political issues and concerns affecting nutrition care

Influencing public nutrition for non-communicable disease prevention: from community intervention to national programme-experiences from Finland. Shrimpton R, Hughes R, Recine E, Mason JB, Sanders D, Marks GC, et al. From our review of the literature [7], we identify six major political economy themes (Fig. Puska P, Vartiainen E, Nissinen A, Laatikainen T, Jousilahti P. Background, principles, implementation, and general experiences of the North Karelia Project. They contribute to the economy, cultural diversity, and health of the nation. Glob Food Sec. These political economy challenges will need to be addressed in order to increase the political feasibility of efforts to translate momentum for nutrition into sustained results. Present Address: Nutrition Section, Programme Division, United Nations Childrens Fund, 3 UN Plaza, New York, NY, 10017, USA, Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, 02115, USA, You can also search for this author in 39. Washington, DC: International Food Policy Research Institute; 2011. Reducing childrens television viewing to prevent obesity: a randomized controlled trial. Jurisdiction and funding for different aspects of policies may be spread across government sectors and ministries, which may share unequally the costs and benefits. Large multinational companies frequently have a great influence because of their economic power, government lobbying, and communication and marketing resources. Washington, DC: World Bank; 2013. Hospitals should be incentivised by new quality measures and reimbursement guidelines to implement worksite wellness and engage in community public health.63 At the individual level, nutrition champions or policy advocates are critical to advocate for, and promote attention to, nutrition. Our purpose here is not to provide a detailed review of the literature on the political economy of food and nutrition security, which is provided elsewhere [7, 10], but rather to reflect on the key themes that emanate from this body of work. PDF The social and economic consequences of malnutrition - European Parliament Gillespie S, McLachlan M, Shrimpton R, eds. Employers, communities, schools, hospitals, and religious congregations should implement organisational strategies for healthier eating. 2000;94(02):25167. Balancing public health needs with commercial interests and managing conflicts of interest requires transparent systems and mechanisms. In: Mwatsama M, ed. Food Policy 1975;1(1):5361. National School Lunch Act. U.K. National Health Service. Secondary 2015-2020 Dietary Guidelines for Americans 2015. It is mostly preventable through public health and economic development. This can cause tension between different groupsfor example, champions of nutrition-specific interventions cite the high-quality evidence for efficacy, effectiveness, and cost-benefits to strengthen their arguments, and point to the limited evidence available for nutrition-sensitive interventions, such as agricultural interventions, on improving nutrition outcomesthus exacerbating existing conflicts and differences in opinions. This must include development of clear and transparent policies to identify and minimise conflicts of interest (see, Facilitate participation of other stakeholders in policy development, implementation, and evaluation, Incorporate nutrition and health in all of government, for example, city planning, economic development, agricultural and trade policies, and nutrition impact assessment, Link nutrition and food policies to economic and production indices such as the influence of diet related illness and health on production and the economy, Create a ministerial or cabinet leadership position with oversight and budgetary authority for cross agency food and nutrition policy, Support monitoring and evaluation of nutrition habits, food systems, and corresponding policies including for individuals, communities, and larger systems. Engagement with multiple actors is essential for the implementation of effective policies and programmes to tackle obesity and other chronic diseases. 20 Each of these individual determinants is shaped by, and in turn shapes, much broader drivers of food choice such as food industry formulations and globalisation, farming policy and production practices, national and international trade agreements, and ecosystem influences.21 Political economy analysis for nutrition policy. From these themes, we frame six political economy challenges facing the implementation of nutrition policy today. Cultural influencers (eg, celebrities, athletes, chefs) can help change social norms. Factors driving policy for some outcomes (e., employment, business profits) may differ from those for nutrition and health, How to align different government sectors with historically different priorities, stakeholders, and cultures. What drives political commitment for nutrition? A review and framework report | Jun 14, 2023 Based on advances in behavioural and policy science, we review strategies and approaches that governments can use to directly improve nutrition. UNICEF. Secondary Supplemental Nutrition Assistance Program Participation and Costs 2018. The Nutrisavings scoring system. 