Designing, implementing and monitoring evidence-based policies effectively with multiple actorsBoyd SwinburnProfessor of Population Nutrition & Global Health, University of Auckland, New ZealandandAlfred Deakin Professor, Global Obesity Centre, Deakin University, Australia

Overview• Understanding the accountability cycle– Set the account– Take the account– Share the account– Hold to account– Respond to the account 

• Ways forward for strengthening accountability for nutrition outcomes – reducing malnutrition in all its forms

Accountability systems• Responsibility (one actor)

– Being in charge of or owning a task – eg government responsibility for developing food

policies; corporate social responsibility • Accountability (multiple actors)

– One actor being answerable to another actor(s) for tasks being done and explaining decisions/actions

– eg governments requiring food companies to follow food labelling laws or go to court to defend themselves

– Involves power relationships (holding to account)• Multi-actor accountability systems

– Reduce large power imbalances between actors– Mutual accountability versus independent

accountability

Accountability Framework (Kraak V, Public Health Nutr, 2014)

What needs to be done to improve nutrition?

Broad goals and strategies are agreed globally: But, they need to be defined more tightly & specifically

SMART goals for nutrition

Nutrition in SDGs

GNR 2016

Accountability Framework (Kraak V, Public Health Nutr, 2014)

More ‘upstream’ monitoring indicators needed1. Food policy implementation 2. Food supply and environments

– eg food availability, composition, labelling, promotion, price, provision, retail, trade & investment agreements

• WHO / FAO surveys• WCRF Nourishing framework and exemplars• Global Nutrition Reports• Access to Nutrition Index (ATNI)• INFORMAS – benchmarking

– International Network for Obesity/NCDs Research, Monitoring, and Action Support

NGOs and academia

WHO/FAO monitoring systems• Several databases– eg FAO Food Balance Sheets, WHO NCD Country

Capacity Survey, Global database on Implementation of Nutrition Actions (GINA), databases on child growth, BMI, infant feeding etc

• Challenges – Comprehensiveness of countries and indicators

(eg policy implementation)– Validity – Disaggregation – Utilisation

World Cancer Research Fund

NOURISHING Framework

• Nutrition policy areas• International exemplars

www.wcrf.org

Public sector policies and actions Private sector policies and actions

How much progress have (international, national, state and local) governments made towards good practice in improving

food environments and implementing obesity/NCDs prevention policies and actions?

(University of Auckland)

How are private sector organisations affecting food environments and influencing obesity/NCDs prevention

efforts?(Deakin University)PR

OCE

SSES

IMPA

CTS

OU

TCO

MES

Food composition

Foodlabelling

Food marketing

Food provision Food retail Food prices Food trade &

investment

What is the nutrient

composition of foods and non-

alcoholic beverages?(The George

Institute)

What health-related

labelling is present on

foods and non-alcoholic

beverages?(University of

Oxford)

What is the exposure and

power of promotion of

unhealthy foods and non-

alcoholic beverages to

different population

groups?(University of Wollongong)

What is the nutritional

quality of foods and non-alcoholic

beverages provided in

different settings (eg.

schools, hospitals,

workplaces)?(University of

Toronto)

What is the availability of healthy and unhealthy

foods and non-alcoholic

beverages in communities

and within retail outlets?(University of

Auckland)

What is the relative price

and affordability of ‘less healthy’

compared with ‘healthy’ diets, meals & foods?

(Queensland University of Technology)

What are the impacts of trade and

investment agreements on the healthiness

of food environments?

(Australian National

University)

Population diet Physiological & metabolic risk factors Health outcomes

What is the quality of the diet of different population groups?

(University of Sao Paulo)

What are the burdens of obesity and other risk factors?

(WHO)

What are burdens of NCD morbidity and mortality?

(WHO)

INFORMAS module structureO

RGAN

ISAT

ION

SFO

OD

ENVI

RON

MEN

TSPO

PULA

TIO

NS

Countries using INFORMAS modulesGovt Indust

ryComposition

Labels

Promotion

Prices

Retail

Provision

Trade

NZLAUSFIJTHAMEXCHLGTMGBRARGCANBRACHNCRIINDUSAZAFVNMMYSMLT

www.informas.org

Accountability Framework (Kraak V, Public Health Nutr, 2014)

INFORMAS• Food-EPI = Food

Environments Policy Index

• NZ example• 20 food policy

indicators• 20 supporting

infrastructure indicators

• Independent experts evaluate evidence of implementation progress

Dashboards for accountability

Tolley H et al BMC Public Health 2016

Access to Nutrition Index – 25 top global food manufacturers

www.accesstonutrition.orgDone in 2013 and 2015Country spotlight - India

ATNI tool being adapted for INFORMAS – Company Impact Assessment – Data collection in 6 countries in 2017

Global Nutrition Report (www.globalnutritionreport.org)

Accountability Framework (Kraak V, Public Health Nutr, 2014)

Power relationships in nutrition (1)• National governments – Roles: to implement policies and actions to

improve food systems for population nutrition, sustainability and prosperity

– Problems: corruption/incompetence, neoliberal ideologies, bow to pressure from powerful food corporations, nutrition is a low priority

• UN & international agencies– Roles: standard-setting, convening, technical

support etc– Problems: constrained by funding and member

state politics

Power relationships in nutrition (2)• Food corporations

– Roles: feed populations, make a profit (improving population nutrition and environmental sustainability not required)

– Problems: convert economic power into political power to maintain a political economy favourable for their profits

• Civil society (academia, public-interest NGOs, citizens)– Roles: program delivery, advocacy, monitoring,

research, etc– Problems: multiple factions around food, low funding

and weak leverage • Foundations, development funders

– Roles: funding, leveraging change, advocacy– Problems: moving to fund malnutrition in all its forms

Accountability Framework (Kraak V, Public Health Nutr, 2014)

Double and triple duty actions• Malnutrition in all its forms

– Double burden of undernutrition and obesity– What are the ‘double duty’ actions which address both?

• Food systems and urban/land use systems are big contributors to climate change– ‘Triple duty’ actions may address malnutrition in all its

forms and climate change• Increasing food/nutrition literacy; supporting fresh,

local food systems; constraining marketing & dominance of processed food; strengthening governance for good policy-making; adjusting fiscal incentives/disincentives etc

Summary • Accountability systems need to be

strengthened to achieve better nutrition outcomes

• Accounts need to be more tightly specified (SMART)

• Monitoring systems: more upstream, better coordinated

• Power rebalancing needed - food corporate power, civil society power to give governments more space and support for nutrition policies and nutrition-sensitive food policies

Take home message• Engaging public interest civil society

more in monitoring could:– Increase comprehensiveness and validity of

monitoring systems– Increase the capacity for collecting and using

the monitoring data– Create independent accountability systems to

complement the mutual accountability systems of Member State governed systems

– Support a rebalancing of power to hold the main actors to account for better food policies