Are Iran's Current Policies and Infrastructure Supporting Healthier Food Environments?

Government policies promoting healthier food environments can contribute to healthier diets and prevent obesity and diet-related non-communicable diseases. To assess the level of implementation of internationally recommended food environment policies in Norway and establish prioritised actions to create healthier food environments. The Healthy Food Environment Policy Index (Food-EPI) was adapted to the Norwegian context. It comprised 45 good practice indicators of government food environment policy and infrastructure support. Systematically compiled evidence of relevant policies was verified by government officials and formed the basis for assessing the level of implementation of these policies compared against international best practice benchmarks. The assessment was done by a national non-government expert panel (n = 35). The experts thereafter proposed and prioritized policy actions for government implementation. Most indicators were rated at a medium or high degree of implementation in both the policy action (69%) and the infrastructure support (77%) components. No indicators were rated as having 'none or very little implementation'. Among the 14 recommended policy actions, active use of price regulation to increase the price of unhealthy foods and decrease the price of healthy foods was the highest priority. Other top priorities were ensuring healthy food environments in public settings and introducing free school meals. Demonstrating knowledge-based and coherent political leadership in public health nutrition policies was the highest priority among the 11 recommended infrastructure support actions. The overall policies in Norway to promote a healthy diet show a medium to high level of implementation. This study highlights that there is still room for additional improvements in Norwegian policies and infrastructure support to promote healthy food environments.

Government action is essential to increase the healthiness of food environments and reduce obesity, diet-related non-communicable diseases (NCDs), and their related inequalities. This paper proposes a monitoring framework to assess government policies and actions for creating healthy food environments. Recommendations from relevant authoritative organizations and expert advisory groups for reducing obesity and NCDs were examined, and pertinent components were incorporated into a comprehensive framework for monitoring government policies and actions. A Government Healthy Food Environment Policy Index (Food-EPI) was developed, which comprises a 'policy' component with seven domains on specific aspects of food environments, and an 'infrastructure support' component with seven domains to strengthen systems to prevent obesity and NCDs. These were revised through a week-long consultation process with international experts. Examples of good practice statements are proposed within each domain, and these will evolve into benchmarks established by governments at the forefront of creating and implementing food policies for good health. A rating process is proposed to assess a government's level of policy implementation towards good practice. The Food-EPI will be pre-tested and piloted in countries of varying size and income levels. The benchmarking of government policy implementation has the potential to catalyse greater action to reduce obesity and NCDs.

IntroductionUnhealthy food environments drive the increase of diet-related non-communicable diseases (NCDs).ObjectiveWe aimed to examine healthy food environment policies in Kenya and identify priorities for future action.MethodsUsing the Healthy Food Environment Policy Index (Food-EPI) we collected evidence on the extent of government action to create healthy food environments across 13 policy and infrastructure support domains and 43 related good practice indicators between 2017 and 2018. A panel of 15 national experts rated the extent of government action on each indicator compared to the policy development cycle and international best practice respectively. Based on gaps found, actions to improve food environments in Kenya were identified and prioritized.ResultsIn the policy development cycle, 16/43 (37%) of good practice policy indicators were judged to be in ‘implementation’ phase, including: food composition targets, packaged foods’ ingredient lists/nutrient declarations; systems regulating health claims; restrictions on marketing breast milk substitutes; and school nutrition policies. Infrastructure support actions in ‘implementation’ phase included: food-based dietary guidelines; strong political support to reduce NCDs; comprehensive NCD action plan; transparency in developing food policies; and surveys monitoring nutritional status. Half (22/43) of the indicators were judged to be ‘in development’. Compared to international best practice, the Kenyan Government was judged to be performing relatively well (‘medium’ implementation) in one policy (restrictions on marketing breast milk substitutes) and three infrastructure support areas (political leadership; comprehensive implementation plan; and ensuring all food policies are sensitive to nutrition). Implementation for 36 (83.7%) indicators were rated as ‘low’ or ‘very little’. Taking into account importance and feasibility, seven actions within the areas of leadership, food composition, labelling, promotion, prices and health-in-all-policies were prioritized.ConclusionThis baseline assessment is important in creating awareness to address gaps in food environment policy. Regular monitoring using Food-EPI may contribute to addressing the burden of diet-related NCDs in Kenya.

