Abstract
Mandatory nutrition labelling, introduced in Malaysia in 2003, received a “medium implementation” rating from public health experts when previously benchmarked against international best practices by our group. The rating prompted this qualitative case study to explore barriers and facilitators during the policy process. Methods incorporated semi-structured interviews supplemented with cited documents and historical mapping of local and international directions up to 2017. Case participants held senior positions in the Federal government (n = 6), food industry (n = 3) and civil society representations (n = 3). Historical mapping revealed that international directions stimulated policy processes in Malaysia but policy inertia caused implementation gaps. Barriers hindering policy processes included lack of resources, governance complexity, lack of monitoring, technical challenges, policy characteristics linked to costing, lack of sustained efforts in policy advocacy, implementer characteristics and/or industry resistance, including corporate political activities (e.g., lobbying, policy substitution). Facilitators to the policy processes were resource maximization, leadership, stakeholder partnerships or support, policy windows and industry engagement or support. Progressing policy implementation required stronger leadership, resources, inter-ministerial coordination, advocacy partnerships and an accountability monitoring system. This study provides insights for national and global policy entrepreneurs when formulating strategies towards fostering healthy food environments.
Highlights
Unhealthy diets lead to overweight and obesity and contribute to the development of non-communicable diseases (NCDs) [1,2], which were responsible for 11 million deaths and 255 million disability-adjusted life-years in 2017 [1]
Part II explores the thematic findings related to policy process for this case, followed by a summary of five recommendations for stakeholders to progress future food labelling policy processes
The case study revealed the main influences on the policy processes to be policy commitment, governance and its technical and specificity issues, stakeholders’ relationships, social attributes and impacts, food industry’s policy position, as well as opportunities linked to local and external triggers that influenced policy processes
Summary
Unhealthy diets lead to overweight and obesity and contribute to the development of non-communicable diseases (NCDs) [1,2], which were responsible for 11 million deaths and 255 million disability-adjusted life-years in 2017 [1]. Population diets that contribute to the burden of obesity and NCDs, include suboptimal consumption of healthy foods (e.g., fruits and vegetables, nuts and seeds, milk and whole grains) and overconsumption of sugar-sweetened beverages, processed meat, red meat and ultra-processed foods containing high levels of negative nutrients (e.g., sodium, trans-fat) [1,4]. Rising sales of ultra-processed foods, such as baked goods and sugar-sweetened beverages, reflect the nutrition transition occurring in Asia, in the South and Southeast Asian regions [5]. The easy availability, accessibility and desirability of these unhealthy foods drive consumer purchase and consumption behaviors, requiring effective mediation from public sector stakeholders
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