Understanding the role of policy in ongoing food environment transitions in Zambia and opportunities to build a healthy and sustainable environment

The food environment across Zambia is undergoing unhealthy transitions. This study aimed to understand the role of, and opportunities for food system policy to support a healthier environment in a Zambian context. A combined approach of key informant interviews with policy makers (n = 18), and content review of food system policies since 2005 (n = 10) was applied. Analysis was based on an inductive, and deductive approach following a framework combining food environment and multiple streams theories. Unhealthy transitions including decreasing diversity of healthy foods and increasing availability and desirability of inexpensive unhealthy foods were noted, alongside unregulated marketing. Transitions are underpinned by monocultural agriculture, economic-driven investment policies without explicit public health safeguards, and lower investments in wet markets amidst supermarket growth. Policy places emphasis on improving public awareness, but implementation is slow due to inadequacies in educational strategies and local government’s capacity. Fragmented and uncoordinated government actions result in contradictions across different policies. To bridge gaps, stakeholders suggested a multi-tiered policy, integrating education reforms, strengthening local governments to institutionalise implementation and leveraging digital platforms. Additionally, structural strategies were proposed including public-private partnerships that incentivise healthier foods through diversified production, formalising wet markets into structured regulated systems with traceability mechanisms through vendor co-designed solutions, front of the pack labelling and in-store nudging guidelines for indigenous foods. Zambia’s food environment is increasingly obesogenic due to fragmented policies. Overall, cross-sectoral, integrated policy bundles that align economic incentives across agricultural, trade and processed food value chains with nutrition guidelines are needed.