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

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Increasing access and quality of existing emergency food relief programmes, services and/or networks

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)
References:
Scopes:
Global, Europe, UK

Details:

Types of initiatives: Establish and/or improve emergency food relief networks in collaboration with local food policy groups; develop digital solutions to support people experiencing food insecurity to find community food opportunities and emergency food relief in the local area; create new and/or improve donation pathways to food hubs and emergency food relief providers; increase food storage capacity for food hubs and relief programmes; provision of emergency food relief through schools to children and their families.

What we know: Food policy groups have served as a positive mechanism for facilitating distribution of food relief and improving access and quality of existing emergency food relief programmes, services and networks (Godrich et al., 2023; Barbour et al., 2022). A cited internal evaluation report from the Brighton and Hove Food Partnership (UK), for example, noted the partnership was able to distribute £120,000 worth of fresh local produce to community groups via its Food Factory initiative and launch seven Affordable Food Initiative Programs to support food access for low-income residents (see Taylor, 2021, in Godrich et al., 2023). This cited evaluation also stated that most participants in theses initiatives self-reported increased consumption of vegetables, greater access to healthier food (including for marginalised groups), decreased dependency on food banks and improved social connectedness (see Taylor, 2021, in Godrich et al., 2023).

Examples of implementation: In partnership with Sustain (Australia's Food Network), a youth-led network developed a new donation pathway by growing local fresh produce and donating to local emergency food relief organisations (Godrich et al., 2023). Montgomery County Food Policy Council (Maryland, USA) has established grant funds to empower emergency food organisations to procure more food from wholesalers, expand their storage facilities and/or expand existing distribution services. Good Food Oxfordshire (UK) has a food services database and map, which provides an interactive online map for locating food banks, community larders and community fridges (Godrich et al., 2023).

Food Policy Group-led targeted advocacy activities to improve healthy food access 

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

Details:

Types of identified advocacy activities: FPG-led political engagement to influence local improvement plans; advocating for cross-strategy partnerships and programmes.

What we know: Food policy groups (FPGs) are an effective mechanism for facilitating collaborative political action, bringing together community and charity organisations, local governments and technical expertise to advocate for changes to local food policy (Godrich et al., 2023; Barbour et al., 2022).

Examples of implementation: The Brighton and Hove Food Partnership (UK) was able to secure a specific food section within the council's Sustainable Communities Strategy as well as high-level commitment to support Sustainable Food Cities (SFC) Gold Award Application (Godrich et al., 2023). Collaborative proposals between Sustainable Food Cities Network members helped achieve mayoral support for cross-sectoral strategic food partnership in Greater Manchester (UK) (Godrich et al., 2023). Political advocacy in Aberdeen (Scotland, UK) led to food objectives being written into the Local Outcomes Improvement Plan (Godrich et al., 2023).

Food Policy Group-led activities to increase awareness about food waste and build capacity for waste minimisation strategies

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

Details:

Types of identified activities: Funding education campaigns (e.g. Love Food Hate Waste) and workshops; Zero waste food centres; surplus food programmes; Promoting low-food waste items on menus of food outlets;.

What we know: Food policy groups (FPGs) are an effective mechanism for facilitating collaborative action, bringing together community and charity organisations, local governments and technical expertise to advocate for changes to local food policy and practices (Godrich et al., 2023; Barbour et al., 2022).

Examples of implementation: Several UK-based FPGs have pursued actions to raise awareness about food waste and improve capacity to reduce waste. The Cambridge Food Partnership (UK) developed the 'Taste not Waste' programme to assist food outlets and catering business to reduce their food waste; for all participants, the estimated food waste savings over a year was 20+ tonnes (Godrich et al., 2023). Bristol's Local Food Partnership has established a Food Waste Action Group and Brighton and Hove Food Partnership gained funding from its city council to develop the Surplus Food Network programme for supporting shared meals.

Food Policy Group-led education programmes on sustainable eating practices within local communities 

Area of Interest:
Food and Drink
Lancet Model:
Level:  Levels 5/6: Final routes to health and equity impacts
Drivers:  Norms
Practices:  Scientific practices
Mechanism:
Cognitive
Effect:
+ (Beneficial effect)
References:
Scopes:
Global, Europe, UK

Details:

What we know: Consumer education programmes surrounding nutrition and environmental sustainability, especially around food waste, have been effective in high-income countries (Godrich et al., 2023). In the UK, this activities have increased associated with increased self-reported knowledge about where to purchase local food and the benefits of eating local food (Godrich et al., 2023).

Examples of implementation: The Cambridge Food Partnership (UK) has developed community education programmes to teach residents about sustainable eating practices, reducing food waste and increase consumption of local, seasonal food (Godrich et al., 2023). Surveyed participants in Brighton and Hove Food Partnership's initiatives reported being able to eat better within their budget (74%), trying new foods (56%) and reducing their consumption of unhealthy snacks/drinks (27%) (see Taylor, 2021 in Godrich et al., 2023).

