Actions to address CDoH at the local authority level
Actions to address CDoH at the local authority level

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Social marketing campaigns to support healthy eating and active lifestyles 

Area of Interest:
Food and Drink
Lancet Model:
Level:  Level 4: Environments
Drivers:  Norms
Practices:  Marketing practices
Mechanism:
Socio-cultural
Effect:
+/-0* (Suggestive but inconclusive)
Scopes:
Global, Europe, UK, Other (USA)

Details:

What we know: Social marketing campaigns appear to be a cost-effective approach for promoting physical activity (McKinnon et al., 2016, Appendix Table 1, p. 11). Limited and inconclusive data is available for the effects of social marketing campaigns on healthy eating, but one review indicated this approach may increase awareness and positive behavioural intent to increase fruit and vegetable consumption (Kraak et al., 2012).

Examples of implementation: A review from Danielli et al., (2021) identified two local social marketing campaigns - one to encourage residents to lose weight in Liverpool (UK) and one to increase cycling in Omaha, Nebraska (USA).

Sales bans on energy drinks 

Area of Interest:
Food and Drink
Lancet Model:
Level:  Level 3: Sectoral public policies
Drivers:  N/A
Practices:  Marketing practices
Mechanism:
Physical environment
Effect:
* (Inconclusive)
References:
Scopes:
Global, Europe, UK

Details:

Types of identified restrictions: Age of sale; location-based restrictions for sale or use.

What we know: Limited research has evaluated the efficacy of energy drink policies including sales-related bans and restrictions (Rostami et al., 2024).

Examples of implementation: There are complete bans on sales of energy drinks in Turkey and Denmark. Age of sale restrictions are present in Sweden, UK and Hungary with prohibited sales to under 15s, under 16s and under 18s, respectively. Location-based restrictions on energy drinks are enacted in Norway, where you can only purchase them through pharmacies.

Economic incentives for healthier food and beverage retail and service environments

Area of Interest:
Food and Drink
Lancet Model:
Level:  Level 3: Sectoral public policies
Drivers:  N/A
Practices:  Financial practices, Marketing practices
Mechanism:
Financial
Effect:
+/-0* (Suggestive but inconclusive)
Scopes:
Global, Europe, UK, Other (USA)

Details:

Types of identified incentives: Financial assistance to supermarkets in underserved areas; grants, loans and/or tax incentives for improving quality of food options in retailer / supermarket environments; renovations to stores including new refrigerators to incentivize retailers and improve display ambience; 'Healthy Corner Store’ initiative to support corner stores operating in food deserts; industry incentives to reward companies that promote healthier products.

What we know: The development of new supermarkets in underserved areas may be supported by local communities and potentially reduce food insecurity, but research evidence suggests low adoption and limited to no effects on health (i.e., little or no improvement in body mass indices, household food purchase or dietary intakes). Modelling research suggests that interventions focused on introducing and supporting new stores is less cost-effective than polices targeting welfare benefits (e.g., increasing amount of benefits or coverage).
Less is known about how investment in healthier retail outlets may improve health by increasing economic opportunity, social cohesion and/or safety (Moran et al., 2020).

Examples of implementation: Healthy Food Financing Initiative (USA) (est. 2011) - this national programme aimed to improve access to healthy foods in low-income communities by building supermarkets or farmers' markets as well as by improving the quality of foods in small stores via grants, loans and tax incentives. From 2011-2015, $195 million was provided to community development organisations for almost 1000 healthy food access projects in 35 US states. Similar programmes operate at the US state or local level (Moran et al., 2020).

Food Policy Group led-initiatives to improve awareness of local food poverty and associated resources and services

Area of Interest:
Food and Drink
Lancet Model:
Level:  Level 4: Environments
Drivers:  N/A
Practices:  Marketing practices, Scientific practices
Mechanism:
Cognitive
Effect:
+ (Beneficial effect)
References:
Scopes:
Global, Europe, UK

Details:

Types of identified activities: Collaboration with local food policy groups to deliver awareness building of local food poverty and resource dissemination through emergency relief or relevant local services. Activities included education programmes, media campaigns and training for housing workers and care workers.

What we know: Evaluation of the Brighton and Hove Food Partnership's initiatives reported increased consumer knowledge about where to purchase local foods, the benefits of local food and knowledge and access to relevant local services (Godrich et al., 2023) The Montgomery County Food Policy Council (Georgia, USA) reported increased utilisation of their food relief services following an educational campaign (275% increase over initial projections) (see Montgomery County Food Policy Council et al., (2021) in Godrich et al., 2023).