PROTOCOL: Impact of the food environment on diet-related health outcomes in school-age children and adolescents in low- and middle-income countries: a systematic review.

BackgroundFood environments impact on diets, obesity and non-communicable diseases (NCDs). Government policies are essential to create healthy food environments. This study aimed to assess the strength of European Union (EU)-level policies, and identify and prioritize actions for the EU to create healthy food environments.MethodsThe Healthy Food Environment Policy Index (Food-EPI) was applied. The Food-EPI included 26 policy and 24 infrastructure support indicators. Independent experts (n = 31) rated the strength of EU-level policies and infrastructure support for each of these indicators (on a 5-point scale, from very weak to very strong) and identified and prioritized actions to improve food environments.ResultsFor 65% of the 26 policy indicators, EU-level policies were rated as weak and for 23% as very weak. For 63% of the 24 infrastructure support indicators, EU-level policies were rated as moderate and for 33% as weak. The experts recommended 18 policy and 19 infrastructure support actions to the EU. The Top 5 prioritized policy actions included three actions in the food composition domain (e.g. setting mandatory food composition targets), one action in the food prices domain and one action in the food promotion domain. The Top 5 prioritized infrastructure support actions included three actions in the leadership domain (e.g. developing a high-level NCDs Prevention Strategy) and two actions in the monitoring domain.ConclusionsThere is large potential for the EU to strengthen its policies and infrastructure support in order to improve food environments. This study specifies priority actions for the EU to create healthy food environments.

ObjectivesEffective government policies are essential to increase the healthiness of food environments. The International Network for Food and Obesity/non-communicable diseases (NCDs) Research, Monitoring and Action Support (INFORMAS) has developed a...

BackgroundBenchmarking the implementation of healthy food environment public policies against international best practices may accelerate the government response to prevent obesity and non-communicable diseases (NCDs) in the countries. The aim of the study was to determine the extent of food environment policy implementation in Guatemala and to identify and prioritize actions for the government to accelerate their implementation.MethodsThe INFORMAS Healthy Food Environment Policy Index (Food-EPI from the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support) was used. Evidence of implementation for 50 good practice indicators within the seven food policies and six infrastructure support domains was compiled, and subsequently validated by Guatemalan government officials. A national civil society expert panel on public health and nutrition performed an online assessment of the implementation of healthy food environment policies against best international practices. The level of agreement among evaluators was measured using the Gwet second order agreement coefficient (AC2). The expert panel recommended actions for each indicator during on-site workshops and those actions were prioritized by importance and achievability.ResultsThe expert panel rated implementation at zero for 26% of the indicators, very low for 28% of indicators, low for 42%, and medium for 4% of indicators (none were rated high). Indicators at medium implementation were related to the use of evidence for developing policies and ingredient list/nutrition information panels on packaged foods. Seventy-seven actions were recommended prioritizing the top 10 for immediate action. The Gwet AC2 was 0.73 (95% CI 0.67–0.80), indicating a good concordance among experts.ConclusionsIn the Food-EPI of Guatemala, almost all indicators of good practice had a low or less level of implementation. The expert panel proposed 12 priority actions to accelerate policy implementation to tackle obesity and NCDs in the country.

Policy implementation and priorities to create healthy food environments using the Healthy Food Environment Policy Index (Food-EPI): A pooled level analysis across eleven European countries.

This work aims to identify policies implemented for healthy food environments in Italy within The Healthy Food Environment Policy Index (Food-EPI) project. Food-EPI tool, which includes two components, thirteen domains and fifty good practice indicators, was adapted for the Italian context. Evidence for implementation was gathered and summarized for all fifty indicators from data sources such as governmental websites, non-government organizations publications and websites and via direct contact with Government officials. The highest level of evidence was found within five domains: food composition (2/2 indicators), labelling (3/4), promotion (4/5), provision (4/5) and leadership (5/5). The domains with less identified evidence were food prices (1/4), food in retail (0/4), trade and investment (0/2) and platforms and interaction (1/4). The evidence summarization and the upcoming stakeholders' meeting to rate the level of implementation for each indicator in Italy have the potential to improve Government commitment to shape healthier food environments.

