Fiscal policy levers to improve diets and prevent obesity

Preventing obesity is a high priority for Australian governments. While individuals have a responsibility to manage their own diet and weight, governments also have a role to play. Governments can enable individual health promoting behaviours through a range of means including: the physical environment (for example, by providing access to cycle paths that are safe), economic incentives (for example, by imposing taxes on unhealthy foods), policies (for example, by funding health services that help people lose weight), and social-cultural factors (for example, advertising campaigns designed to change attitudes, beliefs, perceptions, values and norms of the societal or cultural group). This paper considers the evidence regarding economic incentives in the form of targeted taxes and subsidies on food and beverages

Negotiating healthy trade in Australia: health impact assessment of the proposed Trans-Pacific Partnership Agreement

Drawing on leaked texts of potential provisions of the proposed Trans-Pacific Partnership Agreement, this health impact assessment found the potential for negative impacts in the cost of medicines, tobacco control policies, alcohol control policies, and food labeling. Overview The Centre for Health Equity Training Research and Evaluation (CHETRE) has been working with a group of Australian academics and non-government organisations interested in the health of the Australian population to carry out a health impact assessment (HIA) on the Trans-Pacific Partnership Agreement (TPP) negotiations. In the absence of official publicly available drafts of the trade agreement, the health impact assessment drew on leaked texts of potential provisions and formulated policy scenarios based on high priority health policies that could be affected by the TPP. The HIA found the potential for negative impacts in each of the four areas under investigation: the cost of medicines; tobacco control policies; alcohol control policies; and food labeling. In each of these areas, the HIA report traces the relevant proposed provisions through to their likely effects on the policy scenarios onto the likely impact on the health of Australians, focusing particularly on vulnerable groups in the Australian community. The report makes a number of recommendations to DFAT regarding the TPP provisions and to the Australian Government regarding the TPP negotiating process

Advancing Public Health on the Changing Global Trade and Investment Agenda Comment on “The Trans-Pacific Partnership: Is It Everything We Feared for Health?”

Concerns regarding the Trans-Pacific Partnership (TPP) have raised awareness about the negative public health impacts of trade and investment agreements. In the past decade, we have learned much about the implications of trade agreements for public health: reduced equity in access to health services; increased flows of unhealthy commodities; limits on access to medicines; and constrained policy space for health. Getting health on the trade agenda continues to prove challenging, despite some progress in moving towards policy coherence. Recent changes in trade and investment agendas highlight an opportunity for public health researchers and practitioners to engage in highly politicized debates about how future economic policy can protect and support equitable public health outcomes. To fulfil this opportunity, public health attention now needs to turn to strengthening policy coherence between trade and health, and identifying how solutions can be implemented. Key strategies include research agendas that address politics and power, and capacity building for both trade and health officials

How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention

Alcohol, tobacco, and unhealthy foods contribute greatly to the global burden of non-communicable disease (NCD). Member states of the World Health Organization (WHO) have recognized the critical need to address these three key risk factors through global action plans and policy recommendations. The 2013-2020 WHO action plan identifies the need to engage economic, agricultural and other relevant sectors to establish comprehensive and coherent policy. To date one of the biggest barriers to action is not so much identifying affective policies, but rather how a comprehensive policy approach to NCD prevention can be established across sectors. Much of the research on policy incoherence across sectors has focused on exposing the strategies used by commercial interests to shape public policy in their favor. Although the influence of commercial interests on government decisions remains an important issue for policy coherence, we argue, that the dominant neoliberal policy paradigm continues to enable the ability of these interests to influence public policy. In this paper, we examine how this dominant paradigm and the way it has been enshrined in institutional mechanisms has given rise to existing systems of governance of product environments, and how these systems create structural barriers to the introduction of meaningful policy action to prevent NCDs by fostering healthy product environments. Work to establish policy coherence across sectors, particularly to ensure a healthy product environment, will require systematic engagement with the assumptions that continue to structure institutions that perpetuate unhealthy product environments

Trade, food and nutrition security in South Africa: The cases of sugar and poultry

