"designing, implementing and monitoring evidence-based policies effectively
TRANSCRIPT
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Designing, implementing and monitoring evidence-based policies effectively with multiple actorsBoyd SwinburnProfessor of Population Nutrition & Global Health, University of Auckland, New ZealandandAlfred Deakin Professor, Global Obesity Centre, Deakin University, Australia
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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
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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
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Accountability Framework (Kraak V, Public Health Nutr, 2014)
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What needs to be done to improve nutrition?
Broad goals and strategies are agreed globally: But, they need to be defined more tightly & specifically
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SMART goals for nutrition
Nutrition in SDGs
GNR 2016
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Accountability Framework (Kraak V, Public Health Nutr, 2014)
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More ‘upstream’ monitoring indicators needed1. 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
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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
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World Cancer Research Fund
NOURISHING Framework
• Nutrition policy areas• International exemplars
www.wcrf.org
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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)PR
OCE
SSES
IMPA
CTS
OU
TCO
MES
Food composition
Foodlabelling
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 structureO
RGAN
ISAT
ION
SFO
OD
ENVI
RON
MEN
TSPO
PULA
TIO
NS
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Countries using INFORMAS modulesGovt Indust
ryComposition
Labels
Promotion
Prices
Retail
Provision
Trade
NZLAUSFIJTHAMEXCHLGTMGBRARGCANBRACHNCRIINDUSAZAFVNMMYSMLT
www.informas.org
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Accountability Framework (Kraak V, Public Health Nutr, 2014)
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INFORMAS• Food-EPI = Food
Environments Policy Index
• NZ example• 20 food policy
indicators• 20 supporting
infrastructure indicators
• Independent experts evaluate evidence of implementation progress
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Dashboards for accountability
Tolley H et al BMC Public Health 2016
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Access to Nutrition Index – 25 top global food manufacturers
www.accesstonutrition.orgDone in 2013 and 2015Country spotlight - India
ATNI tool being adapted for INFORMAS – Company Impact Assessment – Data collection in 6 countries in 2017
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Global Nutrition Report (www.globalnutritionreport.org)
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Accountability Framework (Kraak V, Public Health Nutr, 2014)
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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
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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
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Accountability Framework (Kraak V, Public Health Nutr, 2014)
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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
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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
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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