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Pradyumna A, Mishra A, Utzinger J, Winkler MS. Health in Food Systems Policies in India: A Document Review. Int J Health Policy Manag 2022; 11:1158-1171. [PMID: 33904697 PMCID: PMC9808200 DOI: 10.34172/ijhpm.2021.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 02/23/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Food systems affect nutritional and other health outcomes. Recent literature from India has described policy aspects addressing nutritional implications of specific foods (eg, fruits, vegetables, and trans-fats), and identified opportunities to tackle the double burden of malnutrition. This paper attempts to deepen the understanding on how health concerns and the role of the health sector are addressed across food systems policies in India. METHODS This qualitative study used two approaches; namely (i) the framework method and (ii) manifest content analysis, to investigate national-level policy documents from relevant sectors (ie, food security, agriculture, biodiversity, food processing, trade, and waste management, besides health and nutrition). The documents were selected purposively. The textual data were coded and compared, from which themes were identified, described, and interpreted. Additionally, mentions of various health concerns and of the health ministry in the included documents were recorded and collated. RESULTS A total of 35 policy documents were included in the analysis. A variety of health concerns spanning nutritional, communicable and non-communicable diseases (NCDs) were mentioned. Undernutrition received specific attention even beyond nutrition policies. Only few policies mentioned NCDs, infectious diseases, and injuries. Governing and advisory bodies were instituted by 17 of the analysed policies (eg, food safety, agriculture, and food processing), and often included representation from the health ministry (9 of the 17 identified inter-ministerial bodies). CONCLUSION We found some evidence of concern for health, and inclusion of health ministry in food policy documents in India. The ongoing and planned intersectoral coordination to tackle undernutrition could inform actions to address other relevant but currently underappreciated concerns such as NCDs. Our study demonstrated a method for analysis of health consideration and intersectoral coordination in food policy documents, which could be applied to studies in other settings and policy domains.
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Affiliation(s)
- Adithya Pradyumna
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Azim Premji University, Bengaluru, India
| | | | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Mirko S. Winkler
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Ma Y, McRae C, Wu YH, Dubé L. Exploring Pathways of Socioeconomic Inequity in Vegetable Expenditure Among Consumers Participating in a Grocery Loyalty Program in Quebec, Canada, 2015-2017. Front Public Health 2021; 9:634372. [PMID: 34409001 PMCID: PMC8365471 DOI: 10.3389/fpubh.2021.634372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 07/08/2021] [Indexed: 01/04/2023] Open
Abstract
Vegetable consumption remains consistently low despite supportive policy and investments across the world. Vegetables are available in great variety, ranging in their processing level, availability, cost, and arguably, nutritional value. A retrospective longitudinal study was conducted in Quebec, Canada to explore pathways of socioeconomic inequity in vegetable expenditure. Data was obtained for consumers who participated in a grocery loyalty program from 2015 to 2017 and linked to the 2016 Canadian census. Vegetable expenditure share (%) was examined as a fraction of the overall food basket and segmented by processing level. Panel random effects and tobit models were used overall and to estimate the stratified analysis by median income split. Consumers allocated 8.35% of their total food expenditure to vegetables, which was mostly allocated to non-processed fresh (6.88%). Vegetable expenditure share was the highest in early winter and lowest in late summer. In the stratified analysis, the low-income group exhibited less seasonal variation, allocated less to fresh vegetables, and spent more on canned and frozen compared to the high-income group. Measures of socioeconomic status were all significant drivers of overall vegetable consumption. Consumers with high post-secondary education in the low-income group spent 2% more on vegetables than those with low education. The complexity of observed expenditure patterns points to a need for more specific vegetable consumption guidelines that include provisions by processing level. Implications for education, marketing, intersectional policies, and the role of government are discussed. Governments can scale present efforts and catalyze health-promoting investments across local, state, national, and global food systems.
