This narrative review examines how government sectors beyond health contribute to the dual goals of equitable obesity prevention and food security through structural, cross‑sector policies. It aimed to synthesise real‑world evidence on the design, implementation and diet‑related impacts of policies across social, education, economic, trade and agricultural, and legal domains. Emerging insights highlight the need for further evaluation of how income supports contribute to diet-related health; the expansion of school meal programs given their multiple co-benefits; the feasibility and impacts of adopting health-promoting taxes that generate public revenue for equity-focused initiatives; how agricultural supports can be repurposed to improve local and equitable food access; and the use of legal instruments to hold food industries accountable and advance public health interests. Coordinated, equitable progress on obesity prevention and food security will require enhanced policy coherence, effective accountability mechanisms, better data on diet and equity outcomes for cross-sector policies, and political commitment to overcome siloed and often unbalanced decision-making processes.

Objective: This study sought to explore how food company representatives perceive the food industry's role in responding to and driving consumer demand for healthy and unhealthy foods.Design: Semi-structured interviews were conducted in 2022 by 2-3 researchers to explore food company representatives' perspectives related to consumer demand for healthy and unhealthy food. Detailed field notes, including verbatim quotes, were recorded, and the data were analysed thematically.Setting: This study was part of a government-funded 12-month intervention programme to assess the impact of tailored support for food companies on company nutrition-related policies and practices.Participants: Thirty-two food company representatives from thirteen large food and beverage manufacturers in Australia.Results: Six themes were identified. Company representatives acknowledged that manufacturers actively shaped demand for both healthy and unhealthy foods. Healthy reformulation and aspects of nutrition labelling were constrained by anticipated consumer resistance, while demand for 'less healthy' products was driven by non-health attributes such as taste, comfort and affordability. Internal company marketing teams held significant influence regarding product development, promotion and labelling. Supermarkets were perceived as shaping demand via their marketing strategies. The competitive landscape, driven by the pursuit of market share, was seen to fuel an ongoing cycle of promotion of 'less healthy' products.Conclusions: Food companies acknowledge playing an active role in influencing consumer demand for healthy and unhealthy food and beverages. A whole-of-system response, including changes in government regulation and practice change by the food industry, is needed to drive stronger action and accountability from food companies to support healthier diets.

OBJECTIVES:Marginalised and non-white voices are under-represented in food and nutrition policy in Australia. To achieve equitable food systems that support healthy diets for all, the voices and lived experiences of people from diverse cultural backgrounds must be meaningfully included in decision-making. This research aimed to understand Sub-Saharan African (SSA) young people's experiences of food and nutrition and identify opportunities for culturally sensitive policies that can improve these experiences in Victoria, Australia. DESIGN:A qualitative approach, grounded in critical theory, experience-based co-design and the Social and Emotional Wellbeing framework, was employed to attain a policy-relevant understanding of SSA young people's perspectives and engagement with food and nutrition in Australia. In-depth interview guides were co-designed with an advisory committee of multicultural young people, including two young SSA Australians. RESULTS:Twenty young people (15-25 years) with East and West African backgrounds were interviewed, mostly from metropolitan Victoria (75%). Four overarching themes were identified describing (i) young people's experiences of cultural food shaping their identity but being difficult to access due to systemic barriers, (ii) food affordability and economic opportunities influencing community wellbeing, (iii) the mixed relevance of dominant food and nutrition policy priorities and (iv) the need for stronger government prioritisation of migrants and equity. CONCLUSION:This research identifies food as a critical determinant of health and wellbeing among SSA youth, serving not only as a cultural factor but also as a pathway for economic and social advancement. Mainstream food and nutrition policies do not fully address the priorities of SSA youth and opportunities exist to develop more culturally sensitive policy options. Additional efforts are required from the public health community to address discrimination across food systems, starting with better inclusion of multicultural experiences and voices in research, policy and practice.

