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)
Food-EPI has been repeated in New Zealand in the years of the 2014 and 2017 national elections. 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:
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:
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:
The Healthy Food Environment Policy Index is currently being implemented in about 14 countries globally. Some countries have finished the process and if you click on the name of the country you will be referred to available reports and publications.
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
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
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
26 Independent Malaysian public health experts undertook the policy analysis with rating against international best practice. Priority recommendations were generated to close critical gaps in policy implementation. Food-EPI findings were disseminated to the new Malaysian government, as well as other South East Asian stakeholders, to strengthen national and regional food policies that would promote healthier food behaviours.