Public Health Nutrition

HOT TOPIC – Food environment

Perceived impact and feasibility of strategies to improve access to healthy foods in Washington State, USA

Donna B Johnsona1 c1, Emilee L Quinna1, Mary Podrabskya1, Nadia Beckwith-Stanleya2, Nadine Chana3, Amy Ellingsa4, Tricia Kovacsa5 and Claire Lanea6

a1 Center for Public Health Nutrition, University of Washington, Box 353410, Seattle, WA 98195 USA

a2 Children's Alliance, Seattle, WA, USA

a3 Public Health Seattle and King County, Seattle, WA, USA

a4 Washington State Department of Health, Olympia, WA, USA

a5 Washington State Department of Agriculture, Olympia, WA, USA

a6 WithinReach, Seattle, WA, USA


Objective The present study measured the perceived impact and political and implementation feasibility of state-level policy strategies related to increasing access to healthy foods and limiting unhealthy foods.

Design Potential state-level policy strategies to improve access to healthy foods were identified through a review of evidence-based literature and policy recommendations. Respondents rated the perceived impact and political and implementation feasibility of each policy on a five-point scale using online surveys.

Setting Washington State policy process.

Subjects Forty-nine content experts (national researchers and subject experts), forty policy experts (state elected officials or their staff, gubernatorial or legislative policy analysts) and forty-five other stakeholders (state-level advocates, programme administrators, food producers).

Results In aggregate, respondents rated policy impact and implementation feasibility higher than political feasibility. Policy experts rated policy strategies as less politically feasible compared with content experts (P < 0·02) or other stakeholders (P < 0·001). Eight policy strategies were rated above the median for impact and political and implementation feasibility. These included policies related to nutrition standards in schools and child-care facilities, food distribution systems, urban planning projects, water availability, joint use agreements and breast-feeding supports.

Conclusions Although they may be perceived as potentially impactful, some policies will be more difficult to enact than others. Information about the potential feasibility of policies to improve access to healthy foods can be used to focus limited policy process resources on strategies with the highest potential for enactment, implementation and impact.

(Received November 15 2012)

(Revised May 30 2013)

(Accepted June 13 2013)

(Online publication August 07 2013)


  • Policy feasibility;
  • Nutrition;
  • Policy development;
  • Food system


c1 Corresponding author: Email