Nutrition policies and programmes: a decade of redirection

This article assesses the effectiveness of nutrition programs and policies since the World Food Conference, 10 years ago. The authors perceive several distinct approaches. Just before the World Food Conference, nutrition programs had passed through an era of enchantment with technological solutions (single-cell protein, oilseed protein isolates). Supply was regarded as the problem; protein inadequacy as the crisis. None of the technological fixes had much of an impact on the malnutrition problem. This contributed to a willingness to entertain a much broader approach to nutrition. The new paradigm manifested itself 1st as a movement toward integrated nutrition planning. The national planning process was assumed to be the appropriate vehicle for applying this methodology. However, integrated nutrition planning threatened, conflicted with or at least brought pressure for change in the administrative and political reality of governmental organizations. Moreover, the nutrition community's capacity to respond to the demands flowing from the new paradigm was limited. The difficulties encountered in trying to achieve full integration led to a reexamination of working within traditional sectors but addressing the problem in several key sectors simultaneously, such as health and agriculture. The past decade also saw a move toward analyzing and improving the design and implementation of various kinds of nutrition interventions. The emphasis was on understanding and dealing with the administrative, economic and political realities of such efforts. Incorporation of consumption and nutrition considerations in the analysis and formulation of food policies in some countries is 1 of the important achievements of the past decade. This overwhelmingly economic approach focuses on pricing policies and market effects, recognizing that poverty and purchasing power are central to the malnutrition problem. Analysis of macrofood policy has filled an important void, giving a more concrete and inclusive view of food security. Nutrition progress during the next decade will require the development community to confront a changed environment and several key challenges, namely the surge of conservative politics in the early 1980s, and the severe economic problems most countries face. There is a need to be realistic about the tenacity of the problem and the multiple barriers to implementation of nutrition policies. The challenges face both national governments and development agencies. There is agreement that, during the decade since the World Food Conference, the field of nutrition has gone through a metamorphosis and that there has been progress. However, the development community still faces an unfinished nutrition agenda.     

Advancing the evidence base for public policies impacting on dietary behaviour,physical activity and sedentary behaviour in Europe: The Policy Evaluation Network promoting a multidisciplinary approach

Non-communicable diseases (NCDs) are the leading cause of global mortality. As the social and economic costs of NCDs have escalated, action is needed to tackle important causes of many NCD’s: low physical activity levels and unhealthy dietary behaviours. As these behaviours are driven by upstream factors, successful policy interventions are required that encourage healthy dietary behaviours, improve physical activity levels and reduce sedentary behaviours of entire populations. However, to date, no systematic research on the implementation and evaluation of policy interventions related to these health behaviours has been conducted across Europe. Consequently, no information on the merit, gaps, worth or utility of cross-European policy interventions is available, and no guidance or recommendations on how to enhance this knowledge across European countries exists. As part of the Joint Programming Initiative “A Healthy Diet for a Healthy Life” (JPI HDHL), 28 research institutes from seven European countries and New Zealand have combined their expertise to form the Policy Evaluation Network (PEN). PEN’s aim is to advance tools to identify, evaluate, implement and benchmark policies designed to directly or indirectly target dietary behaviours, physical activity, and sedentary behaviour in Europe, as well as to understand how these policies increase or decrease health inequalities. Using well-defined evaluation principles and methods, PEN will examine the content, implementation and impact of policies addressing dietary behaviour, physical activity levels and sedentary behaviour across Europe. It will realise the first steps in a bespoke health policy monitoring and surveillance system for Europe, and refine our knowledge of appropriate research designs and methods for the quantification of policy impact. It will contribute to our understanding of how to achieve successful transnational policy implementation and monitoring of these policies in different cultural, demographic or socioeconomic settings. PEN will consider equity and diversity aspects to ensure that policy actions are inclusive and culturally sensitive. Finally, based on three policy cases, PEN will illustrate how best to evaluate the implementation and impact of such policies in order to yield healthy diets and activity patterns that result in healthier lives for all European citizens.     

The potential of diversified agroecological systems to deliver healthy outcomes: Making the link between agriculture,food systems & health

In 2014, the Rome Declaration on Nutrition recognized food system sustainability as a key condition to ensure adequate nutrition and access to healthy diets for all. Five years later, the evidence has never been more clear: despite a series of positive outcomes, our current food systems have increasingly generated severe environmental, social, and health-related costs. Many of the most severe health impacts of food systems can be traced back to the core practices of industrial food and farming systems (e.g. input-intensive agriculture; intensive livestock production; mass marketing of highly processed foods; deregulated global commodity chains). Yet alternatives exist.This article provides an overview of the key impacts generated by current food systems on human and environmental health, with an emphasis on their effects in the region of Europe and Central Asia. It then brings together evidence on how diversified agroecological systems can play a key role in meeting health and nutrition goals, while also addressing the environmental, social, and economic challenges created by current systems. Ultimately, the article sheds light on how to break away from the underlying drivers keeping current systems in place, and suggests how more diversified systems can effectively be promoted through systemic, multi-sector, and integrated policy approaches to ensure healthy diets for all.     

