REPORT
FoodEnvironmentPolicyIndex(Food-Epi)
forEngland
Finalversion
November2016
www.foodfoundation.org.uk
Contents
EXECUTIVESUMMARY......................................................................................................................................1
Approach....................................................................................................................................1
Evidence.....................................................................................................................................1
Policygaps..................................................................................................................................1
Priorityactions...........................................................................................................................2
Strengthsandconstraints...........................................................................................................2
WhydeveloptheFoodEPIforEngland?..........................................................................................................3
WhatisFoodEPI?.............................................................................................................................................4
ConceptualFramework...............................................................................................................4
Method......................................................................................................................................5
Howwastheevidencecompiledandvalidated?............................................................................................6
EvidenceCompilation.................................................................................................................6
EvidenceValidation....................................................................................................................6
Howdidexpertsratepolicies?.........................................................................................................................7
RatingMethods..........................................................................................................................7
RatingResults.............................................................................................................................8
Howweretheactionsprioritised?.................................................................................................................14
PrioritisationMethods..............................................................................................................14
PrioritisationResults................................................................................................................15
WhatarethestrengthsandlimitationsofFoodEPI?....................................................................................20
Strengths..................................................................................................................................20
Limitations...............................................................................................................................20
Whatarethenextsteps?...............................................................................................................................21
AdvocacyPlan..........................................................................................................................21
Bibliography....................................................................................................................................................22
i
Acknowledgements
ExpertsfromthefollowinginstitutionscontributedtoFoodEPIforEngland:
AlexandraRoseCharity,JonathanPauling
BritishMedicalAssociation,GeorgeRoycroft
C3CollaboratingforHealth,KatyCooper
CancerResearchUK,AlisonCox,ChitSelvarajah
Children’sFoodTrust,PatriciaMucavele
CityUniversity,CorinnaHawkes,GeofRayner
CompassioninWorldFarming,DaphneRieder
EatingBetterAlliance,SueDibb
FoodEthicsCouncil,DanCrossley
FoodFoundation,AnnaTaylor,RobinHinks
FoodResearchCollaboration,VictoriaSchoen
FoodSystemAcademy,GeoffTansey
ForumfortheFuture,MarkDriscoll
HealthEqualitiesGroup,RobinIreland
Independent, Amber Wheeler, Lindsay Graham
InstituteofEducation,RebeccaO’Connell
SoilAssociation,PeterMelchett
Sustain,HannahLaurison
SustainableFoodCities,TomAndrews
SustainableFoodTrust,IanFitzpatrick
UKHealthForum,ModiMwatsama
UniversityofAberdeen,FloraDouglas
UniversityofAberystwyth,NaomiSalmon
UniversityofCambridge,JeanAdams,PabloMonsivais
UniversityCollegeofLondon,RichardWatt
UniversityofEastAnglia,AndrewFearne
University of Liverpool, Christopher Birt, Simon
Capewell
University of Oxford, Susan Jebb, Peter Scarborough,
RachelLoopstra,MikeRaynor
UniversityofSouthampton,AlanJackson
University of Stirling & Open University, Gerard
Hastings
London School of Hygiene and Tropical Medicine, UniversityofUlster,SineadFurey
Laura Cornelsen, Harry Rutter, Cecile Knai, Phillip University of Westminster, Regina Keith, Jessica
James,CourtneyScott
Swann
Medact,ElizabethAtherton
Which?SueDavies
NationalObesityForum,TamFry
WorldObesityFederation,TimLobstein
NourishScotland,PeteRitchie
WorldCancerResearchFund,SimoneBosch
Queen Mary University, Kawther Hashem, (Action WRAP,BojanaBajzeli
onSugar)JennyRosborough,SaadiaNoorani
RoyalCollegeofPhysicians&SurgeonsofGlasgow, WWF,DuncanWilliamson
LorraineTulloch
Otherscontributedtotheprocess
CityUniversity,SergioSchneider
FoodFoundation,AlexWard,FionaWatson(leadresearcher)
GreenwichBoroughCouncil,ClaireBennett
InstituteofDevelopmentStudies,JennyConstantine,DolfteLinto,NickNesbitt
UniversityofAuckland,BoydSwinburn,StefanieVandevijvere
Staff from the following government institutions were involved in reviewing the Evidence Paper and
observingtherating:
FoodStandardsAgencyEngland
FoodStandardsScotland
FoodStandardsWales
PublicHealthEngland
DepartmentofHealth
HMTreasury
DepartmentforEducation
DepartmentforCommunitiesandLocalGovernment
CommitteeofAdvertisingPractice
MultipleteamswithintheScottishandWelshgovernments
ii
Abbreviations
EU:EuropeanUnion
HFSS:HighinFat,Sugarand/orSalt
INFORMAS:InternationalNetworkforFoodandObesity/NCDsResearch,MonitoringandActionSupport
NCD:Non-CommunicableDisease
PHE:PublicHealthEngland
UK:UnitedKingdom
Definitions
Components:ThetwocomponentsofFoodEPIarePoliciesandInfrastructuresupport.
