CVD Prevention Through Policy: a Review of Mass Media, Food/Menu Labeling, Taxation/Subsidies, Built Environment, School Procurement, Worksite Wellness, and Marketing Standards to Improve Diet

Abstract

Poor diet is the leading cause of cardiovascular disease in the USA and globally. Evidence-based policies are crucial to improve diet and population health. We reviewed the effectiveness for a range of policy levers to alter diet and diet-related risk factors. We identified evidence to support benefits of focused mass media campaigns (especially for fruits, vegetables, salt), food pricing strategies (both subsidies and taxation, with stronger effects at lower income levels), school procurement policies (for increasing healthful or reducing unhealthful choices), and worksite wellness programs (especially when comprehensive and multicomponent). Evidence was inconclusive for food and menu labeling (for consumer or industry behavior) and changes in local built environment (e.g., availability or accessibility of supermarkets, fast food outlets). We found little empiric evidence evaluating marketing restrictions, although broad principles and large resources spent on marketing suggest utility. Widespread implementation and evaluation of evidence-based policy strategies, with further research on other strategies with mixed/limited evidence, are essential "population medicine" to reduce health and economic burdens and inequities of diet-related illness worldwide.

Keywords: Advertising; Diet; Labeling; Policy; Regulation; Schools; Subsidy; Tax; Worksite.

Fig. 1

Barriers and opportunities for healthy eating. (Reproduced with permission from: Afshin A, Micha R, Khatibzadeh S, Schmidt L, Mozaffarian D. Dietary policies to reduce noncommunicable diseases. In: Brown G, Yamey G, Wamala S, editors. The Handbook of Global Health Policy. Wiley-Blackwell, San Francisco, 2014) [10]