A review of methods and tools to assess the implementation of government policies to create healthy food environments for preventing obesity and diet-related non-communicable diseases

BACKGROUND: Policies to create healthy food environments are recognized as critical components of efforts to prevent obesity and diet-related non-communicable diseases. There has not been a systematic review of existing methods and tools used to assess the implementation of these government policies. The purpose of this study was to review methods and tools used for assessing the implementation of government policies to create healthy food environments. The study conducted a systematic literature search. Multiple databases as well as the grey literature were searched. All study designs and review papers on assessing the implementation of government policies to create healthy food environments were included. A quality assessment of the methods and tools identified from relevant studies was carried out using the following four criteria: comprehensiveness, relevance, generalizability and feasibility. This quality assessment was completed by two independent reviewers. RESULTS: The review identified 52 studies across different policy areas, levels and settings. Self-administered questionnaires and policy checklists were most commonly applied to assess the extent of policy implementation, whereas semi-structured interviews were most commonly used to evaluate the implementation process. Measures varied widely, with the existence of policy implementation the aspect most commonly assessed. The most frequently identified barriers and facilitators for policy implementation were infrastructure support, resources and stakeholder engagement. The assessment of policy implementation on food environments was usually undertaken in combination with other policy areas, particularly nutrition education and physical activity. Three tools/methods were rated 'high' quality and 13 tools/methods received 'medium' quality ratings. CONCLUSIONS: Harmonization of the available high-quality methods and tools is needed to ensure that assessment of government policy implementation can be compared across different countries and settings and over time. This will contribute to efforts to increase government accountability for their actions to improve the healthiness of food environments.

Bailouts, monitoring, and penalties: an integrated framework of government policies to manage the too-big-to-fail problem

This paper discusses optimal government bailout policy where the costs of systemic failures and moral hazard problems are considered. We find that a three-tiered bailout policy that includes an ex post monitoring and bailout scheme for financial institutions with large systemic impacts ('too big to fail') is optimal. The optimal policy also requires a randomized bailout for medium-impact institutions ('Constructive Ambiguity'), and no bailout for institutions that have only minimal systemic consequences ('too small to save'). However, in a volatile, innovative market environment where individual institutions may know more than the government regulator, monitoring error could contribute to risk taking, leaving the government regulator to always play a 'catch-up' role in revising policy. Moreover, the optimal bailout policy may not be time-consistent: institutions not deemed 'too big to fail' may still have an incentive to take excessive risks and expect to be bailed out in case of insolvency, primarily due to the short-term orientation of the government. Finally, because an institution's systemic cost affects the probability of a bailout, we show that the boundary of an institution may be extended by the government subsidy.

Obesity prevention : the role of policies, laws and regulations

The commercial drivers of the obesity epidemic are so influential that obesity can be considered a robust sign of commercial success – consumers are buying more food, more cars and more energy-saving machines. It is unlikely that these powerful economic forces will change sufficiently in response to consumer desires to eat less and move more or corporate desires to be more socially responsible. When the free market creates substantial population detriments and health inequalities, government policies are needed to change the ground rules in favour of population benefits.
Concerted action is needed from governments in four broad areas: provide leadership to set the agenda and show the way; advocate for a multi-sector response and establish the mechanisms for all sectors to engage and enhance action; develop and implement policies (including laws and regulations) to create healthier food and activity environments, and; secure increased and continued funding to reduce obesogenic environments and promote healthy eating and physical activity.
Policies, laws and regulations are often needed to drive the environmental and social changes that, eventually, will have a sustainable impact on reducing obesity. An 'obesity impact assessment' on legislation such as public liability, urban planning, transport, food safety, agriculture, and trade may identify 'rules' which contribute to obesogenic environments. In other areas, such as marketing to children, school food, and taxes/levies, there may be opportunities for regulations to actively support obesity prevention. Legislation in other areas such as to reduce climate change may also contribute to obesity prevention ('stealth interventions'). A political willingness to use policy instruments to drive change will probably be an early hallmark of successful obesity prevention.

Towards global benchmarking of food environments and policies to reduce obesity and diet-related non-communicable diseases : design and methods for nation-wide surveys

Introduction: 

An `upside-down` view of rural health care

Access to high quality health care services plays an important part in the health of rural communities and individuals. This fact is reflected in efforts by governments to improve the quality of such services through better targeting of funds and more efficient management of services. In Australia, the difficulties experienced by rural communities in attracting and retaining doctors has long been recognized as a contributing factor to the relatively higher levels of morbidity and mortality in rural areas. However, this paper, based on a study of two small rural communities in Australia, suggests that resolving the health problems of rural communities will require more than simply increasing the quality and accessibility of health services. Health and well-being in such communities relates as much to the sense of community cohesion as it does to the direct provision of medical services. Over recent years, that cohesion has diminished, undermined in part by government policies that have fuelled an exodus from small rural communities to urban areas. Until governments begin to take an 'upside-down' perspective, focusing on building healthy communities rather than simply on building hospitals to make communities healthy, the disadvantages faced by rural people will continue to be exacerbated.