Diet-related non-communicable diseases (NCDs): Type 2 diabetes, cardiovascular diseases and nutritionrelatedcancers,excludingmicronutrientdeficiencies,undernutrition,stunting,osteoporosis,mentalhealth
andgastrointestinaldiseases.
Domains: Different aspects of the food environment that can be influenced by governments to create
readilyaccessible,availableandaffordablehealthierfoodchoices,arerepresentedasdomains.Thereare
sevendomainsunderthepolicycomponentandsixdomainsundertheinfrastructuresupportcomponent.
ExpertPanel:Publichealthexpertsandotherswithexpertiseinoneormoredomainswhoareindependent
ofthegovernment(e.g.researchersandfromnon-governmentalorganisations).
Foodenvironments:Thecollectivephysical,economic,policyandsocioculturalsurroundings,opportunities
andconditionsthatinfluencepeople’sfoodandbeveragechoicesandnutritionalstatus.
Goodpracticestatements:Statementsthatdescribethemeasures(policiesandinfrastructuresupport)that
governmentsputinplacetocontributetowardsahealthierfoodenvironment.
Internationalexamples:National(orsub-nationale.g.regionalorcity-wide)examplesofmeasures(policies
and infrastructure support) that have been put in place and which contribute towards a healthy food
environment.Theinternationalexamplesarereal-lifepoliciesorinfrastructuresupportsystemsthathave
beenimplementedandfullyorpartiallyequatetothegoodpracticestatements.
iii
EXECUTIVESUMMARY
The United Kingdom (UK) faces multiple challenges in relation to diets and the food system. Rates of
obesityandoverweightareontheriseatthecostofanestimated£27billiontotheeconomy(PHE,2015).
Foodpricesarestartingtoriseand1in10adultsarecurrentlyfoodinsecure(Taylor&Loopstra,2016).A
multitude of factors deter people from eating healthily including advertising of high fat, sugar and salt
(HFSS) products, the proliferation of take-aways, price promotions on less healthy foods, labelling that is
confusing, and poor uptake of school meals (Food Foundation, 2016). Effective government policies and
actions are urgently needed to address the obesity epidemic, reduce food insecurity, and support
sustainablefoodandfarmingsystemsintheUK.
Approach
The Food Foundation, together with the UK Health Forum, World Obesity Federation, Food Research
Collaboration and INFORMAS, applied a Food Environment Policy Index (Food-EPI) to England in order to
influence government policy to create healthier food environments. Food EPI is a useful tool to: identify
and prioritise actions needed to address critical gaps in government policies; compare the extent of
implementationofgovernmentpoliciesinonecountrywiththoseinothercountries;andtrackprogressin
policyovertime.
TheIndexismadeupoftwocomponents:governmentpoliciesandinfrastructuresupport.Theseinturn,
arecategorizedinto13domainsthatrepresentaspectsofthefoodenvironment(foodcomposition,food
labelling, food promotion, food provision, food retail, food prices, food trade and investment) and its
supporting infrastructure (leadership, governance, monitoring and intelligence, funding and resources,
platforms for interaction, health-in-all policies). Good practice statements that describe ‘gold standard’
policiesthatagovernmentcouldputinplace,aresetoutundereachdomain.
ApplicationofFoodEPIinvolves:
(1) Compilingevidenceonpoliciestoimprovethehealthinessofthefoodenvironment;
(2) Bringingindependentexpertstogethertoidentifythegapsandpriorityactions;and
(3) Advocatingtogovernmentonaddressingthepolicygaps.
Evidence
The Food Foundation undertook a review of government policy documents that relate to the food
environment in England and compiled an evidence paper. Documents were accessed through internet
search. The evidence paper is divided into seven policy domains and six infrastructure domains. Officials
from a range of government reviewed the evidence paper to identify inaccuracies and/or absence of
relevant information. Detailed comments were received and amendments were made to the evidence
paper.
