European countries score poorly on healthy food environment policies: immediate action is needed

Published on
December 7, 2022

In eleven European countries, governments should make a larger effort to support people to eat healthy by creating healthy food environments, such as raising taxes on unhealthy food or abolishing unhealthy food marketing aimed at children.

This can be read in the The Lancet Regional Health – Europe publication ‘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’.

Dr Maartje Poelman, one of the leading authors at Wageningen University & Research: "This study shows that urgent action is needed within Europe to create healthy food environments, although it also makes clear that some countries perform better than others. If we really want to prevent overweight and diet-related chronic diseases, collective primary prevention strategies are a necessity. Such structural measures provide larger health benefits at population level."

About the study on effective policies to prevent diet-related diseases

This study is the first to conduct a pooled analysis to assess the overall picture of policies in eleven European countries using the Food Environment Policy Index (Food-EPI). It visualises the different levels of implementation of food environment policies within and between different European countries and identified what actions national governments in each country should take. The Food-EPI consists of seven policy domains that represent key aspects of food environments are highlighted: food composition, food labelling, food promotion, food prices, food provision and food retail and 24 indicators referencing policy support domains, divided into the categories of leadership, governance, monitoring, funding, platforms for interaction, and health-in-all policies.

Low level of policy implementation in the Netherlands

Apart from Finland, Norway, and Portugal, all countries have predominantly ‘low’ to ‘very low’ implementation scores for policies which directly shape food environments. Also, The Netherlands, Spain, and Germany are at the bottom of the list when it comes to creating policies directly aimed at creating healthy food environments.

Experts in the eleven countries recommend immediate action in Europe. Across the eleven participating countries, a total of 212 actions are proposed to create healthy food environments. This could mean setting standards for nutrients of concern in processed foods and the improvement of school food environments, such as the inclusion of the provision of healthy school meals and foods. Also, pricing strategies such as subsidising fruit and vegetables or the taxation of foods not contributing to a healthy diet or restrictions on unhealthy food marketing to children are proposed in a number of countries.

Main outcomes

In most countries the top recommended actions for national governments include:

  • the implementation of price increases on unhealthy foods and beverages.
  • the implementation of nutrition standards in schools, including the provision of healthy school meals and foods.
  • to increase the national budget for primary prevention and health protection strategies.

In half of the countries the top recommended actions for national governments are:

  • a ban on marketing of foods for children that fall outside the healthy dietary guidelines.
  • to demonstrate leadership and commitment to obesity prevention, for example to develop of a government wide, national prevention agreement and implementation plan.
In this European study the previous outcomes of the Netherlands Food-EPI study were integrated. The study was conducted by Dr Maartje Poelman (Wageningen University & Research), Sanne Djojosoeparto and Dr Carlijn Kamphuis (Utrecht University). As part of this study, they examined national government policy on food environments. The researchers asked 28 independent Dutch experts at universities, local authorities, and health and civil society organisations to make assessments based on policy indicators referencing national government policy on the creation of a healthy food environment and policy support domains. The project was part of two EU funded consortia: the Policy Evaluation Network (PEN) to advance the evidence base for public policies impacting on dietary behavior, physical activity, and sedentary behavior in Europe (JPI Healthy Diet for a Healthy Life) and the Science & Technology in childhood Obesity Policy (STOP), a Horizon 2020-funded project to tackle childhood obesity.

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