This document summarizes a study that analyzed multisectoral policy approaches to reshape food systems and promote healthy diets in order to reduce diet-related diseases. The study used a food systems framework and policy analysis models to examine 120 policy documents. Key findings include: 1) Achieving policy coherence across sectors requires a food systems approach; 2) Building collaborative structures can facilitate multisectoral action; 3) Effective policy requires a combination of mechanisms; 4) Food policy research can combine frameworks to generate evidence-informed recommendations; 5) Opportunities can be seized to couple policies that address leverage points.

1. What can policymakers do to reshape food systems for healthy diets? A scoping analysis of multisectoral approaches
Introduction
The study of food, nutrition, and health using a systems approach recognizes that
determinants of diet and diet-related disease do not follow linear causal pathways and
that causality is difficult to establish within a system of multiple levels of risk factors.
The complexities of modern food governance, dietary patterns, and associated health
outcomes (see Figure 1) require cross-sectoral collaboration as the burden of diet-related
non-communicable disease (NCDs) can no longer be addressed by the health sector
alone. Many national governments and international organizations are calling for
multisectoral responses to the global burden of NCDs, however there exist few policy
frameworks providing guidance on multisectoral food policy processes.
Anna Savelyeva1, MSc Food Policy
1Centre for Food Policy, Department of Sociology, City University London, United Kingdom. Contact: Anna.Savelyeva.1@city.ac.uk
Methodology
Policy change results from a constant interplay between actors in the food supply chain,
civil society, and governments, as well as outcomes associated with the actions of
networks, institutions, ideas, and crises and shocks. Using a food systems framework,
multiple types of multisectoral policy processes were analyzed in an attempt to identify
common factors among various policies aiming to reduce and prevent diet-related NCDs.
The Policy Triangle Analysis Framework, Multiple Streams Analysis, and Advocacy
Coalition Framework were used in combination to analyze policy processes.
‘Multisectorality’ is used as an umbrella term to refer to collaboration and integration
achieved through processes, structures, and administrative mechanisms between
governmental sectors and departments (whole-of-government), and between
governmental sectors, industry, and civil society actors (whole-of-society).
Research questions were formulated based on literature availability on particular types of
policies aiming to transform food systems for healthy diets. A literature review identified
a total of 120 documents (106 from peer-reviewed sources & 14 from grey literature) for
analysis.
Country/Policy
Strong civil
society
advocacy
Government-
initiated /
Champions
within
government
Industry
stakeholder
participation
from early
stages
Health
evidence /
Formal
scientific
inquiry /
appraisal
Consumer
awareness
campaign,
and/or
public
concerns
following
media
attention
Government
support,
fiscal
incentives,
and/or
capacity
building
Creation of
action plan
and targets
Surveillance
and
evaluation;
health
surveys
Independent
monitoring
of food
products
Coordination
by multi-
stakeholder
working
group,
committee,
or advisory
agency
Coordination
by
independent
government
agency
Collaboration
without
formal
mechanism
Argentina
(National Salt Reduction Strategy;
Voluntary Agreements) ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Australia
(Food and Health Dialogue;
Voluntary Salt Reduction)
✓ ✓ ✓ ✓ ✓ ✓ ✓
Belgium
(Voluntary salt reduction
agreements with food industry)
✓ ✓ ✓ ✓ ✓ ✓
Brazil
(National Strategy for Sodium
Reduction; Voluntary Agreements) ✓ ✓ ✓ ✓ ✓ ✓ ✓
Canada
(Sodium Reduction Strategy;
Voluntary Agreements)
✓ ✓ ✓ ✓ ✓ ✓ ✓
Chile
(Voluntary salt reduction
agreements with food industry)
✓ ✓ ✓ ✓ ✓ ✓
France
(Charter of engagement with food
industry; voluntary salt reduction) ✓ ✓ ✓ ✓ ✓ ✓
Italy
(Voluntary salt reduction
agreements)
✓ ✓ ✓ ✓ ✓
Ireland
(Salt Reduction Programme;
Voluntary agreements)
✓ ✓ ✓ ✓ ✓
United Kingdom
(Responsibility Deal; voluntary salt
reduction)
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Singapore
(Healthier Hawker Programme;
voluntary product reformulation) ✓ ✓ ✓ ✓ ✓ ✓ ✓
Denmark
(Trans fat ban) ✓ ✓ ✓ ✓ ✓ ✓ ✓
Fiji
(Sales ban on mutton flaps) ✓ ✓ ✓ ✓
Ghana
(Standards for fat content in high-fat
meats)
✓ ✓ ✓ ✓ ✓ ✓
RQ2. Policies aiming to improve the quality of the food supply
Factors facilitating effective policy processes:
• Identifying shared values, interests, and objectives across sectors
• Capacity building through cross-sectoral collaboration (see Figure 2)
• Sharing of activities, management, structures, and functions
• Creating independent multisectoral governance spaces
• Developing needs and impact assessment mechanisms
• Harnessing windows of opportunity for policy coupling
RQ3. Food and Nutrition Policy CouncilsRQ3. Food and Nutrition Policy Councils
National Local
Brazil National Council on Food
and Nutrition Security
