Implementing healthy food environment policies in Aotearoa

This briefing outlines how we conducted Food-EPI in Aotearoa NZ. It looks at progress by the Government on food environment policies and infrastructure support and concludes with an urgent call to action. This research was conducted by Health Coalition Aotearoa and The University of Auckland and supported by over 60 public health experts. 

How was Food-EPI conducted?

Diet-related non-communicable diseases are the biggest preventable cause of death in Aotearoa NZ¹. These are related to our food environments². Health Coalition Aotearoa and The University of Auckland recently conducted Food-EPI (Healthy Food Environment Policy Index) for the fourth time in New Zealand. Food-EPI is an initiative of INFORMAS that assesses government actions contributing to improving food environments and implementation of policies and actions to prevent obesity and nutrition-related non-communicable diseases³. Food-EPI was conducted in May 2023 with an Expert Panel of over 60 independent and government public health and nutrition experts, and previously in 2014, 2017 and 2020 ⁴.

Food-EPI considers government actions in two areas, policy and infrastructure support. Thirteen different domains with 47 good practice indicators are assessed (Figure 1). We compiled evidence of current implementation in NZ for policies on food environments and infrastructure support by documenting publicly available information and validating this with government officials.

Figure 1: Level of implementation of food environment policies and infrastructure support by the New Zealand Government in 2023 against international best practice

What progress has Government made?

Using this evidence, the research team benchmarked policies and actions of the Government against international best practice for creating healthier food environments. The level of implementation was categorised as ‘high’, ‘medium’, ‘low’ or ‘very little, if any’. When we looked back over all four Food-EPI assessments there has been remarkably little progress over the last 12 years.

Nevertheless, some progress has been made since 2017 regarding the provision of healthy school lunches (Ka Ora Ka Ako), implementing the recommendations of the review of the Health Star Rating System, and planning for a future national nutrition survey. While some policies were considered at the level of international best practice, Aotearoa NZ was seen to be falling short in many areas including for healthy food and drinks in all schools, fiscal policies influencing food costs, and restricting the marketing of unhealthy foods and drinks that children see. Gaps were also identified relating to inadequate national infrastructure support for prevention of obesity and diet-related diseases, in particular the lack of government leadership and limited monitoring of progress.

What actions are recommended?

We held three workshops with over 60 participants (the Expert Panel) in May 2023 to recommend actions for the NZ Government. Following the workshops, 50 experts ranked these actions by importance and feasibility, to recommend actions for immediate implementation. Experts were asked to consider the impacts of the actions on health, environmental sustainability, national and local food sovereignty, and equity, as well as adherence to the principles of Te Tiriti o Waitangi.

Over-arching enabling actions and ten specific actions were prioritised to improve the healthiness of New Zealand’s food environments, grouped into four main areas: Food Systems and Nutrition Strategy; People’s capacity; Infrastructure; Healthier Food Environments (Figure 2).

The Expert Panel expressed concern about the extent of food insecurity exposed by the cost-of-living increases, prioritising ‘mana motuhake’ to ensure households receive an adequate income to enable autonomy to make healthy food choices.

The Expert Panel was very clear that for any progress to be made, there needs to be clear leadership from the Public Health Agency, and development of a government-led multi-sectoral National Food Systems and Nutrition Strategy.

Also of major concern was the need for committed funding for a national nutrition survey, with the previous Child and Adult Nutrition Surveys conducted 21 and 15 years ago respectively. Major policy decisions are being made in the absence of evidence about the current nutrition status, food consumption patterns of the population and food supply.

To protect our children’s health the Expert Panel calls for mandatory policies to restrict the marketing of unhealthy food that children see, and that only healthy foods and drinks are provided or sold in schools and early learning services. Previous voluntary approaches have proven to be ineffective as they are not enforceable and therefore not implemented or adhered to.

These actions would collectively result in positive outcomes for environmental sustainability, economic prosperity, improved health and increased equity. If the New Zealand Government invests in the highly cost-effective policies and programs recommended by WHO5 we could meet the standard of those countries currently leading the world on food policies for health and wellbeing.

Author details

Dr Sally Mackay is a Registered Nutritionist and Senior Lecturer at The University of Auckland, School of Population Health. She is co-chair of the Health Coalition Aotearoa (HCA) Food Expert Panel

Assoc Prof Lisa Te Morenga is a nutrition and Māori health researcher at Massey University, Research Centre for Hauora and Health. She is co-chair of both HCA and the HCA Food Expert Panel.

Acknowledgements to Hinako Percival for compiling the evidence document and assisting with the organisation and facilitation of the workshops and to Boyd Swinburn as a co-investigator for Food-EPI. The authors have no competing Interests.

Additional information