Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Chapter 24
has privileged the manufacturing and marketing of
highly processed food products at the expense of more
basic primary foods and has not been in the interests
of public health.
Environmental and social constraints on
the operation of the food system
The viability and integrity of the food system is
dependent on maintaining the biodiversity and carrying
capacity of biological systems. Environmental and
social constraints are placing “ reality checks ” on conventional
thinking towards food policy objectives. For
example, the wisdom of pursuing unfettered food
production and promoting over - consumption is
being increasingly questioned not just by nutritionists,
but also by economists and environmentalists.
Many public health nutritionists argue that rapidly
increasing food prices, food security concerns and
food wastage problems are symptoms of limitations
with conventional thinking, that is, nature is “ biting ”
back as environmental constraints mean that we are
no longer able to sustain profligate exploitation of the
food system. In the future, the environmental and
social impact of food policy objectives will necessarily
receive greater attention in policy planning.
The policy environment for
physical activity
Physical activity levels are significantly influenced by
policies. Policies on transport infrastructure, housing,
urban design, neighborhood development, zoning,
residential development, policing, and so on, influence
the built environment, which in turn influences
the amount children will walk, cycle, play outside, and
take public transport. 15 Although there is some debate
about the mix of individual and environmental contributions
to children ’ s physical activity levels, 16 there
is an increasing consensus that environments that
promote active transport and outdoor recreation are
not only good for health but are also more liveable
and socially connected, less polluting and more sustainable.
Thus, the health advocacy for improved
urban environments is in synergy with many other
movements and the major barrier is the expense of
retro - fitting urban environments that were built for
car dependence. In comparison to the food system,
the policies which influence the built environment
are more locally based and much less internationally
dependent.
Policy instruments
There are a number of instruments, or tools, which
governments have available for implementing policy.
The primary policy instruments are: regulations and
laws (rules); taxation and funding (for programs,
research, monitoring and evaluation, social marketing
and capacity building); services and service delivery
(providing hospitals, workforce, etc.); and advocacy
(to the public, private sector, and other jurisdictions).
Within the contemporary political environment of
many developed countries there exists a dominant
ideology of neoliberalism characterized by the use of
those policy instruments that place more emphasis on
individual responsibility for dietary and physical
activity choices and less reliance on government intervention
in the environments where those choices are
made.
Milio coined the terms “soft ” (services, funding)
and “ hard ” (taxation, regulations) policy instruments
to distinguish among instruments in terms of their
relative level of political risk. 17 Recent studies indicate
that this distinction also may correlate with policy
effectiveness. Brescoll et al asked nutritionists and
public health policy experts to rate 51 possible child
obesity prevention policies for their likely public
health impact and political feasibility, respectively. 18
Results showed that strong regulatory measures such
as bans on food marketing to children were regarded
as being less politically feasible, but more likely to be
effective in obesity prevention. Conversely, policies
that focused on education and information dissemination
were regarded as politically feasible, but likely
to have little impact on obesity prevention.
How evidence gets incorporated
into policy - making
Making policies for the prevention of childhood
obesity, as with any policy, is not a linear, rational,
evidence - based process. The obesity research community
has been collecting large amounts of evidence,
which should be informing policies for obesity prevention,
but very little of it actually comes to bear on
the decision - making process. Why is this? First, much
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