Supporting priority actions in the food and nutrition system
Project title: Diet and chronic disease prevention: Supporting implementation of priority actions in the food and nutrition system
Start date: May 2018
Estimated end date: December 2021
What is the issue?
Poor diet is the leading preventable risk factor contributing to the burden of disease globally and in Australia. It is a major contributor to the more than $50 billion estimated in annual health care costs and lost productivity from overweight and obesity in Australia.
Less than 1% of Australians eat diets recommended by the Australian Dietary Guidelines, and more than 35% of the energy intake of adults and more than 39% of the energy intake of children comes from discretionary food and drinks (those high in added sugar, saturated fat, salt and/or alcohol).
In addition, dietary risks are not distributed equally. Groups who experience greater social disadvantage have poorer diets, and suffer increased risk of malnutrition, obesity and diet-related chronic disease.
We know that poor diets are driven by current food environments and policies which do not support healthy eating. We need to understand how to better influence nutrition policy and ensure governments implement effective actions in the face of competing interests with different levels of power and influence on the food system.
How is the project addressing the issue?
We know the influences on population nutrition are complex, and that multiple policy actions are needed to help improve population diets in Australia. This project builds on previous Prevention Centre research to identify what influences nutrition policy and action, so we can better understand the key leverage points to intervene in the food system.
The project will assess current food environments in each participating jurisdiction; examine how implementation of priority policy actions could be better supported and by which actors; and work with stakeholders and key actors to develop, implement and evaluate specific demonstration projects at multiple levels.
We will use a range of approaches including regulatory and policy science and systems mapping to support stakeholders to improve implementation of evidence-based interventions, including behavioural economics.
Relevance of the project for policy and practice?
This project will provide policy makers and health and nutrition practitioners with assessable and useful information on the current state of Australian food environments, priority nutrition policy actions, and how best to intervene in the food system to improve population nutrition and health.
As a result, the project will generate evidence that helps move beyond the nanny state/individual choice and regulation/deregulation debates that characterise nutrition policy, regulation and governance literature and discourse.
Health professionals will be better equipped to communicate effectively to policy makers, key actors and the public about evidence-based nutrition policy actions, and policy makers will have ready access in user-friendly formats to the information required for evidence-based decision-making around potential nutrition policy actions that can facilitate Australia’s transition to a nutritious, equitable and sustainable food system.
What are the expected outcomes?
This project will progress effective nutrition policy actions in Australia. It aims to improve understanding of Australian food environments and the regulation and governance regime, and identify how best to intervene at key leverage points, including through better regulation.
It will also prioritise potential nutrition policy actions, and generate practical evidence around priority nutrition actions that contribute to low-cost, translatable and scalable solutions
- Generate practical evidence around priority actions that contributes to low-cost, translatable and scalable solutions
- Build on our previous research to address major knowledge gaps regarding the current state of food environments and, importantly, how best to intervene, including by focusing on different forms of governance/regulation at key leverage points in the food and nutrition system
- Improve effective translation of research through the production of policies, guidelines, tools, case studies and interventions to promote the diet-related health of the population, with a focus on evidence relevant to the range of stakeholders involved in implementation of food and nutrition policies
Professor Amanda Lee, University of Queensland
Professor Sharon Friel, Australian National University
Associate Professor Gary Sacks, Deakin University
Professor Anna Peeters, Deakin University
Dr Katherine Cullerton, University of Queensland
Ms Meron Lewis, University of Queensland
Ella Robinson, Research Fellow, Deakin University
Dr Yandisa Ngqangashe, Australian National University
Dr Ashley Schram, Australian National University
Dr Tara Boelsen-Robinson, Deakin University
Dr Shaan Naughton, Deakin University
Cindy Needham, PhD Student, Deakin University
Sally Schultz, Deakin University
Lisa Herron, University of Queensland
Ella Parnell Harrison, University of Queensland
Dori Pattay, University of Queensland
Ru Chyi Tan, University of Queensland
Evelyn Nicoli, University of Queensland
Former members of research team
Tom White, Data Scientist, University of Cambridge
Dr Kathryn Backholer, Deakin University
Funding for this research has been provided from the Australian Government’s Medical Research Future Fund (MRFF). The MRFF provides funding to support health and medical research and innovation, with the objective of improving the health and wellbeing of Australians. MRFF funding has been provided to The Australian Prevention Partnership Centre under the MRFF Boosting Preventive Health Research Program. Further information on the MRFF is available at www.health.gov.au/mrff.
- Several papers have been published in peer-reviewed journals, listed under the Publications and presentations tab.
