Understanding the role of the state in dietary public health policymaking: a critical scoping review

Abstract

Despite evidence that dietary population health interventions are effective and widely accepted, they remain the topic of intense debate centring on the appropriate role of the state. This review sought to identify how the role of the state in intervening in individuals’ food practices is conceptualized across a wide range of literatures. We searched 10 databases and 4 journals for texts that debated dietary population health interventions designed to affect individuals’ health-affecting food practices. Two co-authors independently screened these texts for eligibility relative to inclusion and exclusion criteria. Thirty-five texts formed our final corpus. Through critical reflexive thematic analysis (TA), we generated 6 themes and 2 subthemes concerning choice, responsibility for health, balancing benefits and burdens of intervention, the use of evidence, fairness, and the legitimacy of the state’s actions. Our analysis found that narratives that aim to prevent effective regulation are entrenched in academic literatures. Discourses that emphasized liberty and personal responsibility framed poor health as the result of ‘lifestyle choices’. Utilitarian, cost-benefit rationales pervaded arguments about how to best balance the benefits and burdens of state intervention. Claims about fairness and freedom were used to evoke powerful common meanings, and evidence was used politically to bolster interests, particularly those of the food industry. This review identifies and critically analyses key arguments for and against population dietary public health policies. Our findings should motivate public health researchers and practitioners to avoid unreflexively embracing framings that draw on the languages and logics of free market economics.

Children, young people and the Commercial Determinants of Health

“…Furthermore, recent frameworks have recognized that the CDoH encompasses much more than harmful industry practices ( Lee et al , 2022 ) and include the ‘ systems, practices, and pathways through which commercial actors drive health and equity ’ ( Gilmore et al , 2023 , p. 1195). Scholarship has expanded to investigate the role that structure and agency may play in enabling and supporting, or challenging corporate practices ( Lee et al , 2022 ), including the role that governments play in intervening between these practices and health outcomes ( Karreman et al , 2023 ). These are important areas of focus for the public health and health promotion communities, given the emphasis in the Ottawa Charter for Health Promotion on equity and social justice, and the call in the Charter for policymakers to be ‘ aware of the health consequences of their decisions and to accept their responsibilities for health ’ ( World Health Organization, 1986 , p. 2).…”