Policies for tackling and creating healthier food environments

Scorecard and priority recommendations for the South

February 2017 Further details available at www.foodpolicyindex.org.au

SA

Top 3 Things South is doing well (with reference to international best practice)

Executive Regular monitoring of nutrition status and summary rates of overweight and obesity in South Australian children and Unhealthy diets and obesity Monitoring adults are leading contributors to poor . Regulations to provide Addressing obesity and kilojoule labelling on menus, steps to improve improving population diets the healthiness of food requires a comprehensive through the Premier’s Food ‘Healthy Kids Menus service government response at the Initiative’ Commonwealth and State/ Territory levels. Mechanisms to incorporate population health considerations into policy development 101 experts from 53 organisations Health-in- processes across the assessed the extent to which governments all-Policies South Australian in Australia are implementing globally government recommended policies for tackling obesity and creating healthier food environments.

Top 5 policy recommendations for

Leadership: School food: Food promotion: Monitoring: Leadership: support develop a mandate implement policies actively monitor local governments comprehensive implementation of to restrict the food environments, to develop and strategy and healthy school food promotion of including marketing implement plans to implementation guidelines in all unhealthy foods in of unhealthy foods create healthy food plan for addressing schools, and actively settings controlled to children, and environments and population nutrition monitor compliance or managed by the food in schools improve population needs in South South Australian and public sector nutrition Australia government settings

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FPI South Australia | Page 2 Obesity and diet-related diseases in Australia are a public health crisis

Unhealthy diets and obesity are leading contributors to poor health and non-communicable diseases (NCDs) in Australia.1 Almost 2 out of 3 (63%) Australian adults and 1 in 4 (25%) Australian children are overweight or obese.2 The costs associated with overweight and obesity have been estimated at over $56 billion each year.3

Comprehensive Food Policy Index government policy A Food Policy Index was developed for Australia to assess the food- and diet-related policies that are in action is needed place and identify gaps. This was based on the Healthy Food Environment Policy Index (Food-EPI)4 that was Addressing obesity and improving developed by INFORMAS5, an international network of experts in food policy, and has been applied in several population diets requires a countries. comprehensive government response The Food-EPI covers all of the key policies in this area, at Commonwealth and State/ including specific aspects of food environments (such Territory levels. as food composition, labelling, promotion, prices and provision) that have been shown to have an important impact on population diets and obesity, This project aimed to assess the extent to which and infrastructure support (including leadership, governments in Australia are implementing globally governance, monitoring and funding) that helps recommended policies for tackling obesity and creating facilitate effective policy implementation. healthier food environments, and identify prioritised actions for each government.

Process for assessing extent of policy implementation in Australia

Document Convene Assess Prioritise Synthesise all relevant policy a panel of how well Australian recommended the results for details (up to 30 independent governments were actions for each each jurisdiction, June 2016) for the non-government doing compared with jurisdiction to in consultation Federal government experts ** in each current international address with government and each State/ State / Territory best practice ***, implementation officials Territory, in (n=101 overall, considering policy gaps, in conjunction consultation with 14 in SA) characteristics with expert panel government and extent of members officials * implementation

1 Australian Institute of Health and Welfare 2016. Australian Burden of * Detailed summaries of each government’s policy details are available at Disease Study (2011) www.foodpolicyindex.org.au 2 Australian Institute of Health and Welfare; 2017: ** Panel members included academics, nutritionists, and senior http://www.aihw.gov.au/overweight-and-obesity/ representatives from health NGOs and community groups with expertise 3 Colagiuri S, et al. The cost of overweight and obesity in Australia. in population nutrition and / or obesity prevention MJA 2010; 192 (5):260-264 *** Global benchmarks as identified by INFORMAS. As more countries 4 Swinburn B, et al. Monitoring and benchmarking government complete the Food-EPI assessment process and new evidence of policy policies and actions to improve the healthiness of food environments: action emerges, benchmarks are likely to change, informing future the government healthy food environment policy index. Obesity iterations of the tool. The Federal government and each State/Territory Reviews 2013; 14 Suppl 1:24-37 were assessed separately; however, in some policy areas, policy 5 development involves collaboration between Federal and State/Territory International Network for Food and Obesity/NCDs Research, governments, and implementation of national guidance and policy is at Monitoring and Action Support the discretion of each jurisdiction. FPI South Australia | Page 3 Scorecard for South Australia

Expert panel’s assessment of South Australia’s Very little, level of implementation (up to 30 June 2016) if any Low Medium High of key policies for tackling obesity and creating healthier food environments

