A Food Security Indicator Framework for British Columbia, Canada.

Food security is a determinant of health and increasingly recognized as a focus for health promotion. Led by the Population and Public Health Program, British Columbia Centre for Disease Control, this article outlines the process of development and the evidence-based conceptual framework that guides the systematic selection of food security indicators in the Province. A phased, iterative approach to develop the food security framework was adopted. Phase 1 consisted of a literature search of food security indicator models, and key informant discussions. Phase 2 consisted of modification of the model based on stakeholder consultation. The framework development occurred between January 2016 and April 2019. A structured scan of the literature found no existing conceptual frameworks specific to food security indicators in the Global North. The most relevant and frequently used frameworks for indicator reporting identified were environmental health indicator frameworks. This article presents a matrix framework based on existing environmental health indicator frameworks. It integrates environmental health causal networks (e.g., determinants-current state-impact-response) with food security elements identified as (a) individual and household food insecurity, (b) food systems, and (c) capacity. This framework contributes to food security performance monitoring in the Global North and fills an important gap in evaluating the impact of the public health response to food security. Use of this comprehensive framework can enable program planners and policy makers to be clear about where and how they are attempting to assess, influence and monitor food security, and illustrate the interconnectedness between indicators.

District-level implementation of British Columbia's school food and beverage sales policy: a realist evaluation exploring intervention mechanisms in urban and rural contexts.

INTERVENTION: British Columbia's (BC) provincial school food and beverage sales policy. RESEARCH QUESTION: What are the processes associated with district-level implementation of BC's school food and beverage sales policy? METHODS: We adopted a realist approach and a qualitative, multiple case study design that included three urban and two rural BC school districts. Data collection involved semi-structured interviews and questionnaires with health, education, and industry stakeholders, observations, document analysis and website scans. Analysis identified: (i) mechanisms influencing if and how stakeholders engage in implementation activities at the district level and (ii) specific dimensions of context influencing these mechanisms. RESULTS: We identified three mechanisms driving implementation processes at the school district level associated with BC's school food and beverage sales policy. These mechanisms are influenced by various dimensions of context that lead to a range of implementation outcomes. The 'mandatory mechanism' refers to the mandatory nature of the policy effectively triggering implementation efforts, influenced by a normative acceptance of the education system hierarchy. The 'money mechanism' refers to how this district demand leads vendors to create a compliant supply; it is influenced by beliefs about children's food preferences, health and food, and the existence of competition. Finally, the 'monitoring mechanism' refers to how systems of informal monitoring are used to promote compliance in the context of a competitive sales environment. CONCLUSION: The outcomes of these three policy mechanisms are influenced by complex dimensions of context. Identifying context-mechanism interactions can help inform public health policymakers interested in interventions for improving school food environments.

It's just the right thing to do: Conceptualizing a theory of change for a school food and beverage sales environment interv ention and implications for implementation evaluation.

School food environments are the target of nutrition interventions and evaluations across the globe. Yet little work to-date has articulated the importance of developing a theory of change upon which to base evaluation of both implementation and outcomes. This paper undertakes an interpretive approach to develop a retrospective theory of change for an implementation evaluation of British Columbia's school food and beverage sales Guidelines. This study contributes broadly to a nuanced conceptualization of this type of public health intervention and provides a methodological contribution on how to develop a retrospective theory of change with implications for effective evaluation. Data collection strategies included document analysis, semi-structured interviews with key stakeholders, and participant observation. Developing the logic model revealed that, despite the broad population health aims of the intervention, the main focus of implementation is to change behaviors of adults who create school food environments. Derived from the analysis and interpretation of the data, the emergent program theory focuses on the assumption that if adults are responsibilized through information and education campaigns and provided implementation tools, they will be 'convinced' to implement changes to school food environments to foster broader public health goals. These findings highlight the importance of assessing individual-level implementation indicators as well as the more often evaluated measures of food and beverage availability.

Sustainability in the Qatar national dietary guidelines, among the first to incorporate sustainability principles.

