UPDATE: Policy Committee Meeting Presentation Available Here: https://www.youtube.com/watch?v=SAeLNi2yiXE&t=15s
---
By Jennifer Parker
FLFPC Secretary and Policy Committee Co-Chair
Until recent, the most pressing nutrition and health issues were product of undernutrition due to insufficient food production. To remedy this, governments sought to stimulate production of the most durable, high calorie and inexpensive food commodities (ie. potatoes, corn, wheat etc). This urgent need to increase food production for human survival, however, turned a model that addressed one particular crisis into a mode of profitability, which has since seen rates of obesity and chronic diet related diseases, including type 2 diabetes, Cardiovascular diseases as well as several types of cancers to skyrocket.
Even with the unprecedented rise in obesity and diet related diseases, government policies have continued to emphasize agricultural production of the same high calorie, inexpensive food commodities. While undernutrition has improved, governments (within the US, UK, CAN and the like), have tended to direct responsibility at individuals in response to the rise in these chronic diseases. Examples of the measures governments use to educate individuals which emphasize personal responsibility and choice are through such initiatives as USDA dietary guidelines, food labels, menu labelling, and clinical counselling.
The extent to which people have real choices, however, is debatable (1,2,3,4,5,6,7); while we all like to believe that we choose our food freely, the overwhelming evidence is that our choices are constrained by history, class, gender, income, ethnicity and market issues of access, affordability and global supply patterns. (8) However, it gets even more complicated. There are also 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 mother’s diet during pregnancy, infant feeding practices, and foods consumed in early childhood. (10,11,12) Broader sociocultural determinants of personal choices include household lifestyle patterns such as television watching and sleep, (13,14,15,16) family and community norms, social pressures, social class, social networks, and race/ethnicity. (17) The local environment also plays an important role.(2,3,4,5,6,7)
There is an argument that individuals rather simply select than actually choose food items freely. (8) There appear to be many choices in grocery stores hosting over 40,000 products for consumers to “choose”, however, when these 40,000 products are produced by only 5 companies, it raises the question on who truly controls the food supply, and thus the influences on the food chain and the food choices of individual and communities. Thus to focus public health nutrition initiatives solely on helping individuals make healthier food choices limits the extent to which improvements in public health can be made.
Below is useful list of recommended actions and roles governments can take to improve nutrition and health. This list was published in the British Medical Journal by Dariush Mozaffarian and colleagues (such as Tim Lang) who are prominent stakeholders in the fight for a healthier, sustainable, fair and just food system. These roles and actions are also a great tool for Florida’s Food Policy Council to weigh and assess initiatives going forward in addressing nutrition and policy efforts.
Recommended government roles and actions for a healthier food system (18)
1. Recognise that good nutrition is a priority for local, national, and global health, equity, and economic security
2. Acknowledge the importance of multilevel approaches, not “magic bullets”, in order to implement strategic, coordinated government action. Based on current evidence, the best approaches are:
3. Fiscal incentives/disincentives (eg, taxes and subsidies) for consumers, the food industry, and organisations (eg, worksites)
4. Prioritisation of both food security and nutritional quality in food assistance programmes
5. Appropriate standards for additives including trans fat, sodium, and added sugars
6. Procurement standards for all government food purchases and venues including food assistance programmes
7. Use of schools and worksites to promote healthier eating
8. Incorporation of food and nutrition into the healthcare system at all levels
9. Nutrition standards for marketing of foods and beverages to children
10. Front-of-pack labelling of evidence informed metrics such as overall fat quality (eg, unsaturated to saturated fat ratio), carbohydrate quality (eg, carbohydrate to fibre ratio), and sodium
11. Implement policies using the best available evidence, which also provides an opportunity to build further evidence for better decision making by evaluation of the policies being implemented
12. Emphasise strategies with the greatest potential to reduce social and racial/ethnic disparities from clustering of suboptimal diet habits, local environments, and disease risk factors
13. Increase support for food and nutrition research to ensure that both dietary targets and policy efforts are scientifically sound
14. Support public-private partnerships with the food industry and other major non-food businesses (eg, private health and life insurance, and self-insured corporations) for research and development on healthier products, effective behaviour change, and other common aims. This must include development of clear and transparent policies to identify and minimise conflicts of interest
15. Facilitate participation of other stakeholders in policy development, implementation, and evaluation
16. Incorporate nutrition and health in all of government, for example, city planning, economic development, agricultural and trade policies, and nutrition impact assessment
17. 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
18. Create a ministerial or cabinet leadership position with oversight and budgetary authority for cross agency food and nutrition policy
19. Support monitoring and evaluation of nutrition habits, food systems, and corresponding policies including for individuals, communities, and larger systems. Link to and use existing surveillance systems (eg, healthcare) as well as new technologies (eg, social media, and personal monitors)
20. Identify and use complementary global public health activities (eg, the United Nations Sustainable Development Goals), including to bring stakeholders together and, where necessary, counter the food industry
Join FLFPC’s next policy committee’s monthly call, March 29th at 12 noon EST until 1pm, where we will discuss the challenges and ways in which we can address pressing nutrition and health issues across Florida and the rest of the United States.
