A policy assessment tool to identify causes of inequities that influence obesity prevalence

When policy-makers propose health-related initiatives they need to assess the impact on health inequalities, including disparities in diet-related diseases and obesity. Health impact assessments, including health equity assessments, can provide insights into the potential health outcomes, but they are usually based on engagement with stakeholders and beneficiaries and their quality is not easy to evaluate. In this paper, we propose a policy assessment tool designed to ask a set of questions on the impact on health equity of policies and interventions that may be answerable from empirical evidence or from public health principles. The results can be graded by strength of the impact and direction of the likely effects, and can provide a summary of how a policy or initiative may increase or decrease health inequity. The questions can be used as part of the scoping review for an impact assessment. We describe the application of this approach to the evaluation of three population-based policies to assess their likely impact on obesity inequalities: (i) policies to restrict children's exposure to the promotional marketing of unhealthy foods and beverages; (ii) policies on food and beverage reformulation; and (iii) policies to improve food procurement for public institutions.