An international research team maps food policies in South Asia to combat diet-related non-communicable diseases (NCDs)

• An international team, including researchers from The George Institute for Global Health, mapped, and assessed food policies in Bangladesh, India, Pakistan, and Sri Lanka.
• The study showed the urgent need for comprehensive strategies to combat NCDs, recommending enhanced food labelling, fiscal policies to promote healthy eating, stricter regulations on food promotions, and improved nutritional standards in schools.

An international team of researchers, including scientists from The George Institute for Global Health, has completed a comprehensive study mapping the food policies and supporting infrastructure in Bangladesh, India, Pakistan, and Sri Lanka. The team benchmarked and assessed the level of implementation of these policies and identified priority actions for the primary prevention of diet-related non-communicable diseases (NCDs).

The team comprised researchers from academic and government organisations from the UK, Belgium, Pakistan, Bangladesh, and India. The details of this work have been published in the journal The Lancet Regional Health - Southeast Asia and may be accessed at https://www.sciencedirect.com/science/article/pii/S2772368224000787

Non-communicable diseases (NCDs) are the leading cause of illness and death worldwide. South Asians, in particular, face a higher risk of developing Type 2 diabetes and cardiovascular diseases compared to other populations. The prevalence of diabetes in South Asia is projected to be about 151 million by 2045.

The causes of NCDs are complex, but an unhealthy diet is a leading modifiable risk factor. Evidence suggests that improving food environments and implementing effective food-related policies are key to achieving healthier diets and reducing the prevalence of NCDs.

Rapid urbanisation and economic growth in South Asia have led to a shift in dietary habits. Traditional, locally sourced diets rich in low-fat, high-fibre foods are being replaced by ultra-processed foods high in unhealthy fats, sodium, and sugar. This shift is driven by increased purchasing power, greater availability of processed foods, technological advances, and aggressive marketing strategies.

Policies that promote healthy food environments play an important role in fostering healthy food choices and preventing NCDs. The food environment includes a wide array of factors influencing individuals' access to and consumption of food, such as physical infrastructure, socio-economic conditions, cultural influences, marketing strategies, and individual preferences. Unhealthy food environments promote the availability and attractiveness of energy-dense but nutrient-poor foods.

The World Health Organization (WHO) emphasizes the need for a global monitoring framework to track and assess the implementation of national strategies and plans to control and reduce NCDs. The Healthy Food Environment Policy Index (Food-EPI) is a standardized tool developed to assess progress in policy implementation and prioritize future actions to create healthy food environments.

From 2020 to 2022, the research team reviewed and assessed food environment policies in Bangladesh, India, Pakistan, and Sri Lanka using the Food-EPI tool. Stakeholders from government and non-governmental sectors in South Asia (n = 148) participated in the assessment using the Delphi method.

The study showed that urgent action is required to expand food policies beyond hygiene and food security measures. Key recommendations include:

• Enhancing Food Labelling: Implement clear and informative food labels to help consumers make healthier choices.
• Fiscal Policies: Introduce taxes on unhealthy foods and subsidies for healthy options to encourage better eating habits.
• Regulating Food Promotions: Implement stricter regulations on the marketing of unhealthy foods, especially to children.
• Improving Nutritional Standards in Schools: Ensure that school meals meet high nutritional standards to promote healthy eating habits from a young age.

Speaking about the research, Dr. Elisa Pineda, Research Fellow at The George Institute for Global Health, UK, said, “the findings of this study provide a baseline for future assessments to measure progress in food policy implementation. The creation of an evidence document for each country serves as a valuable resource for both government and non-government sectors to review policy gaps and the stakeholder recommended actions give a clear pathway to improving school food environments and regulating the promotion of unhealthy foods high in saturated fats, sugar, and salt.”

Further, Dr. Elisa Pineda mentioned, “An effective health in all policy approach and food environment policy implementation requires cross-sectoral collaboration, cultural adaptations, and active engagement with stakeholders to ensure broad acceptance and success.”

This research was led by the Centre for Health Economics and Policy Innovation (CHEPI) from Imperial College London. 

This research was funded by the NIHR (16/136/68 and 132960) with aid from the UK Government for global health research. Petya Atanasova also acknowledges funding from the Economic and Social Research Council (ESRC) (ES/P000703/1). The views expressed are those of the authors and not necessarily of the NIHR, the UK government or the ESRC.