Is a voluntary healthy food policy effective? evaluating effects on foods and drinks for sale in hospitals and resulting policy changes
Abstract Background Healthy food and drink guidelines for public sector settings can improve the healthiness of food environments. This study aimed to assess the implementation and impact of the voluntary National Healthy Food and Drink Policy (the Policy) introduced in New Zealand in 2016 to encour...
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BMC
2025-05-01
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| Online Access: | https://doi.org/10.1186/s12916-025-04122-x |
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| author | Cliona Ni Mhurchu Magda Rosin Stephanie Shen Bruce Kidd Elaine Umali Yannan Jiang Sarah Gerritsen Sally Mackay Lisa Te Morenga |
| author_facet | Cliona Ni Mhurchu Magda Rosin Stephanie Shen Bruce Kidd Elaine Umali Yannan Jiang Sarah Gerritsen Sally Mackay Lisa Te Morenga |
| author_sort | Cliona Ni Mhurchu |
| collection | DOAJ |
| description | Abstract Background Healthy food and drink guidelines for public sector settings can improve the healthiness of food environments. This study aimed to assess the implementation and impact of the voluntary National Healthy Food and Drink Policy (the Policy) introduced in New Zealand in 2016 to encourage provision of healthier food and drink options for staff and visitors at healthcare facilities. Methods A customised digital audit tool was used to collate data on foods and drinks available for sale in healthcare organisations and to systematically classify items as green (‘healthy’), amber (‘less healthy’), or red (‘unhealthy’) according to Policy criteria. On-site audits were undertaken between March 2021 and June 2022 at 19 District Health Boards (organisations responsible for providing public health services) and one central government agency. Forty-three sites were audited, encompassing 229 retail settings (serviced food outlets and vending machines). In total, 8485 foods/drinks were classified according to Policy criteria. The primary outcome was alignment with Policy guidance on the availability of green, amber, and red category food/drink items (≥ 55% green and 0% red items). Secondary outcomes were proportions of green, amber, and red category items, promotional practices, and price. Chi-square tests were used to compare results between categorical variables. Results No organisation met the criteria for alignment with the Policy. Across all sites, 38.9% of food/drink items were rated red (not permitted), 39.0% were amber, and 22.1% were green. Organisations that adopted the voluntary Policy offered more healthy foods/drinks than those with their own organisational policy, but the proportion of red items remained high: 32.3% versus 47.5% (p < 0.0001). About one-fifth (21.3%) of all items were promoted, with red (24.6%) and amber (22.2%) items significantly more likely to be promoted than green items (14.0%) (p < 0.001). Green items were also significantly more costly on average (NZ$6.00) than either red (NZ$4.00) or amber (NZ$4.70) items (p < 0.0001). Conclusions Comprehensive and systematic evaluation showed that a voluntary Policy was not effective in ensuring provision of healthier food/drink options in New Zealand hospitals. The adoption of a single, mandatory Policy, accompanied by dedicated support and regular evaluations, could better support Policy implementation. |
| format | Article |
| id | doaj-art-75ed01147e56460c99d22a364d4bd63f |
| institution | DOAJ |
| issn | 1741-7015 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj-art-75ed01147e56460c99d22a364d4bd63f2025-08-20T03:16:40ZengBMCBMC Medicine1741-70152025-05-0123111510.1186/s12916-025-04122-xIs a voluntary healthy food policy effective? evaluating effects on foods and drinks for sale in hospitals and resulting policy changesCliona Ni Mhurchu0Magda Rosin1Stephanie Shen2Bruce Kidd3Elaine Umali4Yannan Jiang5Sarah Gerritsen6Sally Mackay7Lisa Te Morenga8Department of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of AucklandDepartment of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of AucklandNational Institute for Health Innovation, School of Population Health, Faculty of Medical and Health Sciences, University of AucklandNational Institute for Health Innovation, School of Population Health, Faculty of Medical and Health Sciences, University of AucklandNational Institute for Health Innovation, School of Population