Effective government policies are essential to increase the healthiness of food environments and to reduce obesity, NCDs, and their related inequalities. Food environments are defined as the collective physical, economic, policy and socio-cultural surroundings, opportunities and conditions that influence people’s food and beverage choices and nutritional status. Unhealthy food environments lead to unhealthy diets and excess energy intake which have consequences in levels of morbidity and mortality. It is critical that Governments implement preventive policies and actions to match the magnitude of the burden that unhealthy diets are creating. Monitoring the level of implementation of the policies and actions recommended by the World Health Organization (WHO) is an important part of ensuring progress towards better nutritional health.
The Food-EPI index consists of two components (Policies and Infrastructure Support), 13 domains and 47 good practice indicators. A national expert panel aims to rate the level of implementation of policies on food environments by the Government against international best practice, and then, based on the implementation gaps, propose and prioritize key actions for implementation by the government.
In the following video Professor Boyd Swinburn, who coordinates INFORMAS globally, explains the Food-EPI tool and process:
The Healthy Food Environment Policy Index (Food-EPI)
In Australia, the Food-EPI was applied at the federal, as well as the state level. The project team worked closely with government officials to document current policy actions (up to 30 June 2016) in each jurisdiction, across 42 policy areas of the Food-EPI tool. Over 100 experts (including academics, nutritionists, and senior representatives from health NGOs and community groups) from 53 organisations assessed the extent of implementation in each policy area, for each level of government. They also identified policy recommendations for each jurisdiction, and prioritised them based on their perceived importance and achievability. Food-EPI Executive Summary Report Australia
The 2019 Food Policy Index Update report provides a follow up to the 2017 Food Policy Index report. It summarises and assesses the actions taken by Australian governments (July 2016 – December 2018) in relation to the recommended policies identified in the 2017 report. Food-EPI Update 2019
A panel of more than 70 non-governmental experts from 44 universities and non-governmental and professional organizations from across Canada gathered to comprehensively assess Canadian food environment policies compared to international benchmarks of current best practices. Food-EPI Full Report Canada “Creating Healthier Food environments in Canada: Current policies and priority actions” Executive Summary
Canadian adaptation of Food-EPI to municipalities
Local or municipal governments are often the first to implement innovative healthy food policies, as exemplified in the policy development of menu labelling of calories and taxes on sugar-sweetened beverages, and municipal policy has been shown to influence state/provincial and federal level legislation through bottom-up policy diffusion, as seen clearly in the development of tobacco regulations over time. The study was the first adapt the Healthy Food Environment Policy Index (Food-EPI) to the municipal context, known as the Local Food-EPI, and pilot the framework to identify policies and infrastructure supports implemented in three municipal jurisdictions in Ontario, Canada with different population densities and governance structures: The City of Toronto, Region of Peel, and the City of Greater Sudbury.
While municipal governments in Ontario are using a variety of approaches to create healthy food environments, local government and non-government experts agreed there are areas for further improvement. The Local Food-EPI can be used by municipal jurisdictions to evaluate the strengths, weaknesses, and gaps in their local food environment policies.
