Despite being the world’s fifth largest economy when measured in terms of gross domestic product (GDP),2 having the sixth largest military budget,3 being a nuclear power and a permanent member of the UN Security Council (UNSC), and member of, inter alia, the North Atlantic Treaty Organization (NATO) and the G7, the United Kingdom (UK) is facing a period of deep uncertainty. This uncertainty is in part borne out of “Brexit,” but equally significantly is borne out of a requirement, amid decreasing economic and military power, to redefine its role in the world and adapt to the changing geopolitical, economic and military landscape – a landscape that potentially has Asia as its fulcrum and Southeast Asia at its heart.4
The UK economy is dominated by the service sector that accounts for 80 per cent of GDP5 and as such the UK is heavily reliant on trade to satisfy the needs of its citizens and businesses. This trade is in part facilitated by the UK’s “Red Ensign”6 merchant navy fleet, which is the tenth largest in the world,7 and the Royal Navy, which is widely considered to be one of the top five most powerful navies,8 yet both had been in decline until recently, numerically in terms of ship numbers and also in terms of influence.9 This decline is not without consequence, most acutely in respect of the Royal Navy’s ability to deploy globally and simultaneously to various areas of operation.
Obesity evidence-based policies (EBPs) can make a lasting, positive impact on community health; however, policy development and enactment is complex and dependent on multiple forces.
Aims and objectives:
This study investigated key factors affecting municipal officials’ policymaking for obesity and related health disparities.
Semi-structured interviews were conducted with 20 local officials from a selection of municipalities with high obesity or related health disparities across the United States between December 2020 and April 2021.
Policymakers follow a general decision-making process with limited distinction between health and other policy areas. Factors affecting policymaking included: being informed about other local, state, and federal policy, conducting their own research using trustworthy sources, and seeking constituent and stakeholder perspectives. Key facilitators included the need for timely, relevant local data, and seeing or hearing from those impacted. Key local policymaking barriers included constituent opposition, misinformation, controversial issues with contentious solutions, and limited understanding of the connection between issues and obesity/health. Policymakers had a range of understanding about causes of health disparities, including views of individual choices, environmental influences on behaviours, and structural factors impacting health. To address health disparities, municipal officials described: a variety of roles policymakers can take; limitations based on the scope of government; challenges with intergovernmental collaboration or across government levels; ability of policymakers and government employees to understand the problem; and the challenge of framing health disparities given the social-political context.
Discussion and conclusion:
Understanding factors affecting the uptake of EBPs can inform local-level interventions that encourage EBP adoption.