Playing the policy game: a review of the barriers to and enablers of nutrition policy change.

OBJECTIVE: To progress nutrition policy change and develop more effective advocates, it is useful to consider real-world factors and practical experiences of past advocacy efforts to determine the key barriers to and enablers of nutrition policy change. The present review aimed to identify and synthesize the enablers of and barriers to public policy change within the field of nutrition. DESIGN: Electronic databases were searched systematically for studies examining policy making in public health nutrition. An interpretive synthesis was undertaken. SETTING: International, national, state and local government jurisdictions within high-income, democratic countries. RESULTS: Sixty-three studies were selected for inclusion. Numerous themes were identified explaining the barriers to and enablers of policy change, all of which fell under the overarching category of 'political will', underpinned by a second major category, 'public will'. Sub-themes, including pressure from industry, neoliberal ideology, use of emotions and values, and being visible, were prevalent in describing links between public will, political will and policy change. CONCLUSIONS: The frustration around lack of public policy change in nutrition frequently stems from a belief that policy making is a rational process in which evidence is used to assess the relative costs and benefits of options. The findings from the present review confirm that evidence is only one component of influencing policy change. For policy change to occur there needs to be the political will, and often the public will, for the proposed policy problem and solution. The review presents a suite of enablers which can assist health professionals to influence political and public will in future advocacy efforts.

Using political science to progress public health nutrition: a systematic review.

OBJECTIVE: Poor dietary intake is the most important behavioural risk factor affecting health globally. Despite this, there has been little investment in public health nutrition policy actions. Policy process theories from the field of political science can aid understanding why policy decisions have occurred and identify how to influence ongoing or future initiatives. The present review aims to examine public health nutrition policy literature and identify whether a policy process theory has been used to analyse the process. DESIGN: Electronic databases were searched systematically for studies examining policy making in public health nutrition in high-income, democratic countries. SETTING: International, national, state and local government jurisdictions within high-income, democratic countries. SUBJECTS: Individuals and organisations involved in the nutrition policy-making process. RESULTS: Sixty-three studies met the eligibility criteria, most were conducted in the USA and a majority focused on obesity. The analysis demonstrates an accelerating trend in the number of nutrition policy papers published annually and an increase in the diversity of nutrition topics examined. The use of policy process theory was observed from 2003; however, it was utilised by only 14 % of the reviewed papers. CONCLUSIONS: There is limited research into the nutrition policy process in high-income countries. While there has been a small increase in the use of policy process theory from 2003, an opportunity to expand its use is evident. We suggest that nutrition policy making would benefit from a pragmatic approach that ensures those trying to influence or understand the policy-making process are equipped with basic knowledge around these theories.