The purpose of this paper is to consider the role that trade plays in food and nutrition security in South Africa. Despite an established commercial food system, South Africans experience high levels of food and nutrition insecurity – both under-nutrition and rising rates of diet-related non-communicable diseases (NCDs). The Food and Agriculture Organization of the United Nations (FAO) defines food security as ‘a situation that exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life’1. This paper considers three dimensions of food security – availability, access and nutrition – and unpacks the role of trade across these dimensions at policy level and in practice in sugar and poultry, two key commodities in the food basket of resource-poor South African households. According to the South African National Health and Nutrition Examination Survey (SANHANES- 1) (Shisana et al., 2013:10), 26% of households surveyed nationally reported experiencing hunger, with another 28% of households at risk of hunger. Households in ‘urban informal’ contexts, followed by those in rural formal and then rural informal settings experienced the highest levels of food insecurity. Eastern Cape and Limpopo are the provinces with the highest proportion of food insecure people. The 2005 National Consumption Survey showed that 18% of children in South Africa were stunted, with rural and then urban informal areas most severely affected. ‘Wasting’ (from poor nutrition quality, rather than insufficient food) affected 4.5% of South African children, with 9.3% of children being underweight (DAFF, 2014:9)

School food environment in urban Zambia: A qualitative analysis of drivers of adolescent food choices and their policy implications

Identifying context specific points for reforming policy to promote healthier food environments and consumer behavior in critical life stages like adolescence is crucial in addressing the double burden of malnutrition. Using a qualitative study design, we conducted 20 focus group discussions with grade 10 pupils from ten secondary schools in Lusaka. Turner’s framework which conceptualizes the food environment into two domains—the external domain (availability, pricing, vendor and product properties, and marketing and regulation of food) and the internal domain (accessibility, affordability, convenience, and desirability of food)—was used to guide thematic data analysis and results interpretation. Adolescents stated their food choices are largely based on personal preference linked to the need for social acceptability among peers

A Systematic Review of the Effect of Remittances on Diet and Nutrition

Background: Remittance income is rising rapidly in most low- and middle-income countries. Despite nutrition being a key policy priority for health and development, we know little about the effect of remittance income on diets and nutrition. Objective: To identify the effect of remittance income on nutrition. Method: Systematic review of English-language studies providing information on the impact of remittances on food consumption, food expenditure, or measures of nutritional status, using a narrative synthesis approach for analysis. We searched the English-language published and gray literature using key words ‘‘remittances,’’ ‘‘nutrition,’’ and ‘‘diets.’’ Results: This systematic review identified 20 studies that examined the effect of remittance income on food consumption, dietary intake, and nutritional status, 2 of which were qualitative studies. Overall, the quality of the studies was weak to moderate. These studies show that remittances can increase access to (purchased) food and may have a consumption smoothing effect, reducing households’ vulnerability and leading to improved food security and reductions in underweight. However, remittances appear to have little effect on markers of chronic undernourishment. The studies also suggest that the extra income from remittances may compound trends toward purchasing less healthy (nontraditional) foods that are associated with the nutrition transition. Conclusion: There is an urgent need for further research on the effect of remittances on nutrition and diets, with remittance income forecast to rise rapidly into the future. Programs to ensure that those households receiving remittances move beyond just meeting sufficient calories and improve dietary quality could create nutritional benefits

Accelerating the Worldwide Adoption of Sugar-Sweetened Beverage Taxes: Strengthening Commitment and Capacity Comment on “The Untapped Power of Soda Taxes: Incentivizing Consumers, Generating Revenue, and Altering Corporate Behavior”

Abstract In their recent article Roache and Gostin outline why governments and public health advocates should embrace soda taxes. The evidence is strong and continues to grow: such taxes can change consumer behavior, generate significant revenue and incentivize product reformulation. In essence, such taxes are an important and now well-established instrument of fiscal and public health policy. In this commentary we expand on their arguments by considering how the worldwide adoption of such taxes might be further accelerated. First, we identify where in the world taxes have been implemented to date and where the untapped potential remains greatest. Second, drawing upon recent case study research on country experiences we describe several conditions under which governments may be more likely to make taxation a political priority in the future. Third, we consider how to help strengthen the technical and legal capacities of governments to design and effectively administer taxes, with emphasis on low- and middle-income countries. We expect the findings to be most useful to public health advocates and policy-makers seeking to promote healthier diets and good nutrition