5. Linking policy instruments with the behaviour change framework

In this chapter, we explore the interaction between the various determinants that drive behavioural change, as outlined in the framework, and the policy instruments listed in Table 1. Additionally, this chapter examines how, in theory, different policy instruments, may be more or less suitable for guiding behaviour change towards better diets.

Table 1 provides a summary of the key features of various policy instruments, their level of intrusiveness, and their interconnectedness with food-, person-related, and socio-environmental determinants. The primary focus is on how these instruments are designed to function and how they intend to address the diverse determinants outlined in the framework. Furthermore, the far-right column of the table correlates policy instruments with components of behaviour change, indicating which components are addressed by each category of policy instruments.

Category of policy instruments. Level of intrusiveness	Key characteristics	Food-related	Person-related	Social and environmental determinants	Which behavioural change components do policy instruments address
Market-based instruments Medium to high	Taxes: Consumer price increases Subsidies: Consumer price reductions.	Taxes and subsidies can indirectly influence taste preferences, e.g. if healthier options are made cheaper.	Age, gender, education level and previous eating habits influence the acceptance of food taxes. More educated individuals might be more responsive to the rationale behind taxes and subsidies.	Generally higher financial impact but also health benefits of food taxes on lower income individuals. Political ideology, personal values influence the level of acceptance of food taxes.	Opportunity (impacting affordability).
Regulatory instruments High	Regulation of marketing and labelling. Regulating public procurement. Regulation of choice of e.g., school meals (including vending-machine bans and provision of free fruit and vegetables).	Over time, can have a significant influence on shaping consumer taste preferences and choices.	A significant impact on shaping beliefs and attitudes. Understanding the reasons behind regulatory measures (e.g., the health benefits of certain foods) can influence their effectiveness. This understanding can be influenced by the level of education and knowledge.	Regulating the accessibility of certain foods may be particularly beneficial for lower-income groups and children.	Opportunity (impacting availability).
Nudging Low to medium	Portion sizes/placement in restaurants and shops. Interventions. Primes carefully designed to activate specific thoughts, emotions, or associations.	May encourage individuals to taste new and different food products, altering taste and preferences.	Over time, nudging can subtly influence individual beliefs and attitudes towards certain foods and contribute to changing cultural norms. The success of nudges often depends on their alignment with existing beliefs, attitudes and social norms.	Cultural norms and values, as well as income level may influence access to food choices and receptivity to nudges.	Capability, motivation and opportunity (impacting accessibility, appeal, availability).
Information-based instruments Low	Labelling, Knowledge and support based information, campaigns/menus/dietary advice.	Labelling can alter the perceived appeal of food products. People’s unique dietary needs and experiences can affect how they respond to information.	Diverse impact of age, gender, knowledge and education level on the way information is perceived and comprehended.	Place of residence and socio-cultural environment may impact on the way nutritional and health-related information is perceived, sought and comprehended.	Capability and motivation (changing beliefs, attitudes, norms, knowledge and skills).

Table 1 Description of various policy instruments and how they might relate to the different types of determinants. Some selected examples.

The influence of policy instruments on steering behaviour

The following section examines the impact of policy instruments on guiding behaviour and proposes strategies to encourage a positive trend. Assessing the effectiveness of various policy instruments in influencing behaviour towards healthier and more sustainable diets is highly important to do but also challenging, as it is highly dependent on the context in which the interventions are implemented, as well as their design and execution (Von Bah et al. 2019). Moreover, the impact is shaped by a range of factors, including an individual’s economic status, health priorities, cultural norms, and the availability of healthy food options. Additionally, there are inherent limitations in research methodologies and data quality in studies evaluating the effectiveness of policy interventions aimed at promoting dietary changes, which are discussed in the ‘Study limitations’ section. The outcomes of such studies show considerable variation in the literature reviewed. While acknowledging these limitations, the primary aim of this section is to stimulate discussion and provide insights that can inform the development of policy interventions to effectively promote healthier and more sustainable dietary habits, rather than to present conclusive evaluations of the effectiveness of these policy instruments.

