the Peruvian Amazon (n = 177 households), and semi-structured interviews with key informants (n = 24). We found that national food programs in Peru rarely provide foods that are desired and preferred among the Shawi, particularly familiar and locally-sourced protein sources such as bushmeat and fish. Food and social programming requirements do not integrate consideration of the remoteness of many vulnerable households, and are considered culturally or linguistically inaccessible to many families. In some cases, foods supplied by national programs are not consumed as they are perceived as unfamiliar. Key opportunities to improve food and social programing include: monitoring and revising eligibility requirements for remote and highly vulnerable households; increasing provision of locally-preferred protein food and familiar food types; avoiding use of written Spanish as a sole source of information to support programming; extending food provision outside of school months; developing contingency plans during education sector strikes; considering hiring of staff with working knowledge of local languages for community distributions; using visual or oral communication rather than written communication to increase accessibility of programs; increasing knowledge on the use and nutritional value of external food; and considering exemptions to school and health eligibility requirements during the rainy season and during sector strikes. Nationally-developed programming that does not consider Indigenous and cultural contexts risks inefficiency, limited improvement of health outcomes, and the potential to increase inequities in Indigenous health.     

School meals and pupil satisfaction. Evidence from Italian primary schools

This paper aims to analyse to what extent pupils value the characteristics of the state school foodservice and identify which variables affect the degree of pupils’ satisfaction with the quality of school meals. A representative sample of 33 state primary schools providing meals was extracted for the metropolitan city of Naples. Two questionnaires were distributed, one to the headteachers concerned and the other to 5th grade pupils (10–11 years old). Information about the catering companies was mainly sourced from the AIDA database. Pupil satisfaction was measured by two key variables: pleasantness of eating at school and food tastiness. Controlling for pupil, family, school, foodservice and catering company characteristics, the paper shows that the catering company size negatively impacts upon pupil satisfaction with the foodservice, whereas the estimated meal average production cost is positively associated with pupil satisfaction. The study could assist city boroughs in devising meal quality indicators to be taken into account in designing competitive tendering.     

The politics of success in the fight against malnutrition in Peru

The dramatic reduction in children’s chronic malnutrition in Peru observed in recent years has defied the patterns of stunting reduction worldwide. After nearly a decade of stalled progress, the government reported a reduction in stunting rates of nearly 10 points, from 29.8% in 2005 to 18.1% in 2011. The specialized literature has acknowledged the critical role that immediate (e.g. increasing breastfeeding promotion) and underlying (e.g. investments to improve household food security) interventions have played in reducing stunting (Black et al., 2013), as well as the contributing role of enabling factors related to economic performance. This paper offers an alternative explanation to success by looking at the shift in the government’s nutrition strategy after 2006 with the formation of the Child Malnutrition Initiative (CMI), a civil society working platform, and the adoption of a national poverty reduction strategy prioritizing nutrition interventions (known as CRECER) and conditional cash transfers (JUNTOS). The paper uses veto players theory to explain how these changes effectively contributed to policy change by reducing the effective number of nutrition stakeholders involved and facilitating policy agreements around a common policy platform and established goals. The Peruvian case also highlights the importance of the government’s public commitment to reduce chronic malnutrition in children under five by 5 percent in 5 years (“5 by 5 by 5”) and the accompanying role, advocacy and monitoring from civil society organizations.The paper looks at the success of implementing the nutrition strategy in three dimensions. Horizontally, it looks at the coordination between government and non-government agencies to converge around a common policy discourse;vertically, it looks at the implementation of the nutrition strategy across national, regional and municipal governments;and financially, it looks at the coordinated and conditional allocation of nutrition funding and how this created greater incentives for horizontal and vertical coordination. The paper draws some theoretical and policy implications for improving the effective and accountable delivery of nutrition interventions in Peru and other countries outside Latin America.     

