Healthy Food Environment Policy Index Research Articles

Has the Netherlands created a healthy food environment for its citizens? Application of the Food Environment Policy Index (Food-EPI)

Abstract Background Healthy food environments have the potential to improve population nutrition and decrease NCDs. The aim of the study was to assess the efforts of the National Government in the Netherlands towards creating healthier food environments using the Healthy Food Environment Policy Index (Food-EPI). Methods We compiled evidence on national food environment policies in the Netherlands for each of the 47 indicators. This document has been verified for completeness and accuracy by Dutch governmental officials. A panel of independent, nongovernment experts specialized in nutrition, obesity or chronic diseases, was provided with this evidence and rated the extent of implementation of Dutch policies by benchmarking these policies against international best practices during an online survey in May-July 2020. The experts also rated to which extent policies could lead to a decrease or widening of socio-economic inequalities in dietary intake. In addition, experts formulated actions to improve food environment policies in the Netherlands. Results This is the first interdisciplinary study to assess food environment policies developed and set by the Netherlands. The overview of national level policies resulted in a evidence document, describing policies (or the lack thereof) for each of the 47 indicators. The evidence document shows that the Netherlands has mostly voluntary policies, mainly through the National Prevention Agreement (launched in 2018) and Agreement on Product Improvement (launched in 2014). Results from the online survey and the formulated actions will be presented during the conference. The results will reflect the experts' ratings supported by documented evidence and will provide meaningful guidance to governmental officials and public health advocates in their efforts to improve the food environment policies in the Netherlands.

A study on implementation of food-related policies in Poland using the Healthy Food Environment Policy Index

Abstract Background Existing studies indicate obesity and diseases associated with diet and sedentary lifestyle as leading health problem in Poland that cannot be solved without explicit public intervention. The purpose of this study is to evaluate actions to create a healthy food environment, undertaken by public authorities in Poland. Methods We used the Food Environment Policy Index (Food-EPI) to describe the Polish national food environment policy. We analysed available government documents, studies, reports, legal acts and other relevant materials to compile a evidence document, which has been then validated with government officials. In the next stage (March 2020), national policies will be subject to assessment in reference to international best practices by independent experts through an online Delphi study. Results of the survey will be then used during a national workshop (April 2020) in order to formulate and prioritize actions. Results For 15 out of 47 indicators we found no evidence for government actions that would meet the criteria set out in the Food-EPI definition. In case of the other 6 indicators it was observed that the existing solutions are non-binding and result from government-independent policies. The lack or limits of government involvement was observed in particular in the domains related to food promotion, food provision, food in retail, and Health in All Policies. Results from the online study and the workshop will be presented during the conference. Conclusions The preliminary results obtained through the review of the evidence point to the need for intensified government activities in the area of shaping food policy in Poland. Full conclusions will be formulated after the study is completed. Preliminary findings of the Food-EPI project suggest the need for strengthening food environment policy in Poland.

Implementation level of best practice policies by Italian government for healthier food environments

Abstract Background Government actions play a critical role in shaping healthy food environments, which can improve population's diet and decrease the burden of disease. This study aims to determine and compare the level of policy implementation for healthy food environments in Italy with reference to international benchmarks and make prioritized recommendations based on the identified implementation gaps. Methods The Healthy Food Environment Policy Index (Food-EPI) tool from the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) was adapted for the Italian context. This tool includes two components, thirteen domains and fifty good practice indicators, which were verified with experts from National Health Institute (NHI). 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. After collecting all evidence, experts from the NHI verified the completeness and accuracy of it. The evidence document will be presented to stakeholders, aiming to seek consensus on the priority actions to be implemented by the Italian Government to improve food environments. Results The evidence for policy implementation concerning Italy varied among domains and indicators. We found the highest level of evidence within three domains: Food Composition (2/2 indicators), Food Labelling (3/4 indicators) and Food Promotion (4/5 indicators). The domains with less identified evidence were Food Prices (1/4 indicators), Food Retail (0/4 indicators), Food Trade and Investment (0/2 indicators) and Platforms and Interaction (1/4 indicators). Conclusions 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. Key messages Food environment policies, implemented by the government, play a key role in the health of the population, decreasing the burden of disease. Several food environment policies have been implemented and supported by the Italian government but there are still some priority actions to be taken towards healthier food environments.

