An assessment of implementation gaps and priority recommendations on food environment policies: the Healthy Food Environment Policy Index (Food-EPI) in Japan

Abstract Objective: This study aimed to evaluate policies and actions for food environments by the Japanese Government using the Healthy Food Environment Policy Index (Food-EPI). Design: Public health experts rated the extent of implementation of food environment-related the Policy and the Infrastructure-support components, compared to international best practices. Subsequently, the experts proposed and prioritized future actions to address implementation gaps in an online workshop. Setting: Japan Participants: A total of 66 experts rated policy implementation by the Japanese Government, and 23 participated in the workshop on future actions. Results: The implementations of regulations on unhealthy foods and non-alcoholic beverages were rated low in the domains of Food composition, Food labelling, Food promotion, Food prices, and Food retail in the Policy component. The implementations of several domains in the Infrastructure-support component were, overall, rated at a higher level, specifically for monitoring and intelligence systems. Based on the rating, reducing health inequalities by supporting people, both economically and physically, was the highest priority for future actions in both components. Conclusions: This study found that Japan has a robust system for long-term monitoring of population health but lacks regulations on unhealthy foods and non-alcoholic beverages compared to international best practices. This study confirmed the importance of continuous accumulation of evidence through national monitoring systems. Developing comprehensive regulations to restrict food marketing, sales, and accessibility of unhealthy foods and non-alcoholic beverages are needed to improve the health of food environments in Japan.

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

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1085 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

S K Djojosoeparto ◽

C B M Kamphuis ◽

F van Lenthe ◽

M P Poelman

Keyword(s):

The Netherlands ◽

Best Practices ◽

Food Environment ◽

Online Survey ◽

National Level ◽

Healthy Food ◽

Food Environments ◽

Environment Policy ◽

National Prevention ◽

Interdisciplinary Study

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.

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OP34 The INFORMAS healthy food environment policy index (Food EPI) in Ireland: an assessment of implementation gaps and priority recommendations

10.1136/jech-2020-ssmabstracts.34 ◽

2020 ◽

Author(s):

JM Harrington ◽

C Griffin ◽

IJ Perry

Keyword(s):

Food Environment ◽

Healthy Food ◽

Environment Policy ◽

Implementation Gaps

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

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16224473 ◽

2019 ◽

Vol 16 (22) ◽

pp. 4473 ◽

Cited By ~ 1

Author(s):

Lana Vanderlee ◽

Sahar Goorang ◽

Kimiya Karbasy ◽

Stefanie Vandevijvere ◽

Mary R L’Abbé

Keyword(s):

Policy Implementation ◽

Food Environment ◽

Good Practice ◽

Critical Role ◽

Food Choices ◽

Healthy Food ◽

Food Environments ◽

Promising Practices ◽

Environment Policy ◽

Health Promoting

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.

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22.D. Workshop: The Food Environment Policy Index for the EU, Germany, the Netherlands, Norway and Poland

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1082 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

◽

Keyword(s):

Public Health ◽

The Netherlands ◽

Food Environment ◽

Food System ◽

Healthy Food ◽

Policy Implications ◽

Global Network ◽

Food Environments ◽

Environment Policy ◽

The Eu

Abstract Unhealthy diets are a key risk factor for disease and premature death in Europe and worldwide. Moreover, the food system is a key driver behind many processes of global environmental change, including climate change, biodiversity and habitat loss. Accordingly, calls have been made for a transformation of the global food system. This requires action in a variety of policy fields and on all political levels. The creation of healthy food environments through public sector action on a national and regional level is an essential aspect of this. The Food Environment Policy Index (Food-EPI) is an established methodological framework for the assessment, analysis and benchmarking of public policies influencing food environments, developed by INFORMAS, a global network of public-interest organizations. In this 90 min workshop, we will present the approach used by the Food-EPI and results from the implementation of the Food-EPI on the EU level and in Germany, the Netherlands, Norway and Poland, followed by a joint discussion of lessons learnt and key policy implications. The Food-EPI has two components (policy and infrastructure support domains) covering a total of 13 domains and 47 indicators. For each indicator, policies and actions are compiled and benchmarked against international best practice by independent experts and stakeholders. Based on this assessment, priority actions for reform are identified. Policy makers and independent public health and nutrition experts are involved in key steps of the process to ensure policy relevance and impact. Key messages The systematic assessment and benchmarking of nutrition policies helps to identify priority actions to improve food environments and enhances government accountability for public health. Both on the EU level and in EU member states, governments have taken action to support healthy food environments, but considerable room for improvement remains.

