Reeve Erica, Thow Anne-Marie, Bell Colin, Soti-Ulberg Christina, Sacks Gary
Deakin University, Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, 1 Gheringhap Street, Locked Bag 20001, Geelong, Victoria, 3220, Australia.
Menzies Centre for Health Policy, School of Public Health, University of Sydney, Level 2, Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia.
BMC Public Health. 2021 Jan 29;21(1):246. doi: 10.1186/s12889-021-10203-2.
Despite global recommendations to prioritise policies that create healthy food environments within education institutions, the implementation of effective healthy school food policies has proved challenging for many countries. This study examined the experience of Samoa subsequent to the 2012 introduction of a stronger policy to improve the healthiness of school food environments. Our aim was to identify opportunities to strengthen healthy school food policy implementation in Samoa and other comparable contexts.
We used a qualitative case study approach, underpinned by policy science theory. In 2018, we conducted in-depth semi-structured interviews with 30 informants, coupled with analysis of relevant documents, to generate a detailed understanding of the relevant policy implementation processes in Samoa, and the perspectives and capacities of key implementation actors. Data collection and analysis were guided by the Health Policy Analysis Triangle, supplemented by other policy theories relevant to policy process.
Samoa's school food policy operationalizes international 'best practice' recommendations. We found health policymakers and leaders in Samoa to be strongly committed to improving school food environments. Despite this, there continued to be challenges in ensuring compliance with the school nutrition standards. Key issues that negatively impacted the policy's effectiveness were the lack of priority given to school food by stakeholders outside of health, the high prevalence of unhealthy food in the areas immediately surrounding schools, vendor knowledge and capacity, and the high degree of agency exercised by actors in and around the school. We noted several opportunities for policies to be effectively implemented and sustained. Respondents identified community-level leaders as potentially pivotal stakeholders, particularly where school governance arrangements draw heavily on community representation.
Sustained and effective implementation of healthy school food policies requires continued engagement from political and community leaders, beyond initial commitment. There is potential to capitalize on political will for diet-related NCD prevention by more clearly demonstrating the institutional and operational requirements for effective and sustained implementation. Strong incentives for compliance and effective enforcement mechanisms are also likely to be crucial to success.
尽管全球都建议优先制定能在教育机构内营造健康食品环境的政策，但对许多国家而言，实施有效的健康学校食品政策已被证明颇具挑战性。本研究考察了萨摩亚在2012年引入更强有力政策以改善学校食品环境之后的经历。我们的目的是确定在萨摩亚及其他类似背景下加强健康学校食品政策实施的机会。
我们采用了以政策科学理论为基础的定性案例研究方法。2018年，我们对30名受访者进行了深入的半结构化访谈，并结合对相关文件的分析，以详细了解萨摩亚相关政策的实施过程，以及关键实施行为体的观点和能力。数据收集和分析以健康政策分析三角为指导，并辅以与政策过程相关的其他政策理论。
萨摩亚的学校食品政策将国际“最佳实践”建议付诸实施。我们发现萨摩亚的卫生政策制定者和领导人坚定致力于改善学校食品环境。尽管如此，在确保遵守学校营养标准方面仍存在挑战。对政策有效性产生负面影响的关键问题包括：卫生领域以外的利益相关者对学校食品缺乏重视、学校周边地区不健康食品的高流行率、供应商的知识和能力，以及学校内外行为体的高度自主性。我们注意到有几个政策有效实施和持续推进的机会。受访者认为社区层面的领导人可能是关键利益相关者，特别是在学校治理安排大量依赖社区代表的情况下。
健康学校食品政策的持续有效实施需要政治和社区领导人在最初的承诺之外持续参与。通过更清晰地展示有效和持续实施所需的制度和操作要求，有可能利用与饮食相关的非传染性疾病预防的政治意愿。强有力的合规激励措施和有效的执行机制对成功也可能至关重要。
