Box 5-2

Applying the Evidence Typology: A Case Study of New York City’s Menu Labeling Policy

The Problem: “New York City is home to approximately 2 million overweight and 1 million obese adults. Diabetes has been diagnosed in nearly 10% of overweight adults and 18% of obese adults in the city, and an estimated 200,000 residents have undiagnosed diabetes. Hospitalization costs for New Yorkers with diabetes topped $481 million in 2003” (Mello, 2009, p. 2015).

Public Health Laws and Policy Actions to Address the Problem: Restaurants were required to make calorie information publicly available, posted on all menus and menu boards.

Types of Questions Decision Makers Might Ask to Grasp the Problem Comprehensively and Guide Evidence-Gathering Efforts:

“Why” take action?

  1. What are the data on the prevalence of the problem? How widespread is the problem in different parts of the community and subpopulations?

  2. What diseases are known to be associated with obesity, and what is the degree of association with serious diseases?

  3. How many deaths result annually from diseases known to be related to obesity in New York City?

  4. What is the cost burden of the city’s obesity problem on the health care system?

  5. On average, what is the annual frequency of visits to food service establishments and their use by the typical family in New York City? How many calories and what foods are purchased?

“What” action should we take that will give us the results we want?

  1. What is the evidence that different types of community interventions (e.g., public education about calorie intake and obesity [which was the option chosen in New York City], community health campaigns, school-based programs) work in curbing the obesity problem (or a related public health problem) on a large scale?

“How” should we implement this action?

  1. For the action chosen, what do experts tell us about the barriers to implementing a communitywide policy successfully? What means are effective for monitoring the policy implementation processes?

  2. What is the parallel evidence on policy actions addressing other community health issues, such as smoking?

NOTE: This list is not intended to be exhaustive.

SOURCE: Mello, 2009.

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