The effectiveness, cost-effectiveness and policy processes of regulatory, voluntary and partnership policies to improve food environments: an evidence synthesis

Blanchard L, Ray S, Law C, Vega-Salas MJ, Bidonde J, Bridge G, Egan M, Petticrew M, Rutter H and Knai C (2024)

NIHR Public Health Research Library - DOI 10.3310/JYWP4049

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Evidence Categories

• Care setting: Commercial food environment
• Care setting: National, regional or local policy
• Population group: General Population
• Population group: General population
• Intervention: Policy/environmental: Labelling
• Intervention: Policy / environmental: Portion size
• Intervention: Policy / environmental: Availability
• Intervention: Policy / environmental: Taxation & subsidies
• Intervention: Policy / environmental: Policy actions
• Intervention: Policy / environmental: Reformulation
• Outcome: Healthy Eating: Energy intake
• Outcome: Healthy Eating: Energy selected
• Outcome: Healthy Eating: Sugar-sweetened drinks intake
• Outcome: Healthy Eating: sugar sweetened drinks purchases
• Outcome: Healthy eating: Sugar-added food intake
• Outcome: Healthy Eating: Fat intake
• Outcome: Healthy Eating: Salt intake
• Outcome: Healthy Eating: Whole diet quality

Type of Evidence

Review of reviews

Aims

The authors state:

• "Governments act in various ways to promote healthy diets by improving food environments: these are the physical and social surroundings that influence what and how much people eat. Some actions are regulated by government, for example, to control food production, marketing and promotions. Other actions are led by, or with, food businesses, making voluntary changes to the foods they produce, for example, by reducing salt content; this can be done by businesses alone or in partnership with government (referred to as ‘public–private partnerships’)."
• "This study aimed to conduct a systematic review of the effectiveness, cost-effectiveness and policy process of real-world evaluations of national and state policies on improving food environments, with a focus on whether they were regulatory, voluntary or partnership approaches."
• "Six separate evidence reviews were conducted to assess the evidence of effectiveness, cost-effectiveness and policy processes of policies to improve food environments."

Findings

The authors state:

• "Most regulations appear to be effective at supporting better diets. However, voluntary changes led by businesses had limited success. There were not many evaluations that assessed the effectiveness of public–private partnerships. Of those that did, partnerships with the food industry had limited effectiveness, resulting in largely unchanged outcomes."
• "When looking at how these actions improve diets, we found that clear leadership, public support for the policy, the use of the best evidence and of local expertise helped with getting actions implemented. Factors that appear to make it harder to implement policy actions include a lack of evidence specific to the context, conflicting beliefs about what works, limited human or financial resources, lack of engagement by key people."
• "This was a complex evidence synthesis due to its scope and some policy evaluations may have been missed as the literature searches did not include specific policy names. The literature was limited to studies published in English from 2010 to 2020, potentially missing studies of interest."

Conclusions

The authors state:

• "From the available evidence reviewed, this study finds that regulatory approaches appear most effective at improving the food environment, and voluntary agreements and partnerships have limited effectiveness."
• "These findings should be carefully considered in future public health policy development, as should the findings of geographic imbalance in the evidence and inadequate representation of equity dimensions across the policy evaluations."
• "We find that food policies are at times driven by factors other than the evidence and shaped by compromise and pragmatism. Food policy should be first and foremost designed and driven by the evidence of greatest effectiveness to improve food environments for healthier diets."