Nutrition policy process challenges in Iran

Authors

  • Hamid Ravaghi Department of Health Services Management, Health Management and Economics Research Centre, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran

Keywords:

nutrition policy challenges, nutrition analysis, health policy process analysis, stages heuristic

Abstract

Introduction: Nutrition transition is occurring rapidly in the world, especially in developing countries. The nutrition transition occurred in Iran very fast due to urbanization and changes in the lifestyle of people, leading to overweight and obesity. However, nutritional deficiencies are still detected due to economic factors and low nutritional knowledge. Nutrition policies do not adequately respond to the nutrition challenges in Iran. This study was conducted to evaluate and analyze the nutrition policy process challenges in Iran.

Methods: A qualitative study using semi-structured interviews was conducted with 59 policy makers and nutrition experts of medical universities across Iran. Interviews were continued until data saturation was achieved. Data were supplemented with surveys and documentary analysis. Thematic analysis was guided by the propositions of the stages heuristic framework.

Results: The results were categorized into four main themes and eight sub-themes. The main themes were 1) nutrition problem definition, 2) policy formulation, 3) implementation of the policies, and 4) evaluation of the policies. However, the multi-faceted nature of the nutritional problem makes it difficult to deal with, so a multi-sectoral approach is needed.

Conclusion: Nutrition policies have been implemented in Iran with varying degrees of success and with different levels of cross-sectoral collaboration. The nutrition policies sometimes have not been able to respond to the nutritional problems. One of the important reasons is that nutrition is not a priority for policy makers. Many policies suffer from a lack of adequate and appropriate resource allocation. Cooperation mechanisms to resolve nutritional problems are sometimes ineffective and inefficient.

 

References

De Onis M, Brown D, Blossner M, Borghi E. Levels and trends in child malnutrition. UNICEF-WHO-The

World Bank joint child malnutrition estimates. 2012.

Popkin BM, Gordon-Larsen P. The nutrition transition: worldwide obesity dynamics and their

determinants. Int J Obes Relat Metab Disord. 2004; 28 Suppl 3: S2-9. doi: 10.1038/sj.ijo.0802804, PMID:

Popkin BM. The nutrition transition: an overview of world patterns of change. Nutr Rev. 2004; 62(7 Pt 2):

S140-3. doi: 10.1111/j.1753-4887.2004.tb00084, PMID: 15387480. 4) Kelishadi R, Alikhani S, Delavari A, Alaedini F, Safaie A, Hojatzadeh E. Obesity and associated lifestyle

behaviours in Iran: findings from the first national non-communicable disease risk factor surveillance

survey. Public Health Nutr. 2008; 11(03): 246-51. doi: 10.1017/S1368980007000262, PMID: 17625028.

Popkin BM. The shift in stages of the nutrition transition in the developing world differs from past

experiences! Public health nutrition. 2002; 5(1A): 205-14, PMID: 12027286 . 6) Walt G, Shiffman J, Schneider H, Murray SF, Brugha R, Gilson L. 'Doing' health policy analysis:

methodological and conceptual reflections and challenges. Health Policy Plan. 2008; 23(5): 308-17. doi:

1093/heapol/czn024, PMID: 18701552, PMCID: PMC2515406.

Collins T. Health policy analysis: a simple tool for policy makers. Public Health. 2005; 119(3): 192-6. doi:

1016/j.puhe.2004.03.006, PMID: 15661129.

Buse K, Mays N, Walt G. Making health policy: McGraw-Hill Education (UK); 2012.

Walt G, Gilson L. Can frameworks inform knowledge about health policy processes? Reviewing health

policy papers on agenda setting and testing them against a specific priority-setting framework. Health

Policy Plan. 2014; 29 Suppl 3: iii6-22. doi: 10.1093/heapol/czu081, PMID: 25435537.

Breton E, De Leeuw E. Theories of the policy process in health promotion research: a review. Health

Promot Int. 2011; 26(1): 82-90. doi: 10.1093/heapro/daq051, PMID: 20719803.

Walt G, Feingold E. Health Policy: An Introduction to Process and Power. Journal of Public Health Policy.

