Understanding the role of the state in dietary public health policymaking: a critical scoping review.
Health promotion international 2023 ; 38: .
Karreman N, Huang Y, Egan N, Carters-White L, Hawkins B, Adams J, White M
DOI : 10.1093/heapro/daad100
PubMed ID : 37665718
PMCID : PMC10476878
URL : https://academic.oup.com/heapro/article/38/5/daad100/7259639
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.
Lay Summary
Health promotion activities intervene in practices generally considered to be personal or private, including diet.
We searched academic papers for arguments about whether and how the state should intervene in diet.
We identified arguments across six key areas: individual choice, responsibility for health, balancing costs and benefits, evidence, fairness, and whether the state’s actions are legitimate.
Many arguments we identified used economic language and methods that can be used to delay or prevent regulation of the food industry.
We caution the public health community against unconsciously drawing on these arguments and implicitly supporting the diversionary messages of the food industry.