OBJECTIVE: To present one of the first national dietary guidelines that incorporates food sustainability principles into its public health recommendations. DESIGN: The paper outlines recommendations and utilizes an ecological framework of policy analysis to examine context, drivers, consequences and future suggestions in establishing and maintaining sustainability principles within the Qatar Dietary Guidelines. SETTING: Qatar. SUBJECTS: Population of Qatar. RESULTS: Qatar has produced one of the first national dietary guidelines to integrate principles of food sustainability. National interest in environmental sustainability and food security, population concern over food waste (reinforced by Islamic religious law), strong authority of the Supreme Council of Health (supported by an Emirate government), a small domestic food industry and a lack of food industry influence on the guidelines have contributed to the inclusion of sustainability principles within the document. CONCLUSIONS: Whether these principles will be embraced or rejected by the population in the long term will likely be determined by the Dietary Guidelines Task Force and the Supreme Council of Health's commitment to educating the population about the relevance and importance of these principles and establishing champions to advocate for them.

Exploring Public Health's roles and limitations in advancing food security in British Columbia.

OBJECTIVES: This research analyzes the roles and limitations of Public Health in British Columbia in advancing food security through the integration of food security initiatives into its policies and programs. It asks the question, can Public Health advance food security? If so, how, and what are its limitations? METHODS: This policy analysis merges findings from 38 key informant interviews conducted with government and civil society stakeholders involved in the development of food security initiatives, along with an examination of relevant documents. The Population Health Template is used to delineate and analyze Public Health roles in food security. RESULTS: Public Health was able to advance food security in some ways, such as the adoption of food security as a core public health program. Public Health's leadership role in food security is constrained by a restricted mandate, limited ability to collaborate across a wide range of sectors and levels, as well as internal conflict within Public Health between Food Security and Food Protection programs. CONCLUSIONS: Public Health has a role in advancing food security, but it also faces limitations. As the limitations are primarily systemic and institutional, recommendations to overcome them are not simple but, rather, require movement toward embracing the determinants of health and regulatory pluralism. The results also suggest that the historic role of Public Health in food security remains salient today.

Integrating food security into public health and provincial government departments in British Columbia, Canada.

Food security policy, programs, and infrastructure have been incorporated into Public Health and other areas of the Provincial Government in British Columbia, including the adoption of food security as a Public Health Core Program. A policy analysis of the integration into Public Health is completed by merging findings from 48 key informant interviews conducted with government, civil society, and food supply chain representatives involved in the initiatives along with relevant documents and participant/direct observations. The paper then examines the results within the context of historic and international trends and theoretical models of food policy, community food security, and applied policy research. Public Health re-emerged as a driver of food security in BC-both as a key player and in positing the public's health as a driver in food security and food systems. While Public Health's lead role supported an increase in legitimacy for food security in BC, interviewees described a clash of cultures between Public Health and civil society. The clash of cultures occurred partly as a result of Public Health's limited food security mandate and top down approach. Consequently civil society voice at the provincial level was marginalized. A social policy movement toward a new political paradigm-regulatory pluralism-calls for greater engagement of civil society, and for all sectors to work together toward common goals. A new, emerging policy map is proposed for analyzing the dynamics of food security and health promotion initiatives in BC.

Putting food on the public health table: Making food security relevant to regional health authorities.

Food security is emerging as an increasingly important public health issue. The purpose of this paper is to describe a conceptual model and five classes of food security indicators for regional health authorities (RHAs): direct, indirect, consequence, process, and supra-regional. The model was developed after a review of the food security literature and interviews with British Columbia community nutritionists and public health officials. We offer this conceptual model as a practical tool to help RHAs develop a comprehensive framework and use specific indicators, in conjunction with public health nutritionists and other community stakeholders. We recommend using all five classes of indicator together to ensure a complete assessment of the full breadth of food security. This model will be useful for Canadian health authorities wishing to take a holistic community-based approach to public health nutrition to develop more effective policies and programs to maximize food security. The model and indicators offer a rational process that could be useful for collaborative multi-stakeholder initiatives to improve food security.