- We have expanded networks, including practitioners and policymakers in government and NGO sectors, and other academics internationally during the COVID-19 pandemic.
- Several knowledge translation activities planned around the PHAA World Public Health Nutrition Congress 2020 were unable to proceed because of its cancellation due to COVID-19 restrictions. We are currently considering how to repackage activities in different formats and timeframes.
- In May 2020, we launched a report entitled ‘Inside our Supermarkets 2020’ that compared the major Australian supermarket chains on the healthiness of their in-store environments.
- We have analysed healthy and current diet cost and affordability throughout Queensland, and are consulting currently with stakeholders on the best way to present the results.
- The web-based (i-pad compatible) interface to collect food prices and analyse the cost and affordability of healthy and current diets is now available for other groups to use.
- Members of the Project Team had leadership roles at the PHAA Food Futures’ Conference, chairing several plenary sessions and presenting highly relevant and well-received papers in plenary and concurrent sessions.
- 2019 Report Cards for each jurisdiction on the healthiness of food environments and government policies were launched in April 2019. These included data regarding federal and state nutrition-related policy implementation since the launch of the 2017 Food Policy Index reports. Data were collected in conjunction with government representatives in each jurisdiction. Details can be found here: www.foodpolicindex.org.au The launch of the reports attracted significant national media attention, for more detail, visit: https://www.foodpolicyindex.org.au/in-the-media
- Data collection protocols for food price and food retail audits in Victoria and Queensland have been finalised, data collectors have been trained (May 2019), and data collection is underway in both jurisdictions.
- Healthy Diets ASAP food price data are being collected in Victoria and Queensland by a variety of methods (in store by trained research assistants or by trained Country Women’s Association volunteers using paper-based methods; by electronic ‘scraping’ from the websites of large supermarkets and phone calls to smaller outlets) in order to identify the most cost effective and reliable methods for future national surveys.
- Summary results brief: Healthy, equitable and sustainable diets cost and affordability in Queensland. Professor Amanda Lee, Meron Lewis, Lisa Herron, Dori Patay. June 2020.
- Access Policies for tackling obesity and creating healthier food environments: 2017 and 2019 progress reports from our project on benchmarking obesity policies here.
- Friel S. Climate Change and the People’s Health. Oxford University Press. February 2019.
- Lee, A. Invited presentation and delivery of training workshop on the INFORMAS’ Food Prices Module at the first meeting of the African Food Environment Research Network (FERN) Initiative. FERN aims to encourage research collaboration, capacity building, and implementation of innovative food environment research in Africa, and other LMIC settings. Organised by the MEALS4NCDs (Providing measurement, Evaluation, Accountability and Leadership for NCDs Prevention) program based in Ghana. 3-5 November 2020.
- Lee, A. Invited keynote: A Fork in the Road – steps to healthy, equitable and sustainable nutrition policy action. International Conference on Public Health for Tropical and Coastal Development. Lifestyle and Environmental Changes: challenge for public health in coastal and tropical areas. Semarang, Indonesia. 29-30September 2020.
- Ngqangashe, Y. Framing the impacts of COVID-19: Securing food regulatory policies for the prevention of non-communicable diseases. 2020.
- Ngqangashe, Y. Regulatory governance for population nutrition webinar. Webinar, School of Regulation and Global Governance, July 2020.
- Ngqangashe Y. COVID-19, NCDs and the role of food regulation, Rural Health Advocacy project and Healthy Living Alliance (South Africa), 2020.
- Boelsen-Robinson T. Tools for implementing healthy food retail practices. Nourish Network. May 2020.
- Lee A. Aboriginal and Torres Strait Islander Healthy Diets ASAP (Australian Standardised Affordability and Pricing) methods, Symposium on World Food Day, Melbourne, Australia. 16 October 2019.
- Tara Boelsen-Robinson, Engaging small businesses in healthy food service initiatives: Lessons for local governments [PDF 510 KB]. This infographic relates to findings in the paper, Barriers and facilitators to implementing a healthier food outlet initiative Perspectives from local governments.