; 16(4): 506-8. doi: 10.2307/3342629.

Sabatier PA, Sabatier P, Jenkins‐Smith H. Policy change over a decade or more: PA; 1993.

Green A, Gerein N, Mirzoev T, Bird P, Pearson S, Martineau T, et al. Health policy processes in maternal

health: a comparison of Vietnam, India and China. Health Policy. 2011; 100(2): 167-73. doi:

1016/j.healthpol.2010.11.016, PMID: 21194780.

Attride-Stirling J. Thematic networks: an analytic tool for qualitative research. Qualitative research. 2001;

(3): 385-405. doi: 10.1177/146879410100100307.

Polit DF, Beck CT. Nursing research: Generating and assessing evidence for nursing practice: Lippincott

Williams & Wilkins; 2008.

Silverman D. Qualitative research: Sage; 2010.

Mays N, Pope C. Qualitative research in health care: Assessing quality in qualitative research. BMJ. 2000;

(7226): 50. doi: 10.1136/bmj.320.7226.50, PMID: 10617534, PMCID: PMC1117321.

Meho LI. E‐mail interviewing in qualitative research: A methodological discussion.. J Assoc Inf Sci

Technol. 2006; 57(10): 1284-95. doi: 10.1002/asi.20416.

Cho J, Trent A. Validity in qualitative research revisited. Qualitative research. 2006; 6(3): 319-40. doi:

1177/1468794106065006.

Braun V, Clarke V. Using thematic analysis in psychology. Qualitative research in psychology. 2006; 3(2):

-101. doi: 10.1191/1478088706qp063oa.

MAXQDA P. 10.(1989-2013). MAXQDA, software for qualitative data analysis.(Version 10). Berlin,

Germany: VERBI Software-Consult-Sozialforschung GmbH.

Stamoulis KG, Pingali P, Shetty P. Emerging challenges for food and nutrition policy in developing

countries. Electronic Journal of Agricultural and Development Economics. 2004; 1(2): 154-67.

Esteghamati A, Khalilzadeh O, Mohammad K, Meysamie A, Rashidi A, Kamgar M, et al. Secular trends of

obesity in Iran between 1999 and 2007: National Surveys of Risk Factors of Non-communicable Diseases.

Metab Syndr Relat Disord. 2010; 8(3): 209-13. doi: 10.1089/met.2009.0064, PMID: 20085488.

Kelishadi R. Childhood overweight, obesity, and the metabolic syndrome in developing countries.

Epidemiol Rev. 2007; 29(1): 62-76. doi: 10.1093/epirev/mxm003, PMID: 17478440.

Boutayeb A. The double burden of communicable and non-communicable diseases in developing countries.

Trans R Soc Trop Med Hyg. 2006; 100(3): 191-9. doi: 10.1016/j.trstmh.2005.07.021, PMID: 16274715.

Prentice AM. The emerging epidemic of obesity in developing countries. Int J Epidemiol. 2006; 35(1): 93- 9. doi: 10.1093/ije/dyi272, PMID: 16326822.

Trübswasser U, Branca F. Nutrition policy is taking shape in Europe. Public health nutrition. 2009; 12(03):

-306. doi: 10.1017/S1368980009004753

Caraher M, Coveney J. Public health nutrition and food policy. Public health nutrition. 2004; 7(05): 591-8.

doi: 10.1079/PHN2003575.

Gilson L, Raphaely N. The terrain of health policy analysis in low and middle income countries: a review

of published literature 1994–2007. Health Policy Plan. 2008; 23(5): 294-307. doi: 10.1093/heapol/czn019.

Walt G, Gilson L. Reforming the health sector in developing countries: the central role of policy analysis.

Health Policy Plan. 1994; 9(4): 353-70. doi: 10.1093/heapol/9.4.353.

Tantivess S, Walt G. The role of state and non-state actors in the policy process: the contribution of policy

networks to the scale-up of antiretroviral therapy in Thailand. Health Policy Plan. 2008; 23(5): 328-38. doi:

1093/heapol/czn023, PMID: 18658197.

Published

2022-02-21