Policygaps
During a workshop, 51 experts rated the implementation of government policies and infrastructure
support,onascalefrom1to5(1=leastimplementation,5=mostimplementation)withanoptionof‘cannot
rate’= 6. Firstly, policies were rated against international examples of best practice (How well is England
doingcomparedtoothercountries?).Secondly,policieswereratedagainstthe‘goldstandard’assetoutin
the good practice statement (Is England doing as well as it should?). Inter-rater reliability was 0.61
(95%CI=0.55-0.66)forratingagainstinternationalexamplesand0.76(95%CI=0.70-0.85)forratingagainst
the‘goldstandard’.
1
The experts rated the following policy areas as well implemented in comparison with best practice
examplesfromothercountries.
Scoreoutof5
1. Systemstoregularlymonitorobesityrates 4.1
2. Systemstoregularlymonitorriskfactorsfornon-communicablediseases 4.1
3. Inclusionofingredientlistsandnutrientdeclarationsonpackagedfoods
3.9
4. Accessbythepublictokeygovernmentfoodanddiet-relateddocuments 3.6
5. Existenceofdietaryguidelines
3.5
6. Adoptionoffoodstandardsinmostschools 3.5
The experts rated the following policy areas as less well implemented in comparison with best practice
examplesfromothercountries.
Scoreoutof5
1. Formalplatformsbetweengovernmentandcivilsocietytodiscuss
foodpoliciesandstrategies
1.3
2. Subsidiesthatfavourhealthyfoodoverunhealthyfood
1.4
3. Nationalinvestmentstrategiesthatprotectnutritionandhealth
1.4
4. Planningregulationsandzoningtoencouragehealthyfoodoutlets 1.5
5. Government-ledsystemsbasedapproachtoimprovingthefoodenvironment
1.5
6. Advertisinginchildsettings 1.6
Priorityactions
In order to prioritise actions to fill the policy gaps, a set of 20 actions were prepared with the help of
experts.Theactionsarerecommendationsforpoliciesthatthegovernmentcouldputinplacetoimprove
the food environment in England. The proposed actions were based on existing recommendations from
civil society groups and government bodies. Experts were asked to prioritise the actions through E mail
consultation. Prioritisation was done separately for policy actions and infrastructure actions using two
criteria: (1) Importance (need, impact, equity, other positive effects, other negative effects); (2)
Achievability(feasibility,acceptability,affordability,efficiency).
Atotalof34responseswerereceivedthoughinseveralcases,thisrepresentedanorganisationresponse,
ratherthananindividualresponse.Thetoppriorityactionswere:
1. Controltheadvertisingofunhealthyfoodtochildren
2. Implementthelevyonsugarydrinks
3. Reducethesugar,fatandsaltcontentinprocessedfoods
4. Monitorschoolandnurseryfoodstandards
5. Prioritisehealthandtheenvironmentinthe25-yearFoodandFarmingPlan
6. Adoptanationalfoodactionplan
7. Monitorthefoodenvironment
8. Applybuyingstandardstoallpublicsectorinstitutions
9. Strengthenplanninglawstodiscouragelesshealthyfoodoffers
10. Evaluatefood-relatedprogrammesandpolicies
Strengthsandconstraints
TheexpertsprovidedfeedbackonthestrengthsandconstraintsoftheFoodEPImethod.
2
WhydeveloptheFoodEPIforEngland?
The United Kingdom (UK) faces multiple challenges in relation to diets and the food system. Firstly, poor
diets contribute to one of the highest rates of overweight and obesity in Europe. Two thirds (63.4%) of
adultsandupto40%ofchildrenaged11to18yearsintheUKareeitheroverweightorobese(NatCen&
UCL,2013).Dietsarehighinprocessedfoodswhichhavelowfibreandhighfat,sugarand/orsalt(HFSS)
content.Thecostsassociatedwithbeingoverweightorobeseare£6.1billioneveryyearfortheNational
Health Service (NHS) and £27 billion for the wider economy (PHE, 2015). Secondly, food has become
increasinglyunaffordableforpeoplelivingonlowincomes.Thecostoffoodishighernowthanitwas10
years ago. Food prices in the UK rose 11.5% in real terms between 2007 and their peak in June 2012 as
measuredbytheConsumerPriceIndex,followingalongperiodinwhichtheyhadfallen(UKGov,2015).In
contrast, incomes have stagnated or even declined in value. Whilst there has been a gradual price
reduction since 2013, food insecurity affects 1 in 10 people aged 15 or over in the UK today (Taylor &
Loopstra, 2016). Furthermore, less healthy foods are cheaper per calorie than healthier foods (Food
Foundation,2016).Thisisreflectedineatinghabits,withthoseinlowersocio-economicgroupsconsuming
less fruit and vegetables and oily fish, and more red and processed meat and sugary foods than higher
socio-economicgroups(Maguire&Montisivais,2015).Thirdly,asarecentreportconcluded“amultitude
of factors in the food environment get in the way of … eating healthily.” (Food Foundation, 2016). These
factors include advertising of HFSS products, the proliferation of take-aways, price promotions on less
healthyfoods,labellingthatisconfusing,andpooruptakeofschoolmeals.
