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Lancet. 2015 Jun 20;385(9986):2534-45. doi: 10.1016/S0140-6736(14)61747-5. Epub 2015 Feb 19.

Strengthening of accountability systems to create healthy food environments and reduce global obesity.

Author information

1
School of Population Health, University of Auckland, Auckland, New Zealand; WHO Collaborating Centre for Obesity Prevention, Deakin University, Victoria, Australia. Electronic address: boyd.swinburn@auckland.ac.nz.
2
WHO Collaborating Centre for Obesity Prevention, Deakin University, Victoria, Australia; Department of Human Nutrition, Foods & Exercise, Virginia Tech, Blacksburg, VA, USA.
3
London School of Hygiene & Tropical Medicine, London, UK.
4
School of Population Health, University of Auckland, Auckland, New Zealand.
5
World Obesity Federation, London, UK.
6
WHO Collaborating Centre for Obesity Prevention, Deakin University, Victoria, Australia.
7
National Cancer Institute of Brazil, Ministry of Health, Rio de Janeiro, Brazil.
8
UK Health Forum, London, UK.
9
Sydney Law School, University of Sydney, Sydney, NSW, Australia.

Abstract

To achieve WHO's target to halt the rise in obesity and diabetes, dramatic actions are needed to improve the healthiness of food environments. Substantial debate surrounds who is responsible for delivering effective actions and what, specifically, these actions should entail. Arguments are often reduced to a debate between individual and collective responsibilities, and between hard regulatory or fiscal interventions and soft voluntary, education-based approaches. Genuine progress lies beyond the impasse of these entrenched dichotomies. We argue for a strengthening of accountability systems across all actors to substantially improve performance on obesity reduction. In view of the industry opposition and government reluctance to regulate for healthier food environments, quasiregulatory approaches might achieve progress. A four step accountability framework (take the account, share the account, hold to account, and respond to the account) is proposed. The framework identifies multiple levers for change, including quasiregulatory and other approaches that involve government-specified and government-monitored progress of private sector performance, government procurement mechanisms, improved transparency, monitoring of actions, and management of conflicts of interest. Strengthened accountability systems would support government leadership and stewardship, constrain the influence of private sector actors with major conflicts of interest on public policy development, and reinforce the engagement of civil society in creating demand for healthy food environments and in monitoring progress towards obesity action objectives.

PMID:
25703108
DOI:
10.1016/S0140-6736(14)61747-5
[Indexed for MEDLINE]

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