To identify the regulatory governance factors that lead to food policies achieving improvements in food environment, consumer behaviour and diet-related health outcomes.

Qualitative comparative analysis (QCA) was used to investigate the relationship between regulatory governance conditions and population nutrition outcomes. The regulatory governance conditions examined entailed: high industry involvement in the policy process, regulatory design, policy instrument design, policy monitoring and enforcement.

n 29 policy cases in the policy areas of food reformulation, nutrition labelling, food taxation and food marketing.

Policies implemented in thirteen countries.

Comprehensive monitoring was identified as a necessary regulatory governance condition for food policies to have an impact and was present in 94 % of policy cases that had a positive impact on nutrition outcomes. We identified two sufficient combinations of regulatory governance conditions. The first sufficient combination of conditions comprised an absence of high industry involvement in the policy process, combined with the presence of strict regulatory design, best-practice instrument design, and comprehensive monitoring and enforcement. Ninety-six percent of policy cases with positive impacts on nutrition outcomes displayed this combination. The second sufficient combination of conditions comprised an absensce of high industry involvement in the policy process, best practice instrument design and comprehensive monitoring. Eighty-two percent of policy cases with positive impacts on nutrition outcomes displayed this combination.

These findings show the importance of regulatory governance on policy outcomes. They suggest a need for more government-led nutrition policy processes and transparent monitoring systems that are independent from industry.

To explore the formal and informal ways in which different actors involved in shaping trade agreements pursue their interests and understand the interactions with nutrition, in order to improve coherence between trade and nutrition policy goals.

The paper draws on empirical evidence from Australian key informant interviews that explore the underlying political dimensions of trade agreements that act as barriers or facilitators to getting nutrition objectives on trade agendas.

Countries experiencing greater availability and access to diets full of energy-dense and nutrient-poor foods through increased imports, greater foreign direct investment and increasing constraints on national health policy space as a result of trade agreements.

Interviews took place with Australian government officials, industry, public-interest non-government organizations and academics.

The analysis reveals the formal and informal mechanisms and structures that different policy actors use both inside and outside trade negotiations to pursue their interests. The analysis also identifies the discourses used by the different actors, as they attempt to influence trade agreements in ways that support or undermine nutrition-related goals.

Moving forward requires policy makers, researchers and health advocates to use various strategies including: reframing the role of trade agreements to include health outcomes; reforming the process to allow greater access and voice to health arguments and stakeholders; establishing cross-government partners through accountable committees; and building circles of consensus and coalitions of sympathetic public-interest actors.

Maximising synergies and minimising conflicts (i.e. building policy coherence) between trade and nutrition policy is an important objective. One understudied driver of policy coherence is the alignment in the frames, discourses and values of actors involved in the respective sectors. In the present analysis, we aim to understand how such actors interpret (i.e. ‘frame’) nutrition and the implications for building trade–nutrition policy coherence.

We adopted a qualitative single case study design, drawing on key informant interviews with those involved in trade policy.

We focused on the Australian trade policy sub-system, which has historically emphasised achieving market growth and export opportunities for Australian food producers.

Nineteen key informants involved in trade policy spanning the government, civil society, business and academic sectors.

Nutrition had low ‘salience’ in Australian trade policy for several reasons. First, it was not a domestic political priority in Australia nor among its trading partners; few advocacy groups were advocating for nutrition in trade policy. Second, a ‘productivist’ policy paradigm in the food and trade policy sectors strongly emphasised market growth, export opportunities and deregulation over nutrition and other social objectives. Third, few opportunities existed for health advocates to influence trade policy, largely because of limited consultation processes. Fourth, the complexity of nutrition and its inter-linkages with trade presented difficulties for developing a ‘broader discourse’ for engaging the public and political leaders on the topic.

Overcoming these ‘ideational challenges’ is likely to be important to building greater coherence between trade and nutrition policy going forward.

The current short communication aimed to provide a new conceptualisation of the policy drivers of inequities in healthy eating and to make a call to action to begin populating this framework with evidence of actions that can be taken to reduce the inequities in healthy eating.

The Healthy and Equitable Eating (HE2) Framework derives from a systems-based analytical approach involving expert workshops.

Australia.

Academics, government officials and non-government organisations in Australia.

