A holistic approach is being taken by local governments, with consideration of the broader food supply chain, health and equity

Many of the policies led by local government to facilitate the uptake of healthy and sustainable diet-related practices adopted a holistic approach. That is, policy action was directed across multiple phases of the food supply chain, rather than simply focusing on the consumption phase, and health and equity were considered in the desired outcomes. A core value in effective urban food policies, as identified by Sonnino (2019), is taking this systemic approach to food, where all phases of the food supply chain are considered and food’s ‘multidimensional connections with different social contexts, sectors and other community systems’ is acknowledged^{(Reference Sonnino58)}, p14. The High-Level Panel of Experts on Food Security and Nutrition (2017) also supports this whole-of-system approach, and recommends that action across the food supply chain is critical to influence peoples’ dietary patterns⁽⁵⁹⁾. Although beyond the scope of this review, further research is warranted to explore the capacity of local governments to support multi-sectorial governance with monitoring and evaluation to measure the impact of this whole-of-system approach.

This review highlighted a number of comprehensive local government policies, such as Belgium’s Ghent en Garde which demonstrated a holistic approach. Ghent en Garde included activity across the food supply chain including production (e.g. promotion of fair trade and organic practices, allocation of urban garden plots), distribution (e.g. an agricultural hub with job-ready training and networking), retail (e.g. farmers markets), consumption (e.g. public facilities serving less meat and more plant-foods) and waste (e.g. supporting local businesses to innovate new models such as growing mushrooms from coffee grounds). The Ghent en Garde policy aims to improve health by updating tender processes for public facility food services (e.g. schools and hospitals), ensuring that all food served at publicly funded events on Thursdays is vegetarian, and raising citizen awareness through social marketing campaigns to eat less meat, and consume more local, organic and seasonal foods. Ghent also invested in strategies to address equity such as creating social employment through food, in social restaurants, social grocers and in local production and distribution of food.

Bristol’s Good Food Action Plan presents another example of a holistic approach, by linking with neighbouring local governments, transforming unused public land into edible gardens and acknowledging the value of good quality soil and insect pollinators for local food production. Bristol defines good food as ‘not only tasty, healthy affordable, but also produced and distributed in a way that is good for nature, workers, animal welfare and local businesses’. This policy addresses health by supporting schools to achieve the Mayor’s Award for Excellence by including nutrition, health and gardening in the curriculum and connecting emergency food relief services with local producers of fresh, healthy food. Bristol also piloted a campaign, ‘Flexitarian City’, by promoting a flexitarian diet in local restaurants and communities. In considering equity, urban agriculture initiatives allocate garden plots for people seeking asylum and the Kitchen on Prescription program involves prescribing accessible cooking, gardening and nutrition training opportunities for individuals experiencing disadvantage. Local governments are demonstrating a holistic approach to food system transformation by considering equity in their policy actions; this could be strengthened however as not all local governments had considered this.

Local government policy actions were found to target multiple phases of the food supply chain to shift dietary patterns. However, this review yielded the least policy actions for the food supply and distribution category of MUFPP’s framework for action. Policy actions from this category included investment in infrastructure, technology and transportation to connect consumers with producers, revitalisation of local food manufacturing, processing, distribution and storage businesses through tax exemptions and expanding alternative retail options to connect consumers with producers. The reason why this category had the least policy options requires further research. It may be that local governments do not consider this area to be part of their mandate, or perhaps a gap in competency and knowledge exists at the local level relating to these activities, requiring funds and resources from national governments to address this gap^{(Reference Sonnino, Tegoni and De Cunto60)}.

Local government authorities can lead local action towards global planetary health targets, however they require enhanced capacity

It has been argued that local government is critical to achieving the ambitious global and national targets needed for food sustainability⁽⁵⁹⁾. Local governments have a unique role in operationalising ‘on the ground’ action to enable nations to achieve ambitious global sustainable development targets^{(61,Reference Candel and Pereira62)} . As the level of government closest to their constituents, they can be more agile and responsive to changing needs and innovation opportunities than national governments, moving more rapidly from the agenda-setting phase to policy implementation^{(61,Reference Candel and Pereira62)} . This review identified that local government authorities played a role of leadership or ownership in policy action for the majority of policies, rather than one of stakeholder representation or consultation. This highlights internal commitment to make urban food systems more sustainable, resilient and equitable, as demonstrated by these cities’ pledges to the MUFPP⁽¹⁶⁾.