- Cicchini S, Lee A, Cullerton K. Who votes for public health? An analysis of Australian politicians’ parliamentary voting behaviour. Public Health Res Pract. November 2020. doi.org/10.17061/phrp30342014
- Lee, A., Cullerton, K., Herron, L. Achieving Food System Transformation: Insights From A Retrospective Review of Nutrition Policy (In)Action in High-Income Countries. International Journal of Health Policy and Management, 2020; (available online prior to press). doi: 10.34172/ijhpm.2020.188
- Needham C, Orellana L, Sacks G, Robinson R, Allender S, Strugnell C. A systematic review of the Australian food retail environment: Characteristics, variation by geographic area, socio-economic position and associations with diet and obesity. Obes Rev. 2020; 21(2). doi: 10.1111/obr.12941
- Boelsen-Robinson T, Orellana L, Backholer K, Kurzeme A, Jerebine A, Gilham B, et al. Change in drink purchases in 16 Australian recreation centres following a sugar-sweetened beverage reduction initiative: An observational study. BMJ Open. 2020;10(3): e029492. https://bmjopen.bmj.com/content/10/3/e029492.long
- White M, Aguirre E, Finegood DT, Holmes C, Sacks G, Smith R. What role should the commercial food system play in promoting health through better diet? BMJ. 2020;368:m545. doi: 10.1136/bmj.m545
- Lee A J, Kane S, Herron L-M, Matsuyama, Lewis M. A tale of two cities: The cost, price differential and affordability of current and healthy diets in Sydney and Canberra, Australia. Int J Behav Nutr Phy. 2020;17(80). doi: 10.1186/s12966-020-00981-0
- Needham C, Orellana L, Allender S, Sacks G, Blake MR, et al. Food retail environments in greater Melbourne 2008–2016: Longitudinal analysis of intra-city variation in density and healthiness of food outlets. Int. J. Environ. Res. Public Health. 2020;17:1321.
- Zorbas C, Lee A, Peeters A, Lewis M, Landrigan T, Backholer K. Streamlined data-gathering techniques to estimate the price and affordability of healthy and unhealthy diets under different pricing scenarios. Public Health Nutr. 2020 Jul;14:1–11. doi: 10.1017/S1368980020001718. [Epub ahead of print.]
- Boelsen-Robinson T, Peeters A, Thow AM, Hawkes C. Barriers and facilitators to implementing a healthier food outlet initiative: Perspectives from local governments. Public Health Nutrition. 2020;1-13. doi: 10.1017/S13689800200023230
- Cullerton K, Baker P, Adsett E, Lee A. What do the Australian public think of regulatory nutrition policies? A systematic scoping review. Obesity Reviews. First published: 03 August 2020. doi: 10.1111/obr.13106
- Lewis M, Lee A. Dietary inequity? A systematic scoping review of dietary intake in low socioeconomic groups compared to high socioeconomic groups in Australia. Public Health Nutrition. 2020 Sept 4. do: 10.1017/S1368980020003006
- Baker P, Brown AD, Wingrove K, Allender S, Wall H, Cullerton K, Lee A, Demaio A, Lawrence M. Generating political commitment for ending malnutrition in all its forms: A system dynamics approach for strengthening nutrition actor networks. Obes Rev. 2019. doi: 10.1111/obr.12871. (Epub ahead of print)
- Cullerton K, Adams J, Forouhi N, Francis O, White M. What principles should guide interactions between population health researchers and the food industry? Systematic scoping review of peer-reviewed and grey literature. Obesity Reviews. 2019;1–12. doi: 10.1111/obr.12851
- Sacks G, Robinson E, Cameron AJ. Issues in measuring the healthiness of food environments and interpreting relationships with diet, obesity and related health outcomes. Current Obesity Reports. 2019;1–14
- Gwynn J, Sim K, Searle T, Senior A, Lee A, Brimblecombe J. Effect of nutrition interventions on diet-related and health outcomes of Aboriginal and Torres Strait Islander Australians: A systematic review. BMJ Open 2019.
