An accountability framework to promote healthy food environments

Abstract

Objective: To review the available literature on accountability frameworks to construct a framework that is relevant to voluntary partnerships between government and food industry stakeholders. Design: Between November 2012 and May 2013, a desk review of ten databases was conducted to identify principles, conceptual frameworks, underlying theories, and strengths and limitations of existing accountability frameworks for institutional performance to construct a new framework relevant to promoting healthy food environments. Setting: Food policy contexts within high-income countries to address obesity and diet-related non-communicable diseases. Subjects: Eligible resources (n 26) were reviewed and the guiding principles of fifteen interdisciplinary frameworks were used to construct a new accountability framework. Results: Strengths included shared principles across existing frameworks, such as trust, inclusivity, transparency and verification; government leadership and good governance; public deliberations; independent bodies recognizing compliance and performance achievements; remedial actions to improve accountability systems; and capacity to manage conflicts of interest and settle disputes. Limitations of the three-step frameworks and 'mutual accountability' approach were an explicit absence of an empowered authority to hold all stakeholders to account for their performance. Conclusions: We propose a four-step accountability framework to guide government and food industry engagement to address unhealthy food environments as part of a broader government-led strategy to address obesity and diet-related non-communicable diseases. An independent body develops clear objectives, a governance process and performance standards for all stakeholders to address unhealthy food environments. The empowered body takes account (assessment), shares the account (communication), holds to account (enforcement) and responds to the account (improvements).

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

“…24 Accountability also involves recognition of achievements and enforcement of performance through the application of sanctions for poor performance or non-compliance. As such, accountability is ultimately about governance and power and determines how and why decisions are made, who makes decisions, how power is used, shared, and balanced, whose opinions are important, and who holds whom to account.…”

“…An accountability framework to improve the healthiness of food environments has been proposed by Kraak and colleagues, 24 following a comprehensive review of 15 interdisciplinary conceptual frameworks for institutional accountability. One example of an institutional accountability framework was developed by the Commission on Infor mation and Accountability for Women's and Children's Health ("Monitor, Review, and Act" three step frame work).…”

“…Since the implicit nature of enforcement was the most problematic and confronting aspect of the accountability process identifi ed in the review, enforcement was included as an explicit step in the framework by Kraak and colleagues (fi gure). 24 The absence of concrete mechanisms for holding to account has also been very problematic in the UN framework for improvement of the human rights performance of transnational corporations ("Protect, Respect, and Remedy"). 39 The core of the framework by Kraak and colleagues 24 is the agreed objectives, processes, and outcomes.…”

“…24 The absence of concrete mechanisms for holding to account has also been very problematic in the UN framework for improvement of the human rights performance of transnational corporations ("Protect, Respect, and Remedy"). 39 The core of the framework by Kraak and colleagues 24 is the agreed objectives, processes, and outcomes. For governments, these are the global and national action plans they create or endorse, especially the WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-20.…”

Why a Global Convention to Protect and Promote Healthy Diets is timely

“…Additionally, accountability for obesity and NCDs prevention at the national level, including measurement, review of progress and stimulation of action, will be essential to ensure progress (22) . In this issue, Kraak et al (23) propose a four-step accountability framework to guide government and food industry engagement to address unhealthy food environments as part of a broader government-led strategy to address obesity and dietrelated NCDs. In addition to a Global Convention for Healthy Diets and stronger accountability mechanisms at the national level, the new WHO high-level Commission on Ending Childhood Obesity (24) could be the strong advocate needed to support critical efforts by governments and the food industry to reduce obesity and diet-related NCDs globally.…”