This study examines public support – and its drivers – for comprehensive policy packages (i.e. bundles of coherent policy measures introduced together) aimed at improving food environments.

Participants completed an online survey with a choice-based conjoint experiment, where they evaluated pairs of policy packages comprising up to seven distinct food environment measures. After choosing a preferred package or opting for a single policy, participants designed their ideal policy package. Based on their choices, respondents were categorised as resistant, inclined or supportive towards policy packaging according to their frequency of opting out for single measures and the number of policies they included in their ideal package.

The study was conducted in Germany via an online survey.

The sample included 1200 eligible German voters, recruited based on age, gender and income quotas.

Based on both opt-out frequency (44·7 %) and ideal policy packaging (72·8 %) outcomes, most respondents were inclined towards policy packages. The inclusion of fiscal incentives and school-based measures in packages enhanced support, while fiscal disincentives reduced it. Key drivers of support included beliefs about the importance of diet-related issues and the role of government in regulation, while socio-demographic factors, political leaning and personal experience with diet-related disease had minimal impact.

The results reveal public appetite for policy packages to address unhealthy food environments, contingent on package design and beliefs about the issue’s severity and legitimacy of intervention. Public health advocates should design and promote policy packages aligned with public preferences, especially given anticipated opposition from commercial interests.

To explore the perspectives, barriers and enablers on salt reduction in out-of-home sectors in Malaysia among street food vendors, caterers and consumers.

A qualitative study involving twenty-two focus group discussions and six in-depth interviews was conducted, recorded and transcribed verbatim. An inductive thematic analysis approach was employed to analyse the data.

Two in-depth interviews and twenty-two focus group discussions were conducted face-to-face. Four in-depth interviews were conducted online.

Focus group discussions were conducted among twenty-three street food vendors, twenty-one caterers and seventy-six consumers of various eateries. In-depth interviews were conducted among two street food vendors and four caterers, individually.

Consumers and food operators perceived a high-salt intake within Malaysia’s out-of-home food sectors. Food operators emphasised the necessity for a comprehensive salt reduction policy in the out-of-home sector involving all stakeholders. Consumers faced limited awareness and knowledge, counterproductive practices among food operators and challenges in accessing affordable low-Na food products, whereas food operators faced the lack of standardised guidelines and effective enforcement mechanisms and uncooperative consumer practices. Both groups expressed that food quality and price of salt were also the barriers, and they advocated for awareness promotion, enhanced regulation of manufactured food products and stricter enforcement targeting vendors. Consumers also suggested promoting and recognising health-conscious food premises, whereas food operators suggested on knowledge enhancement tailored to them, strategies for gaining consumers acceptance and maintaining food quality.

These findings provide valuable insights that serve as foundational evidence for developing and implementing salt reduction policies within Malaysia’s out-of-home sectors.

Governments are seeking to regulate food environments to promote health by restricting sales and marketing of processed foods high in fat, sugar and sodium. We aimed to evaluate whether the legal instruments in member states of the Western Pacific Region (WPR) mandate the declaration of nutrient composition for nutrients of concern in relation to Codex Alimentarius and non-communicable disease (NCD) prevention.

We undertook content analysis of legal instruments governing food quality and safety, documenting mandates for nutrient declarations in the WPR. Legal instruments were purposefully sourced through a systematic search of regional legal databases and Google. We performed qualitative and quantitative analysis, using an adapted version of Reeve and Magnusson’s Framework for Analysing and Improving the Performance of Regulatory Instruments.

Legal instruments governing food quality and safety in twenty-eight member states of the WPR.

There was substantial variation in the nutrient declaration mandates within legal instruments, with only three out of twenty-eight countries mandating nutrient declarations in full alignment with Codex recommendations (energy, protein, available carbohydrate, fat, saturated fat, sodium and total sugars). Just four countries mandated the display of sodium, sugar, saturated fat and trans-fats, in line with NCD prevention recommendations. Sodium labelling was mandated in ten countries, sugar in seven and saturated fat in six.

There is scope for countries to strengthen legal instruments for nutrient declarations to better support diet-related NCD prevention efforts. Regional support agencies can play a key role in promoting greater policy coherence and alignment with international best practice.

To systematically identify and review food taxation policy changes in Pacific Island Countries and Territories (PICTs).

Food taxation polices, regarding excise taxes and tariffs applied from 2000 to 2020 in twenty-two PICTs, and their key characteristics were reviewed. The search was conducted using databases, government legal repositories and broad-based search engines. Identified documents for screening included legislation, reports, academic literature, news articles and grey literature. Key informants were contacted from each PICT to retrieve further data and confirm results. Results were analysed by narrative synthesis.