Assessing market-based policy instruments for facilitating behaviour change

Taxes can be effective in reducing demand for a taxed food product by increasing its price. The long-term effect can vary, depending on factors such as the price elasticity of demand for the product, the level of the tax imposed, and the availability of affordable alternatives. As with other policy instruments, price-based mechanisms alone may not be sufficiently effective in steering a behavioural change. In some specific cases, a combination of taxes and subsidies could play an important role in facilitating the transition of the entire food system (Röös et al. 2021). Below are some tips for selecting and utilizing market-based instruments effectively:

Societal attitudes towards health and sustainability can either amplify or mitigate the effectiveness of taxes and subsidies. In cultures with a strong emphasis on healthy living, these instruments might be more effective (Whitmarsch et al. 2021).
The portrayal of these instruments in the media and public discourse can shape public opinion and their effectiveness (Austin et al. 2020).
In the Nordic context, research shows that acceptance of a meat tax depends on factors such as previous eating habits, gender, education level, and age (Röös et al. 2021). Women, those with higher education, young people, and those leaning left politically are more likely to view a meat tax positively (Röös et al. 2021).
Taxes and subsidies on food products can have a symbolic impact, signalling that the government is taking issues like climate change or unhealthy diets seriously. This could contribute to a shift in social norms towards healthier and more sustainable food consumption (Röös et al. 2021).
Linking food consumption taxes to earmarked revenues for specific purposes can enhance their acceptance among both consumers and producers, making the tax more politically feasible (Gren et al. 2021; Grimsrud et al. 2019; Klenert et al. 2022). For example, revenues from food taxes could be used to lower VAT on fruits and vegetables, thereby making healthy and sustainable food more accessible to consumers (Klenert et al. 2022).
In the case of meat taxes, avoiding labelling the charge as a tax, implementing progressive taxation, and providing a clear explanation of the tax’s impact have been found to strengthen public support for these taxes (Perino and Schwickert 2023).

Taxation can effectively discourage consumption of specific food items by raising their prices, with their success hinging on price sensitivity, tax rates, and alternative options. Combining taxes with subsidies may offer a comprehensive strategy to reform the food system. The effectiveness of these fiscal measures also depends on societal attitudes, media representation, and demographic variables. Tailored approaches, such as earmarking tax revenues for health initiatives and nuanced communication about the taxes, enhance public support, underscoring the critical role of fiscal policies in promoting healthier and more sustainable dietary choices.

Assessing regulatory instruments for facilitating behaviour change

Regulations have a significant potential to reshape the food landscape (physical environment), for instance, by promoting healthier food availability in public kitchens or restricting the emergence of fast-food restaurants in certain areas. The deeply rooted nature of dietary habits and preferences is a crucial factor in determining the success or failure of these regulatory measures. Altering long-standing dietary habits and preferences through regulations can be challenging if individuals are deeply ingrained in certain dietary routines. The effectiveness of regulatory actions is also influenced by the public’s understanding of their underlying motives, such as recognizing the health advantages of certain foods or acknowledging their environmental impacts. Below are some tips for selecting and utilizing regulatory instruments effectively:

The way the regulations are implemented and the level of trust in the government can influence public response. Transparent and well-communicated incentives are likely to be more effective (Livsmedelverket 2023a).
Complementary efforts, such as education and upskilling of kitchen staff and public procurers, and public awareness campaigns, can enhance the effectiveness of regulatory measures by educating the public about the reasons and benefits behind these policies (Fesenfeld et al 2023; Landbrugsstyrelsen 2023).

These regulatory approaches require collaboration and dialogue with private sector stakeholders to ensure feasibility and effectiveness, while balancing economic and environmental considerations. Overall, while regulatory instruments are effective in promoting healthy and sustainable food choices, their success depends on a nuanced understanding of both personal and social determinants. For instance, a person who values health (a personal factor) might be more inclined to adhere to new regulations if they are part of a community that supports and practices healthy eating (a social factor).

In the spring of 2023, the Swedish Food Agency (Livsmedelsverket) established a citizen panel consisting of 70 participants to explore ways to encourage sustainable and healthier eating habits (Livsmedelsverket, 2023a). From their discussions, 30 recommendations emerged, primarily focusing on regulating the pricing and marketing of unhealthy foods by retailers, producers, and suppliers. This supports Fesenfeld et al. (2023)’s findings that softer, less intrusive policy instruments do not necessarily receive higher public support than harder, more intrusive ones. This underscores the importance of both the design of the policy instrument and how it is communicated to the public.