Food labelling Menu labelling Food Restrict promotion of unhealthy food in non-broadcast media promotion Restrict promotion of unhealthy food in children’s settings Food provision Policies in schools promote healthy food choices Policies in public settings promote healthy food choices Support and training systems for public sector settings Support and training systems for private companies Food retail Planning policies and zoning laws: unhealthy foods Planning policies and zoning laws: healthy foods Retail store availability of healthy and unhealthy foods Food service outlet availability of healthy and unhealthy foods Leadership Strong, visible, political support for population nutrition Comprehensive implementation plan linked to state/national needs Priorities for reducing inequalities related to nutrition Governance Restricting commercial influence on policy development Transparency and access to government information Assessing the potential health impacts of all policies Monitoring & Monitoring food environments intelligence Monitoring population nutrition intakes Monitoring population body weight Evaluation of major programs and policies Funding & Research funding for obesity & NCD prevention resources Independent health promotion agency Support for Mechanisms to support community-based interventions communities Implementation of social marketing campaigns Food and nutrition in education curricula

FPI South Australia | Page 4 Prioritised recommended actions for the South Australian government

Domain Recommended policy action SA1 Leadership Develop a comprehensive strategy, with a clear implementation plan and associated funding, that includes addressing population nutrition needs in South Australia SA2 Food Mandate comprehensive implementation of guidelines in the 'Right Bite' (healthy school food) policy in all schools and preschools. provision Actively monitor the extent to which schools comply, and introduce reporting mechanisms, incentives and stronger support systems to increase awareness and compliance SA3 Food Implement policies to restrict the promotion of unhealthy food and beverages in settings controlled or managed by the South promotion Australian government (e.g., public transport, bus shelters, government-owned billboards, sporting facilities and events) SA4 Monitoring Implement ongoing monitoring of food environments, including the extent of marketing of unhealthy foods to children, and the and nutritional quality of food provided / available in schools and public sector settings (such as hospitals, other government facilities intelligence providing food service) SA5 Leadership Support local governments to develop and implement Regional Public Health Plans that include actions to create healthy food environments and improve population nutrition SA6 Funding and Establish an independent, statutory health promotion agency, with a secure funding stream, that includes an objective to improve resources population nutrition SA7 Food Require all organisations, such as community groups and sports clubs, that receive funding from the South Australian government to promotion restrict all promotion related to unhealthy food and beverages as a condition of receiving funding SA8 Food Establish a whole-of-government policy on healthy food procurement and provision across all SA government departments and provision settings under government control (e.g., sport and recreation facilities, community events) SA9 Support for Commit to ongoing, long-term support for social marketing campaigns promoting healthy eating, as part of broader efforts to communities improve population nutrition SA10 Support for Building on the work of OPAL, put in place overarching state-wide structures, with associated resources, to provide broad and communities coordinated support for creating and maintaining healthy food environments at the community level across multiple settings SA11 Food retail Develop and implement programs, including incentives or accreditation schemes, for sports and recreation venues and clubs to sell a healthier range of food and beverages whilst limiting availability of unhealthy food and beverages SA12 Food Provide greater support for early childhood services to develop and implement best practice healthy food policies provision SA13 Food retail Pending a successful pilot, explore the potential to extend the Premier's 'Healthy Kids Menus Initiative' to apply to all food service outlets and restaurants in South Australia, including incentives or accreditation schemes for restaurants, pubs and clubs to improve the healthiness of all their menu options SA14 Monitoring Introduce regular measuring of children's height and weight at key stages of primary and secondary schools, on an 'opt-out' consent and basis intelligence SA15 Governance Continue a health-in-all-policies approach to relevant government priorities. Ensure that where priorities are relevant to population nutrition and health issues, these are considered at each stage of the policy development process SA16 Food Enhance existing menu labelling regulations by requiring a broad range of outlets to display interpretive nutrition labelling (broader labelling than kilojoule labelling), potentially through adaptation of the Health Star Rating scheme

SA

SA1 SA SA SA1

SA SA SA11 SA1 SA

SA1 SA SA1 SA1 SA1 SA Achievability

mportance

Recommended actions were developed by panel members, and prioritised taking into account their perceptions of the relative importance (including perceived need, likely impact and equity) and achievability (including feasibility, level of acceptability to a wide range of key stakeholders, affordability and cost-effectiveness) of each action

FPI South Australia | Page 5 Benchmarks of good practice Policy actions targeting food environments

Domain Policy area International best practise Leading State / Territory in Australia (as identified by INFORMAS) (as per assessments as part of this project)