European consumer preferences for beef with nutrition and health claims: A multi-country investigation using discrete choice experiments

The European Union (EU) nutrition labelling policy aims to facilitate consumers’ food choice, stimulate innovation and facilitate the circulation of foods bearing claims across countries. However, the beef industry has not fully taken advantage of utilizing nutrition and health claims based on the EU nutrition labelling policy to differentiate beef products in the market. This study investigates consumer preferences for nutrition and health claims on lean beef steak. Two choice experiments were conducted among 2400 beef consumers in four EU countries (Belgium, France, the Netherlands, United and United Kingdom). Multinomial logit and error component models were estimated. Our results generally suggest that consumer valuation of nutritional and health claims varies across countries. In Belgium, the Netherlands and France, nutrition and health claims on saturated fat yielded higher utilities than claims on protein and/or iron, while the opposite was found among consumers in the UK. The results imply that marketing opportunities related to nutrition and health claims on beef are promising, but that different nutritional marketing strategies are necessary within different countries.     

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.     

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.     

Nutrition in socioeconomic planning in LDCs

Nutrition should be seen as an integral part of the national planning effort. The author examines longterm determinants of food consumption in developing countries and shows that progress in improving nutrition is closely related to raising productivity and efficiency in the national economy. Optimum programmes in nutrition should be part of the design of appropriate social and economic development. This should be done at national and regional levels, with particular emphasis on the regional level.     

A ‘Common Food Policy’ for Europe: How governance reforms can spark a shift to healthy diets and sustainable food systems

More than half of adults in the European Union (EU) are now either overweight or obese (53%). Non-communicable diseases (NCDs), many of which are diet-related, account for 70% of mortality in Europe and a growing share of healthcare costs. While eating habits have an important role to play in NCD prevention, consumption patterns across the EU are diverging significantly from recommended diets. There is growing consensus on the solution: a series of coordinated and wide-ranging policy interventions to build healthy ‘food environments’.This article argues that EU governance structures remain ill-adapted to the systemic nature of this and other challenges in food systems (e.g. climate change, biodiversity loss, food poverty): conflicting objectives and missed synergies are identified between different policy areas (agriculture, trade, health, environment, etc.) and between different levels of governance (EU, national, local). An integrated food policy framework – a ‘Common Food Policy’ – is therefore required to meet the EU’s public health and sustainability objectives. It identifies four distinct aspects of the governance shift required to promote healthy diets and build sustainable food systems in Europe: (i) coherence across policy areas; (ii) coherence across governance levels; (iii) governance for transition; and (iv) food democracy. Blueprints for a Common Food Policy are already emerging, and are ripe for consideration, development, and implementation by the European institutions.     

Targeting population nutrition through municipal health and food policy: Implications of New York City’s experiences in regulatory obesity prevention

Obesity remains a major public health challenge across OECD countries and policy-makers globally require successful policy precedents. This paper analyzes New York City’s innovative experiences in regulatory approaches to nutrition. We combined a systematic documentary review and key informant interviews (n = 9) with individuals directly involved in nutrition policy development and decision-making. Thematic analysis was guided by Kingdon’s three-streams-model and the International Obesity Task Force’s evidence-based decision-making framework. Our findings indicate that decisive mayoral leadership spearheaded initial agenda-change and built executive capacity to support evidence-driven policy. Policy-makers in the executive branch recognized the dearth of evidence for concrete policy interventions, and made contributing to the evidence base an explicit goal. Their approach preferred decision-making through executive action and rules passed by the Board of Health that successfully banned trans-fats from food outlets, set institutional food standards, introduced menu labeling requirements for chain restaurants, and improved access to healthy foods for disadvantaged populations. Although the Health Department collaborated with the legislature on legal and programmatic food access measures, there was limited engagement with elected representatives and the community on regulatory obesity prevention. Our analysis suggests that this hurt the administration’s ability to successfully communicate the public health messages motivating these contentious proposals; contributing to unexpected opposition from food access and minority advocates, and fueling charges of executive overreach. Overall, NYC presents a case of expert-driven policy change, underpinned by evidence-based environmental approaches. The city’s experience demonstrates that there is scope to redefine municipal responsibilities for public health and that incremental change and contentious public discussion can impact social norms around nutrition.     