This study aimed to prioritise key indicators for monitoring and assessing the healthiness of food environments, including at the country level. We conducted a literature review and engaged a consortium of researchers from the International Network for Food environments Research, Monitoring and Action Support (INFORMAS) as part of a prioritisation process. We identified 375 existing indicators that had been used to measure food environments. Researchers were consulted on priorities and implementation considerations through a series of interviews, focus groups and an online survey. Sixteen indicators were short-listed for prioritisation, and five indicators were identified as key priorities: proportion of packaged food and drinks products classified as unhealthy; frequency of exposure to unhealthy food promotion; price of a healthy diet and the price of the current diet as a proportion of income; proportion of schools in which unhealthy foods are provided or available for sale regularly; and application of back of package and front of package food labelling. This study lays the groundwork for standardised and scalable food environment monitoring that can drive policy action to support healthier food environments globally. Future areas for inquiry include tools to classify healthy foods and outlets, which could be adapted across policy areas, and the establishment of evidence-informed benchmarks for assessment of each indicator.

Retail food environments play a pivotal role in influencing dietary behaviors, and therefore have huge potential as settings for promoting good nutrition and preventing obesity. Conducting research in retail settings can be challenging due to the varied motivations of the parties involved and the complex nature of retail environments. To improve the quality and consistency of research in this field, we have identified 16 thematic topics aimed at guiding researchers and public health practitioners on how to conduct healthy food retail research. A summary for each topic, encompassing existing methodologies, best practice examples, and knowledge gaps, was developed based on available literature and the collective experience and expertise of 32 multidisciplinary researchers from a high-income perspective engaged in healthy food retail research in a diverse range of retail settings. A summary checklist describing key considerations at each stage of conducting healthy food retail research was also developed.

Health inequities are driven by the unequal distribution of resources and power. Local-level actors are closely connected to communities and have the potential to address unfair imbalances in power through health equity interventions. Yet practical strategies on how to do this remain unclear. To address this gap, we conducted a systematic review of five databases, examining how power was addressed in the design and implementation of local-level health equity interventions and their reported impacts. Thirty-eight international studies were analysed using the Health Equity Power Framework and Four Expressions of Power typology. Most articles described community organizing, health education, advocacy, and community funding initiatives. Interventions that strengthened community knowledge, connectedness, and leadership rebalanced power by enhancing individual and collective agency. Shifts in rigid, inequitable structures and institutional processes were observed when interventions activated multiple types of power, across different forms and spaces. Interventions informed by power-centered frameworks and principles, such as empowerment theory and self-determination, helped actors rebalance power dynamics, while entrenched structural and institutional power imbalances moderated efforts to rebalance power. This review underscores the role of local governments, institutions, and community actors in addressing power imbalances and provides practical guidance on strategies to support equitable policymaking.

CONTEXT:The price and affordability of food are priorities for public health and health equity; however, Australia lacks a consistent method to evaluate healthy versus unhealthy diets, creating a gap in routine food price reporting. OBJECTIVE:This review aimed to identify and summarize recent methods used to assess and monitor the price and/or affordability of food and beverages in Australia using a health lens. DATA SOURCES:Four academic databases (MEDLINE Complete, Global Health, CINAHL Complete, and Business Source Complete) were searched in English from 2016 to 2022. Relevant gray literature was searched through Google Scholar and government websites. DATA EXTRACTION:Five reviewers screened titles and abstracts, and full-text screening was conducted by 1 reviewer, with eligibility confirmed by a second reviewer. The quality of studies was assessed using the Joanna Briggs Institute "Checklist for Analytical Cross-Sectional Studies." DATA ANALYSIS:Twenty-five eligible studies were identified. Eleven studies used a version of the Healthy Diets Australian Standardized Affordability and Pricing protocol to collect prices for a "healthy" diet modelled on dietary guidelines and an "unhealthy" diet based on a habitual Australian diet. These studies consistently found unhealthy diets to be more expensive than healthy diets. Other identified methods included assessing the price of household diets across healthy baskets (n = 6), store types (n = 5), a planetary health diet (n = 1), packaged foods according to their Health Star Rating (n = 1), a fruit and vegetable basket (n = 1), school canteen foods against a traffic light system (n = 1), and weekly healthy meal plans (n = 1). Healthy diets tended to be less costly than less healthy diets, but both diets were often unaffordable in regional areas, for people on low incomes, and for First Nations peoples. CONCLUSION:Consistent country-wide application of methods for monitoring the price and affordability of foods and diets in Australia is needed-including tailored approaches for priority groups. SYSTEMATIC REVIEW REGISTRATION:PROSPERO registration no. CRD42022333531.

