Public Sector Policies and Actions (Food-EPI)

How much progress have national governments made towards best practice in improving the healthiness of food environments and implementing obesity/non-communicable diseases (NCDs) prevention policies and actions?

Government action is essential to increase the healthiness of food environments and reduce obesity, diet-related NCDs, and their related inequalities.

A Healthy Food Environment Policy Index (Food-EPI) has been developed by INFORMAS, which comprises a ‘policy’ component with seven domains on specific aspects of food environments, and an ‘infrastructure support’ component with six domains to strengthen systems to prevent obesity and NCDs. The index consists of 13 domains and 47 good practice indicators. A national expert panel rates the level of implementation of policies on food environments by the Government against international best practice, and then based on the implementation gaps, proposes and prioritizes key actions for implementation by the government.

Dr Stefanie Vandevijvere

Senior Research fellow

Department of Epidemiology and Biostatistics,
School of Population Health
The University of Auckland
Email: Stefanie Vandevijvere

Monitoring and benchmarking government policies and actions to improve the healthiness of food environments: a proposed Government Healthy Food Environment Policy Index (pages 24–37) B. Swinburn, S. Vandevijvere, V. Kraak, G. Sacks, W. Snowdon, C. Hawkes, S. Barquera, S. Friel, B. Kelly, S. Kumanyika, M. L’Abbé, A. Lee, T. Lobstein, J. Ma, J. Macmullan, S. Mohan, C. Monteiro, B. Neal, M. Rayner, D. Sanders, C. Walker and INFORMAS

Read the INFORMAS paper online here

Additional Publications

Food-EPI New Zealand 2017

Experts call for action to fill gaps on healthy food policies

New Zealand needs major improvements in food policies if it is going to seriously tackle the country’s obesity epidemic, according to findings in the University of Auckland’s second Healthy Food Environment Policy Index (Food-EPI) published on 24 July 2017.

Cover Picture for Food-EPI

*

Full Food-EPI 2017
This is the full Food-EPI report (1.0 MB, PDF)

*

Food-EPI Executive Summary
This is the Executive Summary of the Food-EPI report (342.9 kB, PDF)

The Food-EPI was first published in 2014. The 2017 version was conducted in 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’.

Today’s report shows that 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, there were a large number of healthy food policies that still need to be implemented in New Zealand.

Nutrition expert Professor Boyd Swinburn says some progress had been made in some areas since 2014, but that New Zealand is still in the grips of an obesity crisis and progress to improve children’s health remained very slow.

“Many large implementation gaps were identified by the experts, including for policies recommended by the World Health Organisation such as healthy food in schools, fiscal policies and marketing restrictions for unhealthy foods.”

Professor Swinburn, of the University’s School of Population Health, says the Expert Panel recommended 53 actions in total but prioritised 9 for immediate action.

The 9 recommendations for immediate action are:

  1. Strengthen the Childhood Obesity Plan
    1. Including policy objectives and targets to reduce obesity prevalence and inequalities, and more and stronger policies to create healthy children’s food environments,
    2. Increasing funding for the implementation and evaluation of the plan.
  2. Set targets for
    1. reducing childhood overweight and obesity by 8 percentage points (from one-third to one-quarter) by 2025 with decreasing inequalities
    2. reducing mean population intakes of salt, sugar and saturated fat based on World Health Organisation recommendations
    3. voluntary reformulation of composition (salt, sugar and saturated fat) in key food groups.
  3. Increase funding for population nutrition promotion to at least 10 per cent of obesity/overweight health care costs
  4. Regulate unhealthy food marketing as defined by the WHO nutrition profiling model, to children up to 18 years
    1. in broadcast media, including during children’s peak viewing times (up to 9pm)
    2. in non-broadcast media, including food packaging, sport sponsorship and social media
    3. in children’s settings, including ‘school food zones’.
  5. Ensure healthy food in schools and early childhood education services
  6. Introduce a substantial (eg 20 percent) tax on sugar-sweetened beverages
  7. Strengthen the Health Star Rating System
  8. Implement the new Eating and Activity Guidelines
  9. Conduct a new national nutrition survey for children

“The Expert Panel strongly urges the government 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,” Professor Swinburn says.

“Unhealthy food environments drive unhealthy diets. Dietary risk factors and excess energy intake account for 11.4 percent of health loss in New Zealand.

“New Zealand adults and children have the third highest rate of overweight and obesity within OECD countries and the costs attributed to overweight and obesity are probably close to a billion dollars a year by now. The experts recommended that about 10 percent of these costs should be spent on prevention which would mean at least a doubling of current investment in nutrition promotion.”

The report does show some good progress in other areas of food policies and infrastructure support.

The area Food Labelling scored a ‘high’ for ‘ingredient lists and/or nutrient declarations’ and ‘regulatory systems for health and nutrition claims’.

Several areas have improved their scores from the 2014 report. Under the ‘Platforms for interaction’ category, the four sub sections of co-ordination between local and national governments, platforms for government and food sector and platforms for government and civil society, as well as systems-based approach to obesity prevention, all improved from a ranking of ‘low’ in 2014 to ‘medium’ in 2017.

“The top priority from the Expert Panel was to convert the currently weak childhood obesity plan into something which has real targets for reducing prevalence and is backed by serious policies to get us there. Bringing New Zealand’s rate of childhood overweight and obesity down from one in three to one in four by 2025 was considered achievable by the panel because one in four was the current rate in Australia. However, the action on healthy food environments will need to be greatly strengthened to achieve even these modest targets,” Professor Swinburn says.