Organization, programme and structure: an analysis of the Chinese innovation policy framework

The paper first identifies the stakeholders involved in the design and implementation of China's innovation policy and compares them with different government systems in selected Organization for Economic Co-operation and Development (OECD) countries. In order to disclose the relative strength and weaknesses inside China's innovation policy framework, we proceed to utilize policy practices in the OECD countries as a guideline to examine China's innovation policy in five categories: reform in the public S&T institutions, financial policy, business innovation support structure, human resource policy and legislative actions. Subsequently, several weak components of the Chinese innovation policy framework are identified and two of them are selected for further analysis: education and human resource policy, and protection of Intellectual Property Rights (IPR). Finally, the paper provides some priorities and possible actions for future innovation policy developments in China.     

REIT Dividend Policies and Dividend Announcement Effects During the 2008–2009 Liquidity Crisis

Real estate investment trust (REIT) dividend policies and dividend announcement effects during the 2008–2009 liquidity crisis are examined. Multinomial logit results indicate that REITs with higher market leverage or lower market‐to‐book ratios are more likely to cut dividends, suspend dividends or pay elective stock dividends. These results imply that mitigating going‐concern risk is an important motive for REITs adjusting dividend policies during the crisis and support dividend catering theory where investor demand for dividends impacts corporate dividend policies. Moreover, REITs that cut or suspend dividends experience positive cumulative abnormal returns during the post‐announcement period after controlling for the potential influence from simultaneous funds from operation announcements. The positive market response over the post‐announcement period supports the notion that dividend decisions convey information to investors and is also consistent with the broad catering theory of dividend policy.     

Towards better nutrition in Europe: Evaluating progress and defining future directions

This paper provides a snapshot of the implementation of the WHO European Food and Nutrition Action Plan 2015–2020 among Member States in the WHO European Region. The focus is on the level and degree of implementation of selected policies recommended in this regional framework to promote healthy nutrition and prevent diet related noncommunicable diseases including obesity. Data was gathered through online and off-line versions of the Global Nutrition Policy Review questionnaire in 2017, through appointed focal points from the ministries of health. Almost all (94%) countries in the European region responded to the questionnaire, although not all responses were equally detailed. Significant progress has been made in some areas of public health nutrition, such as within school food policies, product reformulation, and implementation of trans fat regulations. However, if countries are to achieve global NCD targets, more ambitious policies with appropriate breadth and depth are needed. This is mainly the case for consumer-friendly front-of-package labelling, restrictions on marketing of foods to children as well as policies to protect, promote and support exclusive breastfeeding and appropriate complementary feeding practices. Lastly, it is crucial to prioritize robust monitoring, surveillance and evaluation systems in order to understand the effect of these actions and to guide timely and appropriate adjustment of policies.     

Canceling the admission priority of private schools enlarges housing price gap in public school districts: Evidence from Shanghai's new admission policy

In 2018, Shanghai implemented an admission policy that canceled the admission priority of private schools to promote education equity. Since this policy is a unique measure for adjusting private and public school competition and discouraging private school choice priority, little is known about the policy effects. In this research, to examine the impact of the new admission policy on the capitalization of public education quality, we apply boundary fixed effect and Difference in Differences (DID) analysis to housing transaction records before and after the policy. The admission policy on average led to an additional 2% housing price premium for every standard deviation increase in public school quality. However, this average increase in premium was mainly driven by elite (top 5%) school districts, where an additional 8.6% housing price premium was generated by the policy. Housing prices in nonelite school districts, on the other hand, demonstrated no significant changes. These results indicate that the policy enlarges the housing price gap among school districts with different education quality. Thus, rather than promoting education equity, this policy may overall worsen the housing affordability in good public-school districts and make access to quality education more exclusive.     

