title: Development, implementation and outcome of standards to restrict fatty meat in the food supply and prevent NCDs: learning from an innovative trade/food policy in Ghana.
abstract: BACKGROUND
  Diet-related noncommunicable diseases represent a major global public health challenge, and require a multisectoral policy response. However, the use of trade policy in this context has met with varied success in the face of strong global trade liberalization agendas. The Government of Ghana has implemented an innovative food standards policy to limit the amount of fat in meat and meat cuts, in response to rising imports of low quality fatty meat cuts. This paper presents an analysis of the policy process and outcomes, as well as contextual factors in policy development, to enable policy learning in other jurisdictions.
  
  
  METHODS
  We conducted 28 semi-structured policy analysis interviews with 37 stakeholders at the national and regional level in Ghana, and collated relevant documents. We analysed the data using the health policy analysis triangle and policy theories related to lesson drawing.
  
  
  RESULTS
  The standards were developed in response to health concerns related to fatty meat (particularly turkey tails), in a context of rising meat imports and a generalised concern about the low quality and high fat content of imported meats. The standards were the result of collaboration between the trade and health sectors. The standards apply to both imported and domestic meat, and were designed to be compliant with Ghana's multilateral trade commitments. The overall effect of the ban has been to reduce availability of specific 'low quality' high-fat meats in the Ghanaian food supply, namely turkey tails and chicken feet.
  
  
  CONCLUSIONS
  This study indicates that the use of standards can reduce availability of high-fat meat in a national food supply. The main strength of a standards approach to reducing fatty meat (mainly imported) in the food supply is compliance with global trade law, while the main challenge is effective enforcement. However, the Government of Ghana appears to have developed a functional and flexible application of the policy. Features of this policy approach useful for policy learning include: collaboration at every stage between ministries of trade and health; considerations relating to compliance with international trade law; strategic enforcement of the policy; and the importance of public awareness efforts.
authors.affiliation: Menzies Centre for Health Policy, School of Public Health, University of Sydney, Victor Coppleson Building (D02), Sydney NSW 2006, Australia. annemarie.thow@sydney.edu.au.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Thow
authors.forename: Reginald
authors.initials: R
authors.lastname: Annan
authors.forename: Laudina
authors.initials: L
authors.lastname: Mensah
authors.forename: Syeda Nafisa
authors.initials: SN
authors.lastname: Chowdhury
mesh_terms: D002908:Chronic Disease / Q000517:prevention & control*; D004041:Dietary Fats; D005523:Food Supply; D005869:Ghana; D006291:Health Policy / Q000331:legislation & jurisprudence; D006801:Humans; D007407:Interviews as Topic; D007858:Learning; D008460:Meat; D011050:Policy Making; D016730:Program Development / Q000379:methods*; D011634:Public Health; D036301:Qualitative Research
chemical_list: D004041:Dietary Fats