Health, Faculty of Medical and Health Sciences, University of AucklandCentre for Translational Health Research: Informing Policy and Practice (TRANSFORM), Faculty of Medical and Health Sciences, University of AucklandDepartment of Social and Community Health, School of Population Health, Faculty of Medical and Health Sciences, University of AucklandDepartment of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of AucklandResearch Centre for Hauora and Health, Massey UniversityAbstract Background Healthy food and drink guidelines for public sector settings can improve the healthiness of food environments. This study aimed to assess the implementation and impact of the voluntary National Healthy Food and Drink Policy (the Policy) introduced in New Zealand in 2016 to encourage provision of healthier food and drink options for staff and visitors at healthcare facilities. Methods A customised digital audit tool was used to collate data on foods and drinks available for sale in healthcare organisations and to systematically classify items as green (‘healthy’), amber (‘less healthy’), or red (‘unhealthy’) according to Policy criteria. On-site audits were undertaken between March 2021 and June 2022 at 19 District Health Boards (organisations responsible for providing public health services) and one central government agency. Forty-three sites were audited, encompassing 229 retail settings (serviced food outlets and vending machines). In total, 8485 foods/drinks were classified according to Policy criteria. The primary outcome was alignment with Policy guidance on the availability of green, amber, and red category food/drink items (≥ 55% green and 0% red items). Secondary outcomes were proportions of green, amber, and red category items, promotional practices, and price. Chi-square tests were used to compare results between categorical variables. Results No organisation met the criteria for alignment with the Policy. Across all sites, 38.9% of food/drink items were rated red (not permitted), 39.0% were amber, and 22.1% were green. Organisations that adopted the voluntary Policy offered more healthy foods/drinks than those with their own organisational policy, but the proportion of red items remained high: 32.3% versus 47.5% (p < 0.0001). About one-fifth (21.3%) of all items were promoted, with red (24.6%) and amber (22.2%) items significantly more likely to be promoted than green items (14.0%) (p < 0.001). Green items were also significantly more costly on average (NZ$6.00) than either red (NZ$4.00) or amber (NZ$4.70) items (p < 0.0001). Conclusions Comprehensive and systematic evaluation showed that a voluntary Policy was not effective in ensuring provision of healthier food/drink options in New Zealand hospitals. The adoption of a single, mandatory Policy, accompanied by dedicated support and regular evaluations, could better support Policy implementation.https://doi.org/10.1186/s12916-025-04122-xHealthy food guidelinesNutritionHospitalAuditEvaluationDigital tool |
| spellingShingle | Cliona Ni Mhurchu Magda Rosin Stephanie Shen Bruce Kidd Elaine Umali Yannan Jiang Sarah Gerritsen Sally Mackay Lisa Te Morenga Is a voluntary healthy food policy effective? evaluating effects on foods and drinks for sale in hospitals and resulting policy changes BMC Medicine Healthy food guidelines Nutrition Hospital Audit Evaluation Digital tool |
| title | Is a voluntary healthy food policy effective? evaluating effects on foods and drinks for sale in hospitals and resulting policy changes |
| title_full | Is a voluntary healthy food policy effective? evaluating effects on foods and drinks for sale in hospitals and resulting policy changes |
| title_fullStr | Is a voluntary healthy food policy effective? evaluating effects on foods and drinks for sale in hospitals and resulting policy changes |
| title_full_unstemmed | Is a voluntary healthy food policy effective? evaluating effects on foods and drinks for sale in hospitals and resulting policy changes |
| title_short | Is a voluntary healthy food policy effective? evaluating effects on foods and drinks for sale in hospitals and resulting policy changes |
| title_sort | is a voluntary healthy food policy effective evaluating effects on foods and drinks for sale in hospitals and resulting policy changes |
| topic | Healthy food guidelines Nutrition Hospital Audit Evaluation Digital tool |
| url | https://doi.org/10.1186/s12916-025-04122-x |
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