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Background:Taxation of sugar and sugar-sweetened beverages is considered a key policy for improving population-level nutrition. Implementation is influenced by the way evidence is used and framed in public debates. At this time, no sugar tax has been implemented in Germany.
Aims and objectives:This study aims to deepen the understanding of the political dynamics that influence the adoption of sugar taxes by analysing the use of evidence in the German media debate on sugar taxation and comparing its findings with analyses from other countries.
Methods:In 114 German newspaper articles, published between 01/2018 and 03/2019, we analysed the use and framing of evidence with an abductive thematic analysis approach. We compared our findings with analyses on the framing around sugar taxation from Mexico, the US and the UK.
Findings:Evidence was a salient component of the German debate. As in the comparison countries, evidence was used by both tax proponents and opponents but framed differently, for example, regarding problem definitions. However, the German debate relied more strongly on examples from other countries and less on economic arguments.
Discussion and conclusions:Our findings suggest that German tax proponents should proactively consider economic arguments and counter spurious arguments made by tax opponents. Researchers should be aware of their work's potential international spillover effects, and public health advocates should correct expectations regarding the evidence on, and health effects of, isolated measures against obesity. To deepen the understanding of the German policy process, further research should involve social media, public documents and stakeholder networks.

Abstract Background Framing plays an important role in health-policy processes. Responsibility for health is a salient and contested concept in the framing around food policies, such as sugar taxes. To deepen the understanding of the sugar tax process in Germany and contribute to a better understanding of how responsibility frames are used in debates on health policies, this study investigated responsibility concepts underlying the German media debate on sugar taxation. Methods We analyzed 114 national German newspaper articles, published between January 2018 and March 2019, following an inductive thematic analysis approach with an additional deductive focus on responsibility. We identified important contested concepts around sugar taxation, analyzed their combination into narrative frames, and scrutinized those narrative frames for underlying responsibility concepts. Results First, we identified important contested concepts regarding problems, actors and solutions (i.e. sugar tax and its potential alternatives). Those laid the basis for 13 narrative frames, of which the 'unscrupulous industry', 'government failure', 'vulnerable youth' and the 'oversimplification', 'responsible industry' and 'nanny state' frames were most salient. Within the narrative frames, we found a dominance of societal responsibility framing with a conflict between binding, legislative measures and voluntary solutions in cooperation with the food and beverages industry. Conclusions Questions around societal responsibility for health and corporate social responsibility framing become more salient in sugar tax debates. Future research should, therefore, investigate how public health advocates can successfully engage with corporate social responsibility narratives, and how legislative measures can be framed in ways that engender trust in governmental actions.

BACKGROUND: Framing plays an important role in health-policy processes. Responsibility for health is a salient and contested concept in the framing around food policies, such as sugar taxes. To deepen the understanding of the sugar tax process in Germany and contribute to a better understanding of how responsibility frames are used in debates on health policies, this study investigated responsibility concepts underlying the German media debate on sugar taxation. METHODS: We analyzed 114 national German newspaper articles, published between January 2018 and March 2019, following an inductive thematic analysis approach with an additional deductive focus on responsibility. We identified important contested concepts around sugar taxation, analyzed their combination into narrative frames, and scrutinized those narrative frames for underlying responsibility concepts. RESULTS: First, we identified important contested concepts regarding problems, actors and solutions (i.e. sugar tax and its potential alternatives). Those laid the basis for 13 narrative frames, of which the 'unscrupulous industry', 'government failure', 'vulnerable youth' and the 'oversimplification', 'responsible industry' and 'nanny state' frames were most salient. Within the narrative frames, we found a dominance of societal responsibility framing with a conflict between binding, legislative measures and voluntary solutions in cooperation with the food and beverages industry. CONCLUSIONS: Questions around societal responsibility for health and corporate social responsibility framing become more salient in sugar tax debates. Future research should, therefore, investigate how public health advocates can successfully engage with corporate social responsibility narratives, and how legislative measures can be framed in ways that engender trust in governmental actions.

