Physik und Wirtschaft (.) - Philipps-Universitt Marburg
49 Free or low price provision of fruits and vegetables, farm to school programmes, and school gardens are also promising strategies, although long term effects and cost-benefits are not yet rigorously evaluated. This article is one of a series commissioned by The BMJ. 100 While the cases vary in their geographical and sociopolitical contexts and objectives, common themes are seen: Interactions between public and commercial sectors are numerous and diverse Transparency and documentation of these interactions are often limited Corresponding risks are. More directly, certain food companies have actively opposed policies about healthier foods, 95 especially in low and middle income countries. Link to and use existing surveillance systems (eg, healthcare) as well as new technologies (eg, social media, and personal monitors) Identify and use complementary global public health activities (eg, the United Nations Sustainable Development Goals including to bring stakeholders together. In addition, further research is needed on how to identify, study, and minimise conflicts of interest in food and nutrition policy. Types of policy interventions Governments can use a spectrum of policies from voluntary to mandatory.
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To our knowledge no country has implemented a full range of updated, comprehensive, and evidence informed strategies to encourage a healthier and more equitable food system ( table 1 ). Employers, communities, schools, hospitals, and religious congregations should implement organisational strategies for healthier eating. Otherwise, such platforms may stall regulation and policy by suggesting agreement among civil society, government, and industry when there are in fact disagreements. Disincentives on specific foods can be politically difficult, however, the rapid international expansion of taxes on sugar sweetened beverages shows the growing acceptance of this approach. Even single or simple interventions induce effects within complex webs of interactions. Edu, for most of human history including much of the 20th century, insufficient food was the greatest nutritional challenge. Hospitals should be incentivised by new quality measures and reimbursement guidelines to implement worksite wellness and engage in community public health. 3 4 Governments should invest in their own employee worksite wellness programming and pursue policies, such as guidelines and tax incentives, to promote the implementation and evaluation by private employers of worksite efforts for healthier eating.
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In contrast to education and information, fiscal incentives and disincentives aimed at consumers, producers, and retailers have more consistent evidence of effectiveness. Industry self regulation is not sufficient to advance public health goals. Actions should include developing and measuring adherence to nutrition policy standards; coordinating efforts of member country; assisting governments as needed with design, implementation, and evaluation of food policies; bringing stakeholders together including global agribusiness, restaurant chains, and food manufacturers; and providing. The effectiveness of such policies on behaviour change overall and in specific population subgroups has been variable and they may have smaller effects in marginalised groups. Ideally, actions should be coordinated between ministries, agencies, and at local, national, and international levels. Unclear or variably enforced government provisions on conflicts of interest can further increase industry influence. The evidence to support policy interventions is also different from that for interventions delivered to individuals. Additional government regulation and standards are important to enforce the implementation of health related food and nutrition policies. However, such approaches can also promote industry reformulations, which may have an important effect on longer term health beyond immediate consumer behaviour.
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These have been achieved through a combination of scientific progress, public awareness and advocacy, consumer demand, industry innovation, government regulation, and cultural change. 10 11 12, broader sociocultural determinants of personal choices include household lifestyle patterns such as television watching and sleep, family and community norms, social pressures, social class, social networks, and race/ethnicity. When industry does play a role in research studies, the involvement should be transparent. 21 22 Uncoordinated, these many influences are powerful and are nearly insurmountable barriers to making healthy dietary choices for many people worldwide. Surveillance systems for monitoring and evaluating nutrition trends and disparities are under resourced. The food industry must be a facilitator for, not a barrier to, healthy food policies and use their expertise, scale, innovation, and marketing to develop, distribute, and market healthier foods, and create transparent, sincere partnerships with academics, advocacy groups, and government.
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Individual providers and health organisations face several barriers to nutrition promotion. Areas for investigation in the next decade, for example, include basic molecular pathways; diet-microbiome-host interactions; individual fatty acids and their lipid derivatives; prebiotics, probiotics, and fermentation; phenols and other bioactive compounds; personalised nutrition; and nutrition data (big data). Governments have a duty to ensure that interests not in the public good do not influence the individuals or institutions responsible for public decision making, and preserving integrity and public trust. At the time, a global pandemic of obesity and chronic diseases from the widespread availability of inexpensive, unhealthy food was inconceivable. View Abstract Back to top. By their nature, public health concerns such as nutrition are multifactorial. Based on current evidence, the best approaches are: Fiscal incentives/disincentives (eg, taxes and subsidies) for consumers, the food industry, and organisations (eg, worksites) Prioritisation of both food security and nutritional quality in food assistance programmes Appropriate standards for additives.
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Large multinational companies frequently have a great influence because of their economic power, government lobbying, and communication and marketing resources. Health systems, clinicians, and insurers should implement strategies on patient behaviour change; advocate for broad changes in health systems to support these efforts; and engage with local communities. Governments should establish guidelines about participants in groups that are responsible for policy design. Role of government policy in nutritionbarriers to and opportunities for healthier eating. Governments should also promote the food industrys shift towards healthier foods, taking advantage of rapidly rising consumer demand. Government must have the will to act and the governance and partnerships to support action. For instance, limitations or standards on trans fat and sodium have been implemented in many countries and similar standards being considered for free or added sugars. 23 We focus on policies directly targeting nutrition rather than more indirect mechanisms related to, for example, trade, farming, food waste, general education, and economic empowerment.
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We appreciate that other nutrition policy frameworks have been considered. 5 6 7 We focus on a broad range of interventions and nutrition policies and discuss their strengths, limitations, uncertainties, and recommendations. To reduce financial regressivity and increase the health effect, tax revenues can be used for other health promotion strategies including retail, manufacturing, or agricultural incentives to reduce the price of healthier food products. For instance, the food and beverage industry should not participate in decision making on the design, implementation, or evaluation of obesity prevention policies. However, with thoughtful, evidence informed policy, each of these factors also provides an opportunity for governments to support improvements in diets, health, wellbeing, and equity. The expertise to combine and phase different policy approaches can be lacking. For each, governments should assess whether the implemented strategies have the intended effects, identify and tackle disparities, and detect unintended consequences. Psychological influences include attitudes to food and health, incentives, motivation, and values.
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The relatively recent rise of diet related chronic diseases including obesity, type 2 diabetes, cardiovascular diseases, and several cancers is at least partly a byproduct of these historical approaches and the responses of industry and consumers. This must include development of clear and transparent policies to identify and minimise conflicts of interest (see box 2 ) Facilitate participation of other stakeholders in policy development, implementation, and evaluation Incorporate nutrition and health in all of government, for example, city. Past successes that can point the way forward include effective public health approaches to complex problems such as tobacco use, motor vehicle crashes, and occupational safety. Multistakeholder platforms should have guidelines on conflict of interest identification, management, and protection. Implementation of policy actions must be accompanied by systematic surveillance and evaluation to assess progress and guide further efforts.
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Open access fees for the series were funded by Swiss Re, which had no input into the commissioning or peer review of the articles. These successes provide a template for a healthier food system, that is: address the consumer, the product (agricultural commodities, foods, and beverages the environment (retailers, cafeterias, and restaurants and the culture (unhealthy eating, and marketing). 82 In addition, vanguard local and national quality standards should be implemented on the use of food additives by industry such as trans fat, sodium, and sugar. Industry opposition can be a major barrier, including political lobbying and marketing campaigns to fight policies they consider unfavourable. Need for more than self regulation. WHO recently published draft guidance for the prevention and management of conflicts of interest in policy development and implementation of national nutrition programmes.