Examples of implementation: The 'Sugar Smart' campaign from Sustain and Sustainable Food Cities (now Sustainable Food Places) in partnership with Brighton and Hove Food Partnership sought to reduce overconsumption of sugar. One of the included components was called 'Taste Adventures', which involved children receiving stamps for trying new foods presented by local producers (Godrich et al., 2023).

Educational and technical assistance to support neighbourhood market and store owners to increase healthy food options

Area of Interest:
Food and Drink
Lancet Model:
Level:  Level 4: Environments
Drivers:  N/A
Practices:  Marketing practices, Supply chain and waste practices
Mechanism:
Cognitive
Effect:
+/-0* (Suggestive but inconclusive)
References:
Scopes:
Global, Europe, UK

Details:

Examples of implementation: A review by Godrich et al., (2023) highlighted the Los Angeles Food Policy Council's 'Healthy Neighbourhood Market Network' programme, which providing educational and technical assistance to local market and store owners to encourage them to increase their offering of healthy food options and produce. The Council reported that all participating store owners cited an increase in healthy product sales and greater profit ($1453.40 per week) after expanding their offer of healthy food options (Godrich et al., 2023).

Development of residential and community garden initiatives

Area of Interest:
Food and Drink
Lancet Model:
Level:  Level 4: Environments
Drivers:  N/A
Practices:  Marketing practices, Supply chain and waste practices
Mechanism:
Physical environment
Effect:
+ (Beneficial effect)
Scopes:
Global, Europe, UK, Other (USA)

Details:

Types of initiatives identified: Urban beekeeping pilot projects; devoting public lands to urban farms and gardens in perpetuity; retrofitting affordable housing developments with community gardens; providing public storage, transport, and aggregation options for urban farmers; co-design rooftop gardens with residents in social housing complexes; edible garden beds at train stations and other public facilities to be maintained by communities and neighbourhood groups; backyard gardens; plots in community gardens or green spaces.

What we know: Residential and community gardening initiatives have been shown to improve food security and access to fresh produce and offset significant percentages of household fresh produce expenditure (Siegner et al., 2018). Household and community gardens, in some urban contexts, have been shown to be unevenly distributed and correlate with patterns of gentrification, with these gardening initiatives not occurring within low-income communities and urban-core areas (see Taylor and Lovell, 2012, in Siegner et al., 2018).

Examples of implementation: Barbour et al., (2022) (see supplementary material 6) has a comprehensive list of local government policies and programmes for facilitating healthy and sustainable food practices including local resident and community garden programmes and initiatives. For example, Paris (France) has a 'Green Hand' Charter to establish more community gardens on publicly-owned lands, with the purpose of food provision as well as therapeutic purposes, social bonding and integration and education. Dakar (Senegal) developed a 'micro-gardens' programme, which involves developing gardens on standing tables using recycled materials. The project is supported by training and demonstration centres and train-the-train education models and targets vulnerable populations like women, young people, elderly, disabled and those in care homes and prisons. This project has reported association with increased fruit and vegetable consumption among target populations, improved access to food and opportunities for social cohesion and income development (Barbour et al., 2022).

Local partnership campaigns with Food Policy Groups to increase support of sales of local food

Area of Interest:
Food and Drink
Lancet Model:
Level:  Level 4: Environments
Drivers:  N/A
Practices:  Marketing practices
Mechanism:
Physical environment
Effect:
+ (Beneficial effect)
References:
Scopes:
Global, Europe, UK

Details:

Types of identified activities: Food policy group (FPG) facilitating local partnership campaigns to increase support of sales of local food such as via local food boxes and sales at school cafeterias.

Examples of implementation: Toronto Food Policy Council collaborated with FoodShare, a local food justice organisation, to launch and deliver the 'Good Food Box' programme, which distributed boxes of affordable produce to neighbourhood drop-off points in low-income neighbourhoods (Godrich et al., 2023). The 'Food Hub Grow Source Eat' project led by Sustain, Australia's national food network, connected urban farmers and Victorian growers to distribute weekly produce boxes to residents of Melbourne and Cardinia via the local Cardinia Community Food Hub. More than half of self-reporting participants stated the programme helped them eat more fresh produce and almost all reported eating more seasonally (87%) (Godrich et al., 2023).