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Benchmarking the implementation of recommended food environment policies in Norway using the Healthy Food Environment Policy Index (Food-EPI)

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1086 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

L E Torheim ◽

A L Løvhaug ◽

S Henjum ◽

L Terragni ◽

G Roos

Keyword(s):

Public Health ◽

Policy Implementation ◽

Food Environment ◽

Social Inequalities ◽

Good Practice ◽

Critical Role ◽

Healthy Food ◽

Food Environments ◽

Policy Action ◽

Environment Policy

Abstract 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.

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

Public Health Nutrition ◽

10.1017/s1368980016002391 ◽

2016 ◽

Vol 20 (3) ◽

pp. 381-390 ◽

Cited By ~ 15

Author(s):

Sirinya Phulkerd ◽

Stefanie Vandevijvere ◽

Mark Lawrence ◽

Viroj Tangcharoensathien ◽

Gary Sacks

Keyword(s):

Food Environment ◽

Best Practice ◽

Food Policy ◽

Food Composition ◽

Healthy Food ◽

Food Environments ◽

Policy Dialogue ◽

Policy Coherence ◽

Thai Government ◽

State Actors

AbstractObjectiveTo 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.DesignData 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.SettingThailand.SubjectsThirty state actors and twenty-seven non-state actors.ResultsLevel 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.ConclusionsAlthough 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.

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

BMJ Open ◽

10.1136/bmjopen-2014-006194 ◽

2015 ◽

Vol 5 (1) ◽

pp. e006194-e006194 ◽

Cited By ~ 14

Author(s):

S. Vandevijvere ◽

B. Swinburn ◽

Keyword(s):

Food Environment ◽

Healthy Food ◽

Food Environments ◽

Pilot Test ◽

Environment Policy

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

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1232 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

D Zace ◽

M L Specchia ◽

A Di Pilla ◽

E Carini ◽

P Cacciatore ◽

...

Keyword(s):

Policy Implementation ◽

Burden Of Disease ◽

Food Environment ◽

Good Practice ◽

Critical Role ◽

Food Prices ◽

Healthy Food ◽

Food Environments ◽

Level Of Evidence ◽

Italian Government

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.

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Benchmarking for accountability on obesity prevention: evaluation of the Healthy Food Environment Policy Index (Food-EPI) in Australia (2016 – 2020)

Public Health Nutrition ◽

10.1017/s136898002100447x ◽

2021 ◽

pp. 1-25

Author(s):

Janelle Kwon ◽

Erica Reeve ◽

Davina Mann ◽

Boyd Swinburn ◽

Gary Sacks

Keyword(s):

Food Environment ◽

Response Rate ◽

Good Practice ◽

Healthy Food ◽

Food Environments ◽

Policy Action ◽

Online Surveys ◽

Environment Policy ◽

Support Policy ◽

The Impact

Abstract Objective: Despite broad agreement on the need for comprehensive policy action to improve the healthiness of food environments, implementation of recommended policies has been slow and fragmented. Benchmarking is increasingly being used to strengthen accountability for action. However, there have been few evaluations of benchmarking and accountability initiatives to understand their contribution to policy change. This study aimed to evaluate the impact of the Healthy Food Environment Policy Index (Food-EPI) Australia initiative (2016-2020) that assessed Australian governments on their progress in implementing recommended policies for improving food environments. Design: A convergent mixed methods approach was employed incorporating data from online surveys (conducted in 2017 and 2020) and in-depth semi-structured interviews (conducted in 2020). Data were analysed against a pre-defined logic model. Setting: Australia. Participants: Interviews: 20 stakeholders (16 government, 4 non-government). Online surveys: 53 non-government stakeholders (52% response rate) in 2017; 34 non-government stakeholders (36% response rate) in 2020. Results: The Food-EPI process involved extensive engagement with government officials and the broader public health community across Australia. Food-EPI Australia was found to support policy processes, including as a tool to increase knowledge of good practice, as a process for collaboration, and as an authoritative reference to support policy decisions and advocacy strategies. Conclusions: Key stakeholders involved in the Food-EPI Australia process viewed it as a valuable initiative that should be repeated to maximise its value as an accountability mechanism. The highly collaborative nature of the initiative was seen as a key strength that could inform design of other benchmarking processes.

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