Local policies related to restaurant menu labeling: Barriers, facilitating factors, and the role of local health departments

Introduction: Policy development is a public health essential function, but local health departments may have limited policy development capacity. Policy models such as the Advocacy Coalition Framework can be used to understand the policy process and to identify effective points of intervention. Methods: Three local health departments in Washington State took different approaches to improve the restaurant food environment. In King County menu labeling was required, in Pierce County a voluntary menu labeling program was conducted in locally owned restaurants, and in Thurston County menus for children's meals were improved in collaboration with a local franchise. This study took advantage of these different policy approaches to build understanding of nutrition policy development processes. Results: Policy beliefs are key determinants of policy development decisions; there were differences in beliefs about the appropriate role of public health departments in the marketplace and the relationships between health departments and industry. External events such as precedent legislation and support from national organizations were important, but played out differently in each county. The structure of the county Board of Health was also a key determinant. Policy learning, or the ability of opposing actors to learn how to find common ground and work together over time, was demonstrated in King County. Discussion: Application of policy development models can build capacity for policy development. Practitioners can use model constructs to structure planning for policy efforts, take a long-term view of the policy development process and be ready to advance policy when the context shifts in their favor.