Development of urban agriculture, farms and/or gardens 

Area of Interest:
Food and Drink
Lancet Model:
Level:  Level 4: Environments
Drivers:  N/A
Practices:  Marketing practices, Supply chain and waste practices
Mechanism:
Physical environment
Effect:
+ (Beneficial effect)
Scopes:
Global, Europe, UK, Other (USA)

Details:

Types of identified initiatives: Commercial vertical or rooftop farms; repurpose publicly-owned land for urban agriculture activities; allocate urban garden plots for people experiencing disadvantage; integration of circular economy principles with composting and soil management to urban agriculture initiatives; use urban agriculture to supply local residents, public facilities and residents; develop code of management to ensure public access and conditions of food production within urban agriculture initiatives; use public funds for urban agriculture infrastructure, materials and tools.

What we know: Urban agriculture initiatives are a positive source of increased food production and appear to reduce food insecurity and undernutrition (Burgaz et al., 2023). These initiatives also are associated with positive climate effects including nitrogen fixation, energy savings, pollination, climate regulation, soil formation and biological control of pests. Theoretical mapping analyses suggest that urban and peri-urban farms can meet significant amounts of food demand within urban centres, with estimates from the US context suggesting urban agriculture expansion on public lands could meet 5-10% of city vegetable depend in Oakland, 30% of seasonal vegetable demand in Detroit and 100% of nutritional needs in South-eastern Minnesota (Siegner et al., 2018). Commercial urban agriculture approaches risk negative equity impacts, as their fresh produce is often unaffordable to low income households and are sold at a premium to restaurants and grocery stores (Siegner et al., 2018).

Examples of implementation: Commercial vertical and/or rooftop farms have been developed in several cities across the US including Gotham Greens (New York City, NY); Plenty (San Francisco, CA) Higher Ground Farm (Boston, MA); and Freight Farms or Aero Farms (various locations). US cities with policies for regulating and/or promoting urban agriculture include the following: Baltimore, Somerville, Detroit, Portland, Madison, Seattle, San Francisco, San Jose, Los Angeles, San Diego, Austin, Minneapolis, New Orleans, Milwaukee, Boston, and Chicago (Siegner et al., 2018).

Development of school gardening programmes

Area of Interest:
Food and Drink
Lancet Model:
Level:  Level 4: Environments
Drivers:  N/A
Practices:  Marketing practices, Supply chain and waste practices
Mechanism:
Physical environment
Effect:
+ (Beneficial effect)
Scopes:
Global, Europe, UK

Details:

What we know: School-based garden programmes have been associated with improved nutritional status for children (Burgaz et al., 2023), and when combined with other school-based measures (e.g., school feeding menu modifications; physical activity programmes), additional positive healthy weight and academic outcomes have been observed (Pereira et al., 2021).

Examples of implementation: Barbour et al., (2022) identified several local food policy strategies and action documents that aimed to integrate gardens into schools including Ghent (Belgium)'s 'Ghent en Garde' (2016) policy, Barcelona (Spain)'s 'Green infrastructure and biodiversity plan' (2020) and Bristol (UK)'s 'Good Food Action Plan' (2015), Vancouver (Canada)'s 'Regional Food System Action Plan' (2016) and Chicago (USA)'s 'A Recipe for Healthy Places' (2013). One particular case to highlight in the UK was the Flagship Food Borough initiative in Lambeth and Croydon (2014), which involved several school-based food-related activities to improve the food-related curriculum (e.g. 'maths with cookery', 'edible playgrounds'), improve nutritional quality of food in schools (e.g., by supporting local growing initiatives), investment in 'food laboratories' to teach cooking skills to students (Barbour et al., 2022, S6).

Free or subsided school meals programmes

Area of Interest:
Food and Drink
Lancet Model:
Level:  N/A
Drivers:  N/A
Practices:  N/A
Mechanism:
N/A
Effect:
+ (Beneficial effect)
Scopes:
Global, Europe, UK

Details:

What we know: Universal free school meals and/or breakfast programmes have shown positive effects for improving nutrition and/or reducing undernutrition and reducing nutrition inequalities (Burgaz et al., 2023).

Examples of implementation: A Food Policy Group in Nevada (USA) was able to successfully advocate for a funded mandate requiring schools to provide eligible students with free or reduced-price breakfast within school hours ('Breakfast after the Bell' model) (Godrich et al., 2023). The Brighton and Hove Food Partnership (UK) has helped increase availability and use of school meal provisions and promote and expand 'Chomp' holiday lunch clubs in local primary schools (Godrich et al., 2023).