Noncommunicable diseases (NCD) are the leading cause of premature death in PICTs and in many jurisdictions globally. An NCD crisis has been declared in the Pacific, and food taxation policy has been recommended to address the dietary risk factors associated with. Progress is unclear.

Of the twenty-two PICTs included in the study, fourteen had food taxation policies and five introduced excise taxes. Processed foods, sugar and salt were the main target of excise taxes. A total of eighty-four food taxation policy changes were identified across all food groups. There was a total of 279 taxes identified by food group, of which 85 % were tariffs and 15 % were excise taxes. Individual tax rates varied substantially. The predominant tax design was ad valorem, and this was followed by volumetric.

A quarter of PICTs have introduced food excise taxes from 2000 to 2020. Further excise taxes, specifically tiered or nutrient-specific designs, could be introduced and more systematically applied to a broader range of unhealthy foods.

The creation of a healthy food environment is highly dependent on the policies that governments choose to implement. The objective of this study is to compare the level of implementation of current public policies aimed at creating healthy food environments in Burkina Faso with international good practice indicators.

This evaluation was carried out using the Food-EPI tool. The tool has two components (policy and infrastructure support), thirteen domains and fifty-six good practice indicators adapted to the Burkina Faso context.

Burkina Faso.

Expert evaluators divided into two groups: the group of independent experts from universities, NGO and civil society and the group of experts from various government sectors.

Among the fifty-six indicators, it was assessed the level of implementation as ‘high’ for six indicators, ‘medium’ for twenty-four indicators, ‘low’ for twenty-two indicators and ‘very low’ for four indicators. High implementation level indicators include strong and visible political support, targets on exclusive breastfeeding and complementary feeding, strong and visible political support for actions to combat all forms of malnutrition, monitoring of exclusive breastfeeding and complementary feeding indicators, monitoring of promotion and growth surveillance programmes and coordination mechanism (national, state and local government). The indicators on menu labelling, reducing taxes on healthy foods, increasing taxes on unhealthy foods and dietary guidelines are the indicators with a ‘very low’ level of implementation in Burkina Faso.

The general results showed that there is a clear need for further improvements in policy and infrastructure support to promote healthy food environments.

Despite commitment by many countries to promote food system transformation, Australia has yet to adopt a national food policy. This study aimed to evaluate Australian Federal Government’s (AFG) food policies and policy actions potential to promote healthy and sustainable food systems.

This study is a desk-based policy mapping followed by a theoretically guided evaluation of policy actions. This involved three steps: (1) identification of government departments and agencies that could influence Australia’s food system; (2) identification of food policies and policy actions within these departments and (3) use of a conceptual framework to evaluate policy actions’ potential of changing the food system as adjust (first-order change), reform (second-order change) or transform (third-order change).

Australia.

None.

Twenty-four food policies and sixty-two policy actions were identified across eight AFG departments and the Food Regulation System and evaluated based on the order of change they represented. Most policies were led by individual departments, reflecting the absence of a joined-up approach to food policy in Australia. Most policy actions (n 25/ 56·5 %) were evaluated as having adjust potential, whereas no transformative policy action was identified.

These findings suggest that Australia is likely to proceed incrementally towards achieving food system change through adjustments and reforms but lacking transformative impact. To promote transformative change, all three orders of change must be strategically implemented in a coherent and coordinated matter. A comprehensive national food policy and a national coordinating body are needed to ensure a cohesive approach to policy.

The objective of this systematic review is to synthesise the evidence on public policy interventions and their ability to reduce household food insecurity (HFI) in Canada.

Four databases were searched up to October 2023. Only studies that reported on public policy interventions that might reduce HFI were included, regardless of whether that was the primary purpose of the study. Title and abstract screening, full-text screening, data extraction, risk of bias and certainty of the evidence assessments were conducted by two reviewers.

Seventeen relevant studies covering three intervention categories were included: income supplementation, housing assistance programmes and food retailer subsidies. Income supplementation had a positive effect on reducing HFI with a moderate to high level of certainty. Housing assistance programmes and food retailer studies may have little to no effect on HFI; however, there is low certainty in the evidence that could change as evidence emerges.

The evidence suggests that income supplementation likely reduces HFI for low-income Canadians. Many questions remain in terms of how to optimise this intervention and additional high-quality studies are still needed.

To examine the extent and nature of food and non-alcoholic drink advertising displayed on public transport and infrastructure on school routes.