A range of policies was identified which have effectively enhanced local government capacity to lead policy action. First, formal structures and networks outside of local governments were shown to facilitate collaborative action and collective capacity and provided opportunities for local government leadership. The MUFPP⁽¹³⁾ is one of these, and others include the C40 Good Food Cities Declaration (https://www.c40.org/other/good-food-cities), and regional networks such as Europe’s Edible Cities Network (www.edicitnet.com). Second, opportunities to enhance capacity were shown to exist within local governments themselves. McCartan and Palermo^{(Reference McCartan and Palermo63)} also found that food policy councils led by local government can provide a forum to combine practical and technical expertise across sectors, and increase capacity through partnerships in an environment where funding is often limited. Third, strategies to connect researchers with local governments facilitated the translation of evidence into practice and enhanced knowledge about the relations between food systems (e.g. urban and rural) and between phases of the food supply chain (e.g. supply and distribution). Finally, policies identified in this review engaged citizens and professionals with technical expertise in decision-making. Examples of this included establishing producers’ networks to facilitate urban, peri-urban and rural linkages, and logistics, nutrition and sustainability experts to inform land use, zoning and new building requirements.

Publicly funded facilities are suitable settings for action

Food procurement policies in schools were identified as a popular approach by local governments to promote healthy and sustainable diet-related practices and induce systemic change across the food supply chain, as has previously been described by Hawkes et al. (2015)^{(Reference Hawkes, Smith and Jewell64)}. Publicly funded settings such as schools, hospitals, community centres, prisons and early learning centres are suitable settings for local governments to fulfil their commitment to achieve planetary health targets. These settings serve large and socio-economically varied groups of people and can shape consumers’ behaviour through their regular interaction with the food environment⁽⁵⁹⁾. Local governments may possess regulatory and legislative powers to manipulate these food environments, and align government spending for food procurement, supply and promotion with public priorities⁽⁶¹⁾.

Some procurement policies were enforced nationally, yet implemented at the local government level (e.g. Brazil and Italy), and others were developed at the local level in Vienna (Austria), Ghent (Belgium), Copenhagen (Denmark), London (United Kingdom), New York City and San Francisco (United States of America). Policy actions included in this review comprise: use of tender processes and legislative mechanisms to promote organic, local, fair-trade food production practices; eco-friendly food packaging and transport; and, school menus with less processed and animal-derived foods and more plant-based and nutritious foods. Comment on the effectiveness of these policies is beyond the scope of this review, however, Goncalves et al. (2015) concluded that Brazil’s Family Farming program which uses legislation to enforce 30 % of Brazilian government funding is used to buy food directly from local family farms, increased the nutritional quality of school menus^{(Reference Goncalves, da Cunha and Stedefeldt46)}. These examples demonstrate that although focused on one setting, food procurement policies can trigger action across phases of the food supply chain and facilitate a number of healthy and sustainable diet-related practices.

Progress is needed to promote the double-win (health & environment) of some diet-related practices

While all 13 healthy and sustainable diet-related practices are important to achieve food system transformation, particularly in middle and high-income contexts, some have greater potential than others^{(Reference Fanzo and Davis3,Reference Fanzo, Haddad and McLaren4)} . According to Springmann (2020) practices with the greatest potential to improve health and sustainability are those which limit animal-derived foods, in particular beef and dairy, increase wholegrain and plant-based foods and avoid over-consumption^{(Reference Springmann, Spajic and Clark65)}. This discussion will therefore describe how local governments are promoting these 3 desired practices in particular, and identify some of the trade-offs that exist as well as opportunities to achieve double-wins for human and planetary health.

