PANEL 7.3 A TOOL FOR ASSESSING GOVERNMENT PROGRESS ON CREATING HEALTHY FOOD ENVIRONMENTS
BOYD SWINBURN G
overnments have a critical responsibility to protect and promote the healthiness of food environments, but attempts to imple- ment food policies to achieve this are often met with fierce and successful food indus- try opposition. Apart from a few standout examples (WCRF 2013), 10-year progress on implementing food policies from WHO’s 2004 Global Strategy on Diet, Physical Activity, and Health (WHO 2004) has been patchy at best. How are governments going to be held accountable for achieving better progress on the latest 2013–2020 WHO global plan for noncommunicable diseases (WHO 2013b)? One attempt to increase accountabil- ity is through an international collaboration of universities and global nongovernmental organizations called INFORMAS (Swinburn et al. 2013). This network aims to monitor, benchmark, and support actions to create healthy food environments and reduce obe- sity, diet-related noncommunicable diseases, and their related inequalities. INFORMAS has developed a tool—called the Healthy Food
Environment Policy Index (Food-EPI)—for monitoring government actions for creating healthier food environments. It comprises two components. A policy component incor- porates seven food environment domains (food composition, labeling, price, marketing, provision in schools and other public sector settings, retail availability, and food in trade and investment agreements). An infrastruc- ture support component incorporates six domains (governance, leadership, funding and resources, monitoring and intelligence, platforms for interaction, and health in all policies). Relevant government officials col- late and verify evidence on the degree of implementation of international best practice exemplars for about 40 indicators. Workshops of experts from academia, nongovernmental organizations, and civil society are conducted with government observers to rate the degree of implementation and set priority recommen- dations for government action. Food-EPI has been pilot tested and imple- mented first in New Zealand (results are at
www.informas.org). The New Zealand govern- ment was rated as meeting international best practices for only 14 percent of indicators. For 74 percent of policy indicators and 48 percent of infrastructure support indicators, New Zea- land was rated as having “low” or “very little, if any” implementation—far short of poten- tial. Following the implementation rating process, the expert participants reviewed the implementation gaps and constructed a series of practical, achievable recommendations for government action that were then rated in terms of priority. For New Zealand, 7 of the 34 recommendations were prioritized for imple- mentation over the next three years, at which time a repeat Food-EPI assessment is planned, just ahead of the general election. Food-EPI can, therefore, become an evidence-based tool for civil society to engage in accountability systems for making policy progress toward healthier food environments.
Total disbursements exclude the US government’s and
the World Bank’s nutrition-sensitive category, but rose from US$1.262 billion to US$1.532 billion, an increase of 21 percent.
Conclusion
These trends give some cause for optimism. Nearly every donor has boosted commitments and disbursements. There have been sizable increases in total commitments from Canada, the EU, the Netherlands, and the United Kingdom and sizable increases in total disbursements from Canada, the United Kingdom, and the Bill & Melinda Gates Foundation. The Children’s Investment Fund Foundation has pledged to add approximately US$100 million a year from 2013 to 2020 to the total. The EU pledged an extra US$533 million at the N4G Summit,7 show fully in the data reported here.
which has yet to
Nevertheless, the numbers reported here seem small in the context of overall official development assistance (ODA). Total ODA was US$135 billion in 2013 (OECD 2014). Total 2012 nutrition commitments were US$6.1 billion, or 4.5 percent of ODA, and total 2012 nutrition disbursements came to US$1.5 billion, or just greater than 1 percent of ODA.
HOW SUPPORTIVE IS THE ENABLING ENVIRONMENT? POLICIES, LAWS, AND INSTITUTIONS
Policies, laws, and institutional arrangements shape the environ- ment for sustainable nutrition improvement. Several tools are available to track these efforts. They are all relatively new, and no attempts to link them with changes in nutrition outcomes have been made, mainly because they either cannot or have not been constructed retrospectively and then linked to current nutrition outcomes.
One such tool is Healthy Food Environment Policy Index (Food-EPI), which focuses on overweight and obesity (Panel 7.3). The Hunger and Nutrition Commitment Index (HANCI) assesses governments’ and external partners’ commitment to reducing undernutrition (te Lintelo et al. 2014). The Access to Nutrition Index (ATNI) scores large companies in terms of their support for good nutrition practices related to overcoming undernutrition,
ACTIONS & ACCOUNTABILITY TO ACCELERATE THE WORLD’S PROGRESS ON NUTRITION 51
The 2015 Global Nutrition Report will work with the nutri- tion community to attempt to develop a convincing rationale for spending targets for nutrition—for ODA, but also for domestic resource mobilization.
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