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      An Evaluation of Four Years Implementation of National Nutrition and Food Security Policy in Iran: Lessons Learned

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          Abstract

          Background:

          National Nutrition and Food Security Policy of Iran was developed and ordered by Office of Community Nutrition Improvement, in cooperation with National Nutrition and Food Technology Research Institute and National Institute of Health Research in 2012. This study was aimed at evaluating the success of the operationalization of the Policy between 2012 and 2015 and using the lessons learned in future policies.

          Methods:

          The participatory evaluation was conducted by taking part of all main partners including trustee organizations involved in implementation of the document, specialists and academic researchers, people's deputies, health service, headquarters experts at Ministry of Health. Three qualitative methods including reviewing evidences, interviews, and focus group discussions have been used to gather information. The degree of achievement of the document's strategic objectives, as well as the degree of adaptation of the document implementation to the desired state, has been determined.

          Results:

          The mean percentage of progress in achieving outcomes and adaptation of the deployment method to ideal criteria (for 2016) of the National Document on Food and Nutrition Security from 2013 to 2017 are 52.6% and 41%, respectively. The best success was found in the existence of an evidence-based program (70%), a coalition of policy implementation (66.1%), and indicators for monitoring the progress of the document (61.1%). The least success was related to the weakness of public justification and public participation (20%) and lack of ranking and encouraging partners' function (24%). Lack of approval of the national document at the High Council for Health and Food Security of the country (HCHFS) was the important factor which led to less progress of the document.

          Conclusions:

          It is recommended to target avoiding structural changes while saving time, strengthening intersectoral capacity for collaboration, encouraging partners, and empowering the environment of the provinces in the coming years.

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          Most cited references28

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          An accelerated nutrition transition in Iran.

          To describe the emergence of the nutrition transition, and associated morbidity shifts, in the Islamic Republic of Iran. Review and analysis of secondary data relating to the socio-political and nutritional context, demographic trends, food utilisation and consumption patterns, obesity, and diet-related morbidity. The nutrition transition in Iran is occurring rapidly, secondary to the rapid change in fertility and mortality patterns and to urbanisation. The transition is occurring against the backdrop of lack of sustained economic growth. There is considerable imbalance in food consumption with low nutrient density characterising diets at all income levels, over-consumption evident among more than a third of households, and food insecurity among 20% of the population. Obesity is an emerging problem, particularly in urban areas and for women, and both diabetes and other risk factors for heart disease are becoming significant problems.
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            What drives political commitment for nutrition? A review and framework synthesis to inform the United Nations Decade of Action on Nutrition

            Introduction Generating country-level political commitment will be critical to driving forward action throughout the United Nations Decade of Action on Nutrition (2016–2025). In this review of the empirical nutrition policy literature, we ask: what factors generate, sustain and constrain political commitment for nutrition, how and under what circumstances? Our aim is to inform strategic ‘commitment-building’ actions. Method We adopted a framework synthesis method and realist review protocol. An initial framework was derived from relevant theory and then populated with empirical evidence to test and modify it. Five steps were undertaken: initial theoretical framework development; search for relevant empirical literature; study selection and quality appraisal; data extraction, analysis and synthesis and framework modification. Results 75 studies were included. We identified 18 factors that drive commitment, organised into five categories: actors; institutions; political and societal contexts; knowledge, evidence and framing; and, capacities and resources. Irrespective of country-context, effective nutrition actor networks, strong leadership, civil society mobilisation, supportive political administrations, societal change and focusing events, cohesive and resonant framing, and robust data systems and available evidence were commitment drivers. Low-income and middle-income country studies also frequently reported international actors, empowered institutions, vertical coordination and capacities and resources. In upper-middle-income and high-income country studies, private sector interference frequently undermined commitment. Conclusion Political commitment is not something that simply exists or emerges accidentally; it can be created and strengthened over time through strategic action. Successfully generating commitment will likely require a core set of actions with some context-dependent adaptations. Ultimately, it will necessitate strategic actions by cohesive, resourced and strongly led nutrition actor networks that are responsive to the multifactorial, multilevel and dynamic political systems in which they operate and attempt to influence. Accelerating the formation and effectiveness of such networks over the Nutrition Decade should be a core task for all actors involved.
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              Smorgasbord or symphony? Assessing public health nutrition policies across 30 European countries using a novel framework