Benchmarking food environment policies for the prevention of diet-related non-communicable diseases in Kenya: National expert panel's assessment and priority recommendations.

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.

Implementation of healthy food environment policies to prevent nutrition-related non-communicable diseases in Ghana: National experts’ assessment of government action

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.

Policies to Create Healthier Food Environments in Canada: Experts’ Evaluation and Prioritized Actions Using the Healthy Food Environment Policy Index (Food-EPI)

Food environment policies play a critical role in shaping food choices, diets, and health outcomes. This study endeavored to characterize and evaluate the current food environment policies in Canada using the Healthy Food Environment Policy Index (Food-EPI) to compare policies in place or under development in Canada as of 1 January 2017 to the most promising practices internationally. Evidence of policy implementation from the federal, provincial, and territorial governments was collated and verified by government stakeholders for 47 good practice indicators across 13 policy and infrastructure support domains. Canadian policies were rated by 71 experts from across Canada, and an aggregate score of national and subnational policies was created. Potential policy actions were identified and prioritized. Canadian governments scored ‘high’ compared to best practices for 3 indicators, ‘moderate’ for 14 indicators, ‘low’ for 25 indicators, and ‘very little or none’ for 4 indicators. Six policy and eight infrastructure support actions were prioritized as the most important and achievable. The Food-EPI identified some progress and considerable gaps in policy implementation in Canada, and highlights a particular need for greater attention to prioritized policies that can help to shift to a health-promoting food environment.

The INFORMAS healthy food environment policy index (Food-EPI) in Mexico: An assessment of implementation gaps and priority recommendations.

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.

The Healthy Food Environment Policy Index: Comparing nutrition policy implementation in 10 countries

The Healthy Food Environment Policy Index: Comparing nutrition policy implementation in 10 countries

The Healthy Food Environment Policy Index: Comparing nutrition policy implementation in 10 countries

The Healthy Food Environment Policy Index: Comparing nutrition policy implementation in 10 countries

Extent of implementation of food environment policies by the Malaysian Government: gaps and priority recommendations.

To determine the degree of food environment policies that have been implemented and supported by the Malaysian Government, in comparison to international best practice, and to establish prioritised recommendations for the government based on the identified implementation gaps. The Healthy Food-Environment Policy Index (Food-EPI) comprises forty-seven indicators of government policy practice. Local evidence of each indicator was compiled from government institutions and verified by related government stakeholders. The extent of implementation of the policies was rated by experts against international best practices. Rating results were used to identify and propose policy actions which were subsequently prioritised by the experts based on 'importance' and 'achievability' criteria. The policy actions with relatively higher 'achievability' and 'importance' were set as priority recommendations for government action. Malaysia. Twenty-six local experts. Majority (62 %) of indicators was rated 'low' implementation with no indicator rated as either 'high' or 'very little, if any' in terms of implementation. The top five recommendations were (i) restrict unhealthy food marketing in children's settings and (ii) on broadcast media; (iii) mandatory nutrition labelling for added sugars; (iv) designation of priority research areas related to obesity prevention and diet-related non-communicable diseases; and (v) introduce energy labelling on menu boards for fast-food outlets. This first policy study conducted in Malaysia identified a number of gaps in implementation of key policies to promote healthy food environments, compared with international best practices. Study findings could strengthen civil society advocacies for government accountability to create a healthier food environment.

Measuring and stimulating progress on implementing widely recommended food environment policies: the New Zealand case study