Abstract Background Dietary risk factors are the leading cause of death globally and in New Zealand (NZ). Processed packaged foods are prevalent in the food supply and contribute excess amounts of sodium, saturated fat, and sugar in diets. Improving the nutritional quality of these foods has the potential to reduce population chronic disease risk. We aimed to evaluate the healthiness using the Australasian Health Star Rating (HSR, from 0.5 to 5 stars, with 5 being the healthiest) and nutrient composition (sodium, saturated fat, and total sugar) of packaged products manufactured by the largest NZ-based food and beverage companies in NZ 2015–2019. This analysis relates to a larger study evaluating structured engagement with food companies to improve nutrition-related policies and actions. Methods Data was sourced from Nutritrack, a NZ-branded supermarket-sourced food composition database. The largest NZ-based companies from annual retail sales revenue (n = 35) were identified using 2019 Euromonitor data. All relevant products of the selected companies were extracted for analysis. Products included totalled 17,795 with a yearly range of 3462–3672 products. The primary outcome was a nutrient profile score estimated using HSR. Healthiness was defined as ≥ 3.5 stars. Secondary outcomes were sodium, total sugar, and saturated fat per 100 g/100 mL. All outcomes were assessed overall, by food company, and food category. Change over time was tested using linear mixed models, adjusting for major food categories and cluster effects of food companies controlling for multiple comparisons. Model-adjusted mean differences between years were estimated with 95% confidence intervals. Results There was a small statistically significant increase in mean HSR between 2015 and 2019 (0.08 [0.15,0.01], p = 0.024). Mean total sugar content decreased over the same period (0.78 g/100 g [0.08,1.47], p = 0.020), but there were no significant changes in mean sodium or saturated fat contents. Seven of the 13 categories showed small increases in mean HSR (0.1–0.2). Most categories (9/13) exhibited a reduction in mean total sugar content. Conclusions Between 2015 and 2019, there were slight improvements in the nutritional quality of selected packaged foods and drinks in NZ. Much more substantive changes are needed to address the health-related burden of unhealthy diets, supported by stronger government action and less reliance on voluntary industry initiatives.

BackgroundLocal governments have a critical role to play in addressing health inequities. Health equity impact assessments are recommended to help governments apply an equity lens to the development and implementation of policies and programs. Despite evidence of equity-positive benefits of such tools, adoption remains limited, prompting calls for evaluations to assess their impact and identify factors that will promote uptake across various contexts.MethodsWe conducted a mixed method study to evaluate the impact of an equity impact assessment (EIA) tool and process on policies and organisational capacity in a local government in Victoria, Australia, and identify factors that influenced this impact. We analysed 33 documents related to 18 EIAs, and conducted surveys (n = 40) and in-depth interviews (n = 17) with staff involved in EIAs.ResultsAlmost all (17 of 18) EIAs resulted in equity-positive changes to policies and programs, most frequently addressing individual-level factors, such as making community communications and consultations more accessible to under-represented or under-served groups. Structural-level recommendations from one EIA, such as increasing diversity in decision-making panels, were found to impact both the current policy and a broad range of future, related projects and services. Improvements in equity-centric organisational culture and capacity (including staff awareness, skills and confidence) and increased engagement with under-represented communities were also reported. Factors perceived to influence the impact of EIA's related to organisational commitment and capacity to prioritise equity, process-level factors related to the type and timing of EIAs, and extent of implementation support.ConclusionOur study supports wider uptake of health equity impact assessments in local government policies and programs. Legislation, leadership and resources from upper-tiers of government can help increase the adoption of equity tools to reduce disparities in population health.

