Implementation lessons for school food policies and marketing restrictions in the Philippines: a qualitative policy analysis.

BACKGROUND: The school environment can enhance children's skills, knowledge and behaviours in relation to healthy eating. However, in many countries, unhealthy foods are commonly available in schools, and children can be exposed to aggressive marketing by the food industry. Taking the perspective of policymakers, this study aimed to identify barriers and enablers to effective school food policy development and implementation in the Philippines. METHODS: In May 2016, semi-structured interviews were conducted with 21 policymakers and stakeholders involved in school food policymaking and implementation in the Philippines. The Health Policy Analysis Triangle was used to identify interview questions and to guide the thematic analysis. These included the political and socio-environmental context, strengths and limitations of existing policy content, roles and behaviours of actors, implementation processes, policy outcomes, and opportunities to improve policy coherence. RESULTS: The Department of Education's policy 'Orders' represented a relatively strong policy framework for the education sector of the Philippines. However, a lack of human and financial resources for implementation, planning, and policy enforcement limited the impact of the policy on the healthiness of school food provision. Ambiguity in policy wording allowed a wide interpretation of the foods eligible to be provided in schools, and led to difficulties in effective monitoring and enforcement. Food companies used existing relationships with schools to promote their brands and compromise the establishment of a stronger food policy agenda. We found a motivated group of actors engaging in policy-oriented learning and advocating for a stronger policy alternative so as to improve the school food environment. CONCLUSIONS: The adoption of policy mechanisms being used to promote healthy dietary practices in the school setting will be strengthened by more robust implementation planning processes, and resources to support implementation and enforcement. Policymakers should ensure policy language clearly and unequivocally promotes healthier food and beverage options. Steps should be taken to achieve policy coherence by ensuring the objectives of one agency or institution are not undermining that of any others. Where there is reliance on the private sector for school resources, safeguards should be established to protect against conflicts of interest.

Prioritizing action on health inequities in cities: An evaluation of Urban Health Equity Assessment and Response Tool (Urban HEART) in 15 cities from Asia and Africa.

Following the recommendations of the Commission on Social Determinants of Health (2008), the World Health Organization (WHO) developed the Urban Health Equity Assessment and Response Tool (HEART) to support local stakeholders in identifying and planning action on health inequities. The objective of this report is to analyze the experiences of cities in implementing Urban HEART in order to inform how the future development of the tool could support local stakeholders better in addressing health inequities. The study method is documentary analysis from independent evaluations and city implementation reports submitted to WHO. Independent evaluations were conducted in 2011-12 on Urban HEART piloting in 15 cities from seven countries in Asia and Africa: Indonesia, Iran, Kenya, Mongolia, Philippines, Sri Lanka, and Vietnam. Local or national health departments led Urban HEART piloting in 12 of the 15 cities. Other stakeholders commonly engaged included the city council, budget and planning departments, education sector, urban planning department, and the Mayor's office. Ten of the 12 core indicators recommended in Urban HEART were collected by at least 10 of the 15 cities. Improving access to safe water and sanitation was a priority equity-oriented intervention in 12 of the 15 cities, while unemployment was addressed in seven cities. Cities who piloted Urban HEART displayed confidence in its potential by sustaining or scaling up its use within their countries. Engagement of a wider group of stakeholders was more likely to lead to actions for improving health equity. Indicators that were collected were more likely to be acted upon. Quality of data for neighbourhoods within cities was one of the major issues. As local governments and stakeholders around the world gain greater control of decisions regarding their health, Urban HEART could prove to be a valuable tool in helping them pursue the goal of health equity.

Working mothers of the World Health Organization Western Pacific offices: lessons and experiences to protect, promote, and support breastfeeding.

Optimal breastfeeding saves lives. However, suboptimal breastfeeding is prevalent, primarily resulting from inappropriate promotion of infant formula and challenges of working mothers to continue breastfeeding. The article aims to determine the extent to which World Health Organization (WHO) policies protect, promote, and support breastfeeding women working at the WHO, Western Pacific Region. An online survey targeted all female WHO and contractual staff in all country and regional offices, who delivered a baby between July 24, 2008 and July 24, 2013. Respondents advised on how the worksite could better support breastfeeding. Thirty-two female staff from 11 of the 12 WHO offices within the Western Pacific Region responded. "Returning to work" (44%) and "not having enough milk" (17%) were the most commonly reported reasons for not breastfeeding. Eighteen (56%) reported using infant formula and 8 (44%) reported that the product was prescribed. Among the suggestions given to better support breastfeeding, 10 (32%) recommended having a private room with a chair, table, electric outlet, and refrigerator. The findings show that women working at the WHO face similar challenges to mothers outside the WHO. Based on the findings, we recommend the following: (1) provide prenatal/postpartum breastfeeding counseling services for employees; (2) establish breastfeeding rooms in country offices and regularly orient staff on agency policies to protect, promote, and support breastfeeding; (3) annually celebrate World Breastfeeding Week with employees; (4) encourage other public and private institutions to conduct online surveys and elicit recommendations from mothers on how their workplace can support breastfeeding; and (5) conduct a larger survey among UN agencies on how to better protect, promote, and support breastfeeding.

The cost of a healthy and sustainable diet--who can afford it?