Food Menu labelling South Korea All fast-food outlets required ACT/NSW/QLD/SA Large fast food chains required to display average labelling to display detailed nutrition information energy content on menus and overall average daily energy intake. (incl. energy, total sugars, protein, NSW supports continued monitoring and evaluation of menu labelling saturated fat and sodium) on menus Food Restrict Quebec, Canada Ban on all commercial ACT Advertising of unhealthy food on government-run buses is promotion promotion advertising directed to children (under 13 restricted, other options under consideration of unhealthy years) through any medium food in non- broadcast media Restrict Spain Legislation requires that ACT Advertising and promotion of red/amber foods or drinks is promotion of kindergartens and schools are free from all restricted at ACT Health facilities and activities. ACT actively exploring unhealthy food advertising options that reduce promotion of unhealthy foods in children’s in children’s settings settings Food Policies in UK Mandatory nutritional standards for all All states and territories have policies for healthy school food provision schools promote food served in schools -restrictions on high provision. ACT has several initiatives designed to increase policy healthy food fat/sugar/salt/processed foods compliance, including a requirement for license agreements with choices canteen operators and active monitoring. WA requires principals to develop whole-of-school food provision policies Policies in New York City, USA Mandatory ACT Mandatory restrictions on the sale/promotion/placement of public settings nutritional standards for all food unhealthy foods in ACT Health facilities, policies and commitments to promote purchased/sold by city agencies (hospitals, improve healthy food choices in all government workplaces and healthy food prisons, aged care, health facilities) facilities choices Support and Japan Mandatory oversight and monitoring VIC Healthy Eating Advisory Service (HEAS) provides a wide range of training systems by dietitian/nutritionist (incl. menu resources to support settings such as childcare centres, schools, health for public sector development) for all government facilities services, and sports centres to provide healthy foods and drinks settings providing >250 meals/day Support and UK Responsibility Deal included collective WA The Healthier Workplace WA program provides a number of free training systems pledges for health at work, including a services to support workplaces state-wide to make cultural, for private focus on healthier staff restaurants - over environmental and policy changes that support and encourage companies 160 signatories positive lifestyle behaviours amongst employees Food retail Planning South Korea ‘Green Food Zones’ around QLD Incorporates health as a key consideration as part of the Planning policies and schools (200 metre radius) in which sales of Act, and provides detailed resources (Active Healthy Communities) for zoning laws: ‘unhealthy’ foods are prohibited local councils on ways to limit access to unhealthy fast food outlets unhealthy foods Planning USA Provision of grants for states to QLD Provides detailed information and resources (Active Healthy policies and provide financial/other types of assistance Communities) for local government on ways to promote healthy food zoning laws: to attract healthier retail outlets to choices through the built environment and encourage outlets that sell healthy foods underserved areas healthy food In-store UK Agreement to increase availability of NT Ongoing formal commitment to support selected remote availability of fruit and vegetables at convenience stores, community stores in encouraging in-store availability of healthy foods healthy and and commitments (as part of the and discouraging availability of unhealthy foods unhealthy foods Responsibility Deal) to decrease availability of confectionery at supermarket checkouts Food service Singapore Government partnership SA South Australian Premier’s Healthy Kids Menus Initiative aims to outlet (‘Healthier Hawker’ program) with selected increase the provision of and access to healthy menu options for availability of food vendors to improve healthiness of children in South Australian restaurants, cafes, hotels and clubs healthy and take-away food unhealthy foods

FPI South Australia | Page 6 Benchmarks of good practice Policy actions targeting food environments Benchmarks of good practice Infrastructure support actions

Domain Policy area International best practise Leading State / Territory in Australia (as identified by INFORMAS) (as per assessments as part of this project)