Food Policy Group-led education programmes designed to increase the use of food vouchers 

Area of Interest:
Food and Drink
Lancet Model:
Level:  Levels 5/6: Final routes to health and equity impacts
Drivers:  N/A
Practices:  Marketing practices
Mechanism:
Cognitive
Effect:
+ (Beneficial effect)
References:
Scopes:
Global, Europe, UK

Details:

What we know: Food policy groups (FPGs) are an effective mechanism for facilitating collaborative action, bringing together community and charity organisations, local governments and technical expertise to advocate for changes to local food policy and practices (Godrich et al., 2023; Barbour et al., 2022).

Examples of implementation: Two examples of FPG-facilitated education programmes to increase food voucher usage were reported in Godrich et al., (2023). An education intervention by the Worcester Advisory Food Policy Council (USA) was associated with decreased food insecurity, likely due to greater use of food stamps and provided personal economics education. The Cambridge Food Partnership promoted 'Healthy Start' vouchers via its cookery activities, which was associated with an increased uptake of vouchers in two regions (by 5% and 3.5%) (Godrich et al., 2023).

Multi-component and cross-sectoral activities to improve local food systems and policy coherence

Area of Interest:
Food and Drink
Lancet Model:
Level:  Level 1: Political and economic system
Drivers:  N/A
Practices:  Political practices, Supply chain and waste practices
Mechanism:
Physical environment
Effect:
+ (Beneficial effect)
Scopes:
Global, Europe, UK

Details:

Types of identified approaches: Cross-sectoral collaboration to improve policy coherence with health; policies; collaboration with academic institutions to support grassroots initiatives with best-practices approaches and co-production for planning, implementing and evaluating activities.

What we know: Community-driven and multisectoral collaboration to improve local food systems, supply chains and environments are associated with positive health effects among Indigenous and non-Indigenous populations including increased sales of fresh produce and water, reduced sales of confectionary and sugar-sweetened beverages (Browne et al., 2020; Danielli et al., 2021).

Examples of implementation: Within the state of Victoria (Australia), the Victoria Public Health and Wellbeing Plan has policy aims to improve healthy food supply chains within government-controlled facilities as well as a Social Enterprise Strategy to provide direct funds to local food producers and shorten supply chains via support for local and regional food cooperatives (Love et al., 2022).

Procurement partnerships with local food producers and suppliers

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

Details:

Types of activities: Develop partnerships, strategies and networks supporting local food producers; public investment in local family farms; policies to regulate production models and markets and support local agricultural production.

What we know: Investments in family farming properties and public policy development to support the agricultural production of local food producers can help improve their productive assets, enable access to additional or different markets and increase their agricultural yields and productivity (Chaves et al., 2023). Institutional markets can be a key political intervention that enables win-win outcomes in local agricultural development and social protection, "as they synergistically stabilize prices, generate income and ensure food security" (Chaves et al., 2023, p. 13).

Examples of implementation: The Brighton Food Factory (UK) worked with local farmers and producers to support their business management activities such as by helping them to complete funding applications, paperwork and marketing (see Taylor, 2021 in Godrich et al., 2023). In the US, the Adams County Food Policy Council efforts to improve access among low-income and under-represented groups to local farmers' markets and strengthen partnerships local farmers were associated with shifts in demographics of clientele and purchasing habits toward fresh produce as well as positive economic benefits for farmers such as an increased customer base and sales of local produce at farmers' markets (see Calancie et al., 2017 in Godrich et al., 2023).

Taxes on unhealthy food (e.g., high fat, salt and/or sugar (HFSS) products)

Area of Interest:
Food and Drink
Lancet Model:
Level:  Level 3: Sectoral public policies
Drivers:  N/A
Practices:  Financial practices
Mechanism:
Financial
Effect:
+ (Beneficial effect)
Scopes:
Global, Europe, UK, Other (USA)

Details:

Types of identified taxes: sales taxes on energy-dense foods, 'junk foods', high fat, salt and/or sugar (HFSS) products.

What we know: There is strong evidence for regulating food markets and fiscal policies like strong taxation of unhealthier products and subsidisation of healthier foods appear to be effective for improving health and reducing health inequalities (Naik et al., 2019). There is no robust, high-quality evidence for negative macroeconomic impacts of diet-related fiscal policies, with most of the arguments against diet-related taxes coming from industry reports, which have been based on selected outcomes, partial measures and questionable assumptions (Mounsey et al., 2020). Three non-industry supported, peer-reviewed studies concluded that there would be no significant job losses nor significant declines in employment and job creation associated with the implementation of these types of policies (Mounsey et al., 2020).

