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  • What drives political commitment for nutrition? A review and framework synthesis to inform the United Nations Decade of Action on Nutrition

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What drives political commitment for nutrition? A review and framework synthesis to inform the United Nations Decade of Action on Nutrition
  1. Phillip Baker1,
  2. Corinna Hawkes2,
  3. Kate Wingrove1,
  4. Alessandro Rhyl Demaio3,
  5. Justin Parkhurst4,
  6. Anne Marie Thow5,
  7. Helen Walls6,7
  1. 1Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
  2. 2Centre for Food Policy, City University London, London, UK
  3. 3Department of Nutrition for Health and Development, World Health Organisation, Geneva, Switzerland
  4. 4Department of Health Policy, London School of Economics and Political Science, London, UK
  5. 5Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia
  6. 6Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
  7. 7Leverhulme Centre for Integrated Research on Agriculture and Health, London, UK
  1. Correspondence to Dr Phillip Baker; phil.baker{at}deakin.edu.au

Abstract

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.

  • nutrition
  • review
  • health policy

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjgh-2017-000485

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    Footnotes

    • 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.