- Pescud M, Sargent G, Kelly P, Friel S. How does whole of government action address inequities in obesity? A case study from Australia. International Journal for Equity in Health. 2019:18;8. doi.org/10.1186/s12939-019-0913-6
- Baker P, Brown AD, Wingrove K, Allender S, Wall H, Cullerton K, Lee A, Demaio A, Lawrence M. Generating political commitment for ending malnutrition in all its forms: A system dynamics approach for strengthening nutrition actor networks. Obes Rev. 2019 Jun 27. doi: 10.1111/obr.12871. (Epub ahead of print)
- Cullerton K, White T, Lee A. Doctors Rule: An Analysis of Health Ministers’ Diaries in Australia. Int. J. Environ. Res. Public Health 2019;16(13), 2440. doi.org/10.3390/ijerph16132440
- Sacks G, Vanderlee L, Robinson E, Vandevijvere S, Cameron AJ et al. BIA‐Obesity (Business Impact Assessment—Obesity and population‐level nutrition): A tool and process to assess food company policies and commitments related to obesity prevention and population nutrition at the national level. Obes Rev. 2019. doi: 10.1111/obr.12878
- Swinburn BA, Kraak VI, Allender S, Atkins VJ, Baker PI, et al. The global syndemic of obesity, undernutrition, and climate change: The Lancet Commission report. Lancet. 2019. doi: 10.1016/S0140-6736(18)32822-8
- Oostenbach L, Slits E, Robinson E, Sacks G. Systematic review of the impact of nutrition claims related to fat, sugar and energy content on food choices and energy intake, BMC Public Health. 2019;19(1):1296. doi: 10.1186/s12889-019-7622-3
- Clarke B, Swinburn BA, Sacks G. Investigating menu kilojoule labelling policy adoption from a political science and systems perspective. Food Policy. 2019;89. doi: 10.1016/j.foodpol.2019.101784
- Clarke B, Swinburn BA, Sacks G. Understanding the LiveLighter obesity prevention policy decision-making process: An investigation using political science and systems thinking. Soc Sci Med. 2020;246. doi: 10.1016/j.socscimed.2019.112757
- Bennett R, Zorbas C, Huse O, Peeters A, Cameron A, et al. Prevalence of healthy and unhealthy food and beverage price promotions and their influence on consumer purchasing behaviour– a systematic review of the literature. Obes Rev. 2019;21(1). doi: 10.1111/obr.12948
- Riesenberg D, Backholer K, Zorbas C, Sacks G, Paix A, et al. Price promotions by food category and product healthiness in an Australian supermarket chain, 2017-2018. Am J Public Health. 2019;109. doi: 10.2105/AJPH.2019.305229
- Esdaile E, Thow AM, Gill T, Sacks G, Golley R, et al. National policies to prevent obesity in early childhood: Using policy mapping to compare policy lessons for Australia with six developed countries. Obes Rev. 2019;20(11). doi: 10.1111/obr.12925
- Backholer K, Sacks G, Cameron A. Food and beverage price promotions: An untapped policy target for improving population diets and health. Curr Nutr Rep. 2019;8(3). doi: 10.1007/s13668-019-00287-z
- Robertson N, Sacks G, Miller P. The revolving door of politics, government and the alcohol, food and gambling industries in Australia. Public Health Res Pract. 2019;29(3). doi: 10.17061/phrp2931921
- Fooks G, Williams S, Box G, Sacks G. Corporations’ use and misuse of evidence to influence health policy: A case study of sugar-sweetened beverage taxation. Globalization Health. 2019;15(56). doi: 10.1186/s12992-019-0495-5
- Cullerton K, Donnet T, Lee A, Gallegos D. Effective advocacy strategies for influencing government nutrition policy: A conceptual model. Int J Behav Nutr Phys Act. 2018;15:83 doi: 10.1186/s12966-018-0716-y
- Lee AJ, Kane S , Lewis M, Good E, Pollard CM, Landrigan TJ and Dick M. Healthy diets ASAP – Australian Standardised Affordability and Pricing methods protocol. Nutrition Journal. 2018;17:88. doi: org/10.1186/s12937-018-0396-0
- Love P, Whelan J, Bell C, Grainger F, Russell C, Lewis M, Lee A. Healthy diets in rural Victoria – Cheaper than unhealthy alternatives, yet unaffordable. Int. J. Environ. Res. Public Health 2018;15, 2469. doi: doi.org/10.3390/ijerph15112469
- Lee A, Lewis M. Testing the price of healthy and current diets in remote Aboriginal communities to improve food security: Development of the Aboriginal and Torres Strait Islander Healthy Diets ASAP (Australian Standardised Affordability and Pricing) methods. Int. J. Environ. Res. Public Health 2018;15, 2912. doi:10.3390/ijerph15122912
- Mackay S, Buch T, Vandevijvere S, Goodwin R, Korohina E, Funaki-Tahifote M, Lee A, Swinburn B. Cost and affordability of diets modelled on current eating patterns and on dietary guidelines, for New Zealand Total Population, Māori and Pacific households. Int J Environ Res Public Health. 2018;15(6), 1255. doi.org/10.3390/ijerph15061255
- ‘Jobs vs health’: What will shape public-health policies after Covid-19? Mail and Guardian, Op-ed, 31 August 2020.
- Supermarkets urged to end heavy promotion of unhealthy food, 18 May 2020.
- How healthy are Australian supermarkets, May 2020
- Lee, A. Health impacts of the Australian megafires, 10 February 2020.
- Ngqangashe, Y. Blurred lines: Food marketing and digital content, February 2020.