Optimal metrics to define access, availability, and types of stores are unclear. A rationale exists for developing the field of nutrition economics which . This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. Decision-makers and donors like to see tangible results and the hitherto lack of progress on nutrition outcomes has trapped nutrition in a low priority cycle [9]: Poor [programmatic] results feed back into the low visibility for nutrition, as they are not attractive to political entrepreneurs and public officials to take them up in their own portfolio of accomplishments. HHS Vulnerability Disclosure, Help However, it is important to note that it may be possible to mitigate or overcome these challenges by developing tailored strategies. Ethical issues for human nutrition in the context of global food A synthesis paper. Pierson P. Increasing returns, path dependence, and the study of politics. 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). Cambridge UK: Cambridge Publishers / Nuffield Council on Bioethics, 2007. 1993;13(1):116. This article is one of a series commissioned by The BMJ. 2017. Washington, DC: World Bank; 2003. World Health Organization. Research What drives political commitment for nutrition? 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. 2015;7:1523. For each, governments should assess whether the implemented strategies have the intended effects, identify and tackle disparities, and detect unintended consequences. Surveillance systems for monitoring and evaluating nutrition trends and disparities are under resourced. Conclusions. Political willingness to act can be undermined by several factors. Hadley 71: 2, c 4, 5, 7, c 8, c 9: Low: Unclear: Not clearly reported, but many from the United States: A change to becoming health care insured was associated with a reduction in mortality ranging between 4% and 25% across studies and improved SRH. Local and national governments have important roles in bringing healthier food and food security to their populations. Each policy strategy can be classified according to different related characteristics (box 1) that need to be considered and defined in government policy design.24. Because multisectoral approaches are necessary to create healthier food systems,5 governments should actively develop and implement policies to promote strategic and sustained change. Impact of Political Economy on Population Health: A Systematic Review First, nutrition does not have a natural institutional home; it is often homeless in government [2, 11]. 5 The aim of the present study was to determine socio-economic factors associated with nutritional status among children in plantation communities, Sri Lanka. Balarajan Y, Reich MR. Differences between natural and industry ingredients (eg, for sugar) are unclear. Impacts of in utero and early infant taste experiences on later taste acceptance: a systematic review, Sweet and sour preferences during childhood: role of early experiences. 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. 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. For example, cost-benefit and cost-effectiveness analyses have been used to support the argument to invest in reducing malnutrition. WHO recently published draft guidance for the prevention and management of conflicts of interest in policy development and implementation of national nutrition programmes.106 Governments, academia and civil society all play an important role. Reflections from the front lines. Introduction Adequate nutrition is a key factor to live an active and healthy life. 2016. The development of a national obesity and diabetes prevention and control strategy in Mexico: actors, actions and conflicts of interest. An earlier survey of over 500 nutritionists revealed that infighting of nutrition community and absence of consensus on priorities was the most commonly cited disappointment among these practitioners [26]. official website and that any information you provide is encrypted Malnutrition adversely affects the physiological and mental capacity of individuals; which in turn hampers productivity levels, making them and their respective countries more susceptible to . Shaw FE, Asomugha CN, Conway PH, Rein AS. 87 Ideally, actions should be coordinated between ministries, agencies, and at local, national, and international levels. Natalicchio M, Garrett J, Mulder-Sibanda M, Ndegwa S, Voorbraak D. Carrots and sticks: the political economy of nutrition policy reforms. Sharma N, Mialon M. Young voters are fired up and research shows they will be a decisive factor in the 2020 election. With nutritions multicausal aetiology, it is both methodologically and practically challenging to address confounding and attribute results to specific actions. In: Mwatsama M, ed. Article Preparation and use of food-based dietary guidelines: Report of a Joint FAO/WHO Consultation. YB, MRR received no funding to develop this paper. Secondary Diabetes Prevention Program (DPP). Angell SY, Silver LD, Goldstein GP, et al. In another situation, a perception strategy could be used to mobilise the media or civil society groups to draw attention to malnutrition as an issue needing attention; this has been done in India, with powerful external framing of child nutrition as a problem identified by the media and supported by credible indicators of severity of the issue, and by the Right to Food movement that has framed undernutrition in terms of constitutional rights and entitlements [50]. Glob Food Sec. 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. 2014;17(03):6828. Furthermore, without clear multisectoral planning it may be difficult to delineate the specific actions and results for which each stakeholder is accountable for. Meal delivery programs reduce the use of costly health care in dually eligible medicare and medicaid beneficiaries. Brambila-Macias J, Shankar B, Capacci S, et al. This requires support from civil society and relevant private and other non-government actors to implement and sustain appropriate policies. Abstract. Washington, DC: World Bank; 2009. Academia should prioritise research on optimal dietary targets and cost effective policies; monitor and evaluate health indicators and policy outcomes; engage with communities, advocacy groups, the media, business, and policy makers; and inform and evaluate government and industry efforts. Ethical issues in the development and implementation of nutrition The growing epidemic of overweight and obesity presents another dimension of accountability challenges for nutrition, especially as they relate to the regulation and governance of multinational corporations in the food sector. These challenges can be described as the leadership challenge, resulting from nutritions institutional homelessness and the limited capacity and power of nutritionists to manage the policy reform process; the sectoral and coordination challenge created by the need to manage the different powers, positions and perceptions of multisectoral stakeholders in the global nutrition system; the accountability challenge, resulting from the multiplicity of owners and shared collective responsibility (or lack thereof) for results; the framing challenge, as multiple narratives are used which can muddy how the nutrition community and those they are trying to influence perceive the issue and its solutions; the hierarchy challenge, stemming from the lower standing and power of nutritionists compared to other health professionals vying for the attention of policymakers; and the demonstrating effectiveness challenge, resulting from the difficulty of demonstrating quick easily attributable wins within short political cycles. For example, factors driving government food production policy (eg, employment, short term business profits, and international competition) may be different from those driving nutrition policy (eg, health and healthcare costs). 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. For example, some policy strategies continue to emphasise reduction in total fat, total saturated fat, or total calories, rather than food type and quality, processing methods, additives, and diet patterns.1 We argue that a mindshift is needed in the nutrition community to reframe the lens to think beyond technical issues. Elevating health in the climate debate The climate crisis poses one of the biggest threats to both the planet and the health of the people who live on it. The Patient Protection and Affordable Care Act: opportunities for prevention and public health. 1Friedman School of Nutrition Science and Policy, Tufts University, Boston MA, USA, 2New York City Department of Health and Mental Hygiene, New York City NY, USA, 3School of Arts and Social Sciences, City University of London, UK, 4Instituto Nacional de Salud Pblica, Mexico City, Mexico, Dariush Mozaffarian and colleagues review strategies governments can use to improve nutrition and health. doi:10.1177/15648265110322s203. Littlewood JA, Loureno S, Iversen CL, Hansen GL. 6 Richardson AS, Ghosh-Dastidar M, Beckman R, et al. Lancet 2013;382(9890):45277. Lancet 2008;371(9612):60821. Accessibility Such a nutrition and health in all policies could greatly improve food systems and health, national productivity, equity, and health savings. New York: UNICEF and MDG Achievement Fund; 2013. UNSCN. A recent report of the UK Health Forum analysed examples of international public-private interactions for food and nutrition policies for the prevention of chronic diseases.99 The report sheds light on relationships between government, civil society, academia, and the food and beverage industry and the need to strengthen governance for the identification and management of conflicts of interest that may arise.100 While the cases vary in their geographical and sociopolitical contexts and objectives, common themes are seen: In Mexico a multistakeholder effort to monitor, evaluate and provide feedback on policies for the prevention and control of obesity and diabetes101 showed that providing the commercial sector privileged access over public health and civil society led to biased conclusions influenced by commercial interests. This in turn creates fewer incentives for further investments in the area [9]. New technology platforms and incentives for healthier eating. Impact of energy intake, physical activity, and population-wide weight loss on cardiovascular disease and diabetes mortality in Cuba, 1980-2005, Rapid declines in coronary heart disease mortality in Eastern Europe are associated with increased consumption of oils rich in alpha-linolenic acid. PDF The social and economic consequences of malnutrition - European Parliament Palar K, Napoles T, Hufstedler LL, et al. Restaurant Menu Labeling Policy: Review of Evidence and Controversies. 