Mexico is one of the countries with the highest prevalence of obesity and recently declared a national epidemic of diabetes. Healthy food environments have the potential to improve the diet of the population and decrease the burden of disease. The aim of the study was to assess the efforts of the Mexican Government towards creating healthier food environments using the Healthy Food Environment Policy Index (Food-EPI). The tool was developed by the International Network for Food and Obesity/Non-communicable Diseases Research, Monitoring and Action Support (INFORMAS). Then, it was adapted to the Latin-American context and assessed the components of policy and infrastructure support. Actors from academia, civil society, government, and food industry assessed the level of implementation of food policies compared with international best practices. Actors were classified as (1) independents from academia and civil society (n=36), (2) government (n=28), and (3) industry (n=6). The indicators with the highest percentage of implementation were those related to monitoring and intelligence. Those related to food retail were rated lowest. When stratified by type of actor, the government officials rated several indicators at a higher percentage of implementation compared with independent actors. None of the indicators were rated at high implementation. Government officials and independent actors agreed upon nine priority actions to improve the food environment in Mexico. These actions have the potential to improve government commitment and advocacy efforts to create healthier food environments.

Background Food-EPI has been developed by the International Network for Food and Obesity/Non-communicable Diseases (NCDs) Research, Monitoring, and Action Support. It is classified into two components: ‘policies’ and ‘infrastructure support’. The policy component includes 7 domains to address the key aspects of food environments, that can be influenced by governments to create healthy food choices. The infrastructure support component includes 6 domains that facilitate policy development and implementation to prevent obesity and NCDs. Good practice statements are proposed within each domain, describing ‘best practices’ governments put in place to contribute towards a healthier food environment. The aim of this work was to assess and compare the extent of implementation of national government policies and actions in Ireland, for creating healthy food environments against international best practice, and identifying the major implementation gaps. Methods Evidence on the extent of government implementation of different policies on food environments and infrastructure support was collected. Government officials validated the evidence document, and an online survey with public health experts and NGO representatives to rate the performance of government against international best practice was conducted. The experts independently scored the degree of implementation of those policies against international benchmarks. A one-day workshop was convened with the expert rating panel to identify potential policy actions. Online prioritisation of these actions will be prioritised. Results There was very little to low levels of implementation for indicators in the ‘policy domain’. Specifically very low levels for ‘Food composition targets for out of home meals’; restricting unhealthy food promotion to children’, ‘healthy public procurement standards;and ‘zoning laws encouraging healthy food outlets’. Only one indicator in the policy domain was rated with a high level of implementation ‘increasing taxes on unhealthy foods’. In the infrastructure domain experts rated policy implementation from medium to high. Experts identified 18 actions in the policy domain and 16 actions in the infrastructure domain to be brought forward for prioritisation. Conclusion This is the first Food-EPI to be conducted in Ireland. It will allow for the first time benchmarking of Irish food environment policies against international best practice and thus identify Government action (or inaction) to improve Irish food environments.

ObjectiveTo assess government actions to improve the healthiness of food environments in New Zealand, based on the healthy food environment policy index.MethodsA panel of 52 public health experts rated the extent of government implementation against international best practice for 42 indicators of food environment policy and infrastructure support. Their ratings were informed by documented evidence, validated by government officials and international benchmarks.FindingsThere was a high level of implementation for some indicators: providing ingredient lists and nutrient declarations and regulating health claims on packaged foods; transparency in policy development; monitoring prevalence of noncommunicable diseases and monitoring risk factors for noncommunicable diseases. There was very little, if any implementation of the following indicators: restrictions on unhealthy food marketing to children; fiscal and food retail policies and protection of national food environments within trade agreements. Interrater reliability was 0.78 (95% confidence interval, CI: 0.76–0.79). Based on the implementation gaps, the experts recommended 34 actions, and prioritized seven of these.ConclusionThe healthy food environment policy index provides a useful set of indicators that can focus attention on where government action is needed. It is anticipated that this policy index will increase accountability of governments, stimulate government action and support civil society advocacy efforts.

