Search

Restrictions on marketing of unhealthy foods and beverages to children is a globally recommended policy measure to improve diets and health. The aim of the analysis was to identify opportunities to enable policy learning and shift beliefs of relevant actors, to engender policy progress on restrictions on marketing of unhealthy foods to children. We drew on the Advocacy Coalition Framework to thematically analyse data from qualitative policy interviews conducted Australia (n  = 24), Fiji (n  = 10) and Thailand (n  = 20). In all three countries two clear and opposing advocacy coalitions were evident within the policy subsystem related to regulation of unhealthy food marketing, which we termed the 'strengthen regulation' and 'minimal/self regulation' coalitions. Contributors to policy stasis on this issue were identified as tensions between public health and economic objectives of government, and limited formal and informal spaces for productive dialogue. The analysis also identified opportunities for policy learning that could enable policy progress on restrictions on marketing of unhealthy foods to children as: taking an incremental approach to policy change, defining permitted (rather than restricted) foods, investing in new public health expertise related to emerging marketing approaches and scaling up of monitoring of impacts. The insights from this study are likely to be relevant to many countries seeking to strengthen regulation of marketing to children, in response to recent global recommendations. [ABSTRACT FROM AUTHOR]

Showing the causal link between community engagement and improved health outcomes is a 'holy grail' of health policy. This article argues that this 'holy grail' has remained elusive because community engagement in primary health care is under-theorized, having been based on positive a priori assumptions, e.g. that people necessarily want to be engaged in governing their health system. By adopting a theory-driven approach and an agnostic premise, we show that understanding why , how and when community engagement may emerge or function spontaneously is important for informing efforts to support community engagement in primary health care primary health care governance. We draw on empirical research on community engagement in Nigeria and on the literature to identify the 'why' (coalition of service users can emerge in response to under-governance); the 'how' (five modes: through meetings; reaching out within their community; lobbying governments; augmenting government support; and taking control of service delivery) and the 'when' (as geographical, socio-economic and institutional context align, such that the benefits of action outweigh costs). Understanding the broad patterns of mechanisms and of contextual factors that apply across communities is, after all, our 'holy grail'—and this understanding should inform efforts to tailor support for community engagement in governance in different settings. [ABSTRACT FROM AUTHOR]

As part of an evaluation of the California Healthy Cities and Communities (CHCC) program, we evaluated resident involvement, broad representation and civic engagement beyond the local CHCC initiative. The evaluation design was a case study of 20 participating communities with cross-case analysis. Data collection methods included: coalition member surveys at two points in time, semi-structured interviews with key informants, focus groups with coalition members and document review. Participating communities were diverse in terms of population density, geography and socio-demographic characteristics. Over a 3-year period, grantees developed a broad-based coalition of residents and community sectors, produced a shared vision, conducted an asset-based community assessment, identified a priority community improvement focus, developed an action plan, implemented the plan and evaluated their efforts. Local residents were engaged through coalition membership, assessment activities and implementation activities. Ten of the 20 coalitions had memberships comprised of mainly local residents in the planning phase, with 5 maintaining a high level of resident involvement in governance during the implementation phase. Ninety percent of the coalitions had six or more community sectors represented (e.g. education, faith). The majority of coalitions described at least one example of increased input into local government decision-making and at least one instance in which a resident became more actively involved in the life of their community. Findings suggest that the Healthy Cities and Communities model can be successful in facilitating community participation. [ABSTRACT FROM PUBLISHER]

This study addressed the question of how to structure coalitions in order to increase their engagement in multiple strategies for health promotion and consequently to improve their effectiveness. Three structural variables were chosen: (i) coalition's heterogeneity, captured by the professional diversity of its members; (ii) coalition's configuration, defined as the way members were involved in the coalition: full- or part-cycle membership, full- or part-time assignment, and core or peripheral membership; and (iii) coalition's contractual collaborations with external professionals. A large non-profit network of community centers served as the setting for this study. The sample consisted of 37 coordinators of local coalitions for health promotion in Israel. The study's design was a cross-sectional survey. Data were collected by a multimethod (semistructured interviews, self reported questionnaires and administrative data) approach. Effectiveness was assessed by a self-report questionnaire administrated to coalition coordinators. Engagements in multistrategies as well as structural variables were measured by semistructured interviews with coalition coordinators. Results demonstrated that while a homogeneous, bounded structure seemed to promote the implementation of health education programs, a more flexible coalition configuration with frequent use of professionals contributed more to working by multiple strategies and improved coalition's effectiveness. In addition, the use of external professionals promoted action for a healthier environment, but did not add to empowering the community. The results contribute to shifting the conception of a coalition as a tightly bounded, well-defined, stable entity to that of a more fluid and permeable structure interacting with an external environment. These findings highlight the importance of incorporating structural considerations into the management of coalitions and are discussed in light of the potential costs and benefits of alternative modes of structuring such coalitions. [ABSTRACT FROM AUTHOR]