Addressing health inequities requires both national and local-level action. In the case of COVID-19, locally-led place-based programs were instrumental in addressing vaccination inequities that resulted from implementation gaps in national and state-level universal COVID-19 vaccination programs. To prepare for future pandemics, understanding which local strategies are effective and the conditions that enable their effectiveness is crucial. We conducted a case study using qualitative interviews (n = 22) and document analysis to identify key strategies employed to increase vaccination uptake among priority populations in a regional community in Victoria, Australia, and the conditions perceived to enable or constrain the success of those strategies. Interviewees included Aboriginal and migrant community members (n = 12) and representatives from organisations that designed and implemented the COVID-19 vaccination program (n = 10). Strategies perceived to be effective by local migrant and Aboriginal communities included the location of outreach clinics (places considered physically, cultural and political accessible and safe), communication via trusted community leaders, practical supports such as translation services and transport, and empowering community in clinical interactions. Conditions perceived to influence program implementation and outcomes related to four themes: (i) shared vision and strong bonds of local partners, (ii) placing community in the driver's seat, (iii) rebalancing power through leadership grit and guts, and (iv) equity-enabling service and funding models. Our study supports strengthening of national and state government investment and engagement with local partnerships to place equity and community at the centre of future pandemic and public health responses.

Healthy food outlet accreditation schemes represent an avenue for incentivizing food retailers to promote healthy eating patterns by improving the healthiness of food environments. This systematic review aimed to (i) assess the impact of food outlet-level accreditation schemes on outlet practices and customer purchases and (ii) identify barriers and enablers to scheme implementation. Peer-reviewed and grey literature were systematically searched. Eligible studies related to outlet-level food and beverage accreditation schemes across any food retail setting. Findings were narratively synthesized by retailer type according to (i) scheme characteristics (governance, targeted products, support, and monitoring); (ii) scheme outcomes (rate of uptake, proportion of certified retailers, impact on purchasing, customer perspectives, and retailer perspectives); and (iii) barriers and enablers to implementation. From 21,943 records screened, 48 were included, covering 26 schemes. Most (18) targeted restaurants or convenience stores. Average uptake was 65% of all outlets approached to participate. Implementation of accreditation schemes was associated with healthier customer purchases in convenience stores, schools, and hospitals, but evidence from restaurants was mixed. Enablers of scheme implementation included support for implementation and maintenance, flexible scheme criteria, and motivated retail staff. Healthy food outlet accreditation schemes represent a promising mechanism for engaging retailers to improve the healthiness of food retail environments.

BACKGROUND:With their close connection to community and increasing preventive health remit, local governments are well positioned to implement policies and programs to address health inequities. Nevertheless, there is a lack of evidence of equity-focused policy action in this sector. We aimed to understand how local government representatives approach equity in the development and implementation of health and wellbeing policies and programs, and to identify potential enablers for strengthening an equity focus.METHODS:We conducted semi-structured interviews (June 2022-January 2023) with 29 health directorate representatives from 21 local governments in Victoria, Australia. Representatives were recruited from urban, regional and rural local government areas, with varying levels of socioeconomic position. Data was analysed inductively using Braun and Clarke's reflexive thematic analysis, informed by social determinants of health theory and a public policy decision making framework.RESULTS:Local governments approach health equity in different ways including focusing on priority populations, disadvantaged geographic areas, or by targeting the upstream determinants of health, such as housing and employment. Enabling factors for more equity-oriented local government policy action included those internal to local governments: (i) having a clear conceptualisation of equity, (ii) fostering a strong equity-centric culture, and (iii) developing organisational-wide competency in health equity. External factors related to key stakeholder groups that support and/or influence local governments included: (iv) strong support from community, (v) state government leadership and legislation, and (vi) supportive local partners, networks and NGO's.CONCLUSIONS:Local governments have a responsibility to implement policies and programs that improve health and reduce health inequities. Local government's capacity to leverage resources, structures, processes and relationships, internally and across sectors and community, will be key to strengthening equity-oriented local government health policies and programs.