Audit of outdoor advertisements on government-controlled public transport and associated infrastructure (e.g. tram shelters, bus stops) on busy school routes in Victoria, Australia. Using a strict protocol, trained field workers collected data on the type and content of outdoor advertising during February 2023 (start of school year). Food/drink advertising was classified (unhealthy or healthy) according to the Council of Australian Governments Health Council National interim guide to reduce children’s exposure to unhealthy food and drink promotion (2018).

Government-controlled buses, trams and public transport infrastructure on routes from eleven of the busiest train stations in metropolitan Melbourne and regional Victoria, Australia to fifty public primary and secondary schools. Stations were chosen based on annual patronage, area-based socio-economic area (SEA) and regionality).

156 out of 888 advertisements were for food and non-alcoholic drinks. Of these, almost six in ten (58 %) were deemed unhealthy irrespective of SEA or regionality. Marketing appeals most featured were taste (31 %), convenience (28 %) and emotion (9 %). A significantly higher proportion of unhealthy advertisements were displayed within 500 m of schools v. outside this radius (91 % v. 57 %, P < 0·01).

Given the detrimental impacts of exposure to unhealthy food/drink advertising on children’s diets, the pervasive, powerful presence of such advertising across government public transport assets, particularly around schools, contradicts public health recommendations to protect children from exposure to and influence by this harmful marketing and warrants government action.

This study investigated how the belief systems and interests of policy actors shaped their framing of the causes and solutions to obesity and how this influenced policy recommendations.

Submissions to the Select Committee on Obesity Epidemic in Australia (SCOEA) were collected, and actors were classified according to their interests in commercial and non-commercial groups. A framework grounded in social constructionism was used to code frames and underlying belief systems. The SCOEA report was analysed to identify the representative distribution of belief systems in recommendations.

Australia.

None.

150 submissions were collected and analysed. 120 submitters were actors with non-commercial interests, including governments (n 13), non-government organisations (n 49), civil society groups and citizens (n 24) and academia (n 34). Thirty submitters were actors with commercial interests including food industry representatives (n 23) and health enterprises (n 7). Conflicting belief systems in the framing of obesity were identified among policy actors, particularly between commercial and non-commercial groups. Non-commercial actors framed obesity in biomedical, lifestyle and socio-ecological terms, whereas commercial actors exclusively framed obesity as an issue of individual choices and proposed behavioural change interventions. A broad range of belief systems expressed by the submitters was represented in the SCOEA final report.

These findings illustrate how policy actors’ beliefs and interests shaped their frames and influenced the development of a key policy report. Policymakers seeking to advance obesity prevention policy must critically evaluate strategic framing by various actors and ensure that policy decisions are evidence-based and aligned with health, equity and ecological perspectives.

To identify politico-economic factors relating to policy surrounding the production, processing and trade of sugar in Indonesia and identify strategies to support improved integration of national nutrition and food security priorities with respect to sugar.

This study was a qualitative policy analysis, informed by political economy and power analysis approaches and drawing on both documentary policy data and interviews.

Indonesia.

Interviewees from various national and sub-national government and non-government sectors, with expertise in health and food safety (n 7), finance and economics (n 2), trade and industry (n 3) and others (n 4).

Sugar was articulated as a policy priority in three distinct ways: (1) sugar as an economic good; (2) sugar in relation to health and (3) sugar as a commodity for food security. High political priority was given to national economic development, as well as concerns relating to farmer rights and welfare. Nutrition priorities and objectives to reduce sugar consumption were addressed in health policies; however, they were not reflected in production and economic policies promoting sugar.

Creating opportunities to diversify agricultural production and ensuring a just transition to protect the livelihoods of sugar farmers in Indonesia will be crucial in enabling the achievement of nutrition priorities to reduce sugar consumption.

To examine power and governance arrangements in food and nutrition policy formulation and agenda setting in South Africa.

Analysis of the policy implementation environment and in-depth interviews were conducted focusing on: existing policy content and priorities across food system sectors; institutional structures for cross-sectoral and external stakeholder engagement; exercise of power in relation to food system policies and opportunities to strengthen action on nutrition.

South Africa.

Interviews were conducted with forty-eight key stakeholders involved in the food and nutrition policy sphere: government sectors relevant to food systems (n 21), the private sector (n 4), academia (n 10), non-government organisations (n 11) and farmers (n 2).

This study found that there are power dynamics involved in shaping the planning agenda that is inadvertently generating a food system that undermines the right to food. The concept of nutrition governance remains poorly defined and applied in different ways and usually based on a relatively narrow interpretation – therefore limiting policy coherence and coordination. South Africa has strong legal institutions and practices, and social policies that support public provisioning of food, but a non-interventionist approach to the food system.