OBJECTIVE: To systematically assess Germany's nutrition policies, to benchmark them against international best practices and to identify priority policy actions to improve population-level nutrition in Germany. DESIGN: We applied the Food Environment Policy Index (Food-EPI), a methodological framework developed by the International Network for Food and Obesity/non-communicable Diseases Research, Monitoring and Action Support (INFORMAS) network. Qualitative content analysis of laws, directives and other documents formed the basis of a multistaged, structured consultation process. SETTING: Germany. PARTICIPANTS: The expert consultation process included fifty-five experts from academia, public administration and civil society. RESULTS: Germany lags behind international best practices in several key policy areas. For eighteen policy indicators, the degree of implementation compared with international best practices was rated as very low, for twenty-one as low, for eight as intermediate and for none as high. In particular, indicators on food taxation, regulation of food marketing as well as retail and food service sector policies were rated as very low to low. Identified priority actions included the binding implementation of nutrition standards for schools and kindergartens, a reform of the value added tax on foods and beverages, a sugar-sweetened beverage tax and stricter regulation of food marketing directed at children. CONCLUSIONS: The results show that Germany makes insufficient use of the potential of evidence-informed health-promoting nutrition policies. Adopting international best practices in key policy areas could help to reduce the burden of nutrition-related chronic disease and related inequalities in nutrition and health in Germany. Implementation of relevant policies requires political leadership, a broad societal dialogue and evidence-informed advocacy by civil society, including the scientific community.

BACKGROUND: Regular consumption of sugar-sweetened beverages (SSB) can increase the risk for obesity, type 2 diabetes, cardiovascular disease, and dental caries. Interventions that alter the physical or social environment in which individuals make beverage choices have been proposed to reduce the consumption of SSB. METHODS: We included randomised controlled, non-randomised controlled, and interrupted time series studies on environmental interventions, with or without behavioural co-interventions, implemented in real-world settings, lasting at least 12 weeks, and including at least 40 individuals. Studies on the taxation of SSB were not included, as these are subject of a separate Cochrane review. We used standard Cochrane methods for data extraction, risk of bias assessment, and evidence grading and synthesis. Searches were updated to January 24, 2018. RESULTS: We identified 14,488 unique records and assessed 1,030 full texts for eligibility. We included 58 studies comprising a total of 1,180,096 participants and a median length of follow-up of 10 months. We found moderate-certainty evidence for consistent associations with decreases in SSB consumption or sales for the following interventions: traffic light labelling, price increases on SSB, in-store promotion of healthier beverages in supermarkets, government food benefit programs with incentives for purchasing fruits and vegetables and restrictions on SSB purchases, multi-component community campaigns focused on SSB, and interventions improving the availability of low-calorie beverages in the home environment. For the remaining interventions we found low- to very-low-certainty evidence for associations showing varying degrees of consistency. CONCLUSIONS: With observed benefits outweighing observed harms, we suggest that environmental interventions to reduce the consumption of SSB be considered as part of a wider set of measures to improve population-level nutrition. Implementation should be accompanied by evaluations using appropriate methods. Future studies ...

Angesichts des Angriffs Russlands auf die Ukraine rufen wir die Bundesregierung dazu auf, die Transformation des Ernährungssystems aktiv zu beschleunigen. Der Ukraine-Krieg führt zu steigenden Preisen von Lebensmitteln, Agrarrohstoffen und landwirtschaftlichen Produktionsmitteln (v.a. von Getreide, Ölsaaten, Futter- und Düngemitteln sowie Agrardiesel). In zahlreichen Ländern des Globalen Südens droht deshalb eine Zunahme der Ernährungsunsicherheit und von damit einhergehender Unter- und Mangelernährung. Diese Entwicklungen verschärfen auch in Deutschland und der EU soziale Ungleichheiten in der Ernährung. Im Einklang mit dem aktuellen Aufruf von mehr als 600 Wissenschaftler*innen, sehen wir vor allem die Reduktion des Fleischverzehrs, der Lebensmittelabfälle und der Nutzung von Bioethanol als essentielle Chance, trotz des Ukraine-Krieges eine Zunahme von Mangel- und Unterernährung zu verhindern. Zeitgleich kann dies Klimaschutz, Artenvielfalt, langfristige Ernährungssicherheit und damit Gesundheit, wirtschaftliche Stabilität und Frieden fördern. Der aktuelle Krieg in der Ukraine erhöht somit nicht nur den politischen Handlungsdruck, sondern öffnet auch neue Handlungsoptionen für eine strategische Neuausrichtung der Agrar- und Ernährungspolitik. Von zentraler Bedeutung für eine umfassende Transformation des Ernährungssystems ist, dass produktions- und konsumseitige Maßnahmen wirksam ineinandergreifen. Die Bundesregierung sollte daher umgehend eine Strategie und konkrete Maßnahmen-Pakete zur Minderung des Fleischkonsums und -produktion, der Lebensmittelabfälle sowie Nutzung von Bioethanol (aus Energiepflanzenanbau) umsetzen. In diesem offenen Brief stellen wir konkrete Handlungsoptionen auf Konsum- und Produktionsseite vor, die kurz- und mittelfristig besonders wirkungsvoll und umsetzbar sind.