Examples of implementation: In Mexico, both an 11% sugar-sweetened beverage excise tax and 8% non-essential energy-dense food ad valorem tax (>275 kcal/100gm) were implemented and associated with reductions in sales of SSBs and non-essential energy-dense foods (see Guerrero-Lopez et al., 2017 in Mounsey et al., 2020). There were also no reductions in employment associated with the implemented Mexican fiscal policies (see Guerrero-Lopez et al., 2017 in Mounsey et al., 2020). Within Australia, modelling evidence indicated that the implementation of a 10% 'junk food' tax was associated with reductions in mean weight (see Sacks et al., 2011 in Vellakkal et al., 2022).

Taxes on sugar-sweetened beverages (SSBs)

Area of Interest:
Food and Drink
Lancet Model:
Level:  Level 3: Sectoral public policies
Drivers:  N/A
Practices:  Financial practices
Mechanism:
Financial
Effect:
+ (Beneficial effect)
Scopes:
Global, Europe, UK, Other (USA)

Details:

Types of identified taxes at the local, state or regional levels: Single-tier volume-base excise tax; tiered volume-based excise tax; sales taxes; SSB taxes that raise revenue for health programmes, healthcare system and/or general budget.

What we know: There is strong evidence for regulating food markets and fiscal policies like strong taxation of unhealthier products and subsidisation of healthier foods appear to be effective for improving health and reducing health inequalities (Naik et al., 2019). Taxes specifically targeting sugar-sweetened beverages (SSBs) have shown strong evidence of efficacy for decreasing sales and purchasing of taxed beverages (Teng et al., 2019; Andreyeva et al., 2022) and improving dental health outcomes (MacKenbach et al., 2022). There are fewer real-world evaluations on consumption rates and dietary intake but modelling studies consistently indicate SSB taxes improve long-term health outcomes in adults (e.g., obesity, cardiovascular disease, diabetes) and reduce childhood obesity (Moran et al., 2020; Pereira et al., 2021). SSB taxes have also been shown to be highly cost-effective approaches for improving nutrition and preventing obesity (Teng et al., 2019; Moran et al., 2020; Eykelenboom et al., 2019) and they present a good opportunity for state revenue generation that can be hypothecated for health promoting programmes and interventions (Moran et al., 2020). The extent of SSB tax impact is tied to the taxation level, with evidence of high variability across cities (Moran et al., 2020) and modelling and evaluations suggesting a minimum excise tax rate of 10-20% for effectiveness (Teng et al., 2019, Adreyeva et al., 2022; Redondo et al., 2018). There is also no robust, high-quality evidence for negative macroeconomic impacts of diet-related fiscal policies, with most of the arguments against diet-related taxes coming from industry reports, which have been based on selected outcomes, partial measures and questionable assumptions (Mounsey et al., 2020).

Examples of implementation: Taxes specifically targeting sugar-sweetened beverages (SSBs) have been popular across countries at national and sub-national levels with several examples of implementation at the local level. SSB taxes implemented at the state level in Mexico and the US county and city level have shown reductions in purchases of taxed SSBs, if that tax was greater than 8% , and appeared to have positive equity impacts with greater reductions in low-income neighbourhoods in the case of Berkeley, California (USA) and households of low socio-economic status in Mexico (Redondo et al., 2018). Within Philadelphia (USA), both calorically and non-calorically sweetened beverages (i.e., inclusive of both sugar-sweetened and artificially sweetened beverages) had ad valorem taxes of 1.5 cents per ounce, leading to a 38% reduction in taxed beverage volume sales (Moran et al., 2020).

Taxes on energy drinks 

Area of Interest:
Food and Drink
Lancet Model:
Level:  Level 3: Sectoral public policies
Drivers:  N/A
Practices:  Financial practices
Mechanism:
Financial
Effect:
+ (Beneficial effect)
References:
Scopes:
Global, Europe, UK

Details:

Types of identified taxes: value-added taxes; excise taxes.

What we know: Taxes on energy drinks are generally based on their sugar content, though some taxes are inclusive of both sugar-sweetened and artificially sweetened beverages. These taxes have generally been shown to reduce average purchases and consumption of these beverages, which can potentially lead to improved health outcomes by decreasing calories consumed and added sugar intake (Rostami et al., 2024). Taxing sugar content typically leads to reformulation using non-sugar sweeteners including artificial sweeteners, which can be beneficial by lowering sugar content but may pose other health risks as some artificial sweeteners like aspartame have been classified as "probably carcinogenic to humans" by the WHO (Rostami et al., 2024).

Examples of implementation: Successful and effective local level taxation policies inclusive of energy drinks, which are known to have high sugar content, have been implemented in Seattle (USA), Philadelphia (USA), Catalonia (Spain) and associated with increased prices of energy drinks and reductions in purchases and consumption of energy drinks (Rostami et al., 2024).