Barbour L, Lindberg R, Woods J, Charlton K, Brimblecombe J. Local urban government policies to facilitate healthy and environmentally sustainable diet-related practices: a scoping review. Public Health Nutr. 2021 Oct 25:1-17.
Open access link to article:
While this review is focused on local government policies, it is relevant to all Dietitians-Nutritionists as many policy actions are also applicable to other levels and sectors.
This scoping review identifies and maps healthy and environmentally sustainable diet-related policies implemented by urban local governments within the 199 signatory cities of the Milan Urban Food Policy Pact (MUFPP).
Bottom line for nutrition practice:
Globally, urban local governments have implemented multiple policy actions to advance healthy and environmentally sustainable diet-related practices. The authors contend that these local governments play a leadership role in forwarding global planetary health targets, but greater capacity is required.
Overall, governments have taken a holistic approach, considering health, equity, and the wide scope of the food supply chain. Sixty-six policy actions that urban local governments have implemented to advance sustainable diet-related practices are presented (Table 4).
The most frequent policy actions relate to:
- food waste,
- school feeding program guidelines,
- urban garden plots for the disadvantaged and
- public procurement – the latter suggesting that publicly funded facilities are appropriate settings for action.
The research also showed that local governments engage a wide range of stakeholders in policy making and create governance structures that connect stakeholders and neighboring areas (e.g., a producer’s network with stakeholders from urban and rural areas).
Objective: This scoping review sought to describe the policy actions that urban local governments globally have implemented to facilitate healthy and environmentally sustainable diet-related practices.
Setting: Urban local government authorities.
Design: Five databases were searched to identify publications which cited policies being implemented by local governments within the 199 signatory cities of the Milan Urban Food Policy Pact (MUFPP) that targeted at least one healthy and sustainable diet-related practice. Grey literature was then searched to retrieve associated policy documentation. Data from both sources were charted against the MUFPP’s monitoring framework to analyse the policy actions included in each overarching policy.
Results: From 2624 screened peer-reviewed studies, 27 met inclusion criteria and cited 36 relevant policies amongst signatory cities to the MUFPP. Most were from high income countries (n 29; 81 %), considered health (n 31; 86 %), equity (n 29; 81 %) and the broader food system beyond dietary consumption (n 34; 94 %). Of the 66 policy actions described, the most common involved food procurement within public facilities (n 16; 44 %) and establishing guidelines for school-feeding programs (n 12; 33 %).
Conclusions: This review has demonstrated that urban local government authorities are implementing policies that consider multiple phases of the food supply chain to facilitate population-wide uptake of healthy and sustainable diet-related practices. Opportunities exist for local governments to leverage the dual benefits to human and planetary health of policy actions, such as those which discourage the overconsumption of food including less meat consumption and the regulation of the ultra-processed foods.
Details of results:
Twenty-seven studies referencing policy interventions from the 199 signatory cities to the MUFPP met the inclusion criteria (see: “of additional interest”). Within the 36 relevant policies found, 66 policy actions were identified. The authors categorized these 66 policy actions under six categories of the MUFPP monitoring framework: “enabling effective action (governance); sustainable diets and nutrition; social and economic equity; food production (including urban – rural linkages); food supply and distribution; food waste” (p.5).
The MUFPP category which had the highest reported number of different policy actions was the food waste category (n 17; 26 %), where the lowest number of different actions fell within the food supply and distribution category (n 6; 9 %). When analyzing the number of policies reported for each policy action within a category, however, the most frequent number of policy actions fell within the food supply and food distribution category. While the food supply and food distribution category had only six different actions noted, within these six, sixteen policies (n 16; 44 %) were reported related to the policy action of food procurement in public facilities. This was followed by school feeding program guidelines (under the category “sustainable diets and nutrition) (n 12; 33 %) and allocating urban garden plots for those experiencing disadvantage (n 11; 31 %) (under “social and economic equity”).
The authors cite research suggesting that practices having the highest potential in middle to high income countries to advance both health and sustainability (win-win) include limiting animal-based foods, increasing plant-based foods, and avoiding overconsumption. Actions related to limiting the intake of animal-based foods centred on school feeding guidelines, procurement practices in commercial and public food service facilities, and social marketing campaigns.
The authors note that the benefits of increasing plant-based foods is also related to the adoption of sustainable agricultural practices, however there are multiple trade-offs (e.g., organic food maybe more environmentally sustainable, but yields may be lower and food may be more expensive to purchase). Increasing plant-based food consumption is being addressed through investment in urban agriculture, alternative ways of connecting producers with consumers such as farmers markets, and directing recovered produce from farms to emergency food services.
Finally, policies related to avoiding the overconsumption of food were primarily linked to health (versus environmental) benefits. In order to address trade-offs in advancing these practices, the authors suggest that evidence to inform policy action needs to come from health, nutrition, environment, and the social sciences.
While the study was global and included all 199 signatories of the MUFPP, 81% of policies analyzed occurred in high income countries, 14% in upper middle income countries, and 6% in low middle income countries. No policies were cited in the included studies for low income countries. The authors acknowledge that the under representation in low to middle income countries may have occurred as these governments may have a lesser ability to access academic resources to publish outcomes or best practice examples in the peer-reviewed literature.
Of additional interest:
In order to be eligible for inclusion in the study, the intended outcome of the policy had to include at least one of the healthy and sustainable diet related practices outlined in below. This research was previously published by some of the authors of this study.
Barbour L, Woods J & Brimblecombe J. Translating evidence into policy action: which diet-related practices are essential to achieve healthy and environmentally sustainable food system transformation? Aust N Z J Public Health. 2020. 45,83–84.
Background: A healthy and sustainable diet must:
- Be nutritionally adequate, healthy and safe
- Have a low environmental impact and protect biodiversity
- Be culturally acceptable
- Be accessible, economically fair and affordable.
What healthy and sustainable eating practices can you adopt?
Where to source food?
- Strengthen local food systems by connecting with primary producers
- Eat seasonally, incorporating native and wild-harvested foods
- Eat locally available foods
- Select food grown using sustainable food production practices, valuing Indigenous knowledges
What to eat?
- Avoid over-consumption beyond your body’s energy requirements
- Consume no more than recommended animal-derived foods
- Limit intake of highly processed, nutrient-poor and over-packaged food
- Increase intake of plant-based foods
- Eat a wide variety of foods to promote biodiversity
How to eat?
- Adopt food waste-minimisation strategies
- Preference home-made meals and share with others
- Consume safe tap water as preferred drink
- Breastfeed infants where possible
The authors suggest that the importance of avoiding consumption as a sustainability practice is overlooked. The Dietitians of Canada role paper on Sustainable Food Systems and Sustainable Diets (see link below) includes a message related to overconsumption, but cautions how it is communicated.
The Dietitians of Canada message (below) focuses on policies and strategies related to marketing overconsumption, rather than messages targeted toward individuals. The intent is to avoid giving those with disordered eating more rationale to limit their intake, and not to shame people for eating.
The Dietitians of Canada message reads as follows: “Promote policies and strategies that de-emphasize market-driven overconsumption” (p.22). Dietitians of Canada. The Role of Dietitians in Sustainable Food Systems and Sustainable Diets: www.dietitians.ca/Advocacy/Priority-Issues-(1)/Food-Policy/Sustainable-Food-System
While the noted best practice of “directing recovered produce to emergency food services” can be a temporary solution to food insecurity, it does not address the root of the problem. In higher income countries, food insecurity results primarily from inadequate income.
Conflict of interest/ Funding:
The authors reported no conflict of interest. This study forms part of the first authors’ PhD research, which is funded by an Australian National Health and Medical Research Council (NHMRC) Post-Graduate Scholarship.
External relevant links:
As indicated above within the text.
Liza Barbour, firstname.lastname@example.org
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