              Background Countries across Europe have introduced a wide variety of policies to improve nutrition. However, the sheer diversity of interventions represents a potentially bewildering smorgasbord. We aimed to map existing public health nutrition policies, and examine their perceived effectiveness, in order to inform future evidence-based diet strategies. Methods We created a public health nutrition policy database for 30 European countries . National nutrition policies were classified and assigned using the marketing "4Ps" approach Product (reformulation, elimination, new healthier products); Price (taxes, subsidies); Promotion (advertising, food labelling, health education) and Place (schools, workplaces, etc.). We interviewed 71 senior policy-makers, public health nutrition policy experts and academics from 14 of the 30 countries, eliciting their views on diverse current and possible nutrition strategies. Results Product Voluntary reformulation of foods is widespread but has variable and often modest impact. Twelve countries regulate maximum salt content in specific foods. Denmark, Austria, Iceland and Switzerland have effective trans fats bans. Price EU School Fruit Scheme subsidies are almost universal, but with variable implementation. Taxes are uncommon. However, Finland, France, Hungary and Latvia have implemented ‘sugar taxes’ on sugary foods and sugar-sweetened beverages. Finland, Hungary and Portugal also tax salty products. Promotion Dialogue, recommendations, nutrition guidelines, labelling, information and education campaigns are widespread. Restrictions on marketing to children are widespread but mostly voluntary. Place Interventions reducing the availability of unhealthy foods were most commonly found in schools and workplace canteens. Interviewees generally considered mandatory reformulation more effective than voluntary, and regulation and fiscal interventions much more effective than information strategies, but also politically more challenging. Conclusions Public health nutrition policies in Europe appear diverse, dynamic, complex and bewildering. The "4Ps" framework potentially offers a structured and comprehensive categorisation. Encouragingly, the majority of European countries are engaged in activities intended to increase consumption of healthy food and decrease the intake of "junk" food and sugary drinks. Leading countries include Finland, Norway, Iceland, Denmark, Hungary, Portugal and perhaps the UK. However, all countries fall short of optimal activities. More needs to be done across Europe to implement the most potentially powerful fiscal and regulatory nutrition policies. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-1195) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                Int J Prev Med
                Int J Prev Med
                IJPVM
                International Journal of Preventive Medicine
                Wolters Kluwer - Medknow (India )
                2008-7802
                2008-8213
                2020
                17 October 2020
                : 11
                : 173
                Affiliations
                [1] Department of Governance and Health, Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Science and Health Services, Tehran, Islamic Republic of Iran
                [1 ] Department of Community Nutrition, Deputy of Health, Iran Ministry of Health Treatment and Medical Education, Tehran, Islamic Republic of Iran
                [2 ] Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
                [3 ] Research Department of Food and Nutrition Policy and Planning, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
                Author notes
                Address for correspondence: Dr. Fatemeh Mohammadi-Nasrabadi, No 7., Hafezi (West Arghavan) St., Farahzadi Blvd., Qods Town, Zip code: 1981619573, P.O. Box: 19395-4741, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran. E-mail: f.mohammadinasrabadi@ 123456sbmu.ac.ir
                Article
                IJPVM-11-173
                10.4103/ijpvm.IJPVM_405_19
                7804874
                ad0ba4de-e528-416a-8585-8a8b71ed3770
                Copyright: © 2020 International Journal of Preventive Medicine

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 24 October 2019
                : 27 January 2020
                Categories
                Original Article

                Health & Social care
                implementation,deployment,iran,nutrition and food security,policy,program evaluation

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