Introduction Generating country-level political commitment will be critical to driving forward action throughout the United Nations Decade of Action on Nutrition (2016–2025). In this review of the empirical nutrition policy literature, we ask: what factors generate, sustain and constrain political commitment for nutrition, how and under what circumstances? Our aim is to inform strategic ‘commitment-building’ actions.
Method We adopted a framework synthesis method and realist review protocol. An initial framework was derived from relevant theory and then populated with empirical evidence to test and modify it. Five steps were undertaken: initial theoretical framework development; search for relevant empirical literature; study selection and quality appraisal; data extraction, analysis and synthesis and framework modification.
Results 75 studies were included. We identified 18 factors that drive commitment, organised into five categories: actors; institutions; political and societal contexts; knowledge, evidence and framing; and, capacities and resources. Irrespective of country-context, effective nutrition actor networks, strong leadership, civil society mobilisation, supportive political administrations, societal change and focusing events, cohesive and resonant framing, and robust data systems and available evidence were commitment drivers. Low-income and middle-income country studies also frequently reported international actors, empowered institutions, vertical coordination and capacities and resources. In upper-middle-income and high-income country studies, private sector interference frequently undermined commitment.
Conclusion Political commitment is not something that simply exists or emerges accidentally; it can be created and strengthened over time through strategic action. Successfully generating commitment will likely require a core set of actions with some context-dependent adaptations. Ultimately, it will necessitate strategic actions by cohesive, resourced and strongly led nutrition actor networks that are responsive to the multifactorial, multilevel and dynamic political systems in which they operate and attempt to influence. Accelerating the formation and effectiveness of such networks over the Nutrition Decade should be a core task for all actors involved.
- health policy
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Handling editor Valery Ridde
Contributors PB, CH and ARD proposed the idea for the review. PB developed the review protocol with input from all authors. PB and KW undertook the systematic search with final approval of included studies by all authors. PB extracted the data including coding of the included studies, analysed the data with input from KW and wrote the first draft of the manuscript. All authors provided input into the interpretations of the results and ongoing iterations of the manuscript. All authors approved the final version.
Funding Funding for the development of this paper was provided by the Department of Nutrition for Health and Development, WHO, Switzerland.
Disclaimer The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy or views of the WHO.
Competing interests ARD is a full-time staff member of WHO.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement We have provided all data as supplemental text.