The right to food and nutrition, as outlined in the South African Constitution, has not yet been effectively utilised to establish a robust normative and legal basis for tackling the dual challenges of food insecurity and malnutrition. Currently, the governance of the food system is grappling with substantial obstacles, balancing the influence of powerful stakeholders who uphold the status quo against its responsibilities for food justice.

This paper aims to summarise the frameworks currently used to analyse food policymaking processes and to critically assess whether those frameworks can be applied to the analysis of integrated, ‘systems’ approaches to policymaking.

Two electronic databases were searched to identify publications analysing food policymaking processes. Data from the publications were charted using an iterative coding process, and details of the underlying analytical frameworks were recorded. Identified frameworks were evaluated using theories of systems approaches to food policy development.

Governmental food policy at the supranational, national and local levels.

The search process yielded 532 results. After screening, a final forty-three publications and twenty-four frameworks were identified. In the studies, frameworks were used to analyse agenda-setting, stakeholder networks, policy coherence and development of national food and nutrition policies. All twenty-four frameworks allowed for analysis of actors and context in policymaking processes, while space for considering policy coherence featured less (n 11).

Three frameworks were highlighted as particularly applicable to the context of food systems approaches to policymaking. The application of analytical frameworks for policymaking processes is limited in food policy research. However, this review demonstrates that there are considerable benefits to using such frameworks to understand the ideas, knowledge, power and decision-making that lead to food policy development. This is particularly useful in understanding the complex stakeholder networks and policy coherence necessary for successful policies for sustainable food systems.

To investigate the causal link between the North American Free Trade Agreement (NAFTA) unrestricted sugar trade agreement signed in 2008 between the USA and Mexico and the diabetes prevalence across all fifty US states.

A quasi-experimental research design to investigate the causal effect of the NAFTA unrestricted sugar trade agreement on diabetes prevalence. Our study utilises a comprehensive panel dataset spanning from 2000 to 2016, comprising 1054 observations. To conduct our analysis, we applied both the difference-in-differences and event-study methodologies.

All the states in the USA.

The fifty states in the USA.

After the enactment of the NAFTA sugar trade agreement between the USA and Mexico in 2008, most states witnessed an increase in diabetes prevalence. The annual impacts displayed significant variation among states, with percentage increases spanning from 0·50 to 2·28 %.

States with a higher percentage of their population living below the poverty line, a larger Black resident population and a lower proportion of high school graduates had more significant increases in diabetes prevalence attributed to the NAFTA sugar trade agreement.

Local governments have an important role to play in creating healthy, equitable and environmentally sustainable food systems. This study aimed to develop and pilot a tool and process for local governments in Australia to benchmark their policies for creating healthy, equitable and environmentally sustainable food systems.

The Healthy Food Environment Policy Index (Food-EPI), developed in 2013 for national governments, was tailored to develop the Local Food Systems Policy Index (Local Food-EPI+) tool for local governments. To incorporate environmental sustainability and the local government context, this process involved a literature review and collaboration with an international and domestic expert advisory committee (n 35) and local government officials.

Local governments.

The tool consists of sixty-one indicators across ten food policy domains (weighted based on relative importance): leadership; governance; funding and resources; monitoring and intelligence; food production and supply chain; food promotion; food provision and retail in public facilities and spaces; supermarkets and food sources in the community; food waste reuse, redistribution and reduction; and support for communities. Pilot implementation of the tool in one local government demonstrated that the assessment process was feasible and likely to be helpful in guiding policy implementation.

The Local Food-EPI+ tool and assessment process offer a comprehensive mechanism to assist local governments in benchmarking their actions to improve the healthiness, equity and environmental sustainability of food systems and prioritise action areas. Broad use of this tool will identify and promote leading practices, increase accountability for action and build capacity and collaborations.

This study assessed the suitability of nutritional composition data from a commercial dataset for policy evaluation in Brazil.

We compared the proportions of packaged foods and beverages, classified according to the Nova food classification and the nutritional composition of matched products using data from a commercial database of food labels (Mintel-Global New Products Database (GNPD)) and the Brazilian Food Labels Database (BFLD), collected in 2017 as a ‘gold standard.’ We evaluated the agreement between the two datasets using paired t tests, Wilcoxon–Mann-Whitney test and the Intraclass Correlation Coefficient (ICC) for energy, carbohydrates, total sugars, proteins, total fats, saturated fats, trans-fats, sodium and fiber.

Brazil.

Totally, 11 434 packaged foods and beverages collected in 2017 provided by BFLD and 67 042 packaged foods and beverages launched from 2001 to 2017 provided by Mintel-GNPD.