For more information contact:

Dr Stefanie Vandevijvere
Research fellow in food policy
Department of Epidemiology and Biostatistics,
School of Population Health
The University of Auckland
Email: Stefanie Vandevijvere

Food-EPI 2014

Food_EPI 2014 Report cover

*

Full Food-EPI report
This is the full Food-EPI report (930.6 kB, PDF)

*

Food-EPI Executive Summary 2014
This is the Executive Summary of the Food-EPI report (1.9 MB, PDF)

Below is the INFORMAS protocol to download. Please contact us if you would like more information. Please read the terms and agreements (embedded in the protocol) regarding the use of the protocols, and inform us if you are using and/or adapting the protocol.

You may use, modify and reproduce the protocol, but the work that results from using the INFORMAS resources remains available to the INFORMAS group and falls under the same copyleft principles as the original protocol (i.e., you can’t claim copyright on protocols you develop based on INFORMAS resources).

You don’t have to share the whole work that results from using the INFORMAS resources, but are expected to share:

  • Any modifications or updates you make to the protocol (e.g., updates for your own country)
  • The final (cleaned) data as collected using the protocol.

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 (kimiya.karbasy@utoronto.ca);

Lana Vanderlee (lana.vanderlee@uwaterloo.ca);

Mary L’Abbe (mary.labbe@utoronto.ca)

Official reports with the evidence documents:

City of Toronto

Region of Peel

City of Greater Sudbury

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 (tilly_karu@yahoo.co.uk

Food-EPI New Zealand 2017

Experts call for action to fill gaps on healthy food policies New Zealand needs major improvements in food policies if it is going to seriously tackle the country’s obesity epidemic, according to findings in the University of Auckland’s second Healthy Food Environment Policy Index (Food-EPI) published on 24 July 2017.
Cover Picture for Food-EPI
*

Full Food-EPI 2017 This is the full Food-EPI report (1.0 MB, PDF)
*

Food-EPI Executive Summary This is the Executive Summary of the Food-EPI report (342.9 kB, PDF)
 
The Food-EPI was first published in 2014. The 2017 version was conducted in 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’. Today’s report shows that 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, there were a large number of healthy food policies that still need to be implemented in New Zealand. Nutrition expert Professor Boyd Swinburn says some progress had been made in some areas since 2014, but that New Zealand is still in the grips of an obesity crisis and progress to improve children’s health remained very slow. “Many large implementation gaps were identified by the experts, including for policies recommended by the World Health Organisation such as healthy food in schools, fiscal policies and marketing restrictions for unhealthy foods.” Professor Swinburn, of the University’s School of Population Health, says the Expert Panel recommended 53 actions in total but prioritised 9 for immediate action. The 9 recommendations for immediate action are:

  1. Strengthen the Childhood Obesity Plan
    1. Including policy objectives and targets to reduce obesity prevalence and inequalities, and more and stronger policies to create healthy children’s food environments,
    2. Increasing funding for the implementation and evaluation of the plan.
  2. Set targets for
    1. reducing childhood overweight and obesity by 8 percentage points (from one-third to one-quarter) by 2025 with decreasing inequalities
    2. reducing mean population intakes of salt, sugar and saturated fat based on World Health Organisation recommendations
    3. voluntary reformulation of composition (salt, sugar and saturated fat) in key food groups.
  3. Increase funding for population nutrition promotion to at least 10 per cent of obesity/overweight health care costs
  4. Regulate unhealthy food marketing as defined by the WHO nutrition profiling model, to children up to 18 years
    1. in broadcast media, including during children’s peak viewing times (up to 9pm)
    2. in non-broadcast media, including food packaging, sport sponsorship and social media
    3. in children’s settings, including ‘school food zones’.
  5. Ensure healthy food in schools and early childhood education services
  6. Introduce a substantial (eg 20 percent) tax on sugar-sweetened beverages
  7. Strengthen the Health Star Rating System
  8. Implement the new Eating and Activity Guidelines
  9. Conduct a new national nutrition survey for children

“The Expert Panel strongly urges the government 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,” Professor Swinburn says. “Unhealthy food environments drive unhealthy diets. Dietary risk factors and excess energy intake account for 11.4 percent of health loss in New Zealand. “New Zealand adults and children have the third highest rate of overweight and obesity within OECD countries and the costs attributed to overweight and obesity are probably close to a billion dollars a year by now. The experts recommended that about 10 percent of these costs should be spent on prevention which would mean at least a doubling of current investment in nutrition promotion.” The report does show some good progress in other areas of food policies and infrastructure support. The area Food Labelling scored a ‘high’ for ‘ingredient lists and/or nutrient declarations’ and ‘regulatory systems for health and nutrition claims’. Several areas have improved their scores from the 2014 report. Under the ‘Platforms for interaction’ category, the four sub sections of co-ordination between local and national governments, platforms for government and food sector and platforms for government and civil society, as well as systems-based approach to obesity prevention, all improved from a ranking of ‘low’ in 2014 to ‘medium’ in 2017. “The top priority from the Expert Panel was to convert the currently weak childhood obesity plan into something which has real targets for reducing prevalence and is backed by serious policies to get us there. Bringing New Zealand’s rate of childhood overweight and obesity down from one in three to one in four by 2025 was considered achievable by the panel because one in four was the current rate in Australia. However, the action on healthy food environments will need to be greatly strengthened to achieve even these modest targets,” Professor Swinburn says.

For more information contact:

Dr Stefanie Vandevijvere Research fellow in food policy Department of Epidemiology and Biostatistics, School of Population Health The University of Auckland Email: Stefanie Vandevijvere

Food-EPI 2014
Food_EPI 2014 Report cover
 
*

Full Food-EPI report This is the full Food-EPI report (930.6 kB, PDF)
*

Food-EPI Executive Summary 2014 This is the Executive Summary of the Food-EPI report (1.9 MB, PDF)
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