What we know about the actual implementation process of public physical activity policies: results from a scoping review

Upstream Determinants of Overweight and Obesity in Europe

PURPOSE OF REVIEW

To review the upstream determinants of overweight and obesity in Europe, including food and built environments, and political, commercial, and socioeconomic determinants.

RECENT FINDINGS

Overweight and obesity affect 60% of European adults, and one in three children, and are more common in individuals with low compared to high socioeconomic position (SEP). Individuals in low SEP groups are more exposed to unhealthy built and food environments, including higher exposure to unhealthy food marketing. Industries influencing the food system have much economic power, resulting in ignoring or silencing the role of ultra-processed foods and commercial practices in weight gain. Overall, effective policies to address overweight and obesity have been insufficiently implemented by governments. To accelerate implementation, strengthened political commitment is essential. Policies must also focus on the upstream, structural, and systemic drivers of overweight and obesity; be comprehensive; and target socioeconomic inequalities in diets and physical activity.

Good practice recommendations on implementation evaluation for policies targeting diet, physical activity, and sedentary behaviour

Health policies aim to achieve specific health goals through system-level changes, unlike common health interventions that focus on promoting specific health behaviors on individual level. However, reliable data on the feasibility and implementation of policy actions across Europe are lacking. Moreover, no practice-oriented guidance exists for policy makers and implementers on how to evaluate policy implementation.As part of the Policy Evaluation Network, we aimed to synthesise knowledge on how to evaluate the implementation of policies promoting healthy diets, physical activity, and reducing sedentary behaviours. The multidisciplinary working group comprised 16 researchers and conducted two scoping reviews, three systematic reviews, two meta-reviews, two qualitative case studies and one quantitative case study over three years. The target populations included the general population, those at risk for obesity, and school children. Based on these reviews and case studies, this article summarises and presents the findings and lessons learned regarding the implementation evaluation of policies in nine case reports.Drawing on these experiences, three critical requirements for policy implementation evaluation were set: 1) conduct a comprehensive policy implementation evaluation from a multi-level perspective, 2) use implementation frameworks to address processes, determinants, and outcomes, and 3) engage relevant stakeholders in policy implementation evaluation. Finally, the consensus process resulted in 10 steps for the implementation evaluation of policies to promote physical activity and a healthy diet and to reduce sedentary behaviours, which adhere to the requirements and resources of the targeted policy.The findings of an implementation evaluation can lead to a better understanding of why policies work or not and can serve as a basis for developing solutions. This practice-oriented guidance outlines factors that should be considered in policy implementation evaluation to address its complexity. In this way, involved researchers and practitioners are empowered to engage in the evaluation process to close the knowledge gap regarding policy implementation.

A critical analysis of walking policy in Ireland and its contribution to both national and international development goals

Introduction

Increasing population levels of walking holds benefits for public and planetary health. While individual level interventions to promote walking have been shown to be efficacious, upstream interventions such as policies harness the greatest potential for impact at the population level. However, little is known about the nature and presence of walking policy in Ireland and the extent to which it aligns to national and global goals. This paper aims to provide an overview of local and national walking policy in Ireland and to understand the potential of Irish walking policy to contribute to national and global targets.

Methods

This study used multiple methods to provide a critical overview of walking policy. Firstly, a six-phase process was employed to conduct a content analysis of local and national walking policy in Ireland. Secondly, conceptual linkage exercises were conducted to assess the contribution of walking, and national walking policy in Ireland, to Ireland's National Strategic Outcomes and the United Nations Sustainable Development Goals.

Results

Overall, half (n = 13) of the counties in the Republic of Ireland were found to have no local level walking policies. Results from the content analysis suggest that counties which had walking specific local level policies (n = 2) were outdated by almost two decades. Walking was identified to hold the potential to contribute to over half (n = 6) of Ireland's National Strategic Outcomes, and over half (n = 7) of the United Nations Sustainable Development Goals. Ireland's only national level walking specific policy, the Get Ireland Walking Strategy and Action Plan 2017-2020, was identified to potentially contribute to four of Ireland's National Strategic Outcomes and three United Nations Sustainable Development Goals.

Discussion

Multidisciplinary action is required to update walking-related policy with embedded evaluation and governance mechanisms in all local walking systems. Furthermore, given sufficient collaboration across sectors, walking policy in Ireland has the potential to contribute to a wider breadth of national and global targets beyond the health, sport, tourism, and transport sectors.