Chapter 28. The Role of Public Policy

  1. William H. Herman2,
  2. Ann Louise Kinmonth3,
  3. Nicholas J. Wareham4 and
  4. Rhys Williams5
  1. Julia Critchley and
  2. Nigel Unwin

Published Online: 12 JAN 2010

DOI: 10.1002/9780470682807.ch28

The Evidence Base for Diabetes Care, Second Edition

The Evidence Base for Diabetes Care, Second Edition

How to Cite

Critchley, J. and Unwin, N. (2010) The Role of Public Policy, in The Evidence Base for Diabetes Care, Second Edition (eds W. H. Herman, A. L. Kinmonth, N. J. Wareham and R. Williams), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/9780470682807.ch28

Editor Information

  1. 2

    Department of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, MI, USA

  2. 3

    General Practice and Primary Care Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK

  3. 4

    MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK

  4. 5

    School of Medicine, Swansea University, Swansea, UK

Author Information

  1. Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK

Publication History

  1. Published Online: 12 JAN 2010
  2. Published Print: 19 FEB 2010

ISBN Information

Print ISBN: 9780470032749

Online ISBN: 9780470682807

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Keywords:

  • public health;
  • policy;
  • healthy public policy;
  • interventions;
  • primary prevention;
  • physical activity;
  • diet;
  • transport;
  • built environment

Summary

Public policies outside of the health service play a major role in influencing public health, generally by facilitating (or hindering) healthier choices among the population. In terms of the prevention and control of type 2 diabetes, this is mainly through influencing the major lifestyle behaviours (diet, physical activity, smoking) associated with prevention of the disease and its complications. Examples include transport policies which encourage physical activity, such as appropriate safe cycling or walking routes to urban centres, and those which discourage sedentary behaviour such as congestion charges or car parking fees. The major ways in which public policy can influence health are through legislation and regulation (e.g. protecting consumers against harmful products in foods such as trans-fatty acids, improving nutritional standards for school meals), improving the built environment (parks and recreational facilities, safer roads), and advocacy and community mobilisation (such as interventions to promote multi-risk factor reduction in specific settings). Effective public policy interventions often encompass several of these policy domains. In general, the evidence base for public policy is very limited, partly because the interventions are often not amenable to evaluation through standard ‘clinical’ designs such as randomized controlled trials. However, there is good evidence that community mobilization and advocacy policies to improve diet and physical activity can be effective, particularly if supported by legislative, regulatory or financial incentives, although it is not always clear if benefits are sustained. There are some suggestions that legislation to remove subsidies on potentially harmful foods or to promote the consumption of healthier options may also be effective at a country level. Policies to change the built environment should offer increased opportunities for physical activity, but evidence is lacking. The WHO Global Strategy on Diet and Physical Activity has published a set of indicators which can be used to monitor strategy implementation and could be combined with country level research to obtain further evidence of the effectiveness of a range of policy measures in different settings