4.2 Article

Understanding the role of the state in dietary public health policymaking: a critical scoping review

期刊

HEALTH PROMOTION INTERNATIONAL
卷 38, 期 5, 页码 -

出版社

OXFORD UNIV PRESS
DOI: 10.1093/heapro/daad100

关键词

diet; food; health policy; qualitative methods; systematic review

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This study aims to explore the conceptualization of the role of the state in intervening in individuals' food practices across various literatures. Through thematic analysis, it was found that some academic literature attempts to prevent effective regulation. Discourses emphasizing personal freedom and responsibility frame poor health as a result of lifestyle choices. Cost-benefit rationales dominate discussions on balancing the benefits and burdens of state intervention. Claims of fairness and freedom are used to evoke powerful common understandings, and evidence is used politically to support interests, particularly those of the food industry. This review identifies and critically analyzes key arguments for and against population dietary public health policies.
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.

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