Where is the evidence supporting voluntary and public-private partnership policies for promoting healthy food environments? Findings from four evidence syntheses
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London School of Hygiene and Tropical Medicine, United Kingdom
University of Reading, United Kingdom
University of Bath, United Kingdom
Publication date: 2023-04-27
Popul. Med. 2023;5(Supplement):A1773
Background and Objective: Policies are increasingly being implemented to promote healthy food environments. These include regulations by governments, voluntary actions by governments and private actors, and public private partnerships (PPP). PPPs have particularly been encouraged by global leaders. This project aimed to assess the effectiveness of these approaches. Methods: Studies of national and state policies promoting healthy food environments were searched in 14 databases and two websites. Four evidence syntheses were generated relating to effectiveness: 1) An evidence map of primary research; 2) An overview of reviews of regulatory, voluntary and PPP approaches. Quality of the systematic reviews was assessed using the SIGN checklist; 3) A systematic review of PPPs; 4) A systematic review of voluntary commitments by private actors. In systematic reviews 3-4, risk of bias was appraised using a modified Newcastle-Ottawa Scale. Results: Among the 483 publications in the evidence map, 60 % (n=288) reported on at least one regulatory initiative, 43% (n=209) on at least one voluntary, 15 assessed policies combining both, and 31 assessed a PPP (of which 22 on two partnerships in England and Australia). The overview of reviews included ten systematic reviews. Most regulatory approaches were effective at improving health, consumer behaviour (e.g. food intake, purchases), or food environment outcomes, whereas effects for voluntary approaches were mixed. No PPP was included. The review of PPPs included 17 studies on eight PPPs. Partnerships with the food industry were not effective to improve the food environment. Lastly, sixteen studies assessed nine voluntary approaches by private actors. The direction of effect for most outcomes was either inconclusive or worse for participants. Conclusions: Regulatory approaches are generally effective for improving food environments while voluntary approaches by governments or private actors and PPPs are not. Data on PPPs are limited. This questions why PPPs have been encouraged globally.