For more information on the Local Food-EPI, please contact
Kimiya Karbasy (firstname.lastname@example.org);
Lana Vanderlee (email@example.com);
Mary L’Abbe (firstname.lastname@example.org)
Official reports with the evidence documents:
A Food-EPI was conducted for England with a national Expert Panel involving 73 experts from 41 organisations. This Index evaluates how well England is doing in the development of healthy food policies and identifies priorities for action. The Food-EPI was launched in Parliament in November 2016. Food-EPI Full Report England Food Environment Policy Brief England Food-EPI infographics UK
Larr, A., Barnes, A., Bash, K., Aryeeley, R., Mensah, K., Vandevijvere, S., & Holdsworth, M. (2019). Benchmarking Ghana’s Policies for Creating Healthy Food Environments. doi:10.17608/k6.auckland.8188763
Asiki, G; Wanjohi, M; Barnes, A; Bash, K; Vandevijvere, S, Muthuri S, Kimani E, Holdsworth, M. (2019). Benchmarking policies for creating healthy food environments in Kenya to prevent diet-related non-communicable diseases (NCDs). Healthy Food Environment Policy Index (Food-EPI) country scorecards and priority recommendations for action in Kenya. doi.org/10.17608/k6.auckland.8251415
The Healthy Food-Environment Policy Index (Food-EPI) report card is now in the public domain for Malaysia since 2018. The Food-EPI tool, developed by INFORMAS, has 47 indicators relating to food environment policies and infrastructure support. Data collected between August 2016 and April 2017 covered 13 Government Ministries, at Federal level. The engagement process of the Food-EPI enabled participation of government stakeholders, even during the benchmarking process which saw 26 public health experts from non-governmental organisations (n=15) and academia or professionals (n=11) rating the extent of implementation of the policies in Malaysia, against international best practice.
In general, a majority (62%) of policy areas were rated as low implementation (26-50%), with 38% as medium implementation (51-75%). A total of 8 domains covering both ‘policy’ and ‘infrastructure support’ components were prioritised as most important and achievable measures for the government, in facilitating a healthy food environment. For more details on these findings, please refer to the technical report titled, “Food-Environment Policy Index (Food-EPI): Benchmarking Current Priorities and Determining Priorities for Future Policies for the Malaysian Government 2016-2017”.
For more information on this project, please contact:
Prof. Tilakavati Karupaiah (email@example.com)
Food-EPI has been repeated in New Zealand in the years of the 2014 and 2017 national elections and is currently being repeated in 2020. New Zealand has an unacceptably high prevalence of overweight and obesity. Two in three adults and one in three children are overweight or obese. Diet-related non-communicable diseases (NCDs), such as diabetes, cardiovascular diseases and cancer, are the biggest cause of death and ill-health in New Zealand and they are preventable. Dietary risk factors (high salt intake, high saturated fat intake and low fruit and vegetable intake) and excess energy intake (high body mass index) account for 11.4% of health losses in New Zealand. It is critical that the New Zealand Government implements preventive policies and actions to match the magnitude of the burden that unhealthy diets are creating in New Zealand. Monitoring the level of implementation of the policies and actions recommended by the World Health Organisation (WHO) is an important part of ensuring progress towards better nutritional health for New Zealanders.
The 2017 Food-EPI was conducted from April to May 2017 by a New Zealand Expert Panel of 71 independent and government public health experts who rated the extent of implementation of policies on food environments and infrastructure support by the New Zealand Government against international best practice. Their ratings of each of the 47 good practice indicators were based on documented evidence, validated by government officials, and international best practice benchmarks. The level of implementation was categorised as ‘high’, ‘medium’, ‘low’, or ‘very little, if any’. Over two thirds of the specific food policy indicators but less than one third of the infrastructure support were rated as ‘low’ or ‘very little, if any’ implementation. Taxes on unhealthy foods and beverages and zoning laws to restrict unhealthy food outlets around schools had no evidence of implementation whereas restricting unhealthy food marketing to children and having healthy food policies in schools and early childhood centres were rated as low implementation. Four workshops around the country with the experts also identified and prioritised actions for the Government to improve food environments and contribute to a reduction in obesity and diet-related diseases. The unique report card, funded by the Health Research Council, is New Zealand’s second systematic study on national food policies and it showed that, while there were some strengths, many large implementation gaps were identified by the experts, including for policies recommended by the World Health Organisation The Government is performing well, at the level of international best practice, in preventing unhealthy foods carrying health claims, providing nutrition information panels on packaged foods, transparency in policy development processes, providing access to information for the public and monitoring prevalence of chronic diseases and their risk factors and inequalities. Experts recognized progress since 2014 for implementation of the Health Star Ratings, initiating systems-based approaches with communities, developing and implementing the Healthy Food and Drink Policy in the public sector and improving platforms for interaction between Government and other sectors and across Government. There are however major implementation gaps with about 70% of the recommended policies such as healthy food in schools, fiscal policies and marketing restrictions for unhealthy foods. One third of the infrastructure support systems rated as ‘low’ or ‘very little, if any’ implementation.. The Expert Panel recommended 53 actions in total but prioritised 9 for immediate action.The Government is strongly urged to act on these recommendations to improve the diets of New Zealanders, especially for children, and to reduce the burgeoning health care costs of obesity and unhealthy diets. The 9 recommendations for immediate action are:
- Strengthen the Childhood Obesity Plan
Including policy objectives and targets to reduce obesity prevalence and inequalities, and more and stronger policies to create healthy children’s food environments and increasing funding for the implementation and evaluation of the plan.
