Skip to main content Accessibility help

An accountability framework to promote healthy food environments

  • Vivica I Kraak (a1), Boyd Swinburn (a2), Mark Lawrence (a3) and Paul Harrison (a4)



To review the available literature on accountability frameworks to construct a framework that is relevant to voluntary partnerships between government and food industry stakeholders.


Between November 2012 and May 2013, a desk review of ten databases was conducted to identify principles, conceptual frameworks, underlying theories, and strengths and limitations of existing accountability frameworks for institutional performance to construct a new framework relevant to promoting healthy food environments.


Food policy contexts within high-income countries to address obesity and diet-related non-communicable diseases.


Eligible resources (n 26) were reviewed and the guiding principles of fifteen interdisciplinary frameworks were used to construct a new accountability framework.


Strengths included shared principles across existing frameworks, such as trust, inclusivity, transparency and verification; government leadership and good governance; public deliberations; independent bodies recognizing compliance and performance achievements; remedial actions to improve accountability systems; and capacity to manage conflicts of interest and settle disputes. Limitations of the three-step frameworks and ‘mutual accountability’ approach were an explicit absence of an empowered authority to hold all stakeholders to account for their performance.


We propose a four-step accountability framework to guide government and food industry engagement to address unhealthy food environments as part of a broader government-led strategy to address obesity and diet-related non-communicable diseases. An independent body develops clear objectives, a governance process and performance standards for all stakeholders to address unhealthy food environments. The empowered body takes account (assessment), shares the account (communication), holds to account (enforcement) and responds to the account (improvements).

    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      An accountability framework to promote healthy food environments
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      An accountability framework to promote healthy food environments
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      An accountability framework to promote healthy food environments
      Available formats


