An accountability framework to promote healthy food environments

Objective
To review the available literature on accountability frameworks to construct a framework that is relevant to voluntary partnerships between government and food industry stakeholders.

Design
Between November 2012 and May 2013, a desk review of ten databases was conducted to identify principles, conceptual frameworks, underlying theories, and strengths and limitations of existing accountability frameworks for institutional performance to construct a new framework relevant to promoting healthy food environments.

Setting
Food policy contexts within high-income countries to address obesity and diet-related non-communicable diseases.

Subjects Eligible resources (n 26) were reviewed and the guiding principles of fifteen interdisciplinary frameworks were used to construct a new accountability framework.

Results
Strengths included shared principles across existing frameworks, such as trust, inclusivity, transparency and verification; government leadership and good governance; public deliberations; independent bodies recognizing compliance and performance achievements; remedial actions to improve accountability systems; and capacity to manage conflicts of interest and settle disputes. Limitations of the three-step frameworks and ‘mutual accountability’ approach were an explicit absence of an empowered authority to hold all stakeholders to account for their performance.

Conclusions
We propose a four-step accountability framework to guide government and food industry engagement to address unhealthy food environments as part of a broader government-led strategy to address obesity and diet-related non-communicable diseases. An independent body develops clear objectives, a governance process and performance standards for all stakeholders to address unhealthy food environments. The empowered body takes account (assessment), shares the account (communication), holds to account (enforcement) and responds to the account (improvements).

A Q methodology study of stakeholders' views about accountability for promoting healthy food environments in England through the responsibility deal food network

In March 2011, the United Kingdom's (UK's) Government launched five Public Health Responsibility Deal Networks to address public health priorities. The Networks used voluntary partnerships to influence peoples' choice architecture to move them toward healthier behaviors. The purpose of this research was to conduct an exploratory study of diverse stakeholders' perspectives about perceived responsibility and accountability expectations to improve food environments in England through the Food Network partnerships. A purposive sample of policy elites (n=31) from government, academia, food industry and non-government organizations sorted 48 statements related to improving food environments in England. Statements were grounded in three theoretical perspectives (i.e., legitimacy, nudge and public health law). PQMethod 2.33 statistical software program used factor analysis to identify viewpoints based on intra-individual differences for how participants sorted statements. The results revealed three distinct viewpoints, which explained 64% of the variance for 31 participants, and emphasized different expectations about responsibility. The food environment protectors (n=17) underscored government responsibility to address unhealthy food environments if voluntary partnerships are ineffective; the partnership pioneers (n=12) recognized government-industry partnerships as legitimate and necessary to address unhealthy food environments; and the commercial market defenders (n=1) emphasized individual responsibility for food choices and rejected government intervention to improve food environments. Consensus issues included: protecting children's right to health; food industry practices that can and should be changed; government working with industry on product reformulation; and building consumer support for economically viable healthy products. Contentious issues were: inadequacy of accountability structures and government inaction to regulate food marketing practices targeting children. We conclude that understanding different viewpoints is a step toward building mutual trust to strengthen accountability structures that may help stakeholders navigate ideologically contentious issues to promote healthy food environments in England.

Salt reduction in Australia: from advocacy to action

BACKGROUND: As part of its endorsement of the World Health Organization's Global Action Plan to prevent non-communicable diseases, the Federal Government of Australia has committed to a 30% reduction in average population salt intake by 2025. Currently, mean daily salt intake levels are 8-9 g, varying by sex, region and population group. A number of salt reduction initiatives have been established over the last decade, but key elements for a co-ordinated population-level strategy are still missing. The objective of this review is to provide a comprehensive overview of existing population-level salt reduction activities in Australia and identify opportunities for further action.

METHODS: A review of the published literature and stakeholder activities was undertaken to identify and document current activities. The activities were then assessed against a pre-defined framework for salt reduction strategies.

RESULTS: A range of initiatives were identified from the review. The Australian Division of World Action on Salt and Health (AWASH) was established in 2005 and in 2007 launched its Drop the Salt! Campaign. This united non-governmental organisations (NGOs), health and medical and food industry organisations in a co-ordinated advocacy effort to encourage government to develop a national strategy to reduce salt. Subsequently, in 2010 the Federal Government launched its Food and Health Dialogue (FHD) with a remit to improve the health of the food supply in Australia through voluntary partnerships with food industry, government and non-government public health organisations. The focus of the FHD to date has been on voluntary reformulation of foods, primarily through salt reduction targets. More recently, in December 2014, the government's Health Star Rating system was launched. This front of pack labelling scheme uses stars to highlight the nutritional profile of packaged foods. Both government initiatives have clear targets or criteria for industry to meet, however, both are voluntary and the extent of industry uptake is not yet clear. There is also no parallel public awareness campaign to try and influence consumer behaviour relating to salt and no agreed mechanism for monitoring national changes in salt intake. The Victorian Health Promotion Foundation (VicHealth) has recently instigated a State-level partnership to advance action and will launch its strategy in 2015.

CONCLUSIONS: In conclusion, salt reduction activities are currently being implemented through a variety of different programs but additional efforts and more robust national monitoring mechanisms are required to ensure that Australia is on track to achieve the proposed 30% reduction in salt intake within the next decade.

Voluntary demand for auditing by farm businesses: an Australian perspective

 This study investigates voluntary demand for auditing by Australian farm businesses, a significant but relatively unexplored segment of the economy. Most farms operate as family partnerships or sole proprietors and we thus focus on incentives to audit arising from internal sources (owner-manager), controlling for traditional incentives arising from external contractual constraints (i.e., debt), organisational characteristics (i.e., size), and agency conflict. We hypothesise that an external audit assists management in enhancing internal control by complementing the process of profit planning and control (budgeting) and that increased family conflict provides an incentive to engage external audit. Of the 457 survey questionnaire respondents, 27% voluntarily engage an external auditor and 66% conduct some formal written planning. Results from logistic regression analyses support the predicted impact of both size and debt on audit, and further support the hypothesised impact of budgeting. The positive association between budgeting and audit confirms the complementary relationship. More importantly, this relationship is not confounded by the combined impact of size and budgeting and debt and budgeting on voluntary audit. In addition, family conflict has no impact on voluntary demand for auditing by farm business.

Empowering partnerships: nurses and those they care for

This chapter:
• explores the traditional roles of nurses and those they care for;
• discusses the concepts of empowerment and partnerships as they apply
   to the provision of health care;
•examines the key concepts of a partnership model:
  a) non-patronising empowerment;
  b) collaborative decision making;
  c)  valuing diversity and individuality; and
  d) mutually beneficial relationship; and
•  identifies the threat to each characteristic of the partnership model.

Providing space for teacher renewal: the role of the facilitator in school-university partnerships

This article uses the process of a teacher renewal partnership programme to explore the role of the university academic as a facilitator of change. Responses to a series of interview questions relating to change were used to explore and examine the dimensions of the facilitator's role. Facilitators report that the role is complex, often uncertain and requires an understanding of the school and its culture and schools' and teachers' previous experiences in professional development programmes. The findings from this article suggest that an effective facilitator creates, for the teachers involved, a space for discussion, reflection and challenge and that this space provides for and legitimates teacher renewal.

Partnerships for capacity building: community, governments and universities working together

This paper summarises initiatives in the area of capacity building between communities, governments and universities since Rio 1992.

First the global advances through the UN and associated agencies are described with lessons learned and challenges remaining being highlighted. This is followed by a similar approach for first regionally based initiatives and finally some of the better examples of nationally based approaches.

Among the key findings from the review were: trying to keep the initial message simple, asking the “user” what they want and what they need from capacity building, the use of local experts in capacity building where ever possible, universities extending themselves to engage in genuine partnerships as well as offering new courses, subjects, etc., attempting to match the strengths and weaknesses of partners in capacity building, concentrating on improving regional partnerships across national boundaries, deriving methods to sustain capacity building programs over the long term, questioning the absence of the private sector from capacity building partnerships, questioning whether capacity building is receiving the attention, funding and centrality to ICM promotion that it warrants, a proposal to build a global ICM capacity building network, the need for greater critical analysis of capacity building programs, integrating capacity building into ICM practices and recognising that effective capacity building practice may require some time and effort to build up, i.e. there are no universal “quick-fixes”.

Seeking industry perspectives to enhance experiential education in university-industry partnerships: going beyond mere assumptions

Setting up and running a program with an industry experiential learning component is based on certain core assumptions. A shared vision of what constitutes a satisfying placement is essential. In this paper we present findings from research into the operation of an Australian Bachelor of Business Information Technology program. In-depth interviews were held with 10 experienced industry sponsors/mentors and one member of a relevant professional body. Industry mentors identify pragmatic reasons for industry involvement in experiential learning programs. They identify some seven skills required of a good industry mentor, and report eight features of a meaningful/satisfying placement

Educational partnerships on-line: global collaborative learning through an on-line student exchange programme

Deakin University and the University of Calgary have used the internet to provide workplace-based learners with the possibility of a student exchange programme which does not disrupt their careers, lives or families.  The programmes involved in this on-line exchange were both developed in response to the needs of workplace learners and are representative of the role of universities in the field of life-long learning.  This paper describes the first phase of the exchange and discusses the shared pedagogical philosophies and shared implementation of on-line groupware which provided a rationale for the exchange.  The paper will explore the cross-cultural implications of the educational experience and the possibilities such an exchange opens up for life-long learners.