Policy Action Within Urban African Food Systems to Promote Healthy Food Consumption: A Realist Synthesis in Ghana and Kenya
Date
2021
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
International Journal of Health Policy and Management
Abstract
Background: Obesity and nutrition-related non-communicable diseases (NR-NCDs) are increasing throughout Africa,
driven by urbanization and changing food environments. Policy action has been limited - and influenced by high-income
countries. Socioeconomic/political environments of African food systems must be considered 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 contextualize the
evidence base. Program theories were generated by stakeholders in Ghana/Kenya. A two-stage search interrogated
MEDLINE, Web of Science, and Scopus. Program theories were tested and refined to produce a synthesized model.
Results: The five policies operate through complex, interconnected 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. Contextualized 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.
Description
Research Article
Keywords
Africa, Food Environments, Food Policy, Food Consumption, Realist Review
Citation
Booth A, Barnes A, Laar A, et al. Policy action within urban African food systems to promote healthy food consumption: a realist synthesis in Ghana and Kenya. Int J Health Policy Manag. 2021;10(12):828– 844. doi:10.34172/ijhpm.2020.255