Corresponding author

*Corresponding author: Email


Hide All
1.World Health Organization (2011) Global Status Report on Noncommunicable Diseases 2010. Geneva: WHO; available at
2.World Health Organization (2004) Global Strategy on Diet, Physical Activity, and Health. Report no. WHA57.17. Geneva: WHO; available at
3.World Health Organization (2013) Follow-up to the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases, 25 May. (accessed May 2013).
4.World Cancer Research Fund/American Institute for Cancer Research (2007) Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective. Washington, DC: AICR; available at
5.European Heart Network (2011) Diet, Physical Activity and Cardiovascular Disease Prevention in Europe. Brussels: EHN; available at
6.World Health Organization (2011) Intersectoral Action on Health. A Path for Policy-Makers to Implement Effective and Sustainable Action on Health. Kobe: WHO Centre for Health Development; available at
7.Committee on Preventing Obesity in Children and Youth, Institute of Medicine (2005) Preventing Childhood Obesity: Health in the Balance [JP Koplan, CT Liverman and VI Kraak, editors]. Washington, DC: The National Academies Press; available at
8.Swinburn, BA, Sacks, G, Hall, KDet al. (2011) The global obesity pandemic: shaped by global drivers and local environments. Lancet 378, 804814.
9.Conflicts of Interest Coalition (2011) Statement of Concern. (accessed April 2013).
10.Moodie, R, Stuckler, D, Monteiro, Cet al. (2013) Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. Lancet 381, 670679.
11.World Health Organization (2013) WHO Director-General addresses health promotion conference. Opening address at the 8th Global Conference on Health Promotion, Helsinki, Finland, 10 June. (accessed June 2013).
12.Brandeis, LD (1913) What publicity can do. Harper's Weekly, 20 December. (accessed May 2013).
13.Rochlin, S, Zadek, S & Forstater, M (2008) Governing Collaboration. Making Partnerships Accountable for Delivering Development. London: AccountAbility; available at
14.Muntaner, C, Ng, E & Chung, H (2012) Making power visible in global health governance. Am J Bioeth 12, 6364.
15.Beaglehole, R, Bonita, R & Horton, R (2013) Independent global accountability for NCDs. Lancet 381, 602605.
16.World Health Organization (2013) United Nations to establish WHO-led Interagency Task Force on the Prevention and Control of Noncommunicable Diseases. Media release, 22 July. (accessed August 2013).
17.McKinnon, RA, Reedy, J, Morrissette, MAet al. (2009) Measures of the food environment: a compilation of the literature, 1990–2007. Am J Prev Med 36, 4 Suppl., S124S133.
18.Glanz, K (2009) Measuring food environments: a historical perspective. Am J Prev Med 36, 4 Suppl.,S93S98.
19.Ball, K & Thornton, L (2013) Food environments: measuring, mapping, monitoring and modifying. Public Health Nutr 16, 11471150.
20.Story, M, Kaphingst, KM, Robinson-O'Brien, Ret al. (2008) Creating healthy food and eating environments: policy and environmental approaches. Annu Rev Public Health 29, 253272.
21.Swinburn, B, Egger, G & Raza, F (1999) Dissecting obesogenic environments: the development and application of a framework for identifying and prioritizing environmental interventions for obesity. Prev Med 29, 563570.
22.Committee on Progress in Preventing Childhood Obesity, Institute of Medicine (2007) Progress in Preventing Childhood Obesity: How Do We Measure Up? [JP Koplan, CT Liverman, VI Kraak et al., editors]. Washington, DC: The National Academies Press; available at
23.US Department of Agriculture & US Department of Health and Human Services (2010) Dietary Guidelines for Americans, 2010, 7th edition. Washington, DC: US Government Printing Office; available at
24.Mozaffarian, D, Afshin, A, Benowitz, NLet al. (2012) Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association. Circulation 126, 15141563.
25.Pérez-Escamilla, R, Obbagy, JE, Altman, JMet al. (2012) Dietary energy density and body weight in adults and children: a systematic review. J Acad Nutr Diet 112, 671684.
26.Lin, BH & Guthrie, J (2012) Nutritional Quality of Food Prepared at Home and Away From Home, 1977–2008. Economic Information Bulletin no. EIB-105. Washington, DC: US Department of Agriculture, Economic Research Service; available at