The proportions of ultra-processed foods (UPF) were similar in both datasets. Paired products exhibited an excellent correlation (ICC > 0·80), with no statistically significant difference in the mean values (P ≥ 0·05) of most nutrients analysed. Discrepancies in fibre and fat content were noted in some UPF subcategories, including sweet biscuits, ice cream, candies, dairy beverages, sauces and condiments.

The Mintel-GNPD dataset closely aligns with the BFLD in UPF distribution and shows a similar nutritional composition to a sample of matched foods available for purchase in stores, indicating its potential contribution to monitoring and evaluating food labelling policies in Brazil and in studies of food and beverages composition in food retail through the verification of policy compliance.

To examine underlying political economy factors that enable or impede the integration of nutrition considerations into food system governance.

Comparative political economy analysis of data collected through (1) value chain analyses of selected healthy and unhealthy commodities and (2) food system policy analyses, using a theoretical framework focused on power, politics, interests and ideas.

Ghana and South Africa.

Value chain actors relevant to healthy and unhealthy foods (Ghana n 121; South Africa n 72) and policy stakeholders from government (Health, Agriculture, Trade and Industry, Finance), academia, civil society, development partners, Civil Society Organization (CSO) and private sector (Ghana n 28; South Africa n 48).

Nutrition was a stated policy priority in both countries; however, policy responsibility was located within the health sector, with limited integration of nutrition into food system sectors (including Agriculture, Trade and Industry). Contributing factors included a conceptions of policy responsibilities for nutrition and food systems, dominant ideas and narratives regarding the economic role of the food industry and the purpose of food system policy, the influence of large food industry actors, and limited institutional structures for cross-sectoral engagement and coordination.

Integrating nutrition into multi-sectoral food policy to achieve multiple food system policy goals will require strategic action across jurisdictions and regional levels. Opportunities included increasing investment in healthy traditional foods, strengthening urban/rural linkages and informal food systems, and strengthening institutional structures for policy coherence and coordination related to nutrition.

Online food delivery (OFD) platforms offer consumers a convenient and fast delivery service of foods and drinks sourced from foodservice partners (e.g. restaurants, quick service restaurants). There is a need to assess the impact of this emergent segment of the foodservice sector on diet and diet-related health. The aim of this narrative review was to describe the OFD sector in Australia, its use and identify potential ways to include OFD platforms in existing public health nutrition policy.

A search was conducted in peer-reviewed and grey literature. Sources were analysed and synthesised to report the characteristics of OFD platforms, delivery process, users and potential drivers of usage. The aim and scope of public health nutrition policies were analysed to identify ways of including OFD platforms.

Australia.

General population.

There are three main operators with 9000–16 000 foodservice partners based predominantly in the main cities of Australia. OFD revenue has grown by 72 % in the last 5 years and is predicted to increase driven by usage by working adults with high disposable income who demand convenience. Current policies and initiatives aimed at manufacturers, retailers and foodservice outlets do not specifically regulate OFD platforms, although there is scope for these to be extended to such platforms.

OFD platforms are disruptors of the foodservice sector. Innovative and consistent health policy options that target the unique challenges and opportunities posed by OFD platforms are required to limit the potentially negative impact of OFD platforms on diet and diet-related health.

Despite broad agreement on the need for comprehensive policy action to improve the healthiness of food environments, implementation of recommended policies has been slow and fragmented. Benchmarking is increasingly being used to strengthen accountability for action. However, there have been few evaluations of benchmarking and accountability initiatives to understand their contribution to policy change. This study aimed to evaluate the impact of the Healthy Food Environment Policy Index (Food-EPI) Australia initiative (2016–2020) that assessed Australian governments on their progress in implementing recommended policies for improving food environments.

A convergent mixed methods approach was employed incorporating data from online surveys (conducted in 2017 and 2020) and in-depth semi-structured interviews (conducted in 2020). Data were analysed against a pre-defined logic model.

Australia.

Interviews: twenty stakeholders (sixteen government, four non-government). Online surveys: fifty-three non-government stakeholders (52 % response rate) in 2017; thirty-four non-government stakeholders (36 % response rate) in 2020.

The Food-EPI process involved extensive engagement with government officials and the broader public health community across Australia. Food-EPI Australia was found to support policy processes, including as a tool to increase knowledge of good practice, as a process for collaboration and as an authoritative reference to support policy decisions and advocacy strategies.

Key stakeholders involved in the Food-EPI Australia process viewed it as a valuable initiative that should be repeated to maximise its value as an accountability mechanism. The highly collaborative nature of the initiative was seen as a key strength that could inform design of other benchmarking processes.