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Policy Change To Create Supportive Environments For Physical Activity and Healthy Eating: Which Options Are The Most Realistic For Local Government?
Policy Change To Create Supportive Environments For Physical Activity and Healthy Eating: Which Options Are The Most Realistic For Local Government?
SUMMARY
The objective is to identify and test regulatory options for intervention to create environments supportive of physical
creating supportive environments for physical activity and activity but little support for policy changes to promote
healthy eating among local governments in Victoria, healthy eating. Participants reported lack of relevance and
Australia. A literature review identified nine potential areas competing priorities as reasons for not supporting particu-
for policy intervention at local government level, including lar interventions. Promoting healthy eating environments
the walking environment and food policy. Discussion was not considered a priority for local government above
documents were drafted which summarized the public food safety. There is a real opportunity for action to
health evidence and legal framework for change in each prevent obesity at local government level (e.g. mandate the
area. Levels of support for particular interventions were promotion of healthy eating environments). For local gov-
identified through semi-structured interviews conducted ernment to have a role in the promotion of healthy food
with key informants from local government. We conducted environments, regulatory change and suitable funding are
11 key informant interviews and found support for policy required.
261
262 S. Allender et al.
walkability (Craig et al., 2002), a high density of evidence base. Bowen and Zwi (Bowen and
fast food outlets (Reidpath et al., 2002) and the Zwi, 2005) suggest that policy-making based on
cheap price and heavy promotion of energy evidence is filtered through considerations of
dense foods (Drewnowski and Darmon, 2005) usefulness (i.e. is the change better than the
have been identified as some of the environ- current approach), complexity and compatibility
mental factors contributing to the obesity epi- with values, costs and whether there may be
demic. Thus, it is likely that education and opportunities for trial and change in a relatively
treatment approaches will not be sufficient to low-risk way.
The walking environment The walking environment includes walking Modify section 6 of the Planning and
for leisure, walking as exercise and Environment Act to require that local
walking with a purpose (e.g. to visit a planning schemes include provisions
local shop). It also includes running and regarding the importance of health in
the use of outdoor park facilities planning
Open spaces for physical Open spaces for physical activity includes Mandate open space requirements within
activity parks and reserves, sporting ovals, the Victoria Planning Provisions for
playgrounds and walking and bike tracks. new developments (current
This is separate to the walking requirements apply primarily to nature
environment and means parks, sports strips)
NB: The information in this table is a condensed version of the policy discussion documents used in interviews. Contact
authors for full details.
example, limiting the right to make objections local government council were identified. These
to planning applications) were rejected for key informants were approached to participate
being inconsistent with basic rules of natural in the study and during the course of an inter-
justice. Those interventions with the greatest view, they were asked to identify others they
chance of implementation and success were felt may be able to provide insight into the
marked as priority areas. research questions. These people were sub-
Our second step was to test the relevance and sequently approached to participate, and so on
applicability of these policy interventions based until subsequent interviews generated no new
on the lived experience of people working data.
within the policy and regulatory framework for Qualitative research can be limited by the
nutrition and physical activity at a local govern- smaller study populations involved when com-
ment level. To this end, a qualitative approach pared with larger quantitative studies. One way
was deemed the most appropriate, in which we attempted to reduce this limitation was by
more in-depth data were collected and analysed, continuing to collect data until we felt no new
allowing for the development of deeper under- information was being collected. In addition, we
standing of the particular phenomena under interviewed a variety of local government
study. experts, including employees of local councils.