Assessing nudging for facilitating behaviour change

In nudging, personal preferences and tastes are pivotal. Nudges may be less effective if they clash with deeply ingrained food preferences. Individuals with specific health concerns or dietary needs may be more open to nudges towards healthier options, whereas children could be more susceptible to unhealthy nudges in food store settings. However, it is also crucial to take into account gender norms and societal expectations. For instance, a nudge promoting responsible drinking may need to be distinctively tailored for men and women, considering their respective social norms and behaviours. The interaction between personal and social determinants also influences the effectiveness of nudging. For example, a health-conscious individual (a personal determinant) might respond more positively to nudges in a community that values sustainability (a social determinant). As a subtle measure, nudges lead to incremental rather than drastic behavioural changes. However, these small changes can accumulate over time to create a significant impact (Contento 2021). Below are some tips for selecting and utilizing nudging instruments effectively:

Systematic reviews indicate that the effectiveness of nudging is highly context-dependent, and the results vary across different types of nudges (Broers et al. 2017).
Nudges may be more effective in controlled environments, such as school cafeterias or workplace dining areas, compared to broader contexts (Thapa and Lyford 2014).
Among various nudging strategies, alterations in proximity and presentation (Laiou et al. 2021), default options like a standard menu featuring a healthy and sustainable dish in a restaurant (Leng et al. 2016), and combined nudges (Broers et al. 2017) have been particularly effective in encouraging healthier dietary choices.
The impact of nudges is influenced by social influence and peer behaviour, which can determine the acceptance or rejection of a particular nudge (Salmivaara 2021).
Nudges are also affected by factors such as stress, mood, and cognitive load, which can influence an individual’s receptiveness to nudges (de Ridder et al. 2022).
Nudges that align with cultural norms and values are likely to be more effective (Sunstein and Reisch 2019).

Nudging, as a strategy for influencing dietary choices, recognizes the importance of personal preferences and social contexts in shaping behaviour. Its effectiveness varies, being contingent on aligning with individual health needs, societal norms, and the specific environment where the nudge is applied. Strategies that modify proximity, presentation, and default options, particularly in settings like schools and workplaces, show promise in nudging people towards healthier choices. Moreover, the subtle, incremental changes prompted by nudges can, over time, aggregate to significant dietary shifts, especially when they resonate with cultural values and are supported by social influences.

Assessing information-based policy instruments for facilitating behaviour change

Information-based instruments alone have a limited impact in steering people towards healthier and more sustainable diets (Röös et al. 2021). While there may be a temporary increase in community knowledge and a changed attitude, evidence of significant long-term behavioural changes is limited (Capacci et al. 2012; Leng et al. 2016). Nonetheless, these tools are crucial in empowering consumers to make informed choices. When combined with other instruments, both legal and market-based, for example, to enhance understanding and acceptance, they can contribute significantly to overall effectiveness (Röös et al. 2021). Eco-labelling, while helpful in highlighting the better option within a specific product category (such as choosing between different types of fish), does not guide consumers in reducing consumption of product categories that are unhealthy or most damaging to the environment (Röös et al. 2021). Therefore, its effectiveness in guiding consumers towards optimal choices is limited. Below are some tips for selecting and utilizing information-based instruments effectively:

The issue of excessive information, or hyper-choice, especially in labelling, should be minimized (Leng et al., 2016; Röös et al. 2021).
Information-based instruments are often more effective when used alongside other strategies, such as nudging and regulations (Röös et al. 2021). For instance, nutritional labelling might be more impactful when combined with healthy eating programmes in schools.
Information that aligns with an individual’s existing attitudes, beliefs, cultural context, and emotional state is more likely to be accepted and influence behaviour. If the information confirms their values and beliefs, they may be more motivated to change (Contento 2011; Duralia 2023). Recognizing individual differences, information campaigns and labels can be effectively tailored to target specific groups.
Information that is culturally sensitive and delivered through trusted social networks can have a stronger impact. People are more likely to accept information that aligns with their cultural values and is endorsed by their community (Salmivaara 2021; Perino and Schwickert 2023).

Positive messages are generally better received. Interventions that promote healthy behaviours are found to have a greater impact than those aimed at stopping unhealthy behaviours (Afshin et al. 2017).

While information-based instruments provide essential insights for informed decision-making, they alone fall short in effecting enduring shifts towards healthier and sustainable dietary habits. The true potential of these tools emerges when they are part of a broader mix of policy measures, including legal and market-based strategies, to amplify their impact. By minimizing information overload, ensuring alignment with cultural and personal values, and integrating these instruments with other behavioural change strategies, their capacity to steer consumers towards healthier and more environmentally friendly choices can be maximized.