What drives political commitment for nutrition? A review and framework synthesis to inform the United Nations Decade of Action on Nutrition

Abstract

IntroductionGenerating country-level political commitment will be critical to driving forward action throughout the United Nations Decade of Action on Nutrition (2016–2025). In this review of the empirical nutrition policy literature, we ask: what factors generate, sustain and constrain political commitment for nutrition, how and under what circumstances? Our aim is to inform strategic ‘commitment-building’ actions.MethodWe adopted a framework synthesis method and realist review protocol. An initial framework was derived from relevant theory and then populated with empirical evidence to test and modify it. Five steps were undertaken: initial theoretical framework development; search for relevant empirical literature; study selection and quality appraisal; data extraction, analysis and synthesis and framework modification.Results75 studies were included. We identified 18 factors that drive commitment, organised into five categories: actors; institutions; political and societal contexts; knowledge, evidence and framing; and, capacities and resources. Irrespective of country-context, effective nutrition actor networks, strong leadership, civil society mobilisation, supportive political administrations, societal change and focusing events, cohesive and resonant framing, and robust data systems and available evidence were commitment drivers. Low-income and middle-income country studies also frequently reported international actors, empowered institutions, vertical coordination and capacities and resources. In upper-middle-income and high-income country studies, private sector interference frequently undermined commitment.ConclusionPolitical commitment is not something that simply exists or emerges accidentally; it can be created and strengthened over time through strategic action. Successfully generating commitment will likely require a core set of actions with some context-dependent adaptations. Ultimately, it will necessitate strategic actions by cohesive, resourced and strongly led nutrition actor networks that are responsive to the multifactorial, multilevel and dynamic political systems in which they operate and attempt to influence. Accelerating the formation and effectiveness of such networks over the Nutrition Decade should be a core task for all actors involved.

Generating political commitment for ending malnutrition in all its forms: A system dynamics approach for strengthening nutrition actor networks

“…It refers to both the intention to act (intentionality or willingness) and action itself . Credible and sustained commitment—from political leaders who champion policy initiatives and government officials who coordinate action, to civil society groups who advocate for attention and resources, and ultimately affected community groups and individual citizens—is crucial to driving nutrition policy responses in the long term …”

“…To further develop and refine these models, we drew from the results of a review of empirical studies on the drivers of political commitment for nutrition conducted by four of the authors (P.B., K.W., H.W., and A.D.) . This involved keyword searches of scholarly databases and institutional websites for research articles and grey literature.…”

“…One essential driver of political commitment is the strength of nutrition actor networks (NANs), defined as the web of individuals and organizations operating within a given country or jurisdiction who share principled ideas, causal beliefs, and a common interest in tackling malnutrition and who act collectively to do so . At the global level, networks have proliferated in recent years as distinct organizational forms to address a number of high‐burden health issues (eg, tobacco control, maternal mortality, and tuberculosis) .…”

“…The Scaling Up Nutrition (SUN) Movement, the world's largest initiative for building commitment and scaling‐up multisectoral implementation efforts, is driven by international as well as national nutrition networks in its 60 member countries. Nutrition policy scholars focused on national and subnational contexts also acknowledge the centrality of networks in mobilizing political systems, institutions and resources, designing policies, building capacities and coordinating responses across levels and sectors, as well as actions on‐the‐ground . Despite this growing body of scholarship, there is limited understanding of how NANs become established within countries, how they develop and evolve over time, and what ultimately drives their effectiveness at generating and sustaining political commitment among diverse actors.…”

An 11‐country study to benchmark the implementation of recommended nutrition policies by national governments using the Healthy Food Environment Policy Index, 2015‐2018

“…Although the reasons behind the implementation gaps were not investigated in this study, they generally include among others the lobbying by food companies opposing recommended policies, the restricted ability or willingness of governments to implement regulations, and the limited pressure from civil society organizations for policy action due to restricted capacity and funding and weak coordination . A recent review identified nutrition actor networks, civil society mobilization, robust data systems, and available evidence among other factors driving political commitment for nutrition irrespective of country context . The Food‐EPI tool and process may hence contribute to create and strengthen several of these factors driving such commitment.…”