Doctor of Philosophy
School of Health and Society
Background: The alarming burden of obesity and diet-related non-communicable diseases (NCDs) worries countries worldwide. Governments and food industries have a responsibility to create healthier food environments. In Malaysia, there was a lack of evidence to appraise the progress of commitments on obesity and NCDs prevention. Additionally, local barriers and facilitators during the food environment policy processes, have not been widely scrutinised. These situations warranted an in-depth national-scale investigation.
Aims: The aim of this research was to build evidence on the progress of the public and private sectors to support the creation of healthy food environments in Malaysia and to explore the barriers to, and facilitators of, food environment policy development and implementation.
Methods: A mixed-methods approach was applied, comprising qualitative and quantitative research methods. In Study I – Food-Environment Policy Index, local experts (n=26) benchmarked the government’s implementation of food environment policies against international best practice exemplars (n=47 indicators) and prioritised recommendations based on achievability and importance criteria. For Study II – Business Impact Assessment-Obesity, at least five out of seven Expert Panel members assessed each food company (n=33). A Review Panel then proposed recommendations for industry. Both studies adapted the INFORMAS protocols with innovative amendments to suit the local context. For Study III – Case studies, two policy areas with the highest (food labelling) and lowest ratings (food marketing) in Study I, were further investigated to understand the barriers and facilitators during policy processes. An integrated theoretical framework guided the semi-structured interviews for Study III.
Results: Most indicators assessed in Study I were rated as having ‘low’ implementation (62%). The experts prioritised 15 recommendations related to food promotion, labelling, composition, retail, prices, funding and investments, monitoring and intelligence, and governance. For Study II, the companies were scored in the range from 1% to 60%. The Review Panel provided recommendations, including to set SMART targets for product reformulation, to implement strict criteria of responsible marketing to children in all settings and to increase accessibility of healthier products. Study III revealed that self-regulatory marketing policies recorded more barriers and fewer facilitators during policy processes, compared to mandatory nutrition labelling. Policy commitments (e.g. resources, implementer characteristics), policy governance (e.g. lack of monitoring, complexity in legislation, strategies in policy process), policy specific issues (e.g. technical challenges) and factors external to the policy organisation (e.g. intra- and inter-ministerial collaboration and support) were important considerations in policy processes. Corporate political activities coupled with a weak pro-public health coalition favoured commercial influences and mooted policy inertia in Malaysia.
Discussion and Conclusion: Despite some progress towards healthy food environment-related policies identified in both sectors, there was still room for improvement when benchmarked against the international best practice. This research provides constructive recommendations to both public and private sectors on priority policy areas for future action. The case studies outline key lessons learnt from past experiences in developing and implementing food environment policies, which will enable future policy actions. Each actor within the policy subsystem is urged to play a critical role and this thesis forms a basis for future actions.
Hoe, Ng See, Implementation of Food Environment Policies to Tackle Diet-related Non-communicable Diseases in Malaysia: A Situational Analysis, Doctor of Philosophy thesis, School of Health and Society, University of Wollongong, 2021. https://ro.uow.edu.au/theses1/1057
FoR codes (2008)
1111 NUTRITION AND DIETETICS, 1117 PUBLIC HEALTH AND HEALTH SERVICES, 1605 POLICY AND ADMINISTRATION
Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.