Towards Health in All Policies for Childhood Obesity Prevention

Table 1

Barriers and facilitators regarding intersectoral collaboration.

Barriers regarding intersectoral collaboration	Reference
Content-related barriers
Lack of awareness of the childhood obesity problem in nonhealth sectors.	Aarts et al. [23]
Limited involvement from other sectors in developing cross-sectoral policies.	Thow et al. [24]
Lack of political support for creating activity-friendly neighborhoods.	Aarts et al. [23]
Neoliberal political climate and individualistic societal climate.	Schwartz and Brownell [25]
Ambiguous political climate, governments do not seem eager to implement restrictive or legislative policy measures since this would mean they have to confront powerful lobbies by private companies.	Nestle [26]; Peeler et al. [27]; Verduin et al. [28]
Relevance to government’s fiscal priorities was important in gaining support for soft drink taxes.	Thow et al. [29]
Lack of agenda-setting: lack of relevance and competing priorities.	Allender et al. [30]
Promoting healthy eating environments is not considered a greater priority for local government than food safety.	Allender et al. [31]; Caraher and Coveney [32]
Other legislated planning guidance may take priority for planning and transport professionals.	Bovill [33]
Focusing only on health concerns: not taking into account policy issues of other sectors.	Thow et al. [24]
“Wicked” nature of obesity making it very unattractive to invest in its prevention.	Head [34]
Complexity of the legislative framework.	Allender et al. [35]
Low probability of decreasing the incidence of childhood obesity within the short timeframe that most politicians work in (which is determined by election frequencies).	Aarts et al. [23]; Head [34]
Difficulty of developing consensus about ways to tackle the problem due to the lack of hard scientific evidence about effective solutions.	Aarts et al. [23]; Head [34]; Nishant et al. [36]
Framing of obesity as an individual health problem.	Dorfman and Wallack [37]; Klein and Dietz [38]; Phillips et al. [39]; Merry [40]
Process-related barriers
Local government officials lacking the knowledge and skills to collaborate with actors outside their own department.	Steenbakkers et al. [16]
Insufficient resources (time, budget).	Steenbakkers et al. [16]; Woulfe et al. [18]; Aarts et al. [23]
Lack of a clear enforcement mechanism.	Thow et al. [24]
Perceived or real lack of power to achieve change.	Thow et al. [29]
Government priorities change.	Nestle [26]
Lack of membership diversity in the collaborative partnerships.	Woulfe et al. [18]
Lack of clarity about the notion of intersectoral collaboration.	Harting et al. [19]
Top-down bureaucracy and hierarchy, disciplinarity and territoriality, sectoral budgets, and different priorities and procedures in each sector.	Bovill [33]
Insufficient organizational structures.	Steenbakkers et al. [16]; Woulfe et al. [18]; Alter and Hage [41]; Hunter [42]; Warner and Gould [43]
Poor quality of interpersonal or interorganizational relationships.	Woulfe et al. [18]; Isett and Provan [44]
Lack of involvement by managers in collaborative efforts.	Steenbakkers et al. [45]
Lack of communication and insufficient joint planning.	R. Axelsson and S. B. Axelsson [46]
Lack of common vision and leadership.	Woulfe et al. [18]; Hunter [42]
Facilitators regarding intersectoral collaboration
Content-related facilitators
Broad justification for the policy initiative.	Thow et al. [24]
Tailoring of information to the political context: information relevant to the government’s agenda.	Schwartz and Brownell [25]; Bowen and Zwi [47]
Political risk assessment and saleability.	Schwartz and Brownell [25]
Selection of policy tools that align with the government priorities (e.g., trade commitments)—ideally tools that are already used by trade policy makers in other contexts—and a broad justification for the policy initiative.	Thow et al. [24]
Process-related facilitators
Policy change supported by external funding.	Thow et al. [29]
Cost-benefit analysis for any potential regulatory intervention.	Thow et al. [29]
Systematic evidence base to provide clear feedback on the size and scope of the obesity epidemic at a local level.	Thow et al. [29]
Sensitivity to community and market forces.	Thow et al. [29]
Suitable funding allowing local government to play a part in the promotion of healthy food environments.	Thow et al. [29]
Changing regulations to allow local government to play a part in the promotion of healthy food environments.	Thow et al. [29]
Strategically planning for agenda-setting.	Nestle [26]
Development and implementation of intersectoral health-promoting policies by engaging stakeholders in finance at an early stage to identify priorities and synergies.	Nestle [26]
Developing cross-sectoral advocacy coalitions.	Nestle [26]
Basing proposals on existing legislative mechanisms where possible.	Nestle [26]
Active involvement of health policy makers in initiating the policies.	Nestle [26]
Advocacy making policy uptake and implementation easier.	Thow et al. [24]
Use of existing taxation mechanisms enabling successful policy implementation.	Nestle [26]