We purposively sampled to recruit participants
who had worked at representative level both for
Recruitment and within local government. In this way, we
A key informant snowball sampling technique have collected data which are more likely to
was used to identify potential participants in reflect the views across all 79 local councils
this study. Following initial discussions with an within Victoria. Qualitative research is intended
expert in urban planning and local government, to be hypothesis generating and it should be
a number of key people with experience explicitly stated that these results cannot be
working within and on behalf of more than one generalized across all local councils. Rather,
266 S. Allender et al.
these results should generate further questions interviews reflected the understanding devel-
and raise the possibility of testing these findings oped from preliminary analysis of previous inter-
using more quantitative methods across all 79 views. Transcripts were checked against the
local councils. initial recording of each interview and key topics
were noted. Transcripts were entered into
NVIVO 7 for data management to support
Participants analysis. Clean transcripts were independently
There were 11 participants who completed reviewed and coded by three researchers (S.A.,
Health Plans (MPHP) that each local govern- Walking environment, absolutely, we can change that;
ment is required to produce. absolutely, we change the cycling environment.
Our results show that there may be a number
of reasons why local governments would not Another strategic manager showed a clear
support particular interventions. These reasons understanding that improving the walking and
included a perceived lack of relevance to local cycling environment was very conducive to
government and competing priorities demand- increased physical activity. In this case, the pre-
ing more attention and resources. Participants existence of excellent road facilities has led the
noted that the motivation for councils was council to begin considering less traditional
largely to serve current community needs and cycling and walking environments:
to provide better facilities for future commu-
nities. The participants also identified that there The bike trails here are fantastic, so that’s quite safe.
So our group tries to ensure that we have more
was a role for the private sector in policy
off-road, rather than on-road bike provisions, so we
change to help create supportive environments try to encourage that more.
for healthy eating and physical activity.
Vignettes are provided which summarize the Also, there was strong support within local gov-
main themes of the discussion with participants. ernment for using land-use zoning to create
What are the most promising policy changes more supportive environments. In contrast to
to improve environments for healthy eating and walking and cycling, which appeared to happen
physical activity? on a council-by-council basis, a number of
There was consistent support from partici- participants, including a strategic manager,
pants for changes to the walking and cycling acknowledged the role of ‘Melbourne 2030’ as
environment. For instance, one strategic providing this guidance already:
manager reflected the broad enthusiasm for
changing the walking and cycling environment I strongly agree with this idea of mixed use develop-
when commenting: ments around public transport centres and we’re really
268 S. Allender et al.
trying to focus on that. That’s one of our strong prin- receptiveness to, healthy policy change (Lavis
ciples around our residential strategy and a lot of et al., 2003).
‘Melbourne 2030’ principles.
An early years coordinator (council employee Policy action areas that were not generally
with responsibility for maternal and child health supported
care) provided further support to the idea of The remainder of the policy interventions ident-
land use mix/zoning as a method for creating ified by our initial review were not widely sup-
. . . lack of understanding about a holistic approach to A stronger drive for change appeared to be the
health. People say a healthy breakfast is a muesli bar perception of councils as stewards for the area
with chocolate on it. . . . I can’t think of a lobby group with a responsibility to provide for future gener-
that would specifically interfere with a health outcome, ations. This base planning stage appears to lead
except the carparking lobby. Like some of our passio-
to forward planning as this CEO describes:
nate cultural attachments to things like cars and our
country town expectation that you can park right out . . . in [Name of Council] for instance, there was a real
the front, so that lobby group would certainly get in need to look at what we were leaving for the commu-
the way of what we’re trying to do. nities and what sort of infrastructure were they going
to need into the future . . . council developed up a 10 –
Hoeijmakers et al. (Hoeijmakers et al., 2007) 15 year capital works program which sort of gives you
suggest that the complexity of modern health some direction about where the shortfalls were and
problems (and particularly of obesity and its you’re then able with other councils to go and lobby
multiple determinants) makes it difficult if not state government and federal government for funds
impossible for local government to conduct a and that sort of thing.