27.Popkin, BM, Duffey, K & Gordon-Larsen, P (2005) Environmental influences on food choice, physical activity and energy balance. Physiol Behav 86, 603613.
28.Lozano, R, Naghavi, M, Foreman, Ket al. (2012) Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 20952128.
29.Lim, SS, Vos, T, Flaxman, ADet al. (2012) A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 22242260.
30.Guthman, J (2008) Thinking inside the neoliberal box: the micro-politics of agro-food philanthropy. Geoforum 39, 12411253.
31.Clarke, J (2004) Dissolving the public realm?: the logics and limits of neo-liberalism. J Soc Policy 33, 2748.
32.Peck, J & Tickell, A (2002) Neoliberalizing space. Antipode 34, 380404.
33.Wilst, WH (2011) Citizens United, public health, and democracy: the Supreme Court ruling, its implications, and proposed action. Am J Public Health 101, 11721179.
34.Piety, TR (2011) Citizens United and the threat to the regulatory state. Michigan Law Review First Impressions 109, 1622.
35.Clapp, J & Fuchs, D (2009) Agrifood corporations, global governance, and sustainability: a framework for analysis. In Corporate Power in Global Agrifood Governance, pp. 128 [J Clapp & D Fuchs, editors]. Cambridge, MA: The MIT Press.
36.Mindell, JS, Reynolds, L, Cohen, DLet al. (2012) All in this together: the corporate capture of public health. BMJ 345, e8082.
37.Bonnell, C, McKee, M, Fletcher, Aet al. (2011) Nudge smudge: UK government misrepresents ‘nudge’. Lancet 377, 21582159.
38.Kraak, VI, Harrigan, P, Lawrence, Met al. (2012) Balancing the benefits and risks of public–private partnerships to address the global double burden of malnutrition. Public Health Nutr 15, 503517.
39.Kraak, VI, Swinburn, B, Lawrence, Met al. (2011) The accountability of public–private partnerships with food, beverage and restaurant companies to address global hunger and the double burden of malnutrition. SCN News issue 39, 1124; available at
40.Watzman, N (2012) Congressional Letter Writing Campaign Helps Torpedo Voluntary Food Marketing Guidelines for Kids. Washington, DC: Sunlight Foundation Reporting Group; available at
41.Yanamadala, S, Bragg, MA, Roberto, CAet al. (2012) Food industry front groups and conflicts of interest: the case of Americans Against Food Taxes. Public Health Nutr 15, 13311332.
42.Grynbaum, MM (2013) In N.A.A.C.P. industry gets ally against soda ban. The New York Times, 23 January. (accessed April 2013).
43.International Food and Beverage Alliance (2013) Our Commitments. (accessed April 2013).
44.Cereal Partners Worldwide SA, Nestlé and General Mills (2009) CPW Commitments. (accessed April 2013).
45.European Commission (2013) Public Health. Nutrition and Physical Activity. The EU Platform for Action on Diet, Physical Activity and Health. (accessed April 2013).
46.Van Koperen, TM, Jebb, SA, Summerbell, CDet al. (2013) Characterizing the EPODE logic model: unravelling the past and informing the future. Obes Rev 14, 162170.
47.Pan American Health Organization/World Health Organization (2008) Healthy Oils and the Elimination of Industrially Produced Fatty Acids in the Americas. Washington DC: PAHO; available at
48.US Healthy Weight Commitment Foundation (2013) Home page. (accessed April 2013).
49.UK Department of Health (2013) Public Health Responsibility Deal. (accessed April 2013).
50.Australia Food and Grocery Council (2012) Healthier Australia Commitment. (accessed April 2013).
51.Facts Up Front (2013) Facts Up Front nutrition education initiative launches digital platform to help Americans make informed decisions when they shop for food. A Joint initiative of the Grocery Manufacturers Association and the Food Marketing Institute. Press release, 17 April. (accessed April 2013).
52.Better Business Bureau (2013) US Children's Food and Beverage Advertising Initiative. (accessed April 2013).
53.Advertising Standards Canada (2013) Canadian Children's Food and Beverage Advertising Initiative. (accessed April 2013).
54.International Food & Beverage Alliance (2011) Five Commitments to Action in support of the World Health Organization's 2004 Global Strategy on Diet, Physical Activity and Health. 2011 Progress Report. (accessed April 2013).
