Week 7 - 7MNT0003 - Policymaking and Nutrition Course

Course Overview

  • Course Title: Policymaking and Nutrition

  • Date: 14th November 2025

  • Instructor: Dr. Kevin Walsh RD FHEA

Learning Objectives

  • To develop an understanding of nutrition policy history within the UK and other regions, including recent UK regulatory changes (2018-2026).

  • To describe the policymaking process and policy options in public health nutrition.

  • To critically discuss current challenges in policymaking in nutrition.

Overview of Key Topics

  • Timeline and history of nutrition policies in the UK.

  • Overview of the policymaking process.

  • Policy options in nutrition.

  • Challenges in policymaking.

  • Activity to engage with the material.

A Brief History of Public Health Nutrition

Key Developments

  • 1910, 1930: Vitamin discovery.

  • 1950: Focus on Food Fortification due to rising cardiovascular diseases (CVD).

  • 1990-2010: Establishment of Food Assistance Programs to eliminate hunger, and a debate over energy vs. protein in undernutrition.

  • Growing focus on dietary patterns, randomized controlled trials (RCTs), and nutrigenomics.

Significant Nutritional Challenges Over Time

  • Historical focus: Iron, vitamin A, and iodine deficiencies in less wealthy countries.

  • Rise in chronic diseases and dietary pattern considerations in wealthier nations.

Historical UK (& EU) Perspective

1940s Developments

  • 1940: Formation of Scientific Sub-Committee on Food Policy based on nutritional needs rather than agricultural interests.

  • Recommended high extraction after pushback from the food/agricultural sector.

  • Welfare Food Scheme: Aimed at ensuring adequate nutrition during WWII; prioritized pregnant women and children with supplemental food.

  • Nutrient standards introduced (1940-1941); fortification of margarine (1942) and flour with calcium (1946).

1950s to 1960s Developments

  • 1951-1954: Phasing out of food rationing in the UK.

  • 1956: Shift in food policy from high extraction to nutrient restitution (fortification).

  • Introduction of EU Common Agricultural Policy (CAP) aimed at agricultural productivity and food supply security.

  • Tightening of fortification regulations in 1963 for bread, flour, and margarine.

1970s to 1990s Developments

  • 1973: UK joined European Economic Area and CAP.

  • 1978-1979: Government releases healthy eating advice, including salt intake reduction.

  • 1981: Maternity and Welfare Act facilitated low-cost milk for impoverished families.

  • Launch of the Eat Well Programme (1994) and the Health of the Nation Report (1992), focusing significantly on nutrition.

2000s Developments

  • 2000: Establishment of the Health Development Agency for public health strategy implementation.

  • 2003: Publication of Salt and Health Report by SACN; introduction of food labelling legislation.

  • 2005: National institute for Clinical Excellence (NICE) set up

  • 2006: Low income survey published detailing nutritional status/diet in lower income groups

Policy Milestones (2016-2026)

  • 2016: Implementation of the childhood obesity plan, including soft drinks industry levy and sugar reduction program.

  • 2018: Introduction of the soft drinks industry levy resulting in a 46% average reduction in eligible beverages (2015-2020).

  • 2022: Calorie labelling mandated for large food outlets (250+ employees) and HFSS (high in fat, salt, sugar) placement restrictions introduced.

  • 2025: Ban on HFSS multi-buy promotions.

  • 2026: HFSS advertising restrictions and mandatory folic acid fortification in non-wholemeal flour.

Monitoring & Surveillance of Nutritional Status

  • Monitoring nutritional status assists with early warning, policy development, and evaluation.

  • Surveillance focuses on population trends rather than individual risk assessment.

  • Referenced Source: Tuffrey, V. (2016). “Nutrition surveillance systems: their use and value.”

  • In the UK, we use NDNS: the National Diet and Nutrition Survey, which provides comprehensive data on the dietary habits and nutrient intake of the population.

Definition of Policy

  • Definition: A set of ideas or plans agreed upon by a group (government, organization) to achieve a desired goal that benefits society.

  • Types of Policy:

    • Proactive: Initiated following party manifesto or aims.

    • Reactive: Responds to crises or health emergencies.

    • Current/Live: Relevant and actively discussed in public agendas.

    • Dormant: Existing but low awareness/enforcement.

Legislative Change

Legalisation = Refers to laws passed through and approved by a legislature like a parliament or congress

  • Passed laws represent a transformative goal for public health advocacy (i.e., soft drinks industry levy, calorie labelling, HFSS restrictions).

  • Enactment requires parliamentary debate and scrutiny; must be articulated clearly to the public.

  • When enacted, benefits from legal apparatus of implementation and enforcement.

The Policymaking Process

  • Described as a decision-making process, which may not be linear, ideal scenario involves:

    • Identifying the problem.

    • Analyzing potential policy solutions.

    • Engaging stakeholders effectively.

Stakeholder engagement is critical.

Role of public health professionals in the process:

 Conducting policy analysis

 Communicating findings

 Developing partnerships

 Promoting and implementing evidence-based interventions.

Problem Identification

  • Process: Collect, summarize, and interpret data related to the problem (frequency, severity, scope); identify gaps in data.

