Healthy public policy to support healthy and equitable eating
Project title: A systems approach to healthy and equitable eating
Start date: October 2014
Estimated end date: January 2018
What is the issue?
Typically, people with less money, less education, insecure working conditions and poor living conditions are more likely to have higher levels of diet-related diseases. What, when and how much different social groups eat is determined by a complex system of interconnected factors. The food system, the social system and individual factors all interact in a complex manner to promote or hinder inequities in healthy eating.
The food system – including production, processing, manufacturing, distribution, marketing, retail and procurement – affects dietary behaviours by influencing consumer food environments and thus the availability, affordability, physical accessibility, and acceptability of different foods.
People’s dietary behaviours are also a response to the daily living conditions in which they are born, live, learn, work and age – the social determinants of healthy eating. These social determinants include income, employment, social protection, education, transport, planning, housing, social exclusion, cultural norms and gender. Individual levels factors also play a role in affecting what people choose to eat and may include but are not limited to knowledge, attitudes, stress, and social support.
The prevention of diet-related chronic diseases and obesity requires policies and actions that aim to improve the availability, affordability, accessibility and acceptability of healthy food, and decrease the availability, affordability and acceptability of unhealthy food. Policy coherence is needed to support and reinforce healthy food choices or one policy may negate another policy’s effectiveness. For example, urban planning policy may support the proliferation of fast-food outlets in low-income neighbourhoods or near schools, undermining policy aimed at promoting health.
When tackling a complex issue such as inequities in healthy eating, the tendency is often to oversimplify the problem and the solution, rather than address the many interacting factors that affect consumption of a healthy diet among all social groups.
To this end, we need an evidence base that takes a systems approach and that can guide coherent policy development and implementation across a range of policy areas (including health, education, social and urban planning), which directly and indirectly affect inequities in healthy eating.
How is the project addressing the issue?
This project is examining the different parts of the food system in Australia to identify what is needed to create a healthy and equitable eating – or HE2 – system in Australia.
The HE2 project has five aims:
- Develop a systems-based framework to clarify and communicate the interconnections between different policy domains and Healthy and Equitable Eating (HE2)
- Explore the quantitative modelling of the interconnections between key policy subsystems and HE2
- Establish the Healthy and Equitable Eating (HE2) framework for addressing the social determinants of inequities in healthy eating
- Test the HE2 framework using Australian federal and state level government policies
- Identify barriers and opportunities to cross-government action that takes a systems approach to the pursuit of HE2 goals
Relevance for practice
The co-production approach to this project will ensure that policy makers are provided with real-time evidence to inform the development of policy and practice and to assess whether their current approaches to enabling healthy eating among all social groups in Australia are effective. The project will also help policy makers across different portfolios understand how policy and action in their sector affects inequities in healthy eating.
What are the expected outcomes?
The project will provide an evidence base for what can be done to improve nutrition equitably. It aims to ensure nutrition and health equity goals are integral to federal and state cross-government policies and programs.
- Professor Sharon Friel, Australian National University
- Professor Louise Baur AM, University of Sydney and The Children’s Hospital Westmead
- Professor Rob Carter, Deakin University
- Ms Megan Cobcroft, NSW Health
- Professor Amanda Lee, Sax Institute
- Ms Elizabeth Munn, NSW Health
- Dr Melanie Pescud, Australian National University
- Adjunct Professor Lucie Rychetnik, Sax Institute
- Dr Gary Sacks, Deakin University
- Professor Alan Shiell, La Trobe University
- Ms Beth Thomas, Heart Foundation
This project was funded by the NHMRC, Australian Government Department of Health, NSW Ministry of Health, ACT Health and the HCF Research Foundation.
- Our HE2 Policy Framework manuscript and the HE2 Systems manuscript are under review
- Interview data are being further analysed and written up
- We have presented locally and internationally at several policy and research forums on systems approaches to health equity and/or obesity
- Carey G, Malbon E, Carey N, Joyce A, Crammond B, Carey A. Systems science and systems thinking for public health: a systematic review of the field. BMJ Open 2015;5:e009002.doi:10.1136/bmjopen-2015-009002
- Friel S, Pescud M, Malbon E, Lee A, Carter R, Greenfield G, Cobcroft M, Potter J, Rychetnik L, Meertens B. Using systems science to understand the determinants of inequities in healthy eating. PLOS ONE 2017. doi: 10.1371/journal.pone.0188872
- Thurber KA., Banwell C, Neeman T, Dobbins T, Pescud M, Lovett R, Banks E. Understanding barriers to fruit and vegetable intake in the Australian Longitudinal Study of Indigenous Children: a mixed-methods approach. Public Health Nutr 2016. pp.1–16. doi:10.1017/S1368980016003013
- Pescud M, Friel S, Lee A, Sacks G, Meertens B, Carter R, Cobcroft M, Munn E, Greenfield J: The Healthy and Equitable Eating (HE2) Policy Framework for Addressing the Social Determinants of Inequities in Healthy Eating, World Congress on Public Health, Melbourne. April 2017.
- Friel S. World Leaders Dialogue – Exploring systems approaches to chronic disease prevention. Working with different systems to develop a national healthy and equitable eating food policy. World Congress on Public Health, Melbourne. April 2017.
- Pescud M, Malbon W, Friel S. HE2: A systems approach to healthy and equitable eating. Heart Foundation, Cardiovascular Health Research Symposium, ACT. May 2016
- Malbon E. Food trail. Mapping the factors impacting equity in the distribution of healthy food. The Australian Prevention Partnership Centre, Investigators Forum. 20 October 2015. Melbourne.
Professor Sharon Friel’s presentations to the Prevention Centre Investigators’ Forum, October 2014
- Prevention Centre news, October 2017: How inequity leads to poor nutrition
- Prevention Centre news, April 2014: Building an equitable system for healthy food
- Prevention Centre news, September 2017: How inequity leads to poor nutrition
- Professor Sharon Friel’s Presentation to the Prevention Centre Investigators’ Forum, October 2014:
Food, governance and equity