FOOD POLICIES FOR HEALTHIER DIETS

Food policies can rely on different instruments to influence consumer's dietary choices. A most important distinction is between ‘push’ and ‘pull’ policy orientations, where the former starts with shaping conducive market- or governance-led food supply conditions, or 'pushing' out (using standards/certification, subsidies/taxes, innovative finance, for example), and the latter focuses on improving consumer demand for healthier foods, or 'pulling' in (with vouchers, information, distribution outlets) from vulnerable segments of the population.

This distinction leads to different strategies that can be used for pursuing healthier food choices. Two distinct strategic opportunities are:

1. demand-oriented incentives that directly modify individual consumer food preferences and buying behavior, and
2. supply-oriented changes in the food environment that modify collective norms regarding food consumption.

It appears that, while many programs for improving diets tend to focus on the demand side, and provide targeted incentives to particular groups of consumers, research evidence suggests that connecting with the consumer through adjustments in the food environment may be more impactful and effective for supporting healthier food choices.

Food choices and nutritional outcomes are shaped by both supply and demand factors. There are major differences between these direct and indirect impact pathways:

Most research is oriented towards measuring the direct impact of prices, information, and market incentives for changing behavior regarding individual food choices, and identifies “nudging” strategies to influence the buying and eating behaviours of different categories of consumers. Evidence increasingly suggests, however, that peer groups and social norms strongly influence individual responses to incentives. Adjustments in the food environment appear to be particularly impactful for changing nutrition patterns. Little is known about the relative importance of and the possible interactions between these different pathways.

The design of effective food policies towards healthier diets requires good understanding of the challenges at hand. How consumers respond to direct or indirect incentives likely depends on four types of issues:

1. Type of nutrition problem: Efforts to reduce undernutrition mostly focus on improving food access and availability, combined with education and training for better nutrition, child care, and sanitation practices. Specific incentives such as cash transfers or vouchers are used to improve demand-side behavior. Addressing micronutrient deficiencies, on the other hand, requires a whole diet approach, even while specific deficiencies could be reduced through public and/or private investment in (bio)fortification. Meanwhile, reducing the risks of overweight and obesity first and foremost requires wider reforms in the food environment, such as more affordable prices for fresh food and better nutritional information, that subsequently support citizen incentives focusing on moderating the intake of ultra-processed foods.
2. Type of agent: Reaching young children - especially during the first 1000 days of child care that are critical for early brain development - can best be pursued by making food products and nutritional information on topics such as breastfeeding available at particular outlets including child care centres. Adolescents need another approach based on norms creation within their particular social groups and with support to living environments, including their neighbourhoods, schools, and workplaces. Focusing on women’s empowerment for improving nutrition should include an empowerment approach that addresses asset ownership, intra-household decision-making, and community norms and practices.
3. Type of food governance system: Food choice and nutrition behaviour is influenced by prevailing governance practices. Under conditions of liberalized food supply, mainly market-led incentives can be used to influence food choice. Modifying prices through taxes or subsidies, as well as different types of food labelling can be considered as key incentives for enhancing healthier diets. Yet interventions focused on changing the food environment are more feasible and substantially easier in rule-oriented political settings that permit legal adjustments in institutional frames. These are mainly used to guarantee food safety and to harmonize food standards, but can also be applied to enforce voluntary guidelines. Analyses of food choice behaviour increasingly recognize that food preferences are most strongly influenced by these contextual factors.
4. Type of food network: Consumers are linked in different ways to places and networks where decisions on access and intake of (healthier) foods are made. At household level, food consumption is known to be influenced by factors like age, gender, education and wealth, while socio-cultural norms tend to guide intra-household distribution practices. At the neighbourhood level, linkages to the food environment become more important. Food deserts, or places with limited access to outlets selling affordable and nutritious food, are usually found in impoverished areas where residents suffer from low purchasing power. Linkages to institutional networks such as schools or workplace canteens offer scope for improving individual diets, behaviour which may spill over to household food habits. In a similar vein, access to ICT infor­mation networks may open perspectives towards personalized nutrition.

Considering these points, policymakers and researchers should note that combining individual incentives with supply-side restrictions may be a particularly effective strategy for steering consumers to choose healthier diets. The combined effect of messaging and incentives also appears with positive outcomes. Finally, combining positive incentives and negative restrictions has proven to be a particularly efficient and effective strategy for supporting healthier food choices.

Ruerd Ruben is Professor of Impact Assessment for Food Systems at Wageningen University & Research. He is a member of A4NH's Planning and Management Committee.