产业政策、融资约束与企业全要素生产率——基于战略性新兴产业政策的实证研究

本文以战略性新兴产业实施为准自然实验,利用2007~2019年我国上市公司面板数据,构建双重差分模型,考察产业政策冲击对企业全要素生产率的影响。研究发现:战略性新兴产业政策促进了处理组企业全要素生产率的提升,并且这种促进作用先增强后减弱;相比于国有企业,非国有企业受到产业政策影响更大;相比于市场化程度低的地区,市场化程度高的地区受到产业政策影响更大;产业政策主要通过改善企业的融资约束状况来提高其全要素生产率。因此,政府应该努力营造良好的融资环境,缓解企业融资约束压力,充分发挥战略性新兴产业政策对企业全要素生产率的提升作用。     

Methods, results and policy implications of poverty and food security mapping assessments

The importance of poverty reduction to the world development agenda has motivated greater interest in the geographic dimensions of poverty and food security. This special issue of Food Policy includes examples of poverty and food security mapping used to support policy development in agricultural and rural areas. The volume includes eight country case studies and one cross-country comparison that illustrate advances in our capacity to assess welfare over large areas and at detailed spatial resolutions. Poverty mapping facilitates assessments of the role of environmental factors on the broad spatial pattern of poverty and food security. Evaluating proximity and accessibility in welfare outcomes can improve our knowledge of poverty patterns and processes. Spatial statistics can enhance our understanding of geographic and neighbourhood effects on poverty and food security outcomes. The development of effective policies requires increased collaboration among stakeholders, researchers and policy makers in constructing and using poverty and food security maps.     

Program equity issues in schooling: The testimony of technology teachers

Assimilation into society via academic achievement is a premise and practice that is universal in schools and school systems. Drawing on the testimonies of technological education teachers and the sociology of knowledge literature, this narrative inquiry research sets the stage for a critical analysis of our reliance on knowledge versus experience in western education policy and planning. A crisp and constructive analysis of the premises school systems take for granted becomes possible, a case for transcending limited ways of thinking about knowledge and experience is made.

Modelling of potential food policy interventions in Fiji and Tonga and their impacts on noncommunicable disease mortality

Background

To compare the likely costs and benefits of a range of potential policy interventions in Fiji and Tonga targeted at diet-related noncommunicable diseases (NCDs), in order to support more evidence-based decision-making.

Method

A relatively simple and quick macro-simulation methodology was developed. Logic models were developed by local stakeholders and used to identify costs and dietary impacts of policy changes. Costs were confined to government costs, and excluded cost offsets. The best available evidence was combined with local data to model impacts on deaths from noncommunicable diseases over the lifetime of the target population. Given that the modelling necessarily entailed assumptions to compensate for gaps in data and evidence, use was made of probabilistic uncertainty analysis.

Results

Costs of implementing policy changes were generally low, with the exception of some requiring additional long-term staffing or construction activities. The most effective policy options in Fiji and Tonga targeted access to local produce and high-fat meats respectively, and were estimated to avert approximately 3% of diet-related NCD deaths in each population. Many policies had substantially lower benefits. Cost-effectiveness was higher for the low-cost policies. Similar policies produced markedly different results in the two countries.

Conclusion

Despite the crudeness of the method, the consistent modelling approach used across all the options, allowed reasonable comparisons to be made between the potential policy costs and impacts. This type of modelling can be used to support more evidence-based and informed decision-making about policy interventions and facilitate greater use of policy to achieve a reduction in NCDs.     

Platform couriers' self-exploitation: The case study of Glovo

This article examines the phenomenon of self-exploitation among platform couriers, using the company Glovo as a case study. The research, based on a qualitative approach with interviews from 22 different stakeholders, highlights the ways in which precarity, entrepreneurial subjectivity, and gamification intersect to create what are referred to as postdisciplinary control mechanisms. These mechanisms shift the locus of exploitation from the employer to the workers' inner selves, which are compelled to follow implicit guidelines due to their precarious situation. The use of algorithmic management by platform companies like Glovo plays a major role in this architecture marked by overwork, exposure to hazardous conditions, and economic dependence. The article urges policymakers to look beyond platform workers' employment status debate and address the design of algorithms and broader forms of labour precarity, so that policies that successfully improve workers' experience are designed.     