detailed analysis of the problem or to estimate
correctly the effects of a proposed solution from A factor extrinsic to council was the influence
within local government. Any such activity of the private sector on policy change. This was
would require the services of specialists from particularly evident with planning provision and
public health and economics, take time and in the change of land-use zoning regulations. A
externalize the rationality for decision-making number of participants, including this CEO,
in policy. For a number of reasons, this may be commented on the role of developers in chan-
challenging to local governments. ging land use patterns:
. . . council has . . . to negotiate how it gets that land
into its control or at least get the infrastructure built by
Reasons for supporting policy action for the developers. So you’ve got to be very proactive and
improved environments work with your developers to have them fund a lot of
it and hand the land over and build pathways and
Respondents identified a number of reasons
build all the infrastructure that’s needed. But in a way
why local councils would support policy that they can still get a return because people want to
changes to create healthy environments. At a live in their estates because they’re actually better to
council level, strong leadership, a sense of live in because they feel better about themselves.
responsibility for future generations and com-
munity needs were strong reasons for support-
ing policy change. Influences from outside the
DISCUSSION
council, including market forces, also had some
impact on the degree of support for policy
This paper aimed to understand which of a pre-
change at the local government level.
defined set of regulatory changes to improve
A strategic manager described the impor-
environments for healthy eating and physical
tance of the CEO in leading council policy:
activity were preferred within local government
. . . our CEO is a really strong bike riding person and in Victoria, Australia. A secondary aim was to
just really highlighted it and we’ve got a really strong understand the reasons why these policy inter-
cycling fraternity going. ventions may or may not gain support at a local
270 S. Allender et al.
government level. We found that there was policies that could contribute to healthy eating.
general support for interventions to improve One hypothesis may be that this reluctance is
environments for walking, cycling and active historical; that is, that current public health
recreation and for the use of zoning provisions initiatives are rooted in the public hygiene
to maximize public transport use and desti- models of the late nineteenth century and the
nations within walking distance. disease agent models prevalent in biomedical
Participants favoured, and could identify, discourse (Baum, 2007). A second hypothesis is
existing policy frameworks which promoted sup- that the current policy environment actively
CONCLUSION
Future research
Further theoretical work is needed to under- The stakeholders interviewed in this study con-
stand existing models of policy change as they sider improving environments for physical
apply to healthy environments within the local activity is core business for local governments
government setting in Australia. A future while promoting healthy eating is outside their
research priority must be to understand why remit. We contend that the creation of healthy
local governments consider certain activities food environments should be a central priority
which could reduce obesity (and which are for local government. The provision of healthy
within their competence) to be outside their food in council offices, at local government
remit. events, and advice through maternal and child
health programmes are immediate changes local
governments could make. MPHP (or their local
Strengths and weaknesses of the study equivalent) present one way that the perceived
One strength of this study is that it combined role of local governments could be broadened
proposed evidence-based suggestions for regu- to include the food environment.
latory changes from a systematic search of peer- The availability of evidence of an interven-
reviewed literature with qualitative information tion’s effectiveness is of little relevance to the
from practitioners about the practicalities of promotion of physical activity and healthy
moving recommendations into practice. In eating if it cannot be translated into action.
attempting to apply a systematic review process Ultimately, the most realistic policy options are
to identify potential interventions, it is concei- those that account for the vagaries of politics
vable that we may have missed some and power. Making healthier choices, easier
Policy change to create supportive environments 273
choices will require making healthier policy De Leeuw, E. (2007) Global Perspectives on Health
changes easier for policy-makers. Possible Promotion Effectiveness, Section 2, pp. 51– 66.
De Leeuw, E., McNess, A., Crisp, B. and Stagnitti, K.
mechanisms for this include lifting the aware- (2008) Theoretical reflections on the nexus between
ness of the local government role in promoting research, policy and practice. Critical Public Health, 18,
healthy eating environments, supporting cham- 5 –20.
pions and targeting external resources towards Department of Education and the Arts QG. (2005)
Healthy Food and Drink Supply Strategy for Queensland
creating supportive environments and building Schools. Queensland Government, Brisbane.
on the public health role of local governments.