BackgroundMonitoring the degree of implementation of widely recommended food environment policies by national governments is an important part of stimulating progress towards better population nutritional health.MethodsThe Healthy Food Environment Policy Index (Food-EPI) was applied for the second time in New Zealand in 2017 (initially applied in 2014) to measure progress on implementation of widely recommended food environment policies. A national panel of 71 independent (n = 48) and government (n = 23) public health experts rated the extent of implementation of 47 policy and infrastructure support good practice indicators by the Government against international best practice, using an extensive evidence document verified by government officials. Experts proposed and prioritised concrete actions needed to address the critical implementation gaps identified.ResultsInter-rater reliability was good (Gwet’s AC2 > 0.8). Approximately half (47%) of the indicators were rated as having ‘low’ or ‘very little, if any’ implementation compared to international benchmarks, a decrease since 2014 (60%). A lower proportion of infrastructure support (29%) compared to policy (70%) indicators were rated as having ‘low’ or ‘very little, if any’ implementation. The experts recommended 53 actions, prioritising nine for immediate implementation; three of those prioritised actions were the same as in 2014. The vast majority of experts agreed that the Food-EPI is likely to contribute to beneficial policy change and increased their knowledge about food environments and policies.ConclusionThe Food-EPI has the potential to increase accountability of governments to implement widely recommended food environment policies and reduce the burden of obesity and diet-related diseases.

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.

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.

Level of implementation of best practice policies for creating healthy food environments: assessment by state and non-state actors in Thailand.

To determine and compare the level of implementation of policies for healthy food environments in Thailand with reference to international best practice by state and non-state actors. Data on the current level of implementation of food environment policies were assessed independently using the adapted Healthy Food Environment Policy Index (Food-EPI) by two groups of actors. Concrete actions were proposed for Thai Government. A joint meeting between both groups was subsequently held to reach consensus on priority actions. Thailand. Thirty state actors and twenty-seven non-state actors. Level of policy implementation varied across different domains and actor groups. State actors rated implementation levels higher than non-state actors. Both state and non-state actors rated level of implementation of monitoring of BMI highest. Level of implementation of policies promoting in-store availability of healthy foods and policies increasing tax on unhealthy foods were rated lowest by state and non-state actors, respectively. Both groups reached consensus on eleven priority actions for implementation, focusing on food provision in public-sector settings, food composition, food promotion, leadership, monitoring and intelligence, and food trade. Although the implementation gaps identified and priority actions proposed varied between state and non-state actors, both groups achieved consensus on a comprehensive food policy package to be implemented by the Thai Government to improve the healthiness of food environments. This consensus is a platform for continued policy dialogue towards cross-sectoral policy coherence and effective actions to address the growing burden of non-communicable diseases and obesity in Thailand.

The healthy food environment policy index: findings of an expert panel in New Zealand.

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.

Pilot test of the Healthy Food Environment Policy Index (Food-EPI) to increase government actions for creating 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...

The Healthy Food Environment Policy Index in New Zealand: Experts’ assessments of policy gaps and priorities for the Government

The Healthy Food Environment Policy Index in New Zealand: Experts’ assessments of policy gaps and priorities for the Government

Development and overview of the Government Healthy Food Environment Policy Index for assessing and benchmarking government policies globally

Development and overview of the Government Healthy Food Environment Policy Index for assessing and benchmarking government policies globally

Attentional bias and response inhibition in obese individuals: A systematic review

monitoring framework was developed based on a review of recommendations for improving food environments and population diets from United Nations bodies, governments and expert advisory groups, and a week-long consultation with international experts. The resulting Government Healthy Food Environment Policy Index (Food-EPI) comprises a ‘policy’ component with seven domains to improve the healthiness of food environments, and an ‘infrastructure support’ component with seven domains to strengthen systems to prevent obesity and diet-related NCDs. Good practice statements are proposed within each domain, and those will evolve into best existing practice exemplars in the future. A rating process is proposed for assessing a government’s level of policy implementation towards good practice and involves the following steps: 1. context analysis, 2. collection of relevant policy documents, 3. evidence-grounding the policies and actions, 4. validation of evidence with government officials, 5. rating of government policies by non-government public health experts and organisations, 6. weighting and aggregation of scores and calculation of the Food-EPI, 7. collection of comments and recommendations from raters, and 8. translation of results for governments and stakeholders. This process ideally should be driven by an existing or formed ‘national coalition’ of public health non-government organisations and researchers. The Food-EPI will be pre-tested and piloted in countries of varying size and income levels, and may potentially increase and improve government policies and actions to reduce obesity and NCDs.

Monitoring and benchmarking government policies and actions to improve the healthiness of food environments: a proposed Government Healthy Food Environment Policy Index

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.