Strengthening Systems Resource Review

This paper presents the NOURISHING framework of food policies to promote healthy diets and uses the framework to summarize the policy actions taken by countries who attended a June 2013 meeting in Bellagio, Italy on the progress of obesity prevention efforts in low and middle income countries. According to the framework, the best way to combat unhealthy diets is with a comprehensive approach in which policymakers can select from a suite of policies and tailor them to specific situations. In addition, because food environments influence dietary behaviors and choices about which foods to eat, it is important to change policies related to food environments. Finally, the paper uses the framework to describe how the countries who attended the Bellagio meeting are implementing NOURISHING policy actions. This is one of the few articles that deals with food labelling and private sector issues.

This report discusses science- and policy-related conceptual frameworks for health equity. Historically, health policies have either been technologically based, relying on cutting edge medical care and public health interventions, or based on the idea that health is a social occurrence, requiring more complex policies. This paper examines the latter interpretation and discusses the socio-economic factors involved in health equity or inequity. In the broader context of understanding systems thinking, this report represents one currently popular school of thought, that of the “social determinants of health”, which embraces the complexity of systems and seeks to provide evidence and logic to the interactions within that system. 

This paper advocates for “health systems analysis” (HSA) as a methodology that should be practiced when designing policies and programs for health system strengthening. Health systems analysis uses history, politics, and other arrangements to analyze how health system inputs, processes, and outputs combine to produce outcomes. Through this analysis, HSA is able to estimate causes of poor health system performance and suggest ways to improve performance.

The authors of this paper used bibliographic searches, a modified Delphi technique, focus groups, and interviews with experts to identify existing models of agriculture, food, nutrition, health, and environmental systems. They then created an integrated conceptual model of the food and nutrition system based on the results of their data collection. The food and nutrition system consists of the processes necessary to change raw materials into foods and changing nutrients into health outcomes.  The conceptual model the authors created is unique because there are very few models which describe the system broadly.  This broad model is able to identify links between the different disciplines within the food and nutrition system. The authors explain, "systems theory takes a holistic perspective in examining system boundaries, delineating subsystems and their relationships, emphasizing the process of homeostasis and considering relationships between systems. Systems are viewed as sets of elements that function together as collective units."

This paper describes the rise and fall of multi-sectoral nutrition planning in the 1970s. The idea was that nutritional improvement to match resources to need should be integrated into broader development planning, not done separately once development planning was underway. If it were integrated into the broader system, solutions could cut across agriculture, health, and education sectors, making alleviating malnutrition much faster and more cost effective. While multi-sectoralism is not the same as a systems approach, a systems approach requires one to consider multiple sectors. This paper is quite useful to refer to when considering the current wave of multi-sectoral nutrition efforts.

See also: Rejoinder: Nutrition Planning is Alive and Well, Thank You

This paper refutes the assertion in the previous paper, Multi-sectoral nutrition planning: a post-mortem, that nutrition planning was a failure. The author argues that multisectoral analysis and multisectoral implementation are two very different things, though Field’s article discusses them together. Berg says that just because malnutrition is caused by many factors, it does not necessarily need to be solved by one overarching solution. He also argues that a good food and nutrition system must have consumers as the central focus.

This report takes a unique, visual approach to discuss the multi-sectoral challenges associated with rising obesity and poor nutrition in the UK. Obesity is a very complex problem that involves many factors and, consequently, there is no single fix. The authors of this report used a systems mapping approach to understand and map obesity’s complexity so that they could understand the interrelationship between all of the determinates and causes and provide insight as to the best policy responses to combat obesity.  The report concludes by exhorting the UK to pioneer a new method of talking obesity by using an integrated approach and setting a global standard.

This report focuses on the ways that food and agriculture policies can foster good nutrition. Both malnutrition and obesity impose high costs on society, but the costs of malnutrition are much higher.  Production and trade policies influence the supply of different types of foods and income, whereas culture and education affect how consumers choose to eat. The food system determines what is available to consumers and if it is appropriately nutritious, affordable, and available.  When food system interventions consider the system as a whole they are far more likely to have positive outcomes.

Because the food system is now global, all other sectors like energy, water supply, land use, and biodiversity are all related. The report emphasizes that coordinating all of these systems is extremely important for policy makers; because if food security is threatened, all other sectors will come to a standstill. This report’s main conclusion is that policy making in all sectors needs to be interconnected.

This book argues that the multisectoral approach is the best way to combat malnutrition and delves into the research necessary to learn whether it is possible to use the approach in nutrition.  The main issue is ensuring collaboration among all of the stakeholders involved in working multisectorally.