  • Define the characteristics (e.g. frequency, severity, scope, economic, and budgetary impacts of the problem

  • Identify gaps in data

  • Problems need to be framed to lend themselves to policy solutions.

Determinant Analysis

  • Identification of factors affecting the problem with a review of their interrelations, recognizing multiple causes.

  • Identification of causal relationships is important for strategy selection and prioritisation

  • Understanding both proximate (direct impact) and distal (influence) causes is crucial for effective intervention strategies.

Policy Options in Nutrition

  • Framework:

    • People, Products, Promotions, Place, Price: essential components influencing nutritional policy.

  • Examples:

    • Reformulation and new product development, e.g., soft drinks industry levy and folic acid fortification.

Stakeholder Engagement

  • Critical at all policymaking stages:

    • Identify key stakeholders (decision-makers, affected individuals, community partners).

    • Assess their characteristics and implement effective communication strategies.

Evaluation of Policy

  • Essential to systematically assess steps in the policy cycle, including impact and outcomes.

  • Formulate prioritised evaluation questions to guide the evaluation process.

Complex Interventions

  • Identify or develop intervention

  • Assess feasibility

  • Assess intervention and evaluate effectiveness

  • Implementation of intervention

Policy Options in Nutrition

Products = Reformulation new product developement. e.g soft drinks levy (2018)

Promotions = Advertising and marketing e.g (Ad restrictions on HFSS from 2026)

Place = Buying standards for public procurement, planning policy (HFSS placement restrictions 2022)

Price = taxes or subsidies (SDIL levy, Multi-buy HFFS ban

People = Increase awareness, educate (eatwell guide)

Policy Analysis/Feasibility

Identify different policy options to address the problem/issue and use quantitative and qualitative methods to evaluate and the policy options to determine the most effective, efficient, and feasible option:

 Research and identify policy options

 

 Describe:

a)how the policy will impact health/nutrition

b)the costs to implement the policy and how the costs compare with the benefits (economic and budgetary considerations)

c)the political and operational factors associated with adoption and implementation (feasibility)

 Assess and prioritise policy options

Always consider the option of doing nothing and assess the impacts compared to ‘active’ policies

Stakeholder Engagement

Crucial in all stages of policymaking process

  • Involves identifying and connecting with decision-makers, partners, those affected by the policy, and the general public:

  •  Identify key stakeholders, including supporters and opponents (e.g., community members, decision-makers, nonprofit, and for-profit agencies)

  •  Assess relevant characteristics (e.g., knowledge, attitudes, needs)

  •  Implement communication strategies and deliver relevant messages and materials

  • Solicit input and gather feedback

Strategy and policy developement and enactment

Identify the strategy for the policy and how the policy will operate

  •  Identify how the policy will operate and what is needed for policy enactment and implementation (e.g., understand jurisdictional context and identify information and capacity needs)

  •  Define strategy for engaging stakeholders and policy actors

  •  Possibly draft the policy (law, regulation, procedures, actions, etc.)

  • Policy Enactment:

  •  Follow internal or external procedures for getting policy enacted or passed

  •  Enact law, regulation, procedure, administrative action, incentive, or voluntary practice

Policy Implementation

Translate the enacted policy into action, monitor uptake, and ensure full implementation:

  •  Translate policy into operational practice and define implementation standards

  •  Implement regulations, guidelines, recommendations, directives and organisational policies

  •  Identify indicators and metrics to evaluate implementation and impact of the policy

  •  Coordinate resources and build capacity of personnel to implement policy 

  •  Assess implementation and ensure compliance with policy

  •  Support post-implementation sustainability of policy

Challenges in Nutrition Policymaking

  • Common Challenges:

    • Lack of political commitment, competition for attention, unclear legislative responsibilities, complexity in policy design.

    • Data gaps leading to poor decision-making and lack of robust surveillance systems.

Case Study: UK Calorie Reduction Programme

  • Problem: Excessive calorie intake among children.

  • Policy Aim: Achieve a 20% reduction in calories from specific food categories through stakeholder engagement and public awareness campaigns.

  • Challenges: Evaluation difficulties for the eating out sector; mixed success regarding calorie reduction initiatives.

Key Takeaways

  • Importance of continuous advocacy and evidence-based policymaking in public health nutrition.

  • Understanding the complexities and necessity of cross-sector collaboration is vital for effective policymaking.

  •  An understanding of what policy is and the different types of policies/policy actors.

  •  UK policy momentum since 2016 includes Soft Drinks Industry Levy (2018), HFSS placement (2022), calorie labelling (2022), HFSS multibuy (2025), HFSS ad restrictions (inc. 2026), and folic acid flour fortification (inc. 2026)

  •  The policymaking process: key stages and what they involve

  •  The many challenges involved when making nutrition policy

  •  Cross-sectoral, multi-disciplinary working is key, but difficult. Buy-in from commercial/industry partners is important.

  •  Importance of public health nutrition needs to be recognised – need continuous advocacy

  •  Need for policymaking to be grounded in evidence, but data gaps/limitations of evidence can make this difficult

Contact Information

  • Instructor: Dr. Kevin Walsh RD FHEA

  • Contact: +44 (0)20 7848 4437 | kevin.walsh@kcl.ac.uk