In this blog, the authors discuss the findings of their study, “Governing evidence use in the nutrition policy process: evidence and lessons from the 2020 Canada food guide,” which explores how evidence is used within guideline development processes.
How should nutrition policymakers use scientific evidence?
Using evidence to inform nutrition policy is a multifaceted challenge. Not only is nutrition among the most contentious fields of science, but nutrition policy is also a highly politicized space where policymakers must balance the interests of several different stakeholders, including powerful industry lobby groups who have a vested economic interest in selling products regardless of their health impacts. Policymakers must also weigh the relative importance of other goals alongside health promotion, including culturally significant eating habits, recipes, and ingredients and economically important sectors such as domestic agriculture and food producers. Policymakers must also consider other factors in the policy process, such as speed, cost, public opinion, and transparency.
In the face of all these considerations, how should governments use evidence to inform nutrition policy?
While many scholars embrace the language of ‘evidence-based policymaking’ – when competing concerns and goals are at hand, it soon becomes impossible to make a simple binary judgement about a policy being ‘evidence-based’ or not. Rather, an alternative is to recognize how all policymaking, including in the field of nutrition, is a value-laden and socially embedded process and then consider whether evidence is being used well in relation to aspects of scientific and democratic good practice.
From evidence-use to the governance of evidence.
This shift in focus away from whether evidence is simply used or not – to instead consider the principles around which good uses of evidence can be judged – was the impetus behind the development of the ‘Good Governance of Evidence’ framework – an approach that looks both at scientific and democratic principles to consider how to judge evidence use in policy settings. The good governance of evidence is seen to capture “rigorous, systematic and technically valid pieces of evidence within decision-making processes that are representative of, and accountable to, populations served.” This approach particularly identifies eight scientific and democratic principles by which to judge evidence use: quality, rigour, appropriateness, representation, stewardship, deliberation, transparency, and contestability.
In a recent paper, we look at evidence used in Canada’s nutrition policymaking. Specifically, we apply the good governance of evidence framework to consider the policy process that creates the Canada Food Guide – Canada’s national nutrition guide that aims to provide citizens with basic guidance for eating a healthy diet. Health Canada, which is the Canadian government’s national health policy department, recently overhauled the process that creates the Canada Food Guide by setting new rules for who gets to be part of the committee that makes the guide and how evidence gets collected, considered, and used to support nutrition recommendations. We wanted to know if these changes served to improve the way that evidence got used to support recommendations. As such, we used the good governance of evidence principles to construct a framework of 28 indicators that could capture important aspects of evidence use in the formation of the Food Guide.
Measuring improvements in the governance of evidence.
Drawing on our newly created indicators, we proposed that improvements in evidence use could be assessed if the newer process met or achieved more of the indicators than the older process. Essentially, the new framework enabled us to compare the evidence use processes for the 2020 Canada Food Guide and the 2007 Canada Food Guide, and then gauge whether the new process improved the way it used evidence.
In reviewing the transformations to the Canada Food Guide policy process, we found that Health Canada’s new process did indeed improve how evidence gets used to inform the food guide as it aligned more closely with the good governance of evidence framework. Notably, the new evidence-use process appeared more valid in relation to both scientific criteria and the promotion of democratic decision-making when powerful food industry lobby groups were sidelined in three important ways. First, by banning industry-commissioned reports from inclusion into the evidence base, the process achieved a greater level of quality and reduced many potential biases. Second, by restricting industry’s ability to lobby the advisory committee, the new process was able to be more representative of the Canadian public. And third, by prohibiting financial conflicts of interests for members of the food guide advisory committee, the new process ensured that the process was better stewarded toward public interests rather than industry interests.
Before these changes, it was common for several food industry representatives, (e.g., members from the BC Dairy Foundation or the Food and Consumer Products Manufacturers of Canada) to sit on the food guide advisory committee, for industry groups to meet one-on-one and lobby committee members, and for recommendations to be based on findings from industry commissioned studies. Perhaps unsurprisingly, old versions of the Canada Food Guide focused heavily on recommendations that favoured dairy and meat industries, while the new 2020 Canada Food Guide recommends that consumers should choose plant-based options, singles out “unhealthy foods”, and has removed “meat” and “dairy” as their own unique food groups.
Ultimately, these findings suggest that Health Canada included several useful improvements in evidence use in its more recent Food Guide development process. This paper, however, aims to be illustrative of how a framework of indicators can be adapted and applied to evaluate evidence-use in many other sectors to help move beyond overly simple statements like, ‘this policy was based on evidence’ or not and instead guide strategic thinking around improvements in evidence use. Our hope is that the framework developed will provide useful insights to scholars working in different fields and can be adapted and applied to evaluate the governance of evidence in a range of policy processes.
The views expressed in this post are those of the authors and in no way reflect those of the Global Health at LSE Blog or the London School of Economics and Political Science.