International Journal of Health Policy and Management

International Journal of Health Policy and Management

Policy Action Within Urban African Food Systems to Promote Healthy Food Consumption: A Realist Synthesis in Ghana and Kenya

Document Type : Review Article

Authors
Andrew Booth 1
Amy Barnes 1
Amos Laar 2
Robert Akparibo 1
Fiona Graham 3
Kristin Bash 1
Gershim Asiki 4
Michelle Holdsworth 5
1 School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
2 School of Public Health, University of Ghana, Accra, Ghana
3 Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
4 African Population and Health Research Center (APHRC), Nairobi, Kenya
5 French National Research Institute for Sustainable Development (IRD), NUTRIPASS Unit, IRD-Univ Montpellier, Montpellier, France
10.34172/ijhpm.2020.255
Abstract
Background
Obesity and nutrition-related non-communicable diseases (NR-NCDs) are increasing throughout Africa, driven by urbanisation and changing food environments. Policy action has been limited - and influenced by high income countries. Socio-economic/political environments of African food systems must be considered in order to understand what policy might work to prevent NR-NCDs, for whom, and under what circumstances.
 
Methods
A realist synthesis of five policy areas to support healthier food consumption in urban Africa: regulating trade/foreign investment; regulating health/nutrition claims/labels; setting composition standards for processed foods; restricting unhealthy food marketing; and school food policy. We drew upon Ghana and Kenya to contextualise the evidence base. Programme theories were generated by stakeholders in Ghana/Kenya. A two-stage search interrogated MEDLINE, Web of Science and Scopus. Programme theories were tested and refined to produce a synthesised model.
 
Results
The five policies operate through complex, inter-connected pathways moderated by global-, national- and local contexts. Consumers and the food environment interact to enable/disable food accessibility, affordability and availability. Consumer relationships with each other and retailers are important contextual influences, along with political/economic interests, stakeholder alliances and globalized trade. Coherent laws/regulatory frameworks and government capacities are fundamental across all policies. The increasing importance of convenience is shaped by demographic and sociocultural drivers. Awareness of healthy diets mediates food consumption through comprehension, education, literacy and beliefs. Contextualised data (especially food composition data) and inter-sectoral collaboration are critical to policy implementation.
 
Conclusion
Evidence indicates that coherent action across the five policy areas could positively influence the healthiness of food environments and consumption in urban Africa. However, drivers of (un)healthy food environments and consumption reflect the complex interplay of socio-economic and political drivers acting at diverse geographical levels. Stakeholders at local, national, and global levels have important, yet differing, roles to play in ensuring healthy food environments and consumption in urban Africa.
Keywords
Africa
Food Environments
Food Policy
Food Consumption
Realist Review

 

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  • Received Date 31 May 2020
  • Revised Date 29 November 2020
  • Accepted Date 12 December 2020
  • First Published Date 09 February 2021
  • Published Date 01 December 2021