The HE2 Framework extends previous conceptualisations of policy responses to healthy eating to include the social determinants of healthy eating and its social distribution, encompassing policy areas including housing, social protection, employment, education, transport, urban planning, plus the food system and environment.

As the burden of non-communicable diseases continues to grow globally, it is important that governments, practitioners and researchers focus attention on the development and implementation of policies beyond the food system and environment that can address the social determinants of inequities in healthy eating.

The marketing of infant/child milk-based formulas (MF) contributes to suboptimal breast-feeding and adversely affects child and maternal health outcomes globally. However, little is known about recent changes in MF markets. The present study describes contemporary trends and patterns of MF sales at the global, regional and country levels.

Descriptive statistics of trends and patterns in MF sales volume per infant/child for the years 2008–2013 and projections to 2018, using industry-sourced data.

Eighty countries categorized by country income bracket, for developing countries by region, and in countries with the largest infant/child populations.

MF categories included total (for ages 0–36 months), infant (0–6 months), follow-up (7–12 months), toddler (13–36 months) and special (0–6 months).

In 2008–2013 world total MF sales grew by 40·8 % from 5·5 to 7·8 kg per infant/child/year, a figure predicted to increase to 10·8 kg by 2018. Growth was most rapid in East Asia particularly in China, Indonesia, Thailand and Vietnam and was led by the infant and follow-up formula categories. Sales volume per infant/child was positively associated with country income level although with wide variability between countries.

A global infant and young child feeding (IYCF) transition towards diets higher in MF is underway and is expected to continue apace. The observed increase in MF sales raises serious concern for global child and maternal health, particularly in East Asia, and calls into question the efficacy of current regulatory regimes designed to protect and promote optimal IYCF. The observed changes have not been captured by existing IYCF monitoring systems.

To develop a policy formulation tool for strategically informing food and nutrition policy activities to promote healthy and sustainable diets (HSD).

A policy formulation tool consisting of two complementary components was developed. First, a conceptual framework of the environment–public health nutrition relationship was constructed to characterise and conceptualise the food system problem. Second, an ‘Orders of Food Systems Change’ schema drawing on systems dynamics thinking was developed to identify, assess and propose policy options to redesign food systems.

Food and nutrition policy activities to promote HSD have been politicised, fragmented and lacking a coherent conceptual and strategic focus to tackle complex food system challenges.

The tool’s conceptual framework component comprises three integrated dimensions: (i) a structure built around the environment and public health nutrition relationship that is mediated via the food system; (ii) internal mechanisms that operate through system dynamics; and (iii) external interactions that frame its nature and a scope within ecological parameters. The accompanying schema is structured around three orders of change distinguished by contrasting ideological perspectives on the type and extent of change needed to ‘solve’ the HSD problem.

The conceptual framework’s systems analysis of the environment–public health nutrition relationship sets out the food system challenges for HSD. The schema helps account for political realities in policy making and is a key link to operationalise the framework’s concepts to actions aimed at redesigning food systems. In combination they provide a policy formulation tool to strategically inform policy activities to redesign food systems and promote HSD.

The present article tracks the development of the Australian National Food Plan as a ‘whole of government’ food policy that aimed to integrate elements of nutrition and sustainability alongside economic objectives.

The article uses policy analysis to explore the processes of consultation and stakeholder involvement in the development of the National Food Plan, focusing on actors from the sectors of industry, civil society and government. Existing documentation and submissions to the Plan were used as data sources. Models of health policy analysis and policy streams were employed to analyse policy development processes.

Australia.

Australian food policy stakeholders.

The development of the Plan was influenced by powerful industry groups and stakeholder engagement by the lead ministry favoured the involvement of actors representing the food and agriculture industries. Public health nutrition and civil society relied on traditional methods of policy influence, and the public health nutrition movement failed to develop a unified cross-sector alliance, while the private sector engaged in different ways and presented a united front. The National Food Plan failed to deliver an integrated food policy for Australia. Nutrition and sustainability were effectively sidelined due to the focus on global food production and positioning Australia as a food ‘superpower’ that could take advantage of the anticipated ‘dining boom’ as incomes rose in the Asia-Pacific region.

New forms of industry influence are emerging in the food policy arena and public health nutrition will need to adopt new approaches to influencing public policy.

To determine key points of intervention in urban food systems to improve the climate resilience, equity and healthfulness of the whole system.

The paper brings together evidence from a 3-year, Australia-based mixed-methods research project focused on climate change adaptation, cities, food systems and health. In an integrated analysis of the three research domains – encompassing the production, distribution and consumption sectors of the food chain – the paper examines the efficacy of various food subsystems (industrial, alternative commercial and civic) in achieving climate resilience and good nutrition.

Greater Western Sydney, Australia.

Primary producers, retailers and consumers in Western Sydney.

This overarching analysis of the tripartite study found that: (i) industrial food production systems can be more environmentally sustainable than alternative systems, indicating the importance of multiple food subsystems for food security; (ii) a variety of food distributors stocking healthy and sustainable items is required to ensure that these items are accessible, affordable and available to all; and (iii) it is not enough that healthy and sustainable foods are produced or sold, consumers must also want to consume them. In summary, a resilient urban food system requires that healthy and sustainable food items are produced, that consumers can attain them and that they actually wish to purchase them.

This capstone paper found that the interconnected nature of the different sectors in the food system means that to improve environmental sustainability, equity and population health outcomes, action should focus on the system as a whole and not just on any one sector.

To articulate a healthy and sustainable (H&S) diet; outline key health and environmental sustainability principles that can be applied in the selection of foods for inclusion in such a diet; and describe a methodology with which to assess the availability and affordability of a H&S food basket.

We synthesized publically available evidence on the environmental impact of different foods from academic, government, industry and non-government sources and constructed a hypothetical H&S equivalent of the typical Australian diet. Based on this, we constructed a weekly H&S food basket for a household of two adults and two children.

Australia.

Australian populations.

The H&S diet is based on three overarching principles: (i) any food that is consumed above a person's energy requirement represents an avoidable environmental burden in the form of greenhouse gas emissions, use of natural resources and pressure on biodiversity; (ii) reducing the consumption of discretionary food choices, which are energy-dense and highly processed and packaged, reduces both the risk of dietary imbalances and the use of environmental resources; and (iii) a diet comprising less animal- and more plant-derived foods delivers both health and ecological benefits.

We have focused on the articulation of a H&S diet not to facilitate ‘policy drift’ to focus on individual dietary choice, but rather to provide evidence to extend dietary guideline recommendations so as to integrate environmental considerations within the scope of food and health policy advice in Australia and elsewhere.

To investigate the relationships between food poverty and food consumption, health and life satisfaction among schoolchildren.

Analysis of the 2002 Health Behaviour in School-aged Children (HBSC) study, a cross-sectional survey that employs a self-completion questionnaire in a nationally representative random sample of school classrooms in the Republic of Ireland.

A total of 8424 schoolchildren (aged 10–17 years) from 176 schools, with an 83% response rate from children.

Food poverty was found to be similarly distributed among the three social classes (15.3% in the lower social classes, 15.9% in the middle social classes and 14.8% in the higher social classes). It was also found that schoolchildren reporting food poverty are less likely to eat fruits, vegetables and brown bread, odds ratio (OR) from 0.66 (95% confidence interval (CI) 0.45–0.87) to 0.81 (95% CI 0.63–0.99); more likely to eat crisps, fried potatoes and hamburgers, OR from 1.20 (95% CI 1.00–1.40) to 1.62 (95% CI 1.39–1.85); and more likely to miss breakfast on weekdays, OR from 1.29 (95% CI 0.33–1.59) to 1.72 (95% CI 1.50–1.95). The risk of somatic and mental symptoms is also increased, OR from 1.48 (95% CI 1.18–1.78) to 2.57 (95% CI 2.33–2.81); as are negative health perceptions, OR from 0.63 (95% CI 0.43–0.83) to 0.52 (95% CI 0.28–0.76) and measures of life dissatisfaction, OR from 1.88 (95% CI 1.64–2.12) to 2.25 (95% CI 2.05–2.45). Similar results were found for life dissatisfaction in an international comparison of 32 countries. All analyses were adjusted for age and social class.

Food poverty in schoolchildren is not restricted to those from lower social class families, is associated with a substantial risk to physical and mental health and well-being, and requires the increased attention of policy makers and practitioners.

The aim of this study was to identify differences in food habits and lifestyle behaviours by dieting status among young people in Ireland.

Cross-sectional survey. Participants responded to a self-completion questionnaire designed by researchers on the World Health Organization's collaborative study – Health Behaviour in School Aged Children. Pupils were selected by school and classroom and the sample was stratified to be representative of the geographical distribution of school students in Ireland.

Data were collected by teachers from school pupils in their classrooms.

Data were collected from 187 schools which included 8497 pupils (51% girls) aged 9–17 years.

While a minority of pupils (12% of girls, 4% of boys) reported that they were on a diet to lose weight, a substantial proportion (28% of girls, 18% of boys) said that they should be on a diet. Dieters reported consuming unhealthy foods less frequently than non-dieters, but did not report an increased consumption of fruit and vegetables. Rather, some categories of dieters reported higher levels of coffee and tobacco use and lower exercise levels than non-dieters.

The results could indicate substitution of unhealthy foods by other unhealthy behaviours as opposed to an increased consumption of healthier foodstuffs, and suggest that both smoking and exercise need to be addressed alongside nutrition in youth health promotion.

To assess the impact and suitability of a pilot dietary educational programme for primary school pupils. The Nutrition Education at Primary School (NEAPS) programme aimed to build awareness of the benefits of healthy eating, induce positive behaviour change and increase the children's knowledge.

A comparative quasi-experimental study with follow-up after 3 months.

Eight primary schools in the Eastern and North Western Health Boards and three control schools in the same board regions.

Data were used from 821 Irish school children aged 8–10 years old.

The education programme comprised 20 sessions over 10 weeks including circular worksheets, homework assignments and an aerobic exercise regime. At baseline and after 3 months pupils completed food diaries and a validated food pairing questionnaire on food behaviour, knowledge and preferences.

Significant differences were found in the intervention children's behaviour and preference levels after the NEAPS programme (P < 0.01 in both sections). Knowledge levels were very high at baseline and though some individual items improved, average change overall was not significant. Rural children appeared to benefit more in behaviour and preferences from the programme (P < 0.01). The NEAPS programme appeared to be less effective in pupils in disadvantaged areas (P < 0.01 for each of the sections: behaviour, preference and knowledge). One hundred and eighty-seven children completed food diaries. The intervention children's consumption of fruit and vegetables increased, and they consumed less salty snacks after the programme. Rural children were confirmed to have healthier diets at baseline.

Following the NEAPS pilot programme positive changes were seen in the school children's eating behaviour and preferences for healthier foodstuffs. This suggests successful development of a culturally sensitive nutrition education programme for school children aged 8–10 years.

To identify, using the novel application of multivariate classification trees, the socio-economic, sociodemographic and health-related lifestyle behaviour profile of adults who comply with the recommended 4 or more servings per day of fruit and vegetables.

Cross-sectional 1998 Survey of Lifestyle, Attitudes and Nutrition.

Community-dwelling adults aged 18 years and over on the Republic of Ireland electoral register.

Six thousand five hundred and thirty-nine (response rate 62%) adults responded to a self-administered postal questionnaire, including a semi-quantitative food-frequency questionnaire.

The most important determining factor of compliance with the fruit and vegetable dietary recommendations was gender. A complex constellation of sociodemographic and socio-economic factors emerged for males whereas the important predictors of 4 or more servings of fruit and vegetable consumption among females were strongly socio-economic in nature. A separate algorithm was run to investigate the importance of health-related lifestyle and other dietary factors on compliance with the fruit and vegetable recommendations. Following an initial split on compliance with dairy recommendations, a combination of non-dietary behaviours showed a consistent pattern of healthier options more likely to lead to compliance with fruit and vegetable recommendations. There did, however, appear to be a compensatory element between the variables, particularly around smoking, suggesting the non-existence of an exclusive lifestyle for health risk.

Material and structural influences matter very much for females in respect to compliance with fruit and vegetable recommendations. For males, while these factors are important they appear to be mediated through other more socially contextual-type factors. Recognition of the role that each of these factors plays in influencing dietary habits of men and women has implications for the manner in which dietary strategies and policies are developed and implemented.