- Set targets for
- reducing childhood overweight and obesity by 8 percentage points (from one-third to one-quarter) by 2025 with decreasing inequalities
- reducing mean population intakes of salt, sugar and saturated fat based on World Health Organisation recommendations
- voluntary reformulation of composition (salt, sugar and saturated fat) in key food groups.
- Increase funding for population nutrition promotion to at least 10 per cent of obesity/overweight health care costs
- Regulate unhealthy food marketing as defined by the WHO nutrition profiling model, to children up to 18 years
- in broadcast media, including during children’s peak viewing times (up to 9pm)
- in non-broadcast media, including food packaging, sport sponsorship and social media
- in children’s settings, including ‘school food zones’.
- Ensure healthy food in schools and early childhood education services.
- Introduce a substantial (eg 20 percent) tax on sugar-sweetened beverages.
- Strengthen the Health Star Rating System.
- Implement the new Eating and Activity Guidelines.
- Conduct a new national nutrition survey for children.
The executive summary, Food Epi score card, full evidence document and online appendices, can be found here below: Food-EPI Executive Summary 18 July 2017 Food-EPI Scorecard 2017 Food-EPI Full Report 18 July 2017 Food-EPI Online Appendices 2017
More than 50 experts participated in the first Food-EPI in May 2014. It was found that the New Zealand Government was performing well, at the level of international best practice, in regards to preventing unhealthy foods carrying health claims, providing ingredient lists and nutrition information panels on packaged foods, transparency in policy development processes, providing access to information for the public and monitoring prevalence of NCDs and their risk factors. However, major ‘implementation gaps’ were identified with the level of implementation of about three quarters (74%) of the policy indicators and half (48%) of the infrastructure support indicators rated as ‘low’ or ‘very little, if any’ compared to international best practice. There was no comprehensive obesity/NCD action plan and restrictions on unhealthy food marketing to children, fiscal policies, food retail policies and protection of food environments from trade and investment agreements were virtually non-existent. The ratings were informed by extensive documented evidence of current implementation of policies by the Government, validated by government officials, and international best practice examples or benchmarks for each of the indicators. The summary and scorecard from 2014 can be found here: Executive Summary and Scorecard 2014 Based on the implementation gaps identified, the Expert Panel recommended 34 concrete actions to improve the healthiness of food environments, prioritising 7 for immediate action:
- Implement a comprehensive national action plan for obesity and NCD prevention.
- Set priorities in Statements of Intent and set targets for:
- reducing childhood & adolescent obesity
- reducing salt, sugar & saturated fat intake
- food composition (salt & saturated fat) in key food groups.
- Increase funding for population nutrition promotion, doubling it to at least $70m/year.
- Reduce the promotion of unhealthy foods to children and adolescents by:
- restricting the marketing of unhealthy foods to children & adolescents through broadcast and non-broadcast media
- ensuring that schools and ECE services are free of commercial promotion of unhealthy foods.
- Ensure that food provided in or sold by schools and ECE services meets dietary guidelines.
- Implement the front-of-pack Health Star Rating labelling system.
- Introduce an excise tax of at least 20% on sugar-sweetened beverages.
The full Food-EPI report 2014 can be found here: Food-EPI Full Report 2014