Policy Evaluation Network (PEN) – Public policies addressing health-related behaviours in Europe – Dr. Liam Kelly

Non-communicable diseases are the leading cause of global mortality, responsible for 39.5 million deaths in 2015, which equates to 70% of all deaths. Successful policy actions to address physical inactivity, unhealthy diets and sedentary behaviour have the potential to influence the health and well-being of an entire population. At the public policy level, the initiation, coordination and implementation of policies that enhance opportunities for whole populations to make healthier physical activity (PA) and diet-related choices are necessary. Yet, no systematic research on the assessment or evaluation of policy interventions across Europe is currently being conducted. Consequently, no information on the merit, worth or utility of policy interventions is available and no guidance or recommendations on how to address this gap in our knowledge exists.

As part of the Joint Programming Initiative on a Healthy Diet for a Healthy Life, researchers from 28 institutes in seven European countries (France, Germany, Ireland, Italy, Norway, Poland, and the Netherlands) and New Zealand combine their expertise to form a Policy Evaluation Network (PEN).

PEN’s vision is to provide Europe with tools to identify, evaluate and benchmark policies designed to directly or indirectly address physical inactivity, unhealthy diets and sedentary behaviour while accounting for existing health inequities. Using structured evaluation principles and methods, PEN will examine the content, implementation and impact of lifestyle policies across Europe and will build on existing knowledge from DEDIPAC (Determinants of Diet and Physical Activity) and the INFORMAS (International Network for Food and Obesity/ non-communicable diseases Research, Monitoring and Action Support) framework. With seven inter-related work packages (WPs), PEN will provide an overview of the ‘best’ public policies most likely to sustainably support more favourable health behaviours.

It will realise the first steps in a bespoke policy monitoring and surveillance system for Europe and refine our knowledge of appropriate research designs and methods for the quantification of policy impact. It will contribute to our understanding of how to achieve successful transnational policy implementation of these evidence-based or evidence-grounded policies in different cultural, demographic or socio-economic settings with particular focus on vulnerable groups. PEN will provide recommendations on equity and diversity to ensure that policy actions are inclusive as opposed to exclusive, are relevant to the changing landscape of Europe and are culturally sensitive. Finally, PEN will provide three worked examples of policy in practice. Three case studies will illustrate how best to evaluate the implementation and impact of policy in order to yield the best results for a healthy diet for a healthy life for European citizens.

PEN will (1) assess public policies with potential influence on food and PA environments, (2) foster a pan-European monitoring and surveillance system, (3) model the impact of policies at the population level, (4) evaluate policy implementation processes and their facilitators and barriers, and (5) give recommendations for an equity and diversity perspective in policies directly or indirectly targeting dietary, PA or SB behaviours across Europe.

Key Objectives

• To adapt and implement a Food Environment Policy Index (Food EPI) and develop a PA Environment Policy Index (PA EPI) in selected European countries, providing benchmarks for good policy practice to improve dietary behaviours and to enhance PA;
• To map health and health behaviour indicators needed to evaluate the outcome of policy interventions to the data already provided by existing surveillance/ monitoring systems and establish an expert platform to further develop these systems;
• To review, critically assess and refine quantitative methods for the evaluation of the impact of public policies;
• To identify key factors, barriers and facilitators of effective policy interventions and to provide tools to assess the successful implementation of policies;
• To summarise the requirements for policy interventions to reach vulnerable groups, including lower socio-economic groups and ethnic minority populations;
• To provide an in-depth assessment of policy impact and implementation in three case studies: (a) taxation of sugar/ sugar-sweetened beverages; (b) active transport policies; and (c) school policies on nutrition, PA and sedentary behaviour.

As noted, PEN is structured around six research work packages (WPs), each with its own scientific concept. All WPs are connected by three cross-cutting case studies (Figure 1), tied together by the overarching framework and 3 case studies:

•  WP1 Policy mapping and EPI development
• WP2 Monitoring and surveillance
• WP3 Estimation and simulation of policy impact
• WP4 Policy implementation evaluation
• WP5 Equity and diversity of policies
• WP6 Policy in practice – Selected case studies
• WP7 Network coordination and dissemination

The University of Limerick research team (Prof Catherine Woods, Dr. Liam Kelly, Dr Enrique García Bengoechea (EHS Dean’s Fellow), Kevin Volf, PESS PhD Student) will lead the PA aspect of WP1. WP1 will provide an overview of public policies with direct/indirect potential influence on food and PA policy environments. An initial systematic literature review will attempt to determine what is the impact of policy interventions on PA outcomes? This systematic literature review was guided by NON COMMUNICABLE DISEASE PREVENTION: Investments that Work for Physical Activity (2012) (http://www.globalpa.org.uk/pdf/investments-work.pdf), developed as part of the Toronto Charter which called for political commitment in order to achieve greater opportunities for PA (Bull et al., 2010). This ‘seven best investments’ document was selected to provide the structure for the search as it provides evidence for the PA domains that are well supported by evidence.

In addition, the systematic literature review will address the complementary question of how policy interventions work. Understanding how an intervention works might help explain the effects observed and provide guidance about generalisability (Panter et al., 2019). The review will provide evidence supporting the development of a tool named the PA EPI. The PA EPI will provide policy makers with a list of policy statements and corresponding actions which the evidence has determined improve PA outcomes. Developed tools to benchmark government (local, regional and national) implementation of policy actions to effect change, and will be made available for the research and practice communities after development and have the potential to contribute to the global database for cross country/continent comparisons.

The latest PEN publication ‘Advancing the evidence base for public policies impacting on dietary behaviour, physical activity and sedentary behaviour in Europe: The Policy Evaluation Network promoting a multidisciplinary approach’ is now available; https://doi.org/10.1016/j.foodpol.2020.101873

Liam Kelly is a Post Doc Researcher in the Department of Physical Education and Sport Sciences at the University of Limerick. He works on the Policy Evaluation Network project with Prof. Catherine Woods. He has a BSc (Hons) in Sport Science and a PhD by Research. His research interests are in the area of men’s health, community-based physical activity programmes, and physical activity policy evaluation and monitoring. You can contact Liam at Liam.Kelly@ul.ie or follow him on twitter at @liamkellyIRL