55.Accenture (2012) 2011 Compliance Monitoring Report for the International Food & Beverage Alliance on Global Advertising on Television, Print and Internet. (accessed April 2013).
56.Vladu, C, Christensen, R & Pana, A (2012) Monitoring the European Platform for action on Diet, Physical Activity and Health activities. Annual Report 2012. Brussels: IBF International Consulting; available at
57.Union of Concerned Scientists (2012) Heads They Win, Tails We Lose. How Corporations Corrupt Science at the Public's Expense. Cambridge, MA: UCS Publications; available at
58.European Court of Auditors (2012) Management of Conflicts of Interest in Selected EU Agencies. Special report no. 15. Luxembourg: European Court of Auditors; available at
59.Freudenberg, N & Galea, S (2008) The impact of corporate practices on health: implications for health policy. J Public Health Policy 29, 86104.
60.Wilst, WH (2006) Public health and the anticorporate movement: rationale and recommendations. Am J Public Health 96, 13701375.
61.Stuckler, D, McKee, M, Ebrahim, Set al. (2012) Manufacturing epidemics: the role of global producers in increased consumption of unhealthy commodities including processed foods, alcohol, and tobacco. PLoS Med 9, e1001235.
62.Brownell, KD & Warner, KE (2009) The perils of ignoring history: Big Tobacco played dirty and millions died. How similar is Big Food? Milbank Q 87, 259294.
63.Which? (2012) Government must do more to tackle the obesity crisis, says Which? The Government's Responsibility Deal is inadequate. Press release, 15 March. (accessed April 2013).
64.Ludwig, DS & Nestle, M (2008) Can the food industry play a constructive role in the obesity epidemic? JAMA 300, 18081811.
65.Brownell, KD (2012) Thinking forward: the quicksand of appeasing the food industry. PLoS Med 9, e1001254.
66.Lumley, J, Martin, J & Antonopoulos, N (2012) Exposing the Charade: The Failure to Protect Children from Unhealthy Food Advertising. Melbourne: Obesity Policy, Coalition; available at
67.Batada, A (2013) Kids’ Meals: Obesity on the Menu. Washington, DC: Center for Science in the Public Interest; available at
68.Hawkes, C & Harris, JL (2011) An analysis of the content of food industry pledges on marketing to children. Public Health Nutr 14, 14031414.
69.Sharma, LL, Teret, SP & Brownell, KD (2010) The food industry and self-regulation: standards to promote success and to avoid public health failures. Am J Public Health 100, 240246.
70.Grant, RW & Keohane, RO (2005) Accountability and abuses of power in world politics. Am Polit Sci Rev 99, 2943.
71.Bovens, M (2007) Analysing and assessing accountability: a conceptual framework. Eur Law J 13, 447468.
72.Steets, J (2010) Accountability in Public Policy Partnerships. UK: Palgrave Macmillan.
73.Wolfe, R & Baddeley, S (2012) Regulatory Transparency in Multilateral Agreements Controlling Exports of Tropical Timber, E-waste and Conflict Diamonds. OECD Trade Policy Papers no. 141. (accessed April 2013).
74.Joshi, A (2013) Context Matters: A Causal Chain Approach to Unpacking Social Accountability Interventions. Brighton: Institute of Development Studies; available at
75.O'Meally, SC (2013) Mapping Context for Social Accountability: A Resource Paper. Washington, DC: The World Bank, Social Development Department; available at
76.Organization for Economic Cooperation and Development (2009) Mutual Accountability: Emerging Good Practice. (accessed April 2013).
77.Steer, L & Wanthe, C (2009) Mutual Accountability at Country Level: Emerging Good Practice. ODI Background Note, April 2009. London: Overseas Development Institute; available at
78.Ruger, JP (2012) Global health governance as shared health governance. J Epidemiol Community Health 66, 653661.
79.World Health Organization (2011) Keeping Promises, Measuring Results. Geneva: WHO Commission on Information and Accountability for Women's and Children's Health; available at
80.United Nations Human Rights Office of the High Commissioner (2011) Guiding Principles on Business and Human Rights. Implementing the United Nations ‘Protect, Respect and Remedy’ Framework. (accessed April 2013).