Race, identity and education achievements among Arab-Australian students

This paper discusses the challenge of managing cultural diversity in secondary schools, focusing on key structural, ideological, cultural, attitudinal and identity factors affecting the educational experiences and outcomes of Australian students from Arabic-speaking background (ASB). Recent research indicates that there are complex processes at play that hinder the ability of non English-speaking background (NESB) students to access constructive and meaningful education, and that such processes need further systematic investigation. It has also been argued that Australian schools are failing the test of social equity and that the dominant approach to curriculum and pedagogy does not meet the needs of the growing numbers of students from divergent cultural and socio-economic backgrounds. This paper focuses on identifying the social, cultural and attitudinal factors that affect the educational achievements of ASB students within a broad multidimensional approach to multicultural education. By linking thorough empirical research and innovative theory with practical, tested plans of action, this study proposes an in-principled approach to multicultural education that is extendable to a variety of schooling contexts while retaining its core focus on effecting positive learning outcomes. The key objectives of the larger study upon which this paper is based are to (a) address the disadvantages and barriers faced by NESB young people, particularly ASB young people, in achieving positive educational outcomes; (2) increase their chances for better life opportunities and self fulfilment; and (3) develop a good practice model for diversity management in Victorian schools. This latter objective will complement Victorian Government policies on cultural diversity and multicultural education.

They went home: racialised spaces in contemporary picture books

This paper discusses Michel de Certeau’s theories of spatialised power and of resistance, especially his characterisation of what he describes as ‘tactics’ by which marginalised groups resist the strategies by which those in power gain and maintain control, in relation to a group of settler society picture books: Edna Tantjingu Williams, Eileen Wani Wingfield and Kunyi June-Anne McInerney’s Down the hole (2000); the Papunya School Book of Country and History (2001); Chiori Santiago and Judith Lowry’s Home to Medicine Mountain (1998); George Littlechild’s This Land Is My Land (1993); and Allen Say’s Home of the Brave (2002). These texts thematise colonial and assimilationist policies in Australia, Canada and the United States which required that racialised groups of children should be removed from their homes and families and placed in institutions. I argue that the first four of these texts position child readers both to understand the dislocation and pain caused by government policies such as those which enforced the removal of the Stolen Generation in Australia, and to appreciate the tactics of resistance by which children evaded or subverted institutional power. Home of the Brave deploys the symbolism of an adult’s journey into the past to show how strategies of repression serve to protect individuals and nations from shame and guilt, and demonstrates the transformative effects which result when the past is scrutinized.

The plasticity of professional boundaries: a case study of collaborative care in maternity services

A case study of twenty-nine midwives and nine obstetricians working in a regional, public sector Australian hospital demonstrates the plasticity of professional boundaries within a post-welfare state. Driven by new discourses of globalisation, marketisation, managerialism and consumerism, professional boundaries in health care are being blurred, reordered and reconstituted. Government policies that call for a new interdisciplinarity between maternity professionals may be seen as responses to the above pressures. However, there remain considerable barriers to achieving collaborative models including conflicting interpretations of risk, of women's bodies and of childbirth; the veto power of decision-making retained by obstetricians; questions of professional accountability; and diversity over appropriate styles of micro-interaction. Collaboration demands a new egalitarianism to eclipse the old vertical system of obstetric dominance and this means that midwives need to create a distinctive professional specialty, or new object of knowledge. Midwives' skill in 'emotion management' could provide this speciality in addition to their rational-technical knowledge and thus elevate midwifery to an equivalent professional status with obstetrics but as yet neither obstetrics nor midwifery have realised its professionalising potential

Governance in rural communities: the case of Victoria

State and federal government policies for rural areas have encouraged local people and organizations to play a greater role in the provision of their local services. This emphasis on local participation has been described as a shift from ‘government’ to ‘governance’. However while there is an emerging research around small towns in Australia there is very little known about the processes of community governance. This paper focuses on local development groups in small towns in rural Victoria that have emerged or have been reconstituted with a broader community focus following municipal amalgamations. The basic aim of this paper is analyse to what degree these local community development groups can be regarded as constituting a form of community governance and the implications this has for democracy and accountability in small rural areas. The paper begins with a discussion of community governance as it represented in the literature. We then analyse ten case studies from across Victoria in the light of the changing political context.

Flushing away professionalism : is it unsustainable?

