Research on nutrition-related policy and practices in Kenya identifies a pathway to reduce disease

March 1, 2021

Danielle Doughman

Danielle Doughman, MSPH, coauthored an article published in PLOS One that reports on research in Nairobi, Kenya, to assess government policies to support access to, knowledge about and consumption of healthy food in Kenya and suggest actions the government can take to improve them.

Noncommunicable diseases (NCDs), especially those related to diet and nutrition, are on the rise, and previous research shows that unhealthy food environments are an important driver of this increase.

A food environment is made up of the physical, economic, political and sociocultural surroundings and conditions that influence what people eat, and this study is one element of a three-part project to assess food consumption in Kenya, learn how the food environment drives consumption of unhealthy foods and identify policies to promote healthy eating.

The purpose of this study was to establish a baseline that researchers in subsequent phases will use to measure progress and identify priorities for future action. To do this, Doughman – who earned a Master of Science in Public Health degree at the UNC Gillings School of Global Public Health and is an adjunct professor at Gillings School’s online MPH@UNC degree program – worked with the African Population and Health Research Center and a team of researchers to rate the degree of implementation of current healthy food environment policies in Kenya.

“This benchmarking research is an excellent tool for policy action,” she said. “Instead of one-off programs or pilots, we hope to work towards lasting, context-appropriate and evidence-based policy change that will improve how people in Nairobi access and make choices about food. We hope that such changes will serve to counteract rising obesity and diet-related non-communicable diseases.”

The team adapted the Healthy Food Environment Policy Index (Food-EPI) developed by an international consortium of food policy experts that work to increase access to healthy food environments – the International Network for Food and Obesity / Noncommunicable Diseases Research, Monitoring and Action Support (INFORMAS).

Between 2017–2018, the researchers reviewed current government policies and programs related to the food environment and categorized them based on 13 indicators related to policy and infrastructure support and 43 indicators related to general good practice. A panel of policy and NCDs experts gauged progress on each of these indicators according to the policy development cycle and international best practices. Based on the implementation gaps they found, the research team identified priority actions to improve food environments in Kenya.

The researchers found that 37% of good practice indicators were in the “implementation” phase of the policy cycle and half were “in development.” The experts rated roughly 84% of policy indicators as “low” or “very little,” and the panel distilled 23 possible actions related to policy and infrastructure support. The research team facilitated a consensus-building process that allowed the panel to narrow these further, resulting in seven priority actions the Government of Kenya can take to improve the country’s food environment in the areas of leadership, food composition, labeling, promotion, prices and health-in-all policies. These priority actions include restricting advertisement of unhealthy foods, establishing food content guidelines and providing tax relief for producers of healthy foods.

“The results of the benchmarking study can be used to initially focus on the most feasible and most important policy actions in hope of some early wins,” said Doughman. “I think pursuing priorities through consensus decision-making makes perfect sense for this topic, on which there are many possible ways forward and many stakeholders.”

Though policies are being implemented in Kenya, most of these policies were found to be in development, and in some cases, progress lags established international good practices. These findings increase awareness of food environments in Kenya and suggest a path forward to address gaps and, over time, hopefully reduce the burden of NCDs in the country.

This study’s focus was limited to the Government of Kenya’s policy efforts, and it was designed as a first step in improving food environments in Kenya. The baseline it establishes will allow measurement of the effectiveness of future policy interventions.

Doughman also notes that this research contributes to a larger body of work to improve food environments, and that, because of the information it collects, the Food-EPI method will more broadly represent international policies on NCDs each time its implemented.

“As a part of the Food-EPI model, we also reviewed good practices from other countries with the expert panel, which is useful in their thinking about what might be adapted for Kenya,” she said. “As the number of participating countries increases, it is hoped that the pool of good practice policies will deepen and strengthen, and include policy innovations from Kenya.”

Contact the UNC Gillings School of Global Public Health communications team at sphcomm@unc.edu.