Leadership Strong, visible, New York City, USA Mayor (Michael ACT Healthy Weight Initiative is a whole of government initiative political support Bloomberg) showed strong political to combat the rise of obesity and overweight in the ACT, led by the for population leadership in introducing landmark food Chief Minister with regular reporting of progress nutrition policies, including restrictions on trans-fat and portion size restrictions on sugary- drinks Comprehensive European Union The European Food and ACT The ‘Towards Zero Growth: Healthy Weight Action Plan’ (the implementation Nutrition Action Plan 2015-20 outlines clear HWAP) outlines clear targets for obesity rates, details a range of plan linked to strategic goals, guiding principles, policy and program initiatives across health and non-health state/national objectives, priorities and tools sectors, with a taskforce and dedicated implementation groups needs established Priorities for New Zealand Ministry of Health upholds WA Key strategic health promotion documents identify priority reducing contracts with NGOs/other institutions to groups, WA government has highlighted a strategic focus on inequalities prioritise Maori health and Maori specific improving nutrition in vulnerable groups, several targeted related to needs in service delivery, service initiatives nutrition development and planning Governance Restricting USA Mandatory and publicly accessible QLD Lobby register includes mandatory reporting of the type and commercial lobby registers – including extensive purpose of lobbying conduct, real-time disclosure of political influence on reporting of nature of lobbying activities donations policy development Transparency and Australia Open access principles across All governments across Australia have open data policies, access to governments, FSANZ processes for extensive frameworks for information access, and policies and procedures government stakeholder engagement in the that ensure transparency information development of new standards Assessing the SA, Australia Mechanisms to incorporate SA Mechanisms to incorporate population health considerations potential health population health considerations into into policy development processes across the South Australian impacts of all policy development processes across the government policies South Australian government Monitoring Monitoring food New Zealand Comprehensive database of ACT Extensive monitoring of unhealthy food marketing to and environments nutrient information for different foods, children, and nutritional quality of food in public sector settings intelligence continued monitoring of school food environments nationwide Monitoring USA National Health and Nutrition WA Health and Wellbeing Surveillance System collects annual data population Examination Survey (NHANES), conducted on key nutrition indicators, Nutrition Monitoring Survey series nutrition intake annually, provides detailed national collects data every three years on community perceptions and information on health status, disease attitudes around nutrition history and nutritional intake of adults and children Monitoring UK National Child Measurement Program ACT/NSW/QLD/SA Regular surveys of self-reported BMI from population body for children’s BMI, assessing children ages adults and children weight 4-6 and 10-11 Evaluation of USA The National Institutes for Health (NIH QLD Health and Wellbeing Strategy outlines key evaluation major programs ) provides dedicated funding for research questions, with associated guidelines - specific evaluation and policies that evaluates new policies/programs framework under development. All programs required to conduct expected to influence obesity related evaluations behaviours Funding Research funding New Zealand Approximately 11% of the NT/WA Provides sustained funding for research that improves and for obesity & NCD Health Research Council’s total budget of foods environments, reduces obesity, NCDs and their related resources prevention $70M spent on population nutrition and/or inequalities prevention of obesity and NCDs Independent , Australia VicHealth is an VIC/WA Independent statutory health promotion agencies, health promotion independent statutory health promotion include an objective to improve population nutrition agency agency Support Mechanisms to Australia Previous National Partnership VIC Multiple targeted strategies, policies and initiatives at state for support Agreement on Preventive Health (now and local level designed to create healthier food environments communities community-based defunct) provided State and Territory level (schools, childcare centres, workplaces, food outlets, sporting interventions support for initiatives aimed at obesity and clubs, businesses and local government) NCD prevention Implementation of Multiple international examples WA Funds several obesity and NCD prevention social marketing social marketing campaigns, online and community programs, including LiveLighter campaigns that has now been adopted in multiple states / territories

Food and nutrition UK National framework for core food ACT/WA Ongoing support and provision of resources to educators in education competency skills and knowledge in for the inclusion of food and nutrition in school curricula curricula children ages 5-16 years

FPI South Australia | Page 7 Acknowledgements

This project was conducted by researchers within Experts from the following organisations the Global Obesity Centre, a WHO Collaborating contributed to the assessment of the South Centre for Obesity Prevention, at Deakin Australian government: Council South University. This research has been supported by Australia, CSIRO, Flinders University, Heart The Australian Prevention Partnership Centre, Foundation South Australia, University of Adelaide, funded by the NHMRC, the Australian Government University of South Australia. Department of Health, the NSW Ministry of Health, Cite this report as: Sacks G for the Food-EPI ACT Health and the HCF Research Foundation, and Australia project team. Policies for tackling administered and hosted by the Sax Institute. obesity and creating healthier food environments: The project forms part of INFORMAS (International scorecard and priority recommendations for the Network for Food and Obesity/NCDs Research, South Australian government. Melbourne: Deakin Monitoring and Action Support), a global network University, 2017. of public-interest organisations and researchers The contents of this published material are solely that seek to monitor and benchmark public and the responsibility of the authors and do not reflect private sector actions to create healthy food the views of the NHMRC or funding partners. environments and reduce obesity and NCDs The research was approved by the Human Ethics globally. The project team was led by Dr Gary Advisory Group of the Faculty of Health at Deakin Sacks, with research assistance provided by Emily University, project number HEAG-H 162_2015. Hadgkiss, Karen Peterson and Brydie Clarke. A steering committee, made up of Prof Sharon Friel, Prof Amanda Lee, Jane Martin, Prof Anna Peeters, Prof Boyd Swinburn and Dr Stefanie Vandevijvere, provided overall guidance to the project. South Australia Health provided assistance in coordinating South Australian government input into the project.

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