A Systems Approach to Tackle Barriers for Healthy Eating among People Experiencing Disadvantages

Abstract Individuals’ dietary behaviour is concentrated on nutrient-poor food and beverages, which magnifies persisting health inequities, as vulnerable groups are more exposed to unhealthy products. Agentic approaches do not acknowledge the complex interplay of the commercial, societal, and political factors that are at the root of this behaviour, creating the illusion that individuals are solely responsible for their health. Systems thinking can provide insights into these intricate problems and can help to identify leverage points for action. This study - as part of the Era4Health FoodPath project - aimed to identify barriers related to healthy eating among people in vulnerable socio-economic situations, from the perspective of both citizens and local stakeholders. Three Group Model Building sessions were organised: one with professionals (n = 6) and one with individuals from a vulnerable neighbourhood in Ghent (n = 8) separately, aimed at creating a causal loop diagram (CLD) depicting the barriers towards healthy eating, guided by the Nutrition Equity framework. The last session combined both groups to understand different perspectives and identify leverage and action points for change. The two CLDs were integrated to illustrate the multiplex of factors influencing individuals’ dietary behaviour. The sessions highlighted the importance of policies, the food environment, and food-related assistance. While in the session with the professionals the value of policies was discussed, the citizens stressed the importance of the availability of local initiatives. Social initiatives were regarded as the pathway towards tackling barriers, through the dissemination of information, bottom-up approaches, or local food markets, next to (policy)-actions on the accessibility of unhealthy commodities. The results can be used to inform stakeholders and policy to foster healthy eating behaviours among individuals in vulnerable situations and reduce health inequities. Key messages • Policies and grassroots initiatives - like local markets, community centres, and information sharing - are crucial for facilitating healthy dietary behaviour and driving change. • Systems approaches are necessary to tackle unhealthy dietary habits and reduce health inequities.