Unhealthy food environments contribute to unhealthy population diets. In Australia, the government currently relies on voluntary food company actions (e.g., related to front-of-pack labelling, restricting promotion of unhealthy foods, and product formulation) as part of their efforts to improve population diets, despite evidence that such voluntary approaches are less effective than mandatory policies. This study aimed to understand public perceptions of potential food industry nutrition-related actions in Australia. An online survey was completed by 4289 Australians in 2020 as part of the International Food Policy Study. The level of public support was assessed for six different nutrition-related actions related to food labelling, food promotion, and product formulation. High levels of support were observed for all six company actions, with the highest support observed for displaying the Health Star Rating on all products (80.4%) and restricting children's exposure to online promotion of unhealthy food (76.8%). Findings suggest the Australian public is strongly supportive of food companies taking action to improve nutrition and the healthiness of food environments. However, given the limitations of the voluntary action from food companies, mandatory policy action by the Australian government is likely to be needed to ensure company practices align with public expectations.

Supermarket environments can strongly influence purchasing decisions. Price promotions are recognised as a particularly persuasive tactic, but the healthiness of price promotions in prominent in-store locations is understudied. This study compared the prevalence and magnitude of price promotions on healthy and unhealthy food and beverages (foods) displayed at prominent in-store locations within Australian supermarkets, including analyses by supermarket group and area-level socio-economic position. A cross-sectional in-store audit of price promotions on foods at key display areas was undertaken in 104 randomly selected stores from major Australian supermarket groups (Woolworths, Coles, Aldi and independents) in Victoria, Australia. Of the display space dedicated to foods with price promotions, three of the four supermarket groups had a greater proportion of display space devoted to unhealthy (compared to healthy) foods at each promotional location measured (end of aisles: 66%; island bins: 53%; checkouts: 88%). Aldi offered very few price promotions. Few measures varied by area-level socio-economic position. This study demonstrated that price promotions at prominent in-store locations in Australian supermarkets favoured unhealthy foods. Marketing of this nature is likely to encourage the purchase of unhealthy foods, highlighting the need for retailers and policy-makers to consider addressing in-store pricing and placement strategies to encourage healthier food environments.

Objective: The current study aimed to investigate availability and placement of healthy and discretionary (less healthy) food in supermarkets in Victoria, Australia, and examine variation by supermarket chain and area-level socio-economic disadvantage. Design: Cross-sectional supermarket audit. Measures included: (i) proportion of shelf space (in square metres) allocated to selected healthy and discretionary food and beverages; (ii) proportion of end-of-aisle, checkout and island bin displays containing discretionary food and beverages and (iii) proportion of space within end-of-aisle, checkout and island bin displays devoted to discretionary food and beverages. Setting: Metropolitan areas of Melbourne and Geelong, Australia. Assessment: June-July 2019. Participants: Random sample of 104 stores, with equal numbers from each supermarket group (Coles, Woolworths, Aldi and Independent stores) within strata of area-level socio-economic position. Results: Proportion of shelf space devoted to selected discretionary foods was greater for Independent stores (72.7 %) compared with Woolworths (65.7 %), Coles (64.8 %) and Aldi (63.2 %) (all P < 0.001). Proportion of shelf space devoted to selected discretionary food for all Coles, Woolworths and Aldi stores was 9.7 % higher in the most compared with the least disadvantaged areas (P = 0.002). Across all stores, 90 % of staff-assisted checkout displays and 50 % of end-of-aisle displays included discretionary food. Aldi was less likely to feature discretionary food in end-of-aisle and checkout displays compared with other supermarket groups. Conclusions: Extensive marketing of discretionary food in all Australian supermarket chains was observed, which is likely to strongly influence purchasing patterns and population diets. Findings should be used to inform private and public sector policies to reduce marketing of discretionary food in supermarkets.