81.Bonita, R, Magnusson, R, Bovet, Pet al. (2013) Country actions to meet UN commitments on non-communicable diseases: a stepwise approach. Lancet 381, 575584.
82.Deegan, C (2002) The legitimizing effect of social and environmental disclosures – a theoretical foundation. Account Audit Accountability J 15, 282311.
83.Isles, A (2007) Seeing sustainability in business operations: US and British food retailer experiments with accountability. Bus Strat Environ 16, 290301.
84.Moerman, L & Van Der Laan, S (2005) Social reporting in the tobacco industry: all smoke and mirrors? Account Audit Accountability J 18, 374389.
85.Newell, P (2008) Civil society, corporate accountability and the politics of climate change. Global Environ Polit 8, 122153.
86.Stanwick, PA, Stanwick, SD (2006) Environment sustainability disclosures: a global perspective and financial performance. In Corporate Social Responsibility. vol. 2: Performance and Stakeholders, pp. 84104 [J Allouche, editor]. New York: Palgrave Macmillan.
87.Swift, T (2001) Trust, reputation and corporate accountability to stakeholders. Bus Ethics Eur Rev 10, 1626.
88.Tilling, MV & Tilt, CA (2010) The edge of legitimacy: voluntary social reporting in Rothmans’ 1956–1999 annual reports. Account Audit Accountability J 23, 5581.
89.Tilt, CA (2010) Corporate responsibility, accounting and accountants. In Professionals’ Perspectives of Corporate Social Responsibility, pp. 11–32 [SO Idowu and WL Filho, editors]. Berlin: Springer-Verlag; available at
90.Irani, T, Sinclair, J & O'Malley, M (2002) The importance of being accountable: the relationship between perceptions of accountability, knowledge, and attitude toward plant genetic engineering. Sci Commun 23, 225242.
91.Dolan, P, Hallsworth, M, Halpern, Det al. (2010) MINDSPACE: Influencing Behaviour Through Public Policy. London: Institute for Government; available at
92.Gostin, LO (2008) A theory and definition of public health law (Georgetown University/O'Neill Institute for National & Global Health Law Scholarship Research Paper no. 8). In Public Health Law Power, Duty and Restraint, revised and expanded 2nd ed., pp. 3–41 [LO Gostin, editor]. Berkley, CA: University of California Press/Millbank Memorial Fund; available at
93.Institute of Medicine, Committee on Public Health Strategies to Improve Health (2011) For the Public's Health: The Role of Measurement in Action and Accountability. Washington, DC: The National Academies Press; available at
94.Institute of Medicine, Committee on Public Health Strategies to Improve Health (2011) For the Public's Health: Revitalizing Law and Policy to Meet New Challenges. Washington, DC: The National Academies Press; available at
95.Turoldo, F (2009) Responsibility as an ethical framework for public health interventions. Am J Public Health 99, 11971202.
96.World Health Organization (2013) Key issues for the development of a policy on engagement with nongovernmental organizations. Report by the Director-General. EB 132/5 Add.2, 18 January. (accessed April 2013).
97.Haynes, AS, Derrick, GE, Redman, Set al. (2012) Identifying trustworthy experts: how do policymakers find and assess public health researchers worth consulting or collaborating with? PLoS One 7, e32665.
98.Corporate Responsibility Organization (2012) CR's 100 Best Corporate Citizens 2012. (accessed April 2013).
99.Bank of America & Merrill Lynch (2012) Globesity – the Global Fight Against Obesity. ESG & Sustainability. (accessed April 2013).
100.Ethical Investment Research Services (2006) Obesity Concerns in the Food and Beverage Industry. SEE Risk Briefing February 2006. London: EIRS; available at
101.Global Reporting Initiative (2013) Global Reporting Framework. (accessed April 2013).
102.Swinburn, B, Sacks, G, Vandevijvere, Set al. (2013) INFORMAS (International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support): overview and key principles. Obes Rev 14, 112.
103.Swinburn, B, Vandevijvere, S, Kraak, Vet al. (2013) Monitoring and benchmarking government policies and actions to improve the healthiness of food environments: a proposed Government Healthy Food Environment Policy Index. Obes Rev 14, 2437.