Topic: Nutrition and Policy
Time: Mar 29, 2019 12:00 PM Eastern Time (US and Canada)
Join Zoom Meeting
https://us04web.zoom.us/j/313503457
One tap mobile
+16465588656,,313503457# US (New York)
+14086380968,,313503457# US (San Jose)
Dial by your location
+1 646 558 8656 US (New York)
+1 408 638 0968 US (San Jose)
Meeting ID: 313 503 457
Find your local number: https://us04web.zoom.us/u/fcn3bbKWkq
References
1. Lang T. The new globalisation, food and health: is public health receiving its due emphasis? Journal of Epidemiology and Community Health 1998; 52: 538–9.
2. Brown GW, Yamey G, Wamala SAfshin A, Micha R, Khatibzadeh S, Schmidt LA, Mozaffarian D. Dietary policies to reduce non-communicable diseases. In: Brown GW, Yamey G, Wamala S, eds. The handbook of global health policy.1st ed. Wiley, 2014:175-93. doi:10.1002/9781118509623.ch9
3. Mozaffarian D, Afshin A, Benowitz NL, et al., American Heart Association Council on Epidemiology and Prevention, Council on Nutrition, Physical Activity and Metabolism, Council on Clinical Cardiology, Council on Cardiovascular Disease in the Young, Council on the Kidney in Cardiovasc. Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association. Circulation2012;126:1514-63. doi:10.1161/CIR.0b013e318260a20b pmid:22907934Abstract/FREE Full Text Google Scholar
4. Afshin A, Penalvo J, Del Gobbo L, et al. CVD prevention through policy: a review of mass media, food/menu labeling, taxation/subsidies, built environment, school procurement, worksite wellness, and marketing standards to improve diet. Curr Cardiol Rep2015;17:98. doi:10.1007/s11886-015-0658-9 pmid:26370554
5. World Cancer Research Fund International. NOURISHING framework. 2017. https://www.wcrf.org/int/policy/nourishing-database Google Scholar
6. Informas. The Healthy Food Environment Policy Index (Food-EPI). 2017. http://www.informas.org/food-epi/Google Scholar
7. Food-PRICE. Food Policy Review and Intervention Cost-Effectiveness (Food-PRICE). 2018. https://www.food-price.org/Google Scholar
8. Caraher, M. & Coveney, J. (2004). Public health nutrition and food policy. Public Health Nutrition, 7(5), pp. 591-598. doi: 10.1079/PHN2003575
9. van’t Riet J, Sijtsema SJ, Dagevos H, De Bruijn GJ. The importance of habits in eating behaviour. An overview and recommendations for future research. Appetite2011;57:585-96. doi:10.1016/j.appet.2011.07.010 pmid:21816186
10. Nehring I, Kostka T, von Kries R, Rehfuess EA. Impacts of in utero and early infant taste experiences on later taste acceptance: a systematic review. J Nutr2015;145:1271-9. doi:10.3945/jn.114.203976 pmid:25878207Abstract/FREE Full TextGoogle Scholar
11. Liem DG, Mennella JA. Sweet and sour preferences during childhood: role of early experiences .Dev Psychobiol2002;41:388-95. doi:10.1002/dev.10067 pmid:12430162
12. DiSantis KI, Collins BN, Fisher JO, Davey A. Do infants fed directly from the breast have improved appetite regulation and slower growth during early childhood compared with infants fed from a bottle?Int J Behav Nutr Phys Act2011;8:89. doi:10.1186/1479-5868-8-89 pmid:21849028
13. Robinson TN. Reducing children’s television viewing to prevent obesity: a randomized controlled trial. JAMA1999;282:1561-7. doi:10.1001/jama.282.16.1561 pmid:10546696
14. Epstein LH, Roemmich JN, Robinson JL, et al. A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children. Arch Pediatr Adolesc Med2008;162:239-45. doi:10.1001/archpediatrics.2007.45doi:10.1001/archpediatrics.2007.45 pmid:18316661
15. Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med2011;364:2392-404. doi:10.1056/NEJMoa1014296 pmid:21696306
16. Patel SR, Hu FB. Short sleep duration and weight gain: a systematic review. Obesity (Silver Spring)2008;16:643-53. doi:10.1038/oby.2007.118 pmid:18239586
17. Brug J, Kremers SP, Lenthe Fv, Ball K, Crawford D. Environmental determinants of healthy eating: in need of theory and evidence. Proc Nutr Soc2008;67:307-16. doi:10.1017/S0029665108008616 pmid:18700052
18. Mozaffarian D, Angell SY, Lang T, Rivera JA. Role of government policy in nutrition—barriers to and opportunities for healthier eating. BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2426 (Published 13 June 2018) BMJ 2018;361:k2426