Viewpoint: Beyond carrots and sticks: Europeans support health nudges

All over the world, nations are using “health nudges” to promote healthier food choices and to reduce the health care costs of obesity and non-communicable diseases. In some circles, the relevant reforms are controversial. On the basis of nationally representative online surveys, we examine whether Europeans favour such nudges. The simplest answer is that majorities in six European nations (Denmark, France, Germany, Hungary, Italy, and the UK) do so. We find majority approval for a series of nudges, including educational messages in movie theaters, calorie and warning labels, store placement promoting healthier food, sweet-free supermarket cashiers and meat-free days in cafeterias. At the same time, we find somewhat lower approval rates in Hungary and Denmark. An implication for policymakers is that citizens are highly likely to support health nudges. An implication for further research is the importance of identifying the reasons for cross-national differences, where they exist.     

Rejoinder: nutrition planning is alive and well,thank you

This article is a rejoinder to an article by John Osgood Field which discussed the failure of multisectoral nutrition planning. The author argues that, although nutrition planners may have been overly optimistic in their hopes that political political systems could be made responsive to the problems, significant advances have been achieved. Many of the successes of nutrition planning and theimportance of multisectoral work are outlined. Malnutrition is a problem that escapes all the standard programs, and cannot be tackled through the health and agriculture sectors alone. There has been much critical thinking by many concerned people various countries. To suggest that nutrition planners moved blindly is to ignore much of the literature. A number of cautions--some of them very early--make it clear that practitioners were not oblivious to the bureaucratic constraints and political realities Professor Field now identifies. It would be cruelly wrong to suggest that no progress has been made. Nutrition planning may have borne fruit of a different sort than some of its early advocates envisioned, but there is no question that it bore fruit. The issue is whether nutrition planning has influenced the way people think about nutrition and the way they analyze problems. And about this there can be no doubt.     

Galvanizing political commitment in the UN Decade of Action for Nutrition: Assessing commitment in member-countries of the Scaling Up Nutrition (SUN) Movement

In pursuit of the global ambition of ending all forms of malnutrition, it is important to understand, measure and strengthen political commitment for nutrition. Building commitment involves advocating, establishing institutions, adopting policies, mobilizing resources and coordinating responses – within and outside of government, across sectors, from national to local levels – for as long as necessary to ensure results, sustained over time. As the Scaling Up Nutrition (SUN) Movement enters its tenth year of existence, this study asks if political commitment for nutrition is evident in the 60 SUN member countries and how this commitment translates into results.Guided by a theoretical framework, we use indicators from the SUN Movement's Monitoring, Evaluation, Accountability and Learning (MEAL) system to measure five forms of political commitment for nutrition - expressed, institutional, operational, embedded and system-wide - in countries stratified by income and duration of SUN membership. We further determine the association between assessed levels of commitment and progress towards achieving established global nutrition targets. In doing so, we identity important commitment gaps.Results show that countries that joined the SUN Movement early (2010–12) had higher expressed and institutional commitment scores compared with late joiners (2013–17), with no difference between low and middle-income countries. For operational commitment, early joiners had higher scores for the finance and legislation subcomponents but not for nutrition-specific intervention coverage. Low-income countries, however, had significantly lower scores for the nutrition-specific intervention coverage sub-component of operational commitment and lower embedded commitment scores compared with middle-income countries. A positive association was found between institutional and operational commitment, irrespective of country economic status. Early joiners in the SUN Movement were more likely to rank in the top half of SUN countries for all four forms of commitment. When divided into terciles based on their overall rank for system-wide political commitment, countries in the highest tercile were more likely to be making progress in the reduction of U5 child stunting.The results point to the importance of working to strengthen all forms of commitment, especially converting expressed and institutional commitments into operational commitment. While institutional commitment matters, it can be ‘tokenistic’ only if there is limited capacity to operationalise that commitment. Countries with system-wide political commitment appear to achieve better nutrition impact. It is difficult to determine whether early joiners were already more committed to nutrition and therefore more likely to join the SUN Movement or whether membership in the SUN Movement compelled such commitment. Most likely it is a combination of both, but it is hard to disentangle the direction of causality without measuring changes in commitments over time, and complementing this type of analysis with qualitative research on the perspectives of different stakeholders. Nonetheless, the ongoing measurement and reporting of political commitment can inform dialogue with country and global-level stakeholders on how to galvanize further commitment during the UN Decade of Action on Nutrition especially in view of the 2020 Nutrition for Growth (N4G) Summit in Tokyo, Japan.     