First, actions to limit the intake of animal-derived foods were identified in less than a third of policies. Eating less animal-derived foods has been demonstrated to improve health, by lowering mortality risk from CVD and some cancers, and reduce environmental degradation, by reducing greenhouse gas contribution, water usage and biodiversity loss^{(Reference Willett, Rockström and Loken5)}. This review identified that local governments are promoting less animal-derived foods by updating school feeding guidelines, incentivising procurement practices in commercial and public food service facilities and investing in social marketing campaigns. Policy documents describe the environmental impact of eating less meat as a more dominant message than the health benefits thereof.

In considering approaches to increase wholegrain and plant-based food intake, actions targeting this practice were identified in nearly three quarters of the policies included in this review. It is important to note that the health and environmental benefits rely on the adoption of sustainable agricultural practices and various trade-offs exist. For example, while organic farming is more environmentally sustainable, there are consequences for food security because yields may be lower and produce is often more expensive to purchase. This review identified that local governments are promoting plant-based food consumption by investing in urban agriculture, redirecting rescued fresh produce to emergency food relief services and connecting producers with consumers through alternative retail avenues such as farmers markets. Local governments often framed these policy actions as achieving social and economic benefits, acknowledging that poor fruit and vegetable intake is disproportionately experienced by people experiencing disadvantage, however they were less likely to describe the environmental benefits^{(Reference Swinburn, Kraak and Allender66)}.

The third diet-related practice to discuss in relation to win-wins is the avoidance of over-consumption of food beyond biological requirements. This practice was promoted by one-third of identified policies, however these primarily focused on the health benefits of reducing overweight and obesity. The environmental benefits of avoiding overconsumption of food are being overlooked, despite convincing evidence that this diet-related practice will reduce deforestation, biodiversity loss, ocean acidification, air, water and soil pollution which result from producing food not deemed essential to nourish life^{(Reference Swinburn, Kraak and Allender66,Reference Frumkin and Haines67,68)} . For example, New York City’s Food Standards (2011) policy was primarily intended to reduce diet-related disease by reducing over-consumption, but included sustainability considerations in its supporting documentation.

There is an increased urgency being placed on policy-makers to consider both health and ecological implications of the food system and dietary recommendations^{(Reference Spiker, Knoblock-Hahn and Brown1,Reference Fanzo, Haddad and McLaren4,Reference Springmann, Spajic and Clark65)} . However, this win-win scenario is complicated by trade-offs which challenge local governments to simultaneously promote health, social justice and environmental sustainability. For example, in promoting organic food production to benefit human health and the environment, governments must consider the lower yields, higher land requirements and increased cost to consumers. To address these complex trade-offs, trans-disciplinary evidence from health, nutrition, environment, the social sciences and beyond must inform policy action to support best-practice across the entire food supply chain.

As described above, this review presents 4 key observations to inform future policy action: (1) a holistic approach is being taken by local governments, with consideration of the broader food system, health and equity; (2) local government authorities can lead local action towards global planetary health targets however require enhanced capacity; (3) publicly funded facilities are suitable settings for holistic policy to be implemented; and (4) progress is needed to promote the double win (health and environment) of recommended diet-related practices.

Limitations and implications for practice

The scope of this review was refined to include an exploration of policies that were cited within literature sourced from scientific databases. This presents some limitations: (i) policies from low-middle income countries have not been adequately represented most likely due to variance in the degree to which governments can engage academic resources to publish outcomes of policy action; and (ii) current best practice examples may have been missed simply because they have not yet been published in the scientific literature. In refining the scope to MUFPP signatory cities, this review does not include the many progressive policies that exist globally that are independent to the MUFPP movement. To identify relevant policy actions, this review referred to 13 diet-related practices identified by the authors in a previous study^{(Reference Barbour, Woods and Brimblecombe28)} however this is just one publication within a large, and rapidly expanding body of evidence to describe healthy and sustainable diets.

Further research is required to explore the intricacies of local government policymaking, such as how policies and their goals are prioritised, why some policy actions receive investment over others and how success and failure can effectively be defined^{(Reference Candel18)}. Likewise, research into the effectiveness and cost-efficiencies of the policies identified in this review, across a range of geographic contexts, is recommended in order to support local governments to develop and implement policies that have the best chance of achieving food system transformation to improve human health and environmental sustainability.