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]. At the time, a global pandemic of obesity and chronic diseases from the widespread availability of inexpensive, unhealthy food was inconceivable. Hospitals are often main community employers with an important local voice, The health system has limited reach, influence, and relevance for daily decisions such as food. Third, the multiplicity of stakeholders involved in nutrition policy creates multiple narratives around nutrition approaches. Political Issues - Research and data from Pew Research Center 100 For example, specific political strategies could be employed to seek common goals among different players and persuade supporters to strengthen their focus on coordinating actions to improve nutrition. Baltimore: The Johns Hopkins University Press; 1993. For example, a power strategy could be to form a coalition of supporting players, with a recognizable name and sufficient resources, to more strongly advocate for nutrition. Guidelines on reducing sugar in food published for industry. Google Scholar. PubMed Cholesterol control beyond the clinic: New York Citys trans fat restriction. First is the leadership challenge, which can result from the lack of an authoritative institutional home for nutrition, and compounded by the limited power and capacity of nutritionists to manage the policy reform process. Changes in diet and lifestyle and long-term weight gain in women and men, Short sleep duration and weight gain: a systematic review. This is in contrast to policy communities for other global health issues, notably HIV/AIDs, which have successfully commanded the attention of global and national policy makersdespite having a less severe disease burden than malnutrition [27]. Political Issues in Health, Population and Nutrition - JSTOR Google Scholar. Yet, a key issue remains: the relative lack of power of nutritionists in promoting policy reforms. Part of The BMJ thanks the series advisers, Nita Forouhi and Dariush Mozaffarian, for valuable advice and guiding selection of topics in the series. U.S. Food and Drug Administration. As a result, there is often a lack of strong political leadership for nutrition, lack of strong ownership and accountability, and a lack of effective advocacy for nutrition. Mayor of London. Provided by the Springer Nature SharedIt content-sharing initiative. Morris SS, Cogill B, Uauy R, Maternal and Child Undernutrition Study Group. 2017. 2020 was a devastating year for global health. How to overcome political challenges is uncertain, These should be implemented by governments. From the perspective of human capital, theseinclude improved health, cognitive development, and workcapacity. Balancing public health needs with commercial interests and managing conflicts of interest requires transparent systems and mechanisms. 4 Washington and New York: World Bank and UNICEF; 2002. IDS Bulletin 2013;44(3):7580. We present key political economy themes emanating from the political economy of nutrition literature. 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]. 4 2009;87:60813. Berkowitz SA, Terranova J, Hill C, et al. 2000;94(02):25167. Private Sector Engagement Toolkit. Given widespread recommendations for public-private alliances and partnerships to support the achievement of global health and development goals, governance of public-private partnerships is important to ensure that efforts to improve food and nutrition are in line with ethical, transparency, and accountability principles. The North Karelia Project: 20 years results and experiences. The evidence to support policy interventions is also different from that for interventions delivered to individuals.2 Scientific Report of the 2015 Dietary Guidelines Advisory Committee. Health systems cannot be the only solution but they have an important role. 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. Acosta AM, Fanzo J. Bethesda, MD 20894, Web Policies Lobbying strategies can greatly affect health policy decisions. A ministerial or cabinet leadership position is needed with oversight and budgetary authority for cross agency food and nutrition policy. Nutrition agenda setting, policy formulation and implementation: lessons from the Mainstreaming Nutrition Initiative. Abstract For nutrition and its associated disciplines, ethical considerations related to research are often complicated by factors that range from the use of experimental research designs that are overly holistic to inextricable links between nutrition research and marketing. The relatively recent rise of diet related chronic diseases including obesity, type 2 diabetes, cardiovascular diseases, and several cancers is at least partly a byproduct of these historical approaches and the responses of industry and consumers. Can the introduction of a full-service supermarket in a food desert improve residents economic status and health? Public health and the food and drinks industry: The governance and ethics of interaction. Evidence is mixed about effects on consumer behaviour, perhaps varying with nutrient or food targets. 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]. Optimal dietary factors or standards to target are not well established, especially for packaged foods, Nutrition standards should guide all food purchases for government offices, public schools, the military, food assistance programmes, and other government funded organisations. Relative sustainability and cost effectiveness are uncertain especially compared with other environmental and systems based strategies, Can be helpful if accompanied by other measures, and if backed by government or semi-official bodies with influence. PART 2 - to identify the key nutritional problems that affect adolescents, the main risk factors, and their interaction with other health problems and life events PART 3- to identify and discuss existing recommendations, strategies and programmes on the
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