Policy implementation and priorities to create healthy food environments using the Healthy Food Environment Policy Index (Food-EPI): A pooled level analysis across eleven European countries
Pineda, Elisa; Poelman, Maartje P.; Aaspõllu, Anu; Bica, Margarida; Bouzas, Cristina; Carrano, Elena; De Miguel-Etayo, Pilar; Djojosoeparto, Sanne; Blenkuš, Mojca Gabrijelčič; Graca, Pedro; Geffert, Karin; Hebestreit, Antje; Helldan, Anni; Henjum, Sigrun; Huseby, Camilla Sanne; Gregório, Maria João; Kamphuis, Carlijn; Laatikainen, Tiina; Løvhaug, Anne Lene; Leydon, Clarissa; Luszczynska, Aleksandra; Mäki, Päivi; Martínez, J. Alfredo; Raulio, Susanna; Romaniuk, Piotr; Roos, Gun; Salvador, Clara; Sassi, Franco; Silano, Marco; Sotlar, Ingrid; Specchia, Maria Lucia; de Arriaga, Miguel Telo; Terragni, Laura; Torheim, Liv Elin; Tur, Josep A.; von Philipsborn, Peter; Harrington, Janas M.; Vandevijvere, Stefanie
(2022) The Lancet Regional Health - Europe, volume 23
(Article)
Abstract
Background: Food environments have been recognised as highly influential on population diets. Government policies have great potential to create healthy food environments to promote healthy diets. This study aimed to evaluate food environment policy implementation in European countries and identify priority actions for governments to create healthy food environments. Methods:
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The Healthy Food Environment Policy Index (Food-EPI) was used to evaluate the level of food environment policy and infrastructure support implementation in Estonia, Finland, Germany, Ireland, Italy, the Netherlands, Norway, Poland, Portugal, Slovenia, and Spain in 2019–2021. Evidence of implementation of food environment policies was compiled in each country and validated by government officials. National experts evaluated the implementation of policies and identified priority recommendations. Findings: Finland had the highest proportion (32%, n = 7/22) of policies shaping food environments with a “high” level of implementation. Slovenia and Poland had the highest proportion of policies rated at very low implementation (42%, n = 10/24 and 36%, n = 9/25 respectively). Policies regarding food provision, promotion, retail, funding, monitoring, and health in all policies were identified as the most important gaps across the European countries. Experts recommended immediate action on setting standards for nutrients of concern in processed foods, improvement of school food environments, fruit and vegetable subsidies, unhealthy food and beverage taxation, and restrictions on unhealthy food marketing to children. Interpretation: Immediate implementation of policies and infrastructure support that prioritize action towards healthy food environments is urgently required to tackle the burden of obesity and diet-related non-communicable diseases in Europe. Funding: This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 774548 and from the Joint Programming Initiative “A Healthy Diet for a Healthy Life”.
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Keywords: Europe, Food environments, Healthy food environment policy index (Food-EPI), Non-communicable diseases (NCDs), Obesity, Public health policies, Internal Medicine, Oncology, Health Policy
ISSN: 2666-7762
Publisher: Elsevier Ltd
Note: Funding Information: This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 774548 and from the Joint Programming Initiative “A Healthy Diet for a Healthy Life”. A. Tur, C. Bouzas, and J.A. Martinez (Spain) were founded by the official funding agency for biomedical research of the Spanish government, ISCIII-CIBEROBN (CB06/03 and CB12/03) and co-founded by the European Regional Development Fund. Implementation of the Food-EPI in Germany was funded by a grant from Germany's Federal Ministry for Education and Research (BMBF) as part of Joint Programming Initiative “A Healthy Diet for a Healthy Life” (JPI HDHL) (Grant number 01EA1818I). The Food-EPI study in Poland was funded by grants from National Centre for Research and Development (NCBiR), Poland, (no. JFA PEN/I/PEN44/03/2018 and JFA PEN/I/PEN14/04/2019) as part of Joint Programming Initiative “A Healthy Diet for a Healthy Life” (JPI HDHL). The funders had no role in the design, analysis, or writing of this article. Funding Information: Many people have contributed to the development of this European Food-EPI publication. We would like to thank all governmental officials who verified the evidence document which was used for the assessment of policies influencing food environments. The evidence document was validated for completeness and accuracy. We would like to thank all experts who participated in the Food-EPI expert panel and rated the strength of current policies, formulated policy and infrastructure support actions to improve food environments in the participating European countries, and prioritised the final list of recommended actions (see Supplementary Material for an overview of the expert panels). We would also like to gratefully acknowledge the support of the INFORMAS research group, in particular Prof. Boyd Swinburn. This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 774548 and from the Joint Programming Initiative “A Healthy Diet for a Healthy Life”. A. Tur, C. Bouzas, and J.A. Martinez (Spain) were founded by the official funding agency for biomedical research of the Spanish government, ISCIII-CIBEROBN (CB06/03 and CB12/03) and co-founded by the European Regional Development Fund. Implementation of the Food-EPI in Germany was funded by a grant from Germany's Federal Ministry for Education and Research (BMBF) as part of Joint Programming Initiative “A Healthy Diet for a Healthy Life” (JPI HDHL) (Grant number 01EA1818I). The Food-EPI study in Poland was funded by grants from National Centre for Research and Development (NCBiR), Poland, (no. JFA PEN/I/PEN44/03/2018 and JFA PEN/I/PEN14/04/2019) as part of Joint Programming Initiative “A Healthy Diet for a Healthy Life” (JPI HDHL). The funders had no role in the design, analysis, or writing of this article. Publisher Copyright: © 2022 The Author(s)
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