Healthy and Sustainable Diets: The Development and Application of a Policy Analysis Framework
Authors: Downs Shauna , Payne Alex , Fanzo Jessica 
Published: November 2023

There is a need to reorient food systems to ensure benefits for human health and nutrition, as well as environmental sustainability. In order for nutrition, agriculture and environmental policies to support healthy and sustainable diets, major shifts in the production and consumption of foods would need to occur, which could impact bottom line economics as well as ethical, social and cultural norms. Thus, the objectives of this study were to: 1) develop a policy analysis framework for examining the components of a healthy and sustainable diet and 2) apply its use to three relevant national polices in Nepal: nutrition (Multisectoral Nutrition Plan 2013–2017), agriculture (Agricultural Development Strategy 2015–2035) and biodiversity (Biodiversity Strategy 2014–2020). Nepal was selected as a case study for the application of the framework given its high rates of malnutrition coupled with its increasing need for adaptation and improved resilience in the face of climate change and immediate natural disasters. We developed a framework based on existing literature that consisted of five main domains of a healthy and sustainable diet: 1) nutrition and health; 2) agriculture and food security; 3) environment and ecosystems; 4) markets, trade and value chains for economic growth; and 5) sociocultural and political. Within each of these domains, 53 constructs representing the key components of a healthy and sustainable diet were identified and subsequently examined in the Nepalese policies. In addition, we examined the overall strength of the policies using an adapted health policy analysis tool developed by Cheung et al. (2010) to appraise the extent to which policy statements align with intended outcomes. Policies were coded based on the components of the framework using NVivo (version 10) by two independent‐researchers (SD and AP) and subsequently compared to ensure consistency. The health policy analysis tool was then used to examine the policies’ overall quality. Nepal's agriculture policy was the most comprehensive in terms of covering the components of a healthy and sustainable diet. It covered 89% (47/53) of the components as compared to 60% (32/53) in the biodiversity and 68% (36/53) in the nutrition policies. In terms of the overall quality of the policies, although all three policies identified clear goals there was less clarity in terms of their evaluation plans as well as whether they have sufficient capacity (both human and financial) for implementation. Although, Nepal's agriculture policy is comprehensive and has the potential to deliver on supporting healthy and sustainable diets, its impact (as well as the impact of the other two policies) will be dependent on the degree to which it is implemented as planned. Future research will build on this research by applying the framework to other country contexts worldwide. It is hoped that this methodology can be used to assess the policy gaps related to healthy and sustainable diets in specific settings with the view to inform future policies and programs and the international dialogue around the Sustainable Development Goals.

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