(CONSEA)
Nordic Nutrition Policy
Councils (Denmark, Finland,
Sweden, Norway)
Toronto Food Policy Council
(Canada)
Vancouver Food Policy Council
(Canada)
Local & State food policy councils
(North America)
Factors facilitating effective policy processes:
• Civil society advocacy
• Policy entrepreneurs/champions
• Enabling structures
• Systems thinking, leverage points, policy coherence
• Government budget allocation
• Strategies and action plans
• Independent advisory capacity
• Strategic partnerships
RQ1. Conceptual frameworks
A. Healthy Public Policies
B. Intersectoral Action for Health
C. Health in All Policies
D. Joined-up Government
E. Agri-health
F. Ecological Public Health
Findings Discussion
Agenda setting
Agenda setting, or policy initiation, is often dependent on windows of opportunity
created by political events; there are however opportunities for policy coupling using
common leverage points and ‘policy entrepreneurship’ even in the absence of an
open window. Policy coherence with non-health sectors occurs when numerous food
system objectives converge and are not solely focused on attaining health-related
goals. Policy integration can be represented by a Collaboration Continuum (see
Figure 2) affecting political agendas, institutional structures, and approaches to
public administration.
Policy implementation processes
Multisectoral policy mechanisms can create enabling conditions for integrating
multiple policies in the long-term. Policy processes such as identifying existing
structural arrangements and leverage points, building partnerships, working with
policy champions, developing strategies, action plans, targets, and monitoring
mechanisms, and establishing multistakeholder working groups can build capacity
for joined-up food policy and help set political agendas.
Advocacy coalitions
Advocacy coalitions are powerful forces in engaging with the evidence and
advocating for specific policy solutions. Advocacy coalitions can effectively move
issues onto the political agenda and can serve as catalysts in the development of new
structures such as working groups, task forces, and food and nutrition policy
councils.
Evidence-informed policy-making
Clear, strategic, and innovative presentation of the evidence base and policy problem
being addressed is an important factor in the policy process. A strong evidence base
does not guarantee policy action; Extensive civil society campaigning, media
attention, and public concern help move food policies onto the political agenda.
Conclusion
Five key lessons on policy processes can be drawn:
1. A food systems approach to NCD reduction means attaining policy coherence with
other sectors
2. Building mechanisms and structures and harnessing existing resources and networks
to facilitate intersectoral action for health can be a first step toward building
capacity for policy integration of food systems approaches to NCD reduction
3. A combination of multiple policy mechanisms must be used for effective
multisectoral food policy processes
4. Food policy research can combine multiple frameworks and approaches to
studying food systems, such as interpretive and deliberative policy analysis, to
generate evidence-informed policy recommendations
5. Using a reflexive policy practice approach, public health policymakers can be
prepared to harness leverage points and policy windows for policy coupling
Research Questions were stated as follows:Research Questions were stated as follows:
RQ1 What are the main conceptual frameworks of multisectorality of relevance to
food policy?
RQ2 What lessons on multisectoral policy processes for NCD reduction can be
learned from policies aiming to improve the quality of the food supply?
RQ3 What lessons on multisectoral policy processes for NCD reduction can be
learned from existing food and nutrition policy councils at local, sub-national,
and national levels?
Line Functioning
Networking
Cooperation / Coordination
Collaboration
Integration
Figure 1. Food systems and their drivers (Source: Ericksen, 2008)
Figure 2. A continuum of multisectoral
collaboration (Source: Garrett et al, 2014)
Selected Bibliography
Ericksen, P. (2008) ‘Conceptualizing food systems for global environmental change research’, Global Environmental Change, Vol 18,
pp. 235-45.
Garrett, J., Kudiyala, S. and Kohli, N. (2014) Working Multisectorally to Improve Nutrition: Global lessons and current status in India.
POSHAN Policy Note 1. New Delhi, India: International Food Policy Research Institute.
Hawkes, C., Thow, A. M., Downs, S., Ghosh-Jerath, S., Snowdon, W., Morgan, E., Thiam, I. and Jewell, J. (2013) Leveraging
agriculture and food systems for healthier diets and noncommunicable disease prevention: the need for policy coherence. Rome: FAO/WHO.
Kickbusch, I. (2010) The Food System: a prism of present and future challenges for health promotion and sustainable development. Geneva:
Health Promotion Switzerland.
Lang, T., Barling, D. and Caraher, M. (2009) Food Policy: integrating health, environment and society. Oxford: Oxford University Press
Acknowledgements
I would like to thank my dissertation supervisor, Professor Tim Lang, who provided valuable guidance throughout the research
process.