Interoperability of interpersonal communications services – A consumer perspective

The European Electronic Communications Code (EECC) enables competent authorities to introduce interoperability obligations also for number-independent interpersonal communications services (NI-ICS) such as Facebook Messenger, LINE, Skype, WeChat and WhatsApp. Under such an obligation, consumers could interact not just with users of the NI-ICS where they have a user account themselves, but also with users of all then interoperable NI-ICS. While with traditional electronic communications services (ECS) economic theory and consumer interests align as regards interoperability since multi-homing across various operators is the exemption, it is not yet clear whether that is also true for NI-ICS for which multi-homing is the norm. Our paper draws on an online survey of n = 2044 consumers in Germany covering traditional ECS, email and 22 other NI-ICS to address this issue from a consumer point of view. We find that people proactively use the boundaries between communications services to compartmentalize their social contacts according to relationship closeness. Our finding echoes indications provided in a rich stream of computer-mediated communication (CMC) research and in particular psychological theories of relationship development. Specifically, people appear to follow a finely tuned cultural code implying a hierarchical order of communications services used depending on the closeness of the contacts. Consequently, our results provide a complementary explanation of how and why certain groups of social ties converge to a specific (set of) communications service(s) beyond network effects and shed a critical light on current policy debates around an interoperability obligation for interpersonal communications applications. They highlight that an interoperability obligation for NI-ICS would likely not be in line with consumer interests.     

The participation society and its inability to correct the failure of market players to deliver adequate service levels in rural areas

This paper critically reviews the ‘participation society’ inspired policy measures of two Dutch provinces (Drenthe and Groningen) for providing rural broadband. Based on a database with broadband initiatives, interviews with stakeholders, focus groups and document analysis, it analyzes how rural broadband initiatives and regional governments interact in their ventures to provide superfast broadband to rural communities. Essential in this is that in the Dutch participation society concept, citizens' initiatives are seen as an important actor to deal with failing service delivery by market players in rural areas. The relation between regional governments and citizens' initiatives, however, is troublesome, resulting in inadequate policies. Key findings are that even when governments come up with supportive policies for citizens' initiatives, initiatives still experience governmental efforts as constraining factors. Regional governments apply ‘old style’ governance and construct generic policy instruments, forcing initiatives to put a lot of effort in complying with generic policy requirements or political goals. Overall, solving a national market problem at the regional level proves to be problematic. More national guidance is needed to solve the rural broadband gap.     

A path model of factors affecting secondary school students’ technological literacy

Technological literacy defines a competitive vision for technology education. Working together with competitive supremacy, technological literacy shapes the actions of technology educators. Rationalised by the dictates of industry, technological literacy was constructed as a product of the marketplace. There are many models that visualise different dimensions of technological literacy, but clear empirical evidence on how these interact is still lacking. A measurement method that comprehensively evaluates technological literacy is missing. Insights into the stem structure and interaction of technological literacy dimensions could be useful for technology education curriculum design and its implementation. In this study, the multifaceted nature of technological literacy was measured using a new assessment method, and dimensions of secondary school students’ technological literacy were empirically investigated. A total of 403 students participated in the quasi-experimental research design. The treatment group consisted of 121 students taught optional subjects relating to technology education. The control group consisted of 282 students. Results from variance analysis showed that optional technology subjects enhance technological literacy, especially students’ technological capacity where a large effect size (η ²  = 0.14) was noted. Results from a path analysis revealed critical thinking and decision-making as the most important dimensions of technological literacy while the predictor of active participation in out-of-school technical activities and technology homework was a key independent influencing factor. A large effect size (R ²  = 0.4) for career path orientation predictors was detected. Technological capacity was revealed as a decisive predictor for a career path in vocational education and technical high school.