Abstract
Background: Policy is widely recognised among the public health community as an effective tool for reducing the risk of obesity. The economic and health burdens of obesity have focused attention on the food industry’s responsibility to improve the ‘obesogenic’ environment. The food industry is developing industry-regulated policies, pledges and commitments targeting the health of staff and consumers. Lack of government oversight of these initiatives is a concern to the public health community in regards to their ability to produce measureable public health outcomes and adequacy of accountability mechanisms. It is widely acknowledged that the balanced scorecard provides a practical tool for assessing the efficacy of policy and public health outcomes. Currently there is no balanced scorecard that assesses the ‘nutrition sensitivity’ of food and beverage (F&B) companies’ policies.
Objective: To develop and apply a balanced scorecard of ‘nutrition sensitivity’ indicators to New Zealand F&B companies’ policies and explore factors affecting this policy process.
Methods: This study utilised blended qualitative and quantitative approaches, embedded in a single case study design. A balanced scorecard deduced from the literature was used to assess three aspects of F&B companies’ policies: development, implementation and nutrition quality. The balanced scorecard compared company policy to 20-evidence informed indicators to formulate a nutrition sensitive score. Semi-structured interviews conducted with a company representative involved in nutrition, explored factors affecting their nutrition policy and the policymaking process. Interview transcripts were thematically analysed using a general inductive approach.
Results: Twenty F&B companies representing the largest market shares in the eight major food groups in the New Zealand diet participated in the study. There was large variability in the nutrition sensitivity of F&B company policy; the median nutrition sensitive score was 32, compared to a benchmark of 75 and exemplar level of 123. Companies with a written policy (n=11) scored three times higher than those with verbal policy on average. Written nutrition policy was found to strengthen policy development and implementation and provide clear direction to nutrition within a company. Interview data revealed that companies are increasingly valuing nutrition and health, driven by consumer demand and pressure from the public health community. The value a company places on nutrition has far reaching influence on the range and type of nutrition initiatives and the level of nutrition expertise within the company. Meaningful accountability mechanisms of F&B company nutrition policy are currently lacking; however public reporting of nutrition commitments provided an informal accountability mechanism through corporate reputational risk.
Conclusion: Strengthening F&B company nutrition sensitive policy requires a collaborative approach between the food industry, public health community, consumers and government. This collaboration should aim to encourage development of written company nutrition policies and evoke government oversight to implement sufficient accountability mechanisms.