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Understanding the role of the state in dietary public health policymaking: a critical scoping review.

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Huang, Yuru 
Egan, Natalie 
Carters-White, Lauren 
Hawkins, Benjamin 


Despite evidence that dietary population health interventions are effective and widely accepted, they remain the topic of intense debate centring on the appropriate role of the state. This review sought to identify how the role of the state in intervening in individuals' food practices is conceptualized across a wide range of literatures. We searched 10 databases and 4 journals for texts that debated dietary population health interventions designed to affect individuals' health-affecting food practices. Two co-authors independently screened these texts for eligibility relative to inclusion and exclusion criteria. Thirty-five texts formed our final corpus. Through critical reflexive thematic analysis (TA), we generated 6 themes and 2 subthemes concerning choice, responsibility for health, balancing benefits and burdens of intervention, the use of evidence, fairness, and the legitimacy of the state's actions. Our analysis found that narratives that aim to prevent effective regulation are entrenched in academic literatures. Discourses that emphasized liberty and personal responsibility framed poor health as the result of 'lifestyle choices'. Utilitarian, cost-benefit rationales pervaded arguments about how to best balance the benefits and burdens of state intervention. Claims about fairness and freedom were used to evoke powerful common meanings, and evidence was used politically to bolster interests, particularly those of the food industry. This review identifies and critically analyses key arguments for and against population dietary public health policies. Our findings should motivate public health researchers and practitioners to avoid unreflexively embracing framings that draw on the languages and logics of free market economics.


Funder: Cambridge Commonwealth Trust

Funder: Gates Cambridge Trust

Funder: Harding Distinguished Postgraduate Scholars Fund

Funder: Wolfson College, University of Cambridge

Funder: Alborada Trust


diet, food, health policy, qualitative methods, systematic review, Humans, Public Health, Diet, Policy Making, Dissent and Disputes, Food

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Health Promot Int

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Oxford University Press (OUP)
MRC (MC_UU_00006/7)
This work was supported by the Medical Research Council [grant number MC_UU_00006/7]. Additional funding for individual authors included: • NK: The Cambridge Commonwealth, European & International Trust; The ALBORADA Trust; Wolfson College, Cambridge. • YH: Gates Cambridge Trust PhD Scholarship. • NE: Harding Distinguished Postgraduate Scholars Fund. • LCW: UK Prevention Research Partnership, an initiative funded by UK Research and Innovation Councils, the Department of Health and Social Care (England) and the UK devolved administrations, and leading health research charities.