Brexit, the result of a referendum to leave the European Union (EU), has thrown up an even greater
challengewithrespecttoUKdietsandthefoodsystem.LeavingtheEUpotentiallymeanshigherUKfood
prices in particular for products such as fruit and vegetables that are largely imported from Europe, reenactment of complicated legislation to protect consumers (e.g. food labelling, food safety), and
uncertainty about the future of farming and the environment (Lang & Schoen, 2016). Whatever the
outcome of negotiations to leave the EU, it is clear that effective government policies and actions are
urgentlyneededtoaddresstheobesityepidemic,reducefoodinsecurity,andsupportsustainablefoodand
farmingsystemsintheUK.
TheFoodFoundation,anindependentthinktankthattacklesthegrowingchallengesfacingtheUK’sfood
systemthroughtheinterestsoftheUKpublic,recognisedthattheFoodEnvironmentPolicyIndex(FoodEPI) could potentially help to: compile the evidence on policies to improve the healthiness of the food
environment; bring independent experts together to identify the priority gaps; and advocate to
governmentonaddressingthepolicygaps.TheFoodFoundationconvenedaSteeringGroupfortheproject
which included the following organisations: UK Health Forum, World Obesity Federation, Food Research
Collaboration, Food Foundation and INFORMAS. This group embarked on applying the Food EPI in
coordination with other non-governmental and academic organisations active in the UK. As there are
importantpolicydifferencesbetweenthefourUKnations(England,Wales,ScotlandandNorthernIreland),
theFoodEPIwasfirstappliedtoEngland.TheUK’sdecisiontoleavetheEUwastakenduringdevelopment
oftheFoodEPI.
This report describes the process of applying the Food EPI for England, the key results and the strengths
andweaknessesoftheapproachinthiscontext.
3
WhatisFoodEPI?
TheFoodEPIisaninternationaltoolthatcanbeusedtoinfluencegovernmentpolicytocreatehealthier
food environments. It focuses on the food environment (those parts of the food system that directly
impingeonconsumerchoice)ratherthanthewiderfoodsystem,andonobesity,overweightandrelated
non-communicablediseases(NCDs).Itdoesn’tcoverpoliciesrelatingtofoodinsecurityorsustainablefood
andfarmingsystems.Nevertheless,inrelationtothefoodenvironment,itisausefultoolto:
(1)Identifyandprioritiseactionsneededtoaddresscriticalgapsingovernmentpolicies;
(2) Compare the extent of implementation of government policies in one country with those in
othercountries;
(3)Trackprogressinpolicyovertime.
The Food EPI has been developed by INFORMAS, an International Network for Food and Obesity/NCDs
Research,MonitoringandActionSupport andassessesagovernment’slevelofimplementationofpolicies
relatedtothefoodenvironment.NewZealandwasthefirstcountrytoapplythemethodinfull,andFood
EPIisnowbeingappliedinanumberofothercountriesincludingThailand,Malaysia,Vietnam,Singapore,
SouthAfrica,Mexico,Chile,Guatemala,CanadaandAustralia.
ConceptualFramework
The Food-EPI was conceptualized at a week-long meeting of international experts in November 2012 in
Bellagio, Italy, described in detail elsewhere (Swinburn, et al., 2013). As shown in figure 1, the index is
made up of two components: government policies and infrastructure support. These in turn, are
categorized into 13 domains that represent aspects of the food environment and its supporting
infrastructure.Goodpracticestatementsweredevelopedundereachofthe13domains.Thesestatements
describe policies that a government could put in place, which can be considered good practice. The
methodsfordevelopingthestatementsaredescribedelsewhere(Swinburn,etal.,2013).
Figure1:ConceptualFrameworkforFoodEPI
4
Method
AfulldescriptionoftheFoodEPIresearchapproachandmethods,asithasbeenappliedtoNewZealand
(Vandevijvere,etal.,2015)andThailand(Phulkerd,etal.,2016)hasbeenpublished.Thekeyelementsof
theapproacