Understanding the dynamics of obesity prevention policy decision-making using a systems perspective: A case study of Healthy Together Victoria

Abstract

Introduction Despite global recommendations for governments to implement a comprehensive suite of policies to address obesity, policy adoption has been deficient globally. This paper utilised political science theory and systems thinking methods to examine the dynamics underlying decisions regarding obesity prevention policy adoption within the context of the Australian state government initiative, Healthy Together Victoria (HTV) (2011–2016). The aim was to understand key influences on policy processes, and to identify potential opportunities to increase the adoption of recommended policies. Methods Data describing government processes in relation to the adoption of six policy interventions considered as part of HTV were collected using interviews (n = 57), document analyses (n = 568) and field note observations. The data were analysed using multiple political science theories. A systematic method was then used to develop a Causal Loop Diagram (CLD) for each policy intervention. A simplified meta-CLD was generated from synthesis of common elements across each of the six policy interventions. Results The dynamics of policy change could be explained using a series of feedback loops. Five interconnected balancing loops served to reduce the propensity for policy change. These pertained to an organisational norm of risk aversion, and the complexity resulting from a whole-of-government policy approach and in-depth stakeholder consultation. However, seven virtuous reinforcing loops helped overcome policy resistance through policy actor capabilities that were improved over time as policy actors gained experience in advocating for change. Conclusion Policy processes for obesity prevention are complex and resistant to change. In order to increase adoption of recommended policies, several capabilities of policy actors, including policy skills, political astuteness, negotiation skills and consensus building, should be fostered and strengthened. Strategies to facilitate effective and broad-based consultation, both across and external to government, need to be implemented in ways that do not result in substantial delays in the policy process.

Diverse Approaches to Creating and Using Causal Loop Diagrams in Public Health Research: Recommendations From a Scoping Review

“…In terms of research aims found in the 23 articles, four themes emerged: 1) to examine the complexity of a public health topic and illustrate complex systems thinking [26][27][28][29][30][31][32][33][34]; 2) to discuss the complexity of a public health intervention [35][36][37][38][39][40]; 3) to describe study protocol and how CLDs were created [41][42][43][44]; and 4) to illustrate how CLDs can be used to monitor and track initiatives to improve population health or evaluate impact of interventions [45][46][47][48].…”

“…Both primary and secondary data were used for creating CLDs (Table 3). Most articles reported on primary data collection (18/ 23) and this included interviews [26,27,33,[35][36][37][38][39][40], group model building with stakeholders and/or community members [32,41,43,44,46,48], behavioral data [42,47], fieldnotes [37], and workshops with experts [31]. Twelve articles used primary data only.…”

Building a Prevention System: Infrastructure to Strengthen Health Promotion Outcomes

“…Systems thinking for prevention requires significant expertise to map systems and locate leverage points to alter their behaviour [29]. At macro and micro levels systems practice requires the reflecting, learning and adapting cycles of emergent strategy to facilitate system interactions via convening stakeholders, engaging communities, connecting agencies, coordinating assets, testing interventions, building consensus and aligning activities [30][31][32]. It involves taking risks in dynamic environments and continuously learning from them to prevent obesity, family violence, diabetes and other chronic problems [33].…”

An action‐oriented framework for systems‐based solutions aimed at childhood obesity prevention in US Latinx and Latin American populations

“…Critical for implementing policy changes is the meaningful involvement of government actors, as well as the consideration of the characteristics, barriers, and facilitators of the political decision‐making process. For instance, investigating the dynamics of obesity prevention policy decision‐making of the Healthy Together Victoria initiative (a state government‐led, multi‐level, multi‐setting complex systems approach to obesity prevention in Australia), Clarke et al 30 identified that alignment of policy proposals to other government objectives and development of viable policy solutions that met the requirements and beliefs of decision‐makers were important facilitators for policy adoption. In contrast, the organizational culture of risk aversion and time required for the policy process can create barriers and delays in the policy decision‐making process.…”