Background and aim: Lifestyle and dietary shifts contribute to widespread or specific micronutrient deficiencies, leading to health issues such as obesity, hypertension, diabetes, cardiovascular diseases, and certain cancers. These problems are linked to unhealthy food environments, yet little is known about Benin policy responses. This study aims to assess how different aspects of the food environment are addressed in Benin's policy documents and their alignment with international best practices. Methods: The study analyzed intentions and actions to ensure a healthy food environment in Benin using various policy documents, including laws, decrees, sectoral policies, strategic and operational plans, regulations, directives, action plans, and program/project documents. It followed the Food-EPI tool (Healthy Food Environment Policy Index) of the INFORMAS network (International Network for Food and Obesity/NCDs, Research, Monitoring and Action Support) focusing on the “Policy and Infrastructure Support” components, with steps like contextual analysis, document collection, and evidence extraction. Results: Of the 98 documents collected, 61 were analyzed and classified into frameworks: 54.09% in the policy framework, 29.50% in the strategic framework, and 16.39% in the operational framework. While nine food environment domains were addressed to some extent, disparities with international best practices were noted, especially in food composition, labeling, pricing, governance, and funding/resources. Evidence gaps were identified in retail food sales, food trade and investments, and health integration in policies. Conclusions: The study reveals diverse approaches and gaps in Benin policies for healthy food environments. Despite progress in some areas, like leadership and monitoring, others, including food composition and governance, need more attention.

Background Obesity prevalence in Norway has increased over the past decades despite political objectives and strategies for obesity prevention. Healthy food environments have the potential to improve the diet of the population and decrease the burden of disease. Governments play a critical role to form such environments. The aim of the study was to assess the efforts of the Norwegian Government towards creating healthier food environments and suggest actions using the Healthy Food Environment Policy Index (Food-EPI) methodology. Methods Evidence of policy implementation was assembled and verified by government stakeholders for 45 good practice indicators across 12 policy and infrastructure support domains. Independent public health nutrition experts from academia and civil society (n = 34) assessed the level of implementation of each indicator compared with international best practices, using an online tool. Results Most indicators were rated at “medium” level of implementation (51%). An almost equal number of indicators were rated at “high” and “low” level of implementation (21% and 28%, respectively). None of the indicators were rated as “very low, if any” level of implementation. More indicators under the infrastructure domain were rated at “high” or “medium” as compared with the policy domain. The expert panel developed a list of priority actions that should be implemented to improve the food environment, including actions regarded as most effective in decreasing social inequalities in diet. The top priority action was that the Government should to a larger extent use price and taxes to change food consumption. Conclusions The Food-EPI framework and process can be used to identify gaps in national policy implementation and to develop recommendations for strengthened policy action supported by a coalition of public health experts.

Nutrition-related non-communicable diseases (NR-NCDs) are a global health problem, increasingly recognised as driven by unhealthy food environments. Yet little is known about government action to implement food environment-relevant policies, particularly in low-and lower-middle income countries. This study assessed government action, implementation gaps, and priorities to improve the food environment in Ghana. Using the Healthy Food-Environment Policy Index (Food-EPI), a panel comprising government and independent experts (n = 19) rated government action to improve the healthiness of food environment in Ghana against international best practices and according to steps within a policy cycle. Forty-three good practice indicators of food environment policy and infrastructure support were used, with ratings informed by systematically collected evidence of action validated by government officials. Following the rating exercise, the expert panel proposed and prioritized actions for government implementation. Three-quarters of all good practice indicators were rated at ‘low’/‘very little’ implementation. Restricting the marketing of breast milk substitutes was the only indicator rated “very high”. Of ten policy actions prioritized for implementation, restricting unhealthy food marketing in children’s settings and in the media were ranked the highest priority. Providing sufficient funds for nationally-relevant research on nutrition and NCDs was the highest priority infrastructure-support action. Other priority infrastructure-support actions related to leadership, monitoring and evaluation. This study identified gaps in Ghana’s implementation of internationally-recommended policies to promote healthy food environments. National stakeholders recommended actions, which will require legislation and leadership. The findings provide a baseline for measuring government progress towards implementing effective policies to prevent NR-NCDs.