OBJECTIVE: Climate change is affecting the ability of food systems to provide sufficient nutritious and affordable foods at all times. Healthy and sustainable (H&S) food choices are important contributions to health and climate change policy efforts. This paper presents empirical data on the affordability of a food basket that incorporates principles of health and sustainability across different food sub-systems, socioeconomic neighbourhoods and household income levels in Greater Western Sydney, Australia. METHODS: A basket survey was used to investigate the cost of both a typical basket of food and a hypothetical H&S basket. The price of foods in the two baskets was recorded in five neighbourhoods, and the affordability of the baskets was determined across household income quintiles. RESULTS: The cost of the H&S basket was more than the typical basket in all five socioeconomic neighbourhoods, with most disadvantaged neighbourhood spending proportionately more (30%) to buy the H&S basket. Within household income levels, the greatest inequity was found in the middle income neighbourhood, showing that households in the lowest income quintile would have to spend up to 48% of their weekly income to buy the H&S basket, while households in the highest income quintile would have to spend significantly less of their weekly income (9%). CONCLUSION: The most disadvantaged groups in the region, both at the neighbourhood and household level, experience the greatest inequality in affordability of the H&S diet. IMPLICATIONS: The results highlight the current inequity in food choice in the region and the underlying social issues of cost and affordability of H&S foods.

Income-related health inequalities in Korea.

Data from the 2001 Korean National Health and Nutrition Examination Survey and the ill health concentration index (CI) were used to examine income-related health inequalities among Koreans. Participants (>19 years old) were requested to provide information regarding monthly household income, expenditures, subjective living conditions, and health status. Ill health was determined both subjectively through self-rated health (SRH) scores and objectively through the number of diseases (ND). At the individual level, the CIs for SRH and ND were -0.147 and -0.093, respectively; age-gender adjusted CIs were -0.065 and -0.071, respectively. These values remained unchanged when estimating CI for grouped data. These results indicate that ill health was more pronounced among lower income groups in Korea. However, avoidable health inequality in Korea was smaller than in the United Kingdom and the United States, larger than in Sweden, Eastern Germany, Finland, and Western Germany, and roughly equal to the Netherlands, Spain, and Switzerland.

Health promotion capacity mapping: the Korean situation.

Ten years ago the Republic of Korea enacted the National Health Promotion Act, setting the stage for health promotion action in the country. A National Health Promotion Fund was established, financed through tobacco taxes, which is now one of the largest in the world. However, despite abundant financial resources, the infrastructure needed to plan, implement, coordinate and evaluate health promotion efforts is still underdeveloped. Currently, health promotion capacity mapping efforts are emerging in Korea. Two international capacity mapping tools have been used to assess the Korean situation, namely HP-Source and the Health Promotion Capacity Profile, which was developed prior to the sixth Global Conference of Health Promotion, held in August 2005 in Bangkok, Thailand. The article summarizes and discusses the results of the capacity mapping exercise, highlights its challenges and suggest ways to improve the accuracy of health promotion capacity mapping.

Predictors of interest in nutrition topics and willingness to participate in local nutrition programmes.

OBJECTIVE: To investigate the predictors of interest in nutrition topics and willingness to participate in weight management courses and nutrition-related chronic disease management courses. METHODS: Data from a cross-sectional survey (n = 1007 Koreans aged >or=30) on nutrition-related conditions, nutrition behaviours, interest in nutrition topics and willingness to participate in two types of nutrition education courses, and general characteristics. Binary logistic regression was used to identify predictors of the participants' interest in the topic and willingness to participate. RESULTS: Younger, richer and more-educated participants were significantly more likely to be willing to participate in 'nutrition-related chronic disease management'. Having a higher income and being male increased the odds of being interested in this topic. Younger, more obese, high-income females and those interested to keep their weight and reduce fatty foods were more likely to be willing to participate in 'weight management'. CONCLUSION: There is a need to increase awareness about the link between nutrition and related health problems, especially regarding 'hidden' health problems to tailor the programmes especially for older, low-income and less-educated people and to focus on increasing their interest in nutrition topics.

Traditional v. modified dietary patterns and their influence on adolescents' nutritional profile.

Korea has experienced exceptionally rapid economic developments. Even though the country has managed to maintain aspects of its traditional diet, dietary habits are changing, especially among adolescents. This study was carried out to identify prevailing dietary patterns among Korean adolescents and to compare the nutrient intakes and dietary behaviours between the patterns. A 3 d diet record, collected from 671 Korean adolescents aged 12-14 years in Seoul, Korea, was assessed. By cluster analysis, subjects were classified into a modified (69.9 %) and a traditional (30.1 %) dietary pattern group. The modified group consumed more bread, noodles, cookies and pizza/hamburgers compared with the traditional group, which consumed mainly rice and kimchi (fermented cabbage). The modified group had significantly higher intakes of all nutrients. It had a higher total daily energy intake (7719 kJ), a higher daily energy intake from fat (29.8 %) and a higher cholesterol intake (326 mg/d), compared with the traditional group (6686 kJ, 24.8 % and 244 mg/d, respectively). The modified group was more likely to consume fast foods, fried foods and carbonated beverages even though they consumed more fresh fruits and milk, while the traditional group was more likely to have a rice-based diet and not to skip breakfast. These results suggest that monitoring dietary behaviours of adolescents, especially in a society experiencing a nutrition transition, is necessary in order to identify both negative and positive changes in respect of risk factors for nutrition-related chronic diseases as well as for undernutrition.