Recently, a family was denied the right to subdivide their four-hectare property on the outskirts of Melbourne, Victoria into nine residential allotments ranging in size from 4000 m2 to 6600 m2. Unsuccessful applications and approaches in the past, prior to our commissioning in late 2003, had been rejected on the basis of assessments of poor land capability, onerous wet weather storage requirements and a curious 60 m buffer from a nearby intermittent watercourse. Restriction on the type of interim wastewater systems deemed suitable for five allotments was also a major issue. The site did not have mains power and had no sewer connections. The water authority and Victorian Civil and Administrative Tribunal (V CAT) order, prior to commissioning of the authors, asserted that "reticulated sewer is the preferred infrastructure for the area under investigation". However, the requirements imposed followed the letter of the guidelines rather than the principles. Various professional reports had already been produced on behalf of both the client and the regulator. A review of these indicated that the project had not been assessed in accordance with standard practices, had unusually restrictive assumptions, and did not accord with government policies on ecologically sustainable development.
The paper highlights the importance of sustaining professional and ethical practices to avoid costly litigation. Some professionals may have been in breach of the Institution of Engineers' Code of Ethics; others may have been in need of professional development. The question also arises whether the regulator had sought to use these adverse reports in order to satisfy unrelated planning issues.
While the writers managed to succeed in convincing the VCAT that these restrictions were unnecessary, the client ultimately had to comply with the regulator's wishes because of financial pressures. This unnecessary regimentation raises the issue of how best to safeguard lay people of moderate means against the practices of professional people who know or should know better.

Soil erosion in developing countries: a socio-economic appraisal

Soil erosion is the single most important environmental degradation problem in the developing world. Despite the plethora of literature that exists on the incidence, causes and impacts of soil erosion, a concrete understanding of this complex problem is lacking. This paper examines the soil erosion problem in developing countries in order to understand the complex inter-relationships between population pressure, poverty and environmental-institutional dynamics. Two recent theoretical developments, namely Boserup's theory on population pressure, poverty and soil erosion and Lopez's theory on environmental and institutional dynamics have been reviewed. The analysis reveals that negative impacts of technical change, inappropriate government policies and poor institutions are largely responsible for the continued soil erosion in developing countries. On the other hand, potential for market-based approaches to mitigate the problem is also low due to the negative externalities involved. A deeper appreciation of institutional and environmental dynamics and policy reforms to strengthen weak institutions may help mitigate the problem.

Reactions and responses : the concept of learning networks

In Victoria, Australia, the potential of networks to respond to issues of risk for young people has been identified. Learning networks have become a means to reform resulting in a number of policy strategies by the Victorian Labour government since 2000 and including School Networks and Local Learning and Employment Networks (LLENs). At the same time organic learning networks continue to form at a ‘grass roots’ level as communities respond to perceived needs. This presentation draws on research into the foundation, formation and practice of the Smart Geelong Region Local Learning and Employment Network (SGR LLEN) and considers the opportunities and tensions when government policies take up and institutionalise solutions in ways that potentially work against the conditions that make them effective, viable and sustainable.

Perceptions of the impact of art : implications for the art sector

This paper explores how individuals perceive art and its impact, and what implications these perceptions have for the art sector. Much previous research into the impact of art has been based on perspectives of art and impact implicit in government policies. This paper posits that to increase demand for art activities, a greater understanding of individuals’ perspectives of these two concepts is necessary. The paper reports findings of a three year research project into the impact of art based on the perception of the individual. Findings highlight three key areas: first, it is not the art product, but creativity or the creative process that results in impact; second, that individuals are autonomous in the creation of art experiences and the resultant impact; and third that there is a link between the motivation to have an art experience and the perceived potential impact.

An industrial organisation economic supply chain approach for the construction industry : a review

Understanding industries in terms of the concepts of chains, clusters and networks is becoming increasingly important in economies around the world. Supply chain management for an individual organization is an
emerging field of research in the construction management discipline, but less attention has been devoted to investigating the nature of the construction supply chains and their industrial organizational economic environment. This selected review of construction and mainstream management supply chain literature is organized around four themes; distribution, production, strategic procurement management and industrial
organization economics, and highlights the need to develop an industrial organization economic supply chain framework for construction. The merging of the supply chain concept with the industrial organization model
as a methodology for understanding firm conduct and industry structure and performance is an important contribution to both construction supply chain and construction economic theory. Much of the industrial organization supply chain literature has tended to focus upon manufacturing industries, where typically firms are permanent organizations. This raises issues as to the differences between industries founded upon temporary compared with permanent organizations. There is potential for the development of an industrial organization methodology applicable to the project based industry. Ultimately industrial organization research seeks to have direct implications for industry performance and government policies.