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

Elisa Pineda; Maartje P Poelman; Anu Aaspõllu; Margarida Bica; Cristina Bouzas; Elena Carrano; Pilar De Miguel-Etayo; Sanne Djojosoeparto; Mojca Gabrijelčič Blenkuš; Pedro Graca; Karin Geffert; Antje Hebestreit; Anni Helldan; Sigrun Henjum; Camilla Sanne Huseby; Maria João Gregório; Carlijn Kamphuis; Tiina Laatikainen; Anne Lene Løvhaug; Clarissa Leydon; Aleksandra Luszczynska; Päivi Mäki; J Alfredo Martínez; Susanna Raulio; Piotr Romaniuk; Gun Roos; Clara Salvador; Franco Sassi; Marco Silano; Ingrid Sotlar; Maria Lucia Specchia; Miguel Telo de Arriaga; Laura Terragni; Liv Elin Torheim; Josep A Tur; Peter von Philipsborn; Janas M Harrington; Stefanie Vandevijvere

doi:10.1016/j.lanepe.2022.100522

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

Lancet Reg Health Eur. 2022 Nov 16:23:100522. doi: 10.1016/j.lanepe.2022.100522. eCollection 2022 Dec.

Authors

Elisa Pineda^{1

2}, Maartje P Poelman³, Anu Aaspõllu⁴, Margarida Bica⁵, Cristina Bouzas⁶, Elena Carrano⁷, Pilar De Miguel-Etayo⁸, Sanne Djojosoeparto^{3

9}, Mojca Gabrijelčič Blenkuš¹⁰, Pedro Graca¹¹, Karin Geffert¹², Antje Hebestreit¹³, Anni Helldan¹⁴, Sigrun Henjum¹⁵, Camilla Sanne Huseby¹⁵, Maria João Gregório¹¹, Carlijn Kamphuis¹⁶, Tiina Laatikainen¹⁴, Anne Lene Løvhaug¹⁵, Clarissa Leydon¹⁷, Aleksandra Luszczynska¹⁸, Päivi Mäki¹⁴, J Alfredo Martínez¹⁹, Susanna Raulio¹⁴, Piotr Romaniuk²⁰, Gun Roos²¹, Clara Salvador¹¹, Franco Sassi¹, Marco Silano²², Ingrid Sotlar¹⁰, Maria Lucia Specchia²³, Miguel Telo de Arriaga²⁴, Laura Terragni¹⁴, Liv Elin Torheim¹⁴, Josep A Tur⁶, Peter von Philipsborn²⁵, Janas M Harrington²⁶, Stefanie Vandevijvere²⁷

Affiliations

¹ Centre for Health Economics & Policy Innovation (CHEPI), Imperial College Business School, London, UK.
² School of Public Health, Imperial College London, London, UK.
³ Chair group Consumption and Healthy lifestyles, Wageningen University, Wageningen, the Netherlands.
⁴ National Institute for Health Development, Tallinn, Estonia.
⁵ National Healthy Eating Promotion Program, Directorate-General of Health, Universidade Nova de Lisboa, Lisbon, Portugal.
⁶ CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain, Research Group on Community Nutrition & Oxidative Stress, University of Balearic Islands-IUNICS & IDISBA, 07122 Palma de Mallorca, Spain.
⁷ School of Food Sciences - University of Roma Tor Vergata Roma, Italy, Carrano Elena (esterno).
⁸ Growth, Exercise, Nutrition and Development (GENUD), University of Zaragoza Research Group, Spain.
⁹ Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, the Netherlands.
¹⁰ National institute of public health (NIJZ), Ljubljana, Slovenia.
¹¹ National Healthy Eating Promotion Program, Universidade Nova de Lisboa, Directorate-General of Health, Lisbon, Portugal.
¹² Chair of Public Health and Health Services Research, Pettenkofer School of Public Health, Ludwig-Maximilians-Universitat Munchen (LMU Munich), Munich, Germany.
¹³ Leibniz Institute for Prevention Research and Epidemiology - Leibniz-Institut fur Praventionsforschung und Epidemiologie - BIPS GmbH BIPS, Bremen, Germany.
¹⁴ Finnish Institute for Health and Welfare, Finnish Institute for Health and Welfare: Terveyden ja hyvinvoinnin laitos Helsinki, Finland.
¹⁵ Department of Nursing and Health Promotion, OsloMet - Oslo Metropolitan University, Oslo, Norway.
¹⁶ Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands.
¹⁷ Centre for Health and Diet Research, School of Public Health, University College Cork, Ireland.
¹⁸ Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Poland.
¹⁹ CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain, Cardiometabolics Precision Nutrition Program, IMDEA Food, CEI UAM + CSIC, 28049 Madrid, Spain.
²⁰ Department of Health Policy, School of Health Sciences in Bytom, Medical University of Silesia in Katowice, Poland.
²¹ Consumption Research Norway - SIFO, Oslo Metropolitan University, Norway.
²² Silano, Marco, PhD, Department of Food Safety, Nutrition and Veterinary Public Health - Istituto Superiore di Sanità - Roma, Italy.
²³ Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy; Clinical Governance Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
²⁴ Division of Literacy, Health and Well-being, Directorate-General of Health, Universidade da Beira Interior, Lisbon, Portugal.
²⁵ Ludwig-Maximilians-Universität München (LMU Munich), Pettenkofer School of Public Health, Munich, Germany.
²⁶ HRB Centre for Health and Diet Research, School of Public Health, University College Cork, Ireland.
²⁷ Sciensano, Department of epidemiology and public health, Brussel, Belgium.

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: 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".

Keywords: Europe; Food environments; Healthy food environment policy index (Food-EPI); Non-communicable diseases (NCDs); Obesity; Public health policies.