Systemic change for equitable diets: participatory approach in four European countries
SK Djojosoeparto, N Sonneveld, M Steele, P Romaniuk, K Kaczmarek, G Cardon, K Alcer, E Van Duin, J Van Kerckhove, M Poelman, C Kamphuis, JM Harrington, N O’ConnorAbstract
Background
Socioeconomic inequalities in health and diet persist across Europe, disproportionately affecting lower‑income populations. Unhealthy diets contribute to these disparities and are shaped by multiple systemic drivers such as poverty and unequal access to resources. This study examines the key dynamics through which these drivers contribute to dietary inequalities and identifies policy actions to promote healthy dietary behaviours among people living on a low income, based on insights from both citizens with experiential knowledge and professionals in lower-income neighbourhoods.
Methods
This study adopts a systems-based participatory approach to map the complex drivers of dietary behaviour among people living on low incomes in four European communities: the Netherlands (Ede, Veldhuizen), Ireland (Togher, Ballyphehane, Cork City Southside), Poland (Zabrze), and Belgium (Ghent). Group Model Building sessions were conducted with citizens with lived experience and professionals from health and social sectors, resulting in country specific system maps that were integrated into one system map.
Results
The system map includes nine interconnected themes: government and policy, food industry, socio-cultural factors, food environment, living conditions, socio-demographic determinants, wellbeing, individual behaviour, and macro-level structural drivers. Four key dynamics emerged in the system map: (1) framing, power, and policy; (2) socioeconomic disadvantage and wellbeing; (3) food environment; and (4) socio-cultural context. These dynamics interact, increasing susceptibility to unhealthy dietary behaviours. Systemic leverage points and policy actions were identified across these dynamics to promote healthier dietary behaviours among low-income populations.
Conclusions
The findings highlight the systemic roots of diet‑related inequalities and underscore the need for multi‑level, inclusive interventions that address the underlying causes of health disparities.