The soft underbelly of applied knowledge: Conceptual and operational problems in nutrition planning

Nutrition planning features a ‘rational choice’ bias that often characterises applied knowledge. John O. Field questions this bias by exploring the softer side of success in nutrition planning efforts. He contrasts the scope of nutrition planning as understood by the international community of experts and by administrators in low income countries. He examines the politics of planning and programme implementation. Consideration of nutrition planning in an ideological and historical perspective reveals both the ambivalence of nutrition planners as agents of change and the tenuous, untested nature of nutrition planning as an approach to ameliorating malnutrition.     

Human rights in nutrition and nutrition in human rights

Many countries around the world are involved in nutrition planning and nutrition program implementation. This concern and activity with regard to nutrition, however, has failed to give the issue proper and adequate consideration in development plans and programs of action. The author proposes a two-pronged approach to promote nutrition as a human right. One approach is to include nutrition as a human right in educational and training programs in nutrition. Another approach is to include nutrition as a human right in educational and training programs on human rights. These approaches are described using examples from experiences in the Philippines. Families, universities, and other training institutions have roles to play in making sure that individuals and groups receive the nutrition they need. It should be stressed that nutrition is both a right and an input for development.     

Integrating climate change,food prices and population health

The inter-related nature of food, health and climate change requires a better understanding of the linkages and a greater alignment of policy across these issues to be able to adequately meet the pressing social and health challenges arising from climate change. Food price is one way through which climate change may affect health. The aim of this study of the global and Australian food systems is to provide a whole-of-system analysis of food price vulnerabilities, highlighting the key pressure points across the food system through which climate change could potentially have the greatest impact on consumer food prices and the implications for population health. We outline areas where there are particular vulnerabilities for food systems and food prices arising from climate change, particularly global commodity prices; agricultural productivity; short term supply shocks; and less direct factors such as input costs and government policies. We use Australia as a high-income country case study to consider these issues in more detail. The complex and dynamic nature of pricing mechanisms makes it difficult to predict precisely how prices will be impacted. Should prices rise disproportionately among healthy foodstuffs compared to less healthy foods there may be adverse health outcomes if less expensive and less healthy foods are substituted. Higher prices will also have equity implications with lower socio-economic groups most impacted given these households currently spend proportionately more of their weekly income on food. The ultimate objective of this research is to identify the pathways through the food system via which climate change may affect food prices and ultimately population health, thereby providing evidence for food policy which takes into account environmental and health considerations.     

欧元区宏观经济需求管理政策评析———兼议宏观审慎政策的介入

为了预防欧债危机再次发酵,欧元区各国主要通过宽松的货币政策和紧缩的财政政策搭配来刺激经济以及改善财政状况。但从长期来看,宽松的货币政策使通货膨胀的风险一再加大,而紧缩的财政政策则让萎靡不振的欧元区经济雪上加霜．两者的叠加很可能导致欧元区在未来陷入滞胀。因此,要想从根本上摆脱危机,欧元区亟须对当前的宏观经济需求管理政策进行反思。另外,在货币和财政政策效果不佳的情况下引入宏观审慎监管政策．则能够在一定程度上弥补传统凯恩斯宏观经济需求管理的缺陷,使货币政策、财政政策和宏观审慎政策互为补充。     

Changing food patterns in West Africa: Implications for policy research

West African consumption of wheat and rice is growing rapidly despite technological barriers to production of these cereals in the region. Soaring imports are of particular concern in view of likely consumption trends. Maize imports are also growing rapidly, as is production in the more humid countries, to the detriment of sorghum. The latter is performing relatively better in the drier countries. Possible factors underlying consumption shifts are discussed, including price policies at variance with stated objectives. Possible policies to slow down these shifts are discussed, along with research requirements for effective diagnosis and implementation.     

Do agricultural outputs of partly autarkic peasants affect their health and nutrition? Evidence from Rwanda

In rural areas of less developed countries because of market imperfections, the health and nutritional status of peasants may directly depend on the production levels of specific agricultural goods rather than solely on income levels. This channel of health and nutrition determination has never been studied.     

Food and nutrition policy in Malta

Food and nutrition policy in Malta was officially endorsed by Government in the late 1980s. The urgency stemmed from the increasingly preoccupying health situation of the Maltese population characterized by the higher rates of cardiovascular diseases and neoplasms. Although a small island in the central Mediterranean, Malta does not have a diet that is characteristic of the rest of the Mediterranean region. The main aim of this paper is to outline the main characteristics of Maltese food consumption and the constraints encountered in the process of implementing the food and nutrition policy. The final section provides some recommendations that could also be considered in other Mediterranean countries that are in the process of designing or implementing similar policies. On the eve of the 21st century and in light of Malta's eventual accession in the European Union, several fundamental measures still need to be introduced and enforced, the most important being those concerning food safety and quality.