104.Sacks, G, Swinburn, B, Kraak, Vet al. (2013) A proposed approach to monitor private-sector policies and practices related to food environments, obesity and non-communicable disease prevention. Obes Rev 14, 3848.
105.Global Alliance for Improved Nutrition (2013) Access to Nutrition Index. Global Index 2013. (accessed April 2013).
106.European Commission (2011) EU Platform for Action on Diet, Physical Activity and Health. 2011 Annual Report. (accessed April 2013).
107.Monge-Rojas, R, Colón-Ramos, U, Jacoby, Eet al. (2011) Voluntary reduction of trans-fatty acids in Latin America and the Caribbean: current situation. Rev Panam Salud Publica 29, 126129.
108.Colón-Ramos, U, Monge-Rojas, R & Campos, H (2013) Impact of WHO recommendations to eliminate industrial trans-fatty acids from the food supply in Latin America and the Caribbean. Health Policy Plan (Epublication ahead of print version).
109.Slining, MM, Wen, S & Popkin, BM (2013) Food companies’ calorie-reduction pledges to improve US diet. Am J Prev Med 44, 174184.
110.Partnership for a Healthier America (2013) In It For Good. PHA 2012 Annual Progress Report. (accessed April 2013).
111.Fox, T & Vorley, B (2004) Stakeholder Accountability in the UK Supermarket Sector. Final Report of the ‘Race to the Top’ Project. London: International Institute for Environment and Development; available at
112.World Health Organization (2010) Set of Recommendations on the Marketing of Foods and Non-Alcoholic Beverages to Children. Geneva: WHO; available at
113.Bryden, A, Petticrew, M, Mays, Net al. (2013) Voluntary agreements between government and business; a scoping review of the literature with specific reference to the Public Health Responsibility Deal. Health Policy 110, 186197.
114.Burch, D, Lawrence, G & Hattersley, L (2013) Watchdogs and ombudsmen: monitoring the abuse of supermarket power. Agric Hum Values 30, 259270.
115.Department for Business, Innovation and Skills (2013) Groceries Code Adjudicator Bill receives Royal Assent. Press release, 25 April. (accessed April 2013).
116.The Sunlight Foundation (2012) Issues we cover. (accessed April 2013).
117.Center for Responsive Politics (2013) Food Industry 2012. (accessed April 2013).
118.World Resources Institute (2006) Freedom of Information Laws by Country. Washington, DC: World Resources Institute; available at
119.Schlosser, E (2001) Fast Food Nation. The Dark Side of the All-American Meal. Boston, MA: Houghton Mifflin Company; available at
120.Moss, M (2013) Salt Sugar Fat: How the Food Giants Hooked Us. New York: Random House; available at
121.Taubes, G & Couzens, CK (2012) Big sugar's sweet little lies. Mother Jones, November/December issue. (accessed April 2013).
122.Hines, A & Jernigan, DH (2012) Developing a comprehensive curriculum for public health advocacy. Health Promot Pract 13, 733737.
123.Devlin-Foltz, D, Fagen, MC, Reed, Eet al. (2012) Advocacy evaluation: challenges and emerging trends. Health Promot Pract 13, 581586.
124.Chapman, S (2004) Advocacy for public health: a primer. J Epidemiol Community Health 58, 361365.
125.The Parents’ Jury (2012) Fame and shame awards 2012. (accessed April 2013).
126.Dorfman, L, Wilbur, P, Lingas, EOet al. (2005) Accelerating Policy on Nutrition: Lessons Learned from Tobacco, Alcohol, Firearms, and Traffic Safety. Berkeley, CA: Berkeley Media Studies Group; available at
127.Utting, P (2008) The struggle for corporate accountability. Dev Change 39, 959975.
128.Robert Wood Johnson Foundation (2014) Major food, beverage companies remove 6.4 trillion calories from U.S. marketplace. (accessed January 2014).
129.Kropp, R (2013) Investors support launch of Access to Nutrition Index. Sustainability Investment News, 27 March. (accessed May 2013).
130.Interfaith Center on Corporate Responsibility (2011) Taking Stock: Shaping the New Age in Corporate Responsibility. Annual Report 2010–2011. (accessed April 2013).
131.Baertlein, L (2012) Anti-obesity proposal fails again at McDonald's. Reuters, 24 May. (accessed April 2013).
132.Kassirer, JP (2001) Pseudoaccountability. Ann Intern Med 134, 587590.


An accountability framework to promote healthy food environments

  • Vivica I Kraak (a1), Boyd Swinburn (a2), Mark Lawrence (a3) and Paul Harrison (a4)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed