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"Designing, implementing and monitoring evidence-based policies effectively

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with multiple actors Boyd Swinburn Professor of Population Nutrition & Global Health, University of Auckland, New Zealand and Alfred Deakin Professor, Global Obesity Centre, Deakin University, Australia "

"www.fao.org/about/meetings/sustainable-food-systems-nutrition-symposium

The International Symposium on Sustainable Food Systems for Healthy Diets and Improved Nutrition was jointly held by FAO and WHO in December 2016 to explore policies and programme options for shaping the food systems in ways that deliver foods for a healthy diet, focusing on concrete country experiences and challenges.

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"Designing, implementing and monitoring evidence-based policies effectively

  1. 1. Designing, implementing and monitoring evidence-based policies effectively with multiple actors Boyd Swinburn Professor of Population Nutrition & Global Health, University of Auckland, New Zealand and Alfred Deakin Professor, Global Obesity Centre, Deakin University, Australia
  2. 2. Overview • Understanding the accountability cycle – Set the account – Take the account – Share the account – Hold to account – Respond to the account • Ways forward for strengthening accountability for nutrition outcomes – reducing malnutrition in all its forms
  3. 3. Accountability systems • Responsibility (one actor) – Being in charge of or owning a task – eg government responsibility for developing food policies; corporate social responsibility • Accountability (multiple actors) – One actor being answerable to another actor(s) for tasks being done and explaining decisions/actions – eg governments requiring food companies to follow food labelling laws or go to court to defend themselves – Involves power relationships (holding to account) • Multi-actor accountability systems – Reduce large power imbalances between actors – Mutual accountability versus independent accountability
  4. 4. Accountability Framework (Kraak V, Public Health Nutr, 2014)
  5. 5. What needs to be done to improve nutrition? Broad goals and strategies are agreed globally: But, they need to be defined more tightly & specifically
  6. 6. SMART goals for nutrition Nutrition in SDGs GNR 2016
  7. 7. Accountability Framework (Kraak V, Public Health Nutr, 2014)
  8. 8. More ‘upstream’ monitoring indicators needed 1. Food policy implementation 2. Food supply and environments – eg food availability, composition, labelling, promotion, price, provision, retail, trade & investment agreements • WHO / FAO surveys • WCRF Nourishing framework and exemplars • Global Nutrition Reports • Access to Nutrition Index (ATNI) • INFORMAS – benchmarking – International Network for Obesity/NCDs Research, Monitoring, and Action Support NGOs and academia
  9. 9. WHO/FAO monitoring systems • Several databases – eg FAO Food Balance Sheets, WHO NCD Country Capacity Survey, Global database on Implementation of Nutrition Actions (GINA), databases on child growth, BMI, infant feeding etc • Challenges – Comprehensiveness of countries and indicators (eg policy implementation) – Validity – Disaggregation – Utilisation
  10. 10. World Cancer Research Fund NOURISHING Framework • Nutrition policy areas • International exemplars www.wcrf.org
  11. 11. Public sector policies and actions Private sector policies and actions How much progress have (international, national, state and local) governments made towards good practice in improving food environments and implementing obesity/NCDs prevention policies and actions? (University of Auckland) How are private sector organisations affecting food environments and influencing obesity/NCDs prevention efforts? (Deakin University) PROCESSESIMPACTSOUTCOMES Food composition Food labelling Food marketing Food provision Food retail Food prices Food trade & investment What is the nutrient composition of foods and non- alcoholic beverages? (The George Institute) What health- related labelling is present on foods and non- alcoholic beverages? (University of Oxford) What is the exposure and power of promotion of unhealthy foods and non- alcoholic beverages to different population groups? (University of Wollongong) What is the nutritional quality of foods and non- alcoholic beverages provided in different settings (eg. schools, hospitals, workplaces)? (University of Toronto) What is the availability of healthy and unhealthy foods and non- alcoholic beverages in communities and within retail outlets? (University of Auckland) What is the relative price and affordability of ‘less healthy’ compared with ‘healthy’ diets, meals & foods? (Queensland University of Technology) What are the impacts of trade and investment agreements on the healthiness of food environments? (Australian National University) Population diet Physiological & metabolic risk factors Health outcomes What is the quality of the diet of different population groups? (University of Sao Paulo) What are the burdens of obesity and other risk factors? (WHO) What are burdens of NCD morbidity and mortality? (WHO) INFORMAS module structureORGANISATIONSFOODENVIRONMENTSPOPULATIONS
  12. 12. Countries using INFORMAS modules Govt Industry Composition Labels Promotion Prices Retail Provision Trade NZL AUS FIJ THA MEX CHL GTM GBR ARG CAN BRA CHN CRI IND USA ZAF VNM MYS MLT www.informas.org
  13. 13. Accountability Framework (Kraak V, Public Health Nutr, 2014)
  14. 14. INFORMAS • Food-EPI = Food Environments Policy Index • NZ example • 20 food policy indicators • 20 supporting infrastructure indicators • Independent experts evaluate evidence of implementation progress
  15. 15. Dashboards for accountability Tolley H et al BMC Public Health 2016
  16. 16. Access to Nutrition Index – 25 top global food manufacturers www.accesstonutrition.org Done in 2013 and 2015 Country spotlight - India ATNI tool being adapted for INFORMAS – Company Impact Assessment – Data collection in 6 countries in 2017
  17. 17. Global Nutrition Report (www.globalnutritionreport.org)
  18. 18. Accountability Framework (Kraak V, Public Health Nutr, 2014)
  19. 19. Power relationships in nutrition (1) • National governments – Roles: to implement policies and actions to improve food systems for population nutrition, sustainability and prosperity – Problems: corruption/incompetence, neoliberal ideologies, bow to pressure from powerful food corporations, nutrition is a low priority • UN & international agencies – Roles: standard-setting, convening, technical support etc – Problems: constrained by funding and member state politics
  20. 20. Power relationships in nutrition (2) • Food corporations – Roles: feed populations, make a profit (improving population nutrition and environmental sustainability not required) – Problems: convert economic power into political power to maintain a political economy favourable for their profits • Civil society (academia, public-interest NGOs, citizens) – Roles: program delivery, advocacy, monitoring, research, etc – Problems: multiple factions around food, low funding and weak leverage • Foundations, development funders – Roles: funding, leveraging change, advocacy – Problems: moving to fund malnutrition in all its forms
  21. 21. Accountability Framework (Kraak V, Public Health Nutr, 2014)
  22. 22. Double and triple duty actions • Malnutrition in all its forms – Double burden of undernutrition and obesity – What are the ‘double duty’ actions which address both? • Food systems and urban/land use systems are big contributors to climate change – ‘Triple duty’ actions may address malnutrition in all its forms and climate change • Increasing food/nutrition literacy; supporting fresh, local food systems; constraining marketing & dominance of processed food; strengthening governance for good policy- making; adjusting fiscal incentives/disincentives etc
  23. 23. Summary • Accountability systems need to be strengthened to achieve better nutrition outcomes • Accounts need to be more tightly specified (SMART) • Monitoring systems: more upstream, better coordinated • Power rebalancing needed - ↓ food corporate power, ↑ civil society power to give governments more space and support for nutrition policies and nutrition- sensitive food policies
  24. 24. Take home message • Engaging public interest civil society more in monitoring could: – Increase comprehensiveness and validity of monitoring systems – Increase the capacity for collecting and using the monitoring data – Create independent accountability systems to complement the mutual accountability systems of Member State governed systems – Support a rebalancing of power to hold the main actors to account for better food policies

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