Inequalities in research on food environment policies: An evidence map of global evidence from 2010-2020.

Abstract

Background: There has been increasing pressure to implement policies for promoting healthy food environments worldwide.

Objective: This evidence map critically explored the breadth and nature of primary research from 2010-2020 evaluating the effectiveness, cost-effectiveness, development, and implementation of mandatory and voluntary food environment policies.

Methods: 'Real-world' evaluations of international, national and state level policies promoting healthy food environments, published between 2010 and 2020, were searched across 14 databases and two websites. We documented the policy and evaluation characteristics, including the International WCRF NOURISHING framework's policy categories and ten equity characteristics using the PROGRESS-Plus framework. Data were synthesised using descriptive statistics and visuals.

Results: We screened 27,958 records, of which 482 were included. Although these covered 70 countries, 81% of publications focused on only 12 countries (USA, UK, Australia, Canada, Mexico, Brazil, Chile, France, Spain, Denmark, New Zealand and South Africa). Studies from these countries employed more robust quantitative methods and included most of the evaluations of policy development, implementation, and cost-effectiveness. Few publications reported on Africa (n=12), Central and South Asia (n=5), and the Middle East (n=6) regions. Few also assessed public-private partnerships (PPPs, n=31, 6%) compared to voluntary approaches by the private sector (n=96, 20%), the public sector (n=90, 19%), and mandatory approaches (n=288, 60%). Most evaluations of PPPs were about two partnerships. Only 50% of publications assessing policy effectiveness compared outcomes between population groups stratified by an equity characteristic, and this proportion has decreased over time.

Conclusions: There are striking inequities in the origin, scope and design of these studies, suggesting that research capacity and funding lies in the hands of a few expert teams worldwide. The small number of studies on PPPs questions the evidence base underlying the international push for PPPs to promote health. Policy evaluations should consider impacts on equity more consistently.

Prospero registration: CRD42020170963.