The regulatory governance conditions that lead to food policies achieving improvements in population nutrition outcomes: a qualitative comparative analysis

OBJECTIVE: To identify the regulatory governance factors that lead to food policies achieving improvements in food environment, consumer behaviour and diet-related health outcomes. DESIGN: Qualitative comparative analysis (QCA) was used to investigate the relationship between regulatory governance conditions and population nutrition outcomes. The regulatory governance conditions examined entailed: high industry involvement in the policy process, regulatory design, policy instrument design, policy monitoring and enforcement. PARTICIPANTS: n 29 policy cases in the policy areas of food reformulation, nutrition labelling, food taxation and food marketing. SETTING: Policies implemented in thirteen countries. RESULTS: Comprehensive monitoring was identified as a necessary regulatory governance condition for food policies to have an impact and was present in 94 % of policy cases that had a positive impact on nutrition outcomes. We identified two sufficient combinations of regulatory governance conditions. The first sufficient combination of conditions comprised an absence of high industry involvement in the policy process, combined with the presence of strict regulatory design, best-practice instrument design, and comprehensive monitoring and enforcement. Ninety-six percent of policy cases with positive impacts on nutrition outcomes displayed this combination. The second sufficient combination of conditions comprised an absensce of high industry involvement in the policy process, best practice instrument design and comprehensive monitoring. Eighty-two percent of policy cases with positive impacts on nutrition outcomes displayed this combination. CONCLUSION: These findings show the importance of regulatory governance on policy outcomes. They suggest a need for more government-led nutrition policy processes and transparent monitoring systems that are independent from industry.