Public Health Nutrition Editorial Highlight ‘Assessing general public and policy influencer support for healthy public policies to promote healthy eating at the population level in two Canadian provinces’

Globally, identifying and implementing evidence-based interventions to promote healthy eating and reduce chronic disease should be a top priority for governments, health advocates, and citizens.

Research suggests that to meaningfully promote healthy eating, interventions must expand beyond individual-level approaches (e.g., nutrition knowledge) and target upstream factors including environment (i.e., the context for eating) and policy (i.e., that shape food environments) determinants.

For health advocates working to promote upstream policy approaches, it is crucial to understand levels of support among: (i) groups who influence policy through their work in government, large workplaces, school boards, and media settings; and (ii) the general public who hold their elected officials to account. Few studies have assessed the opinions of policy influencers specifically, and further, compared such levels of support with opinions expressed by the general public.

To address this gap, we administered the latest iteration of the Chronic Disease Prevention Survey in the Summer of 2016 to, in part, assess general public and policy influencer support for policies to promote healthy eating in Alberta and Québec, Canada.

In interpreting our findings, it was essential to remember that policy making is influenced by a variety of factors. In Canada, a liberal democratic state, policy makers are faced with balancing an emphasis on individual choice and autonomy with the need to support people with limited opportunity to choose (e.g., due to poverty). The Nuffield Council on Bioethics has developed the ‘intervention ladder’ framework to distinguish these ethical choices in public health versus medical interventions. We used the ‘intervention ladder’ framework to code each policy option, analyzing levels of support by their intrusiveness. Our codebook may be useful to others looking to systematically apply this lens.

Overall, we found that the general public and policy influencers were more supportive of healthy eating policies that were less intrusive on individual autonomy. For instance, both groups demonstrated the highest support for education-based policies that provided information. In contrast, both groups had the lowest support for policies that restricted choice, e.g., restricting/banning new drive-through facilities at fast food restaurants. We also found that policy influencers indicated significantly stronger support overall for healthy eating policy options than the public. Finally, policy influencers in Québec tended to show greater support for more restrictive policy options than their Alberta counterparts.

Our 2016 findings highlight three key takeaways for health advocates, policy influencers, and researchers working to promote healthy eating:
1. Additional knowledge brokering may be required to increase support for more intrusive yet impactful evidence-based healthy eating policy interventions;
2. Lower levels of support among the general public may impede policy influencers from taking action on policies to promote healthy eating; and
3. Regional differences may play a role in influencing support for upstream action to promote healthy eating. Advocacy efforts should be tailored in light of political history and current decision-making context.

Public health nutritionists can strategically address choice and autonomy in their research, policy, and practice work to galvanize support for upstream healthy eating interventions.

The full article ‘Assessing general public and policy influencer support for healthy public policies to promote healthy eating at the population level in two Canadian provinces’
Authors: Krystyna Kongats, Jennifer Ann McGetrick, Kim D Raine, Corinne Voyer and Candace IJ Nykiforuk is available to download for free for a limited time.

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