A systematic policy approach to changing the food system and physical activity environments to prevent obesity
Tóm tắt
As obesity prevention becomes an increasing health priority in many countries, including Australia and New Zealand, the challenge that governments are now facing is how to adopt a systematic policy approach to increase healthy eating and regular physical activity. This article sets out a structure for systematically identifying areas for obesity prevention policy action across the food system and full range of physical activity environments. Areas amenable to policy intervention can be systematically identified by considering policy opportunities for each level of governance (local, state, national, international and organisational) in each sector of the food system (primary production, food processing, distribution, marketing, retail, catering and food service) and each sector that influences physical activity environments (infrastructure and planning, education, employment, transport, sport and recreation). Analysis grids are used to illustrate, in a structured fashion, the broad array of areas amenable to legal and regulatory intervention across all levels of governance and all relevant sectors. In the Australian context, potential regulatory policy intervention areas are widespread throughout the food system, e.g., land-use zoning (primary production within local government), food safety (food processing within state government), food labelling (retail within national government). Policy areas for influencing physical activity are predominantly local and state government responsibilities including, for example, walking and cycling environments (infrastructure and planning sector) and physical activity education in schools (education sector). The analysis structure presented in this article provides a tool to systematically identify policy gaps, barriers and opportunities for obesity prevention, as part of the process of developing and implementing a comprehensive obesity prevention strategy. It also serves to highlight the need for a coordinated approach to policy development and implementation across all levels of government in order to ensure complementary policy action.
Tài liệu tham khảo
Seidell JC: The epidemiology of obesity: a global perspective. Obesity prevention and public health. Edited by: Crawford D, Jeffery RW. 2005, Oxford: University Press, 3-20.
World Health Organization (WHO): Reducing Risks, Promoting Healthy Life. World Health Organization. 2005, Geneva: World Health Organization
National Health and Medical Research Council (NHMRC): Strategic Plan 2007–2009. NHMRC. (accessed March, 2008), [http://www.nhmrc.gov.au/publications/synopses/_files/strat_plan0709.pdf]
Ministry of Health (New Zealand): The New Zealand Health Strategy. Ministry of Health. accessed, March 2008, [http://www.moh.govt.nz/publications/nzhs]
Swinburn BA, Egger G: Preventive strategies against weight gain and obesity. Obes Rev. 2002, 3 (4): 289-301. 10.1046/j.1467-789X.2002.00082.x.
Swinburn BA, Egger G, Raza F: Dissecting obesogenic environments: the development and application of a framework for identifying and prioritizing environmental interventions for obesity. Prev Med. 1999, 29 (6 Pt 1): 563-570. 10.1006/pmed.1999.0585.
Mishra G, Ball K, Arbuckle J, Crawford D: Dietary patterns of Australian adults and their association with socioeconomic status: results from the 1995 National Nutrition Survey. Eur J Clin Nutr. 2002, 56 (7): 687-93. 10.1038/sj.ejcn.1601391.
Monteiro CA, Moura EC, Conde WL, Popkin BM: Socioeconomic status and obesity in adult populations of developing countries: a review. Bull World Health Organ. 2004, 82 (12): 940-6.
Kelley B, Smith JA: Legal Approaches to the Obesity Epidemic: An Introduction. J Public Health Pol. 2004, 25 (3/4): 346-352. 10.1057/palgrave.jphp.3190033.
French SA, Story M, Jeffery RW: Environmental influences on eating and physical activity. Annu Rev Public Health. 2001, 22: 309-335. 10.1146/annurev.publhealth.22.1.309.
Nestle M, Jacobson MF: Halting the obesity epidemic: a public health policy approach. Public Health Rep. 2000, 115 (1): 12-24. 10.1093/phr/115.1.12.
Hayne CL, Moran PA, Ford MM: Regulating environments to reduce obesity. Journal of Public Health Policy. 2004, 25 (3–4): 391-407. 10.1057/palgrave.jphp.3190038.
Nestle M: Food marketing and childhood obesity–a matter of policy. The New England Journal of Medicine. 2006, 354 (24): 2527-2529. 10.1056/NEJMp068014.
Gostin LO: Law as a tool to facilitate healthier lifestyles and prevent obesity. The Journal of the American Medical Association. 2007, 297 (1): 87-90. 10.1001/jama.297.1.87.
Schmid TL, Pratt M, Witmer L: A framework for physical activity policy research. Journal of Physical Activity and Health. 2006, 3 (Suppl 1): S20-S29.
Lawrence M: Policy and politics. Public Health Nutrition: from principles to practice. Allen and Unwin. Edited by: Lawrence M, Worsley T. 2007, Sydney
Lawrence M: Using domestic law in the fight against obesity: An introductory guide for the Pacific. World Health Organization. 2002, Geneva: World Health Organization
World Health Organization (WHO): Ottawa Charter for Health Promotion. First International Conference on Health Promotion, Ottawa. 1986, WHO/HPR/HEP/95.1. World Health Organization. Ottawa, 21 November 1986
World Health Organization (WHO): The First Action Plan for Food and Nutrition Policy. Nutrition and Food Security Programme, Division of Technical Support and Strategic Development. 2001, World Health Organization. Geneva
Brownson RCD, Haire-Joshu D, Luke DA: Shaping the context of health: a review of environmental and policy approaches in the prevention of chronic diseases. Annu Rev Public Health. 2006, 27: 341-370. 10.1146/annurev.publhealth.27.021405.102137.
Benjamin E: Public Health Approaches to Obesity: Litigation, Legislation, and Lessons Learned. Pittsburgh Journal of Environmental and Public Health Law. 2006, 1 (1): 127-149.
Faith MS, Fontaine KR, Baskin ML, Allison DB: Toward the reduction of population obesity: macrolevel environmental approaches to the problems of food, eating, and obesity. Psychological Bulletin. 2007, 133 (2): 205-226. 10.1037/0033-2909.133.2.205.
Lobstein T, Baur LA: Policies to prevent childhood obesity in the European Union. European Journal of Public Health. 2005, 15 (6): 576-579. 10.1093/eurpub/cki068.
Schmidhuber J: The Growing Global Obesity Problem: Some Policy Options to Address It. Electronic Journal of Agricultural and Development Economics. 2004, 1 (2): 272-290.
Alston JM, Sumner DA, Vosti SA: Are Agricultural Policies Making Us Fat? Likely Links between Agricultural Policies and Human Nutrition and Obesity, and Their Policy Implications. Review of Agricultural Economics. 2006, 28 (3): 313-322. 10.1111/j.1467-9353.2006.00292.x.
Haby MM, Vos T, Carter R, Moodie M, Markwick A, Magnus A, Tay-Teo KS, Swinburn B: A new approach to assessing the health benefit from obesity interventions in children and adolescents: the assessing cost-effectiveness in obesity project. International Journal of Obesity. 2006, 30: 1463-1475. 10.1038/sj.ijo.0803469.
Frank LD, Engelke PO, Schmid TL: Health and Community Design – The Impact of the Built Environment on Physical Activity. 2003, USA: Island Press
Bauman A, Bellew B, Vita P, Brown W, Owen N: Getting Australia active: towards better practice for the promotion of physical activity. National Public Health Partnership. 2002, Melbourne, Australia