73 Further investigation including implementation and evaluation research is needed to allow the development of more concrete recommendations on how to improve the local food environment. Ethical issues for human nutrition in the context of global food Oxford: Mokoro Ltd; 2015. 69 Several countries currently implement different forms of marketing restrictions: for example, Chile has recently limited advertising and use of cartoon characters to market products to children that do not meet standards for added sugar, added saturated fats, and sodium.70. Some key findings can be highlighted. NHS hospital services - Hospital food standards. Levinson J. Searching for a home: the institutionalization issue in international nutrition. For instance, limitations or standards on trans fat and sodium have been implemented in many countries and similar standards being considered for free or added sugars.2 At the global level, accountability of non-state actors (such as private sector corporations, civil society organizations, private foundations) is limited as institutions and mechanisms for accountability are not well established [45]. Clear rules are needed to manage conflicts of interest. Acknowledge the importance of multilevel approaches, not magic bullets, in order to implement strategic, coordinated government action. Local and national governments have important roles in bringing healthier food and food security to their populations. Recognise that good nutrition is a priority for local, national, and global health, equity, and economic security. Industry self regulation is not sufficient to advance public health goals. How to overcome political challenges is uncertain, These should be implemented by governments. 5 PDF Political economy challenges in nutrition - Globalization and Health Fiscal incentives are effective and should be used by governments. Bernhardt AM, Wilking C, Adachi-Mejia AM, Bergamini E, Marijnissen J, Sargent JD. PubMed Central These successes provide a template for a healthier food system, that is: address the consumer, the product (agricultural commodities, foods, and beverages), the environment (retailers, cafeterias, and restaurants), and the culture (unhealthy eating, and marketing). (PDF) Political economy challenges in nutrition - ResearchGate Washington, DC: International Food Policy Research Institute; 2010. UK Health Forum. Global Nutrition Report 2014: Actions and Accountability to Accelerate the Worlds Progress on Nutrition. Fifth is the hierarchy challenge, stemming from the limited power and lower standing of nutritionists, especially compared to other health professionals, notably physicians, vying for the attention of policymakers. Long MW, Tobias DK, Cradock AL, Batchelder H, Gortmaker SL. Science and Politics of Nutrition: Role of government policy in Combined with the triple-A process, this provides a holistic response for addressing nutrition problems. 7 Even at the individual level, dietary habits are determined by personal preference and also age, gender, culture, education, income, health status, and nutritional and cooking knowledge and skills.8 Psychological influences include attitudes to food and health, incentives, motivation, and values.9 Food preferences may also be influenced by early life exposures, including the mothers diet during pregnancy, infant feeding practices, and foods consumed in early childhood.10 Historically, implementing nutrition policy has confronted persistent obstacles, with many of these obstacles arising from political economy sources. Can the introduction of a full-service supermarket in a food desert improve residents economic status and health? 87 Reproduced with permission from Ashfin et al 2 Beyond the Golden Era of public health: charting a path from sanitarianism to ecological public health, Adoption and design of emerging dietary policies to improve cardiometabolic health in the US. SCN Private Sector Engagement Policy Geneva: 2006 15643743 Contract No. How television fast food marketing aimed at children compares with adult advertisements. 2010. Direct F&V provision, farm to school programmes, and gardens are more costly, Long term effects and cost-benefits are assumed but not yet rigorously evaluated or established, Government should set strong nutrition standards for school, after school, and early child care meals and competitive foods. Global Issues: social, political and economic factors affecting The rise and fall of paradigms in world food and nutrition policy. Second, the nutrition system and nutrition community are fragmented, from global level to community level. A separate article in this series reviews the trends in nutrition science over this period,1 which have slowly shifted focus from undernutrition defined by calories and micronutrient deficiency to food based diet patterns and overall health effects of the food supply. Introduction. Reich MR, Balarajan Y. Article Effectiveness of point-of-purchase labeling on dietary behaviors and nutrient contents of foods: A systemic review and meta-analysis, Location, location, location: eye-tracking evidence that consumers preferentially view prominently positioned nutrition information. Third, the multiplicity of stakeholders involved in nutrition policy creates multiple narratives around nutrition approaches. Unclear or variably enforced government provisions on conflicts of interest can further increase industry influence. Governments should establish guidelines about participants in groups that are responsible for policy design. 100 There is ambiguity about what the priorities should be in the food and nutrition security space, and different policy communities and institutions conceptualize and interpret this space differently, as well as the relative importance of their role in this space. Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. 2015;145(4):66371. Economic factors play a crucial role and could affect personal nutrition status and health. Furthermore, without clear multisectoral planning it may be difficult to delineate the specific actions and results for which each stakeholder is accountable for. Consumption change in some foods may have unpredictable effects on overall dietary quality, depending on substitutes. Annu Rev Nutr. Given the remarkable health and economic burden of diet related illness and the need for multistakeholder solutions, a coordinated national food and nutrition policy strategy should be a priority for all governments. Washington, DC: World Bank; 2009. By their nature, public health concerns such as nutrition are multifactorial. Leroy JL, Menon P. From efficacy to public health impact: a call for research on program delivery and utilization in nutrition. 6 Wan L, Watson E. R. A. Terms and Conditions, US Department of Agriculture. Promising options include front-of-pack (eg, UK, New Zealand), warning labels (eg, Chile, New York Citys sodium menu label, Californias proposed warning label on sugar sweetened beverages). Smart food policies for obesity prevention. Conflicting goals and weakened actions: lessons learned from the political process of increasing sugar-sweetened beverage taxation in Chile. Basic science, medical, and applied (including policy) nutrition research. Designing a front-of-package labelling system to encourage healthier beverage choices in Guatemala. Few rigorous cost effectiveness analyses have been done, making it hard to promote the business case, Government guidelines or fiscal incentives are needed to promote the inclusion and evaluation of nutrition in private employer worksite wellness programmes and insurance plans, Integrated lifestyle interventions by multidisciplinary teams (eg, Diabetes Prevention Program, Consumers and policy makers continue to value and respect healthcare providers. Leveraging Agriculture for Improving Nutrition & Health, New Delhi. Pekka P, Pirjo P, Ulla U. Although dietary shifts can have rapid effects on health,90 CAS Challenges and opportunities for change in food marketing to children and youth: Workshop summary. Growing evidence makes clear that multiple, complex factors beyond personal decisions strongly influence dietary choices and patterns (fig 1).2 The funders had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. Two decades earlier, Pinstrup-Anderson recognized this fragmentation within the nutrition community, with multiple sub-groups competing to get their view of nutrition accepted by others [2]. Consumer attention and awareness may not translate to behaviour. This could be data pertaining to the nutrition situation to quantify the burden and convey the severity of the issue; or analysis of costs and benefits to present an investment case for nutrition. Action and advocacy by many stakeholders are needed to overcome these barriers. Informas. Changes in vegetable and fruit consumption and awareness among US adults: results of the 1991 and 1997 5 A Day for Better Health Program surveys. 5 Additional school based interventions should be implemented if fiscally feasible. For nutrition particularly, managing the different interests of public and private sectors in a transparent and constructive way remains elusive. Chacon V, Benson P, Barnoya J. June 17, 2015; 80 FR 34650. In the field of nutrition, political economy work has been slow to develop. Cambridge UK: Cambridge Publishers / Nuffield Council on Bioethics, 2007. Leading with Nutrition: Leveraging Federal Programs for Better Health. A rationale exists for developing the field of nutrition economics which . Recently, however, there have been several case studies conducted to address this knowledge gap, with findings and lessons learned from working multisectorally in nutrition [22, 42]. Potential legal and political feasibility challenges exist. These six political economy challenges are interrelated, with the relative importance of each one varying according to context. 7 In schools, after school, and early childcare programmes, government should promote nutrition standards for both onsite meals and competitive foods as low cost, sustainable interventionsexamples include standards in the US, Canada, Mexico, Europe, and New Zealand.49 Free or low price provision of fruits and vegetables, farm to school programmes, and school gardens are also promising strategies, although long term effects and cost-benefits are not yet rigorously evaluated. For most such actions, relative healthfulness of different foods must be appropriately classified, perhaps using systems that combine food category classifications with multilevel nutrient criteria. Standards for marketing to children across all formats should be considered and implemented because of the evidence for effects of marketing on food preferences and dietary intakes, as well as inability of young children to discriminate between marketing and regular programming. DiSantis KI, Collins BN, Fisher JO, Davey A. JAR reports personal fees from Tres Montes Lucchetti, not related to this work. From the perspective of human capital, theseinclude improved health, cognitive development, and workcapacity. They can introduce health inequities, and sustain or deepen existing ones. Conclusion: In one analysis, every $1 spent on worksite wellness programming was estimated to generate about $3.27 in lower medical costs and $2.73 in less absenteeism.55 However, relatively few long term worksite studies have evaluated the effects on diet, few rigorous cost effectiveness data are available, and increased employee turnover reduces the immediate incentives to businesses to invest in the health of their employees.3 Bull World Health Organ. 86 Strong government funding for basic nutrition and applied research and innovation is essential to continue to develop evidence based priorities for dietary policies. A programme of government funding and transparent public-private partnerships for nutrition research is also needed to help minimise conflicts of interest and perceived and real biases.86 Many international organisations and non-governmental organisations remain deeply sceptical of the private sector. Washington, DC: World Bank; 2012. 84 Actions should include developing and measuring adherence to nutrition policy standards; coordinating efforts of member country; assisting governments as needed with design, implementation, and evaluation of food policies; bringing stakeholders together including global agribusiness, restaurant chains, and food manufacturers; and providing a countervailing force to multi-national food industry lobbying. the contents by NLM or the National Institutes of Health. 2015;6(6):63947. Private Sector Engagement Toolkit. It relocates diet action within ecological public health, and reconnects with city planning. [17], 608). Foods, nutrients, and health: when will our policies catch up with nutrition science? Angell SY, Silver LD, Goldstein GP, et al. Globalization and Health Inclusion in an NLM database does not imply endorsement of, or agreement with, World Dev. Characterising availability and accessibility is complex, and often not simply related to geographical distance or density. Building awareness of the broader political and economic issues that shape nutrition actions and adopting a more systematic approach to political economy analysis may help to mitigate these challenges. Players in the nutrition field can have sharply different perspectives on what the problem is and what the solution is. Stables GJ, Subar AF, Patterson BH, et al. Applied political economy analysis for nutrition comprises a spectrum of approaches that can be used to inform decision-making and identify political strategies for reform [7, 10]. Glob Public Health. Guidelines must be consistent with other official messages about food and health. First, nutrition does not have a natural institutional home; it is often homeless in government [2, 11]. They use existing systems for improving nutrition, and align poverty reduction with health promotion and healthcare programmes, These often have limited guidelines or standards around diet quality and health. Governments should also promote the food industrys shift towards healthier foods, taking advantage of rapidly rising consumer demand. 7 This mindshift may help to improve the political feasibility of efforts to reform nutrition policy and implementationand ensure that historical legacies do not continue to shape the future. As the final paper of the 2008 Lancet Series on Maternal and Child Undernutrition bluntly stated in its key messages, The international nutrition systemmade up of international and donor organisations, academia, civil society, and the private sectoris fragmented and dysfunctional (Morris et al. To be successful, broad alliances are often required to maintain pressure, provide sound data, and bring about the desire for progress. Brighton: Institute of Development Studies; 2012. A more systematic approach to resolving the political economy challenges for nutrition will ensure that historical legacies do not continue to shape the future. One particularly strong disconnect exists between agriculture, nutrition, and health, with the three sectors often moving along parallel paths that rarely seem to meet despite efforts to bend these paths more toward one another. [18] It is becoming clearer that more gains can be achievedin both nutrition and in complementary sectorsif sector-specific work also aims to address the underlying determinants of nutrition [19]. Food Insecurity Nutrition Incentive (FINI) Grant Program. 1. The authors selected the literature for inclusion in this manuscript based on their own expertise and knowledge, discussions with colleagues, and editorial and reviewer comments. Moreover, the evidence to support these narratives varies in both level and quality [20, 25]. Government can consider these influences as potential targets, barriers, facilitators, and effect modifiers of food policies. More recently, there have been attempts to assess capacities and gaps in nutrition more systematically and to identify the skills required to respond to existing and emerging needs in nutrition [31, 32]. PubMedGoogle Scholar. Lessons from research, policy and practice. 1,000 Days. The .gov means its official. How important are additional indirect effects on substitutes and complements (other foods)? Insights are provided into these key issues that are expected to shape future legislative and regulatory action at the federal and state levels. Roberts MJ, Hsiao WC, Berman P, Reich MR. Getting health reform right: a guide to improving performance and equity. As a library, NLM provides access to scientific literature. Disparities might be exacerbated because of smaller effects on disadvantaged groups, These should be promoted because they are within the consumer market model. Tax incentives and other fiscal policies should promote research, development and marketing of healthier foods in the food industry, combined with (and potentially funded by) fiscal disincentives for marketing and promoting sugar sweetened beverages and junk foods. Political economy challenges in nutrition Improving nutrition will require managing the political economy challenges that persist in the nutrition field at global, national and subnational levels. Washington: Center for Global Development; 2009. 2016. 1946. Berg A. Public-private partnerships (eg, research and development incentives) to promote development and marketing of healthier products are needed. However, the subsequent rise of the Scaling Up Nutrition (SUN) movement and REACH (Renewed Efforts Against Child Hunger and undernutrition) initiative have sought to better align the work of these agencies in nutrition. Such a nutrition and health in all policies could greatly improve food systems and health, national productivity, equity, and health savings. 7, Multilayered influences beyond personal knowledge and preference alter food choices. 8600 Rockville Pike With increased turnover of the workforce, long term employment is becoming rare, reducing financial incentives for employers to improve long term health of their employees. Combating malnutrition: time to act. In: Mwatsama M, ed. 60 Final determination regarding partially hydrogenated oils. CAS The food industry promotion of developing their own internal standards, and staunch opposition to government standards (see, Optimal targets for certain categories of product (eg, to balance health versus functionality, safety, and industry cost) are not known. Industry opposition can be a major barrier, including political lobbying and marketing campaigns to fight policies they consider unfavourable.95 When policies are passed, lack of implementation because of limited resources, management, and accountability can greatly limit their effect,96 as in the case of school food standards in Mexico or quality standards to limit industrial trans fats in India. 20 Citations 15 Altmetric Metrics Abstract Background Historically, implementing nutrition policy has confronted persistent obstacles, with many of these obstacles arising from political economy sources. : OEV/2015/026. Policy interventions to promote healthy eating: a review of what works, what does not, and what is promising. Issues-and-concerns-Nutri-final.pptx - Social and Political The Intertwined Relationship Between Malnutrition and Poverty Approaches can be synchronised with new care delivery investments in social determinants of health and community infrastructure. Fat economics: Nutrition, health and economic policy. For instance, the food and beverage industry should not participate in decision making on the design, implementation, or evaluation of obesity prevention policies. 47 66, Standards for marketing, such as limiting advertising to children of foods and beverages that do not comply with basic nutrition, are recommended by the World Health Organization and Institute of Medicine.67 Areas for investigation in the next decade, for example, include basic molecular pathways; diet-microbiome-host interactions; individual fatty acids and their lipid derivatives; prebiotics, probiotics, and fermentation; phenols and other bioactive compounds; personalised nutrition; and nutrition data (big data).
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