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Affiliation(s)
- Yu Ma
- Desautels Faculty of Management, McGill University, Montreal, QC, Canada.,McGill Centre for the Convergence of Health and Economics, McGill University, Montreal, QC, Canada
| | - Cameron McRae
- Desautels Faculty of Management, McGill University, Montreal, QC, Canada.,McGill Centre for the Convergence of Health and Economics, McGill University, Montreal, QC, Canada
| | - Yun-Hsuan Wu
- McGill Centre for the Convergence of Health and Economics, McGill University, Montreal, QC, Canada.,Department of Public Health, China Medical University, Taichung, Taiwan
| | - Laurette Dubé
- Desautels Faculty of Management, McGill University, Montreal, QC, Canada.,McGill Centre for the Convergence of Health and Economics, McGill University, Montreal, QC, Canada
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Chavez‐Ugalde Y, Jago R, Toumpakari Z, Egan M, Cummins S, White M, Hulls P, De Vocht F. Conceptualizing the commercial determinants of dietary behaviors associated with obesity: A systematic review using principles from critical interpretative synthesis. Obes Sci Pract 2021; 7:473-486. [PMID: 34401205 PMCID: PMC8346378 DOI: 10.1002/osp4.507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/04/2021] [Accepted: 03/12/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Unhealthy diet is an important preventable risk factor for overweight and obesity. Identifying the key drivers of an unhealthy diet is an important public health aim. "Big Food" has been identified as an influential factor shaping dietary behavior and obesity, and their practices have broadly been labeled as the "commercial determinants of obesity," but there is a lack of definitions and conceptualizations for these terms. This review aimed to synthesize literature on the commercial determinants of dietary behavior associated with obesity. It presents the development of an integrative definition and a conceptual framework involving potential influences on dietary behavior, and it examines the prevalence of certain narratives within papers that focus on children and adolescents. METHODS Four electronic databases (Ovid MEDLINE, PubMed, Web of Science, and Scopus) were searched up to December 2020. Eighty-one articles met the inclusion criteria: they were published in a peer-reviewed academic journal, described a practice from the food/beverage industry in relation to dietary behavior or obesity. Data were integrated using critical interpretative synthesis. RESULTS The commercial determinants of dietary behavior are conceptualized in terms of three corporate spheres of action-political and legal; production, processing and design; and marketing and preference shaping-which enable powerful food industry to successfully pursue their business, market, and political objectives. The most frequently reported sphere of action targeting children and adolescents was marketing and preference shaping. CONCLUSIONS In the included literature, the commercial determinants of dietary behavior associated with obesity have been conceptualized as being part of a complex system where corporate practices are enabled by power structures. The proposed framework can facilitate a structured identification and systematic study of the impact of specific aspects of food industry's strategies and increase opportunities for primary prevention by anticipating industry responses and by discouraging corporate practices that harm health.
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Affiliation(s)
- Yanaina Chavez‐Ugalde
- National Institute for Health ResearchSchool for Public Health ResearchNewcastle upon TyneUK
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Russell Jago
- National Institute for Health ResearchSchool for Public Health ResearchNewcastle upon TyneUK
- Centre for Exercise, Nutrition & Health Sciences, School for Policy StudiesUniversity of BristolBristolUK
- National Institute for Health Research Collaboration for Leadership, Applied Health Research and Care West (NIHR CLAHRC West)BristolUK
| | - Zoi Toumpakari
- Centre for Exercise, Nutrition & Health Sciences, School for Policy StudiesUniversity of BristolBristolUK
| | - Matt Egan
- National Institute for Health ResearchSchool for Public Health ResearchNewcastle upon TyneUK
- Department of Public Health, Environments and SocietyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Steven Cummins
- National Institute for Health ResearchSchool for Public Health ResearchNewcastle upon TyneUK
- Department of Public Health, Environments and SocietyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Martin White
- National Institute for Health ResearchSchool for Public Health ResearchNewcastle upon TyneUK
- Centre for Diet and Activity Research (CEDAR) MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - Paige Hulls
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Frank De Vocht
- National Institute for Health ResearchSchool for Public Health ResearchNewcastle upon TyneUK
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- National Institute for Health Research Collaboration for Leadership, Applied Health Research and Care West (NIHR CLAHRC West)BristolUK
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Lencucha R, Thow AM. Intersectoral policy on industries that produce unhealthy commodities: governing in a new era of the global economy? BMJ Glob Health 2021; 5:bmjgh-2019-002246. [PMID: 32816826 PMCID: PMC7430321 DOI: 10.1136/bmjgh-2019-002246] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/04/2020] [Accepted: 05/28/2020] [Indexed: 12/21/2022] Open
Abstract
Tobacco, alcohol and unhealthy foods are key contributors to non-communicable diseases globally. Public health advocates have been proactive in recent years, developing systems to monitor and mitigate both health harms and influence by these industries. However, establishing and implementating strong government regulation of these unhealthy product-producing industries remains challenging. The relevant regulatory instruments lie not only with ministries of health but with agriculture, finance, industry and trade, largely driven by economic concerns. These policy sectors are often unreceptive to public health imperatives for restrictions on industry, including policies regarding labelling, marketing and excise taxes. Heavily influenced by traditional economic paradigms, they have been more receptive to industry calls for (unfettered) market competition, the rights of consumers to choose and the need for government to allow industry free rein; at most to establish voluntary standards of consumer protection, and certainly not to directly regulate industry products and practices. In recent years, the status quo of a narrow economic rationality that places economic growth above health, environment or other social goals is being re-evaluated by some governments and key international economic agencies, leading to windows of opportunity with the potential to transform how governments approach food, tobacco and alcohol as major, industry-driven risk factors. To take advantage of this window of opportunity, the public health community must work with different sectors of government to(1) reimagine policy mandates, drawing on whole-of-government imperatives for sustainable development, and (2) closely examine the institutional structures and governance processes, in order to create points of leverage for economic policies that also support improved health outcomes.
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Affiliation(s)
- Raphael Lencucha
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Anne Marie Thow
- School of Public Health, Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia
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Ngqangashe Y, Goldman S, Schram A, Friel S. A narrative review of regulatory governance factors that shape food and nutrition policies. Nutr Rev 2021; 80:200-214. [PMID: 34015107 DOI: 10.1093/nutrit/nuab023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/14/2021] [Accepted: 03/03/2021] [Indexed: 01/23/2023] Open
Abstract
Food composition, marketing restrictions, nutrition labeling, and taxation policies are recommended for preventing diet-related noncommunicable diseases. In view of the increasing but variable adoption of food policies globally, this narrative review examines the actors, regulatory frameworks, and institutional contexts that shape the development, design, and implementation of these policies. We found a diverse range of actors using various strategies, including advocacy, framing, and evidence generation to influence policy agendas. We identified diverse regulatory designs used in the formulation and implementation of the policies: command and control state regulation for taxes and menu labels, quasi-regulation for sodium reformulation, and co-regulation and industry self-regulation for food marketing policies. Quasi-regulation and industry self-regulation are critiqued for their voluntary nature, lack of independence from the industry, and absence of (or poor) monitoring and enforcement systems. The policy instrument design and implementation best practices highlighted in this review include clear policy goals and rigorous standards that are adequately monitored and enforced. Future research should examine how these combinations of regulatory governance factors influence policy outcomes.
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Affiliation(s)
- Yandisa Ngqangashe
- Y. Ngqangashe, S. Goldman, A. Schram, and S. Friel are with the Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sharni Goldman
- Y. Ngqangashe, S. Goldman, A. Schram, and S. Friel are with the Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Ashley Schram
- Y. Ngqangashe, S. Goldman, A. Schram, and S. Friel are with the Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sharon Friel
- Y. Ngqangashe, S. Goldman, A. Schram, and S. Friel are with the Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
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White M, Aguirre E, Finegood DT, Holmes C, Sacks G, Smith R. What role should the commercial food system play in promoting health through better diet? BMJ 2020; 368:m545. [PMID: 32184211 PMCID: PMC7190369 DOI: 10.1136/bmj.m545] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Martin White and coauthors consider that the commercial food system has the potential to show leadership and support for dietary public health, but systemic change is needed first and this is likely to require governmental action
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Affiliation(s)
- Martin White
- Centre for Diet and Activity Research, MRC Epidemiology Unit, Institute of Metabolic Sciences, University of Cambridge, UK
| | - Emilie Aguirre
- University of Chicago Law School, Chicago, IL, USA
- Harvard Business School, Boston, MA, USA
| | - Diane T Finegood
- Morris J Wosk Centre for Dialogue, Simon Fraser University, Vancouver, BC, Canada
| | | | - Gary Sacks
- Global Obesity Centre, Deakin University, Burwood, VIC 3125, Australia
| | - Richard Smith
- College of Medicine and Health, University of Exeter, Exeter, UK
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Lencucha R, Pal NE, Appau A, Thow AM, Drope J. Government policy and agricultural production: a scoping review to inform research and policy on healthy agricultural commodities. Global Health 2020; 16:11. [PMID: 31959213 PMCID: PMC6971899 DOI: 10.1186/s12992-020-0542-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/13/2020] [Indexed: 12/20/2022] Open
Abstract
Unhealthy foods and tobacco remain the leading causes of non-communicable disease (NCDs). These are key agricultural commodities for many countries, and NCD prevention policy needs to consider how to influence production towards healthier options. There has been little scholarship to bridge the agriculture with the public health literature that seeks to address the supply of healthy commodities. This scoping review synthesizes the literature on government agricultural policy and production in order to 1) present a typology of policies used to influence agricultural production, 2) to provide a preliminary overview of the ways that impact is assessed in this literature, and 3) to bring this literature into conversation with the literature on food and tobacco supply.This review analyzes the literature on government agricultural policy and production. Articles written in English and published between January 1997 and April 2018 (20-year range) were included. Only quantitative evaluations were included. Studies that collected qualitative data to supplement the quantitative analysis were also included. One hundred and three articles were included for data extraction. The following information was extracted: article details (e.g., author, title, journal), policy details (e.g., policy tools, goals, context), methods used to evaluate the policy (e.g., outcomes evaluated, sample size, limitations), and study findings. Fifty four studies examined the impact of policy on agricultural production. The remaining articles assessed land allocation (n = 25) (e.g., crop diversification, acreage expansion), efficiency (n = 23), rates of employment including on- and off-farm employment (n = 18), and farm income (n = 17) among others. Input supports, output supports and technical support had an impact on production, income and other outcomes. Although there were important exceptions, largely attributed to farm level allocation of labour or resources. Financial supports were most commonly evaluated including cash subsidies, credit, and tax benefits. This type of support resulted in an equal number of studies reporting increased production as those with no effects.This review provides initial extrapolative insights from the general literature on the impact of government policies on agricultural production. This review can inform dialogue between the health and agricultural sector and evaluative research on policy for alternatives to tobacco production and unhealthy food supply.
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Affiliation(s)
- Raphael Lencucha
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada.
| | - Nicole E Pal
- Faculty of Sciences, Vrije Universiteit, Amsterdam, Netherlands
| | - Adriana Appau
- Research and Evaluation, PolicyWise for Children and Families, Edmonton, Alberta, Canada
| | - Anne-Marie Thow
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, Australia
| | - Jeffrey Drope
- Economic and Health Policy Research, American Cancer Society, Atlanta, USA
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Lencucha R, Thow AM. How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention. Int J Health Policy Manag 2019; 8:514-520. [PMID: 31657174 PMCID: PMC6815986 DOI: 10.15171/ijhpm.2019.56] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/25/2019] [Indexed: 01/26/2023] Open
Abstract
Alcohol, tobacco, and unhealthy foods contribute greatly to the global burden of non-communicable disease (NCD). Member states of the World Health Organization (WHO) have recognized the critical need to address these three key risk factors through global action plans and policy recommendations. The 2013-2020 WHO action plan identifies the need to engage economic, agricultural and other relevant sectors to establish comprehensive and coherent policy. To date one of the biggest barriers to action is not so much identifying affective policies, but rather how a comprehensive policy approach to NCD prevention can be established across sectors. Much of the research on policy incoherence across sectors has focused on exposing the strategies used by commercial interests to shape public policy in their favor. Although the influence of commercial interests on government decisions remains an important issue for policy coherence, we argue, that the dominant neoliberal policy paradigm continues to enable the ability of these interests to influence public policy. In this paper, we examine how this dominant paradigm and the way it has been enshrined in institutional mechanisms has given rise to existing systems of governance of product environments, and how these systems create structural barriers to the introduction of meaningful policy action to prevent NCDs by fostering healthy product environments. Work to establish policy coherence across sectors, particularly to ensure a healthy product environment, will require systematic engagement with the assumptions that continue to structure institutions that perpetuate unhealthy product environments.
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Affiliation(s)
- Raphael Lencucha
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Anne Marie Thow
- Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
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Samuels TA, Murphy MM, Unwin N. Validating the self-reported annual monitoring grid for the 2007 Caribbean Community Declaration of Port-of-Spain on noncommunicable diseases. Rev Panam Salud Publica 2019; 42:e189. [PMID: 31093216 PMCID: PMC6386129 DOI: 10.26633/rpsp.2018.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/30/2018] [Indexed: 11/27/2022] Open
Abstract
Objectives In 2007, the Caribbean Community (CARICOM) convened the world's first-ever heads of government summit on noncommunicable diseases (NCDs) and issued the landmark Declaration of Port-of-Spain: Uniting to Stop the Epidemic of Chronic NCDs. Since then, ministry of health (MoH) focal points in each country have self-reported annually on their NCD efforts, using a 26-indicator grid created to assess implementation of the Declaration. Our objective was to assess the validity of those grid responses, as compared to information from in-depth interviews and document reviews. Methods Seven national case studies on policy responses to the Declaration were undertaken in 2015. In-depth, semistructured interviews were conducted with stakeholders from multiple sectors, including the MoH. Policy documents were also identified and reviewed. The results from the 2015 case studies were compared to the 2014 MoH focal point grid responses. Kappa statistics evaluated chance agreement. Results The information from the grid and from the case studies agreed closely. Out of a total of 182 indicators (26 each for seven countries), there was a lack of agreement on just 9 (4.9%). All the differences were between policy statements and implementation. Except for physical activity, kappa statistics indicated that agreement was good to excellent for all the clusters of the grid and for the grid as a whole, but with wide confidence intervals. Conclusions In general, the monitoring grid accurately assessed the national situation, but with a possible tendency to overstate performance in some areas. These findings contributed to the design of a new, 50-indicator monitoring grid in 2016. Alongside these improvements, CARICOM countries face a substantial burden from having to complete many other required NCD reports, mainly for the Pan American Health Organization and the World Health Organization.
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Affiliation(s)
- T Alafia Samuels
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, University of the West Indies, Bridgetown, Barbados
| | - Madhuvanti M Murphy
- Faculty of Medical Sciences, Cave Hill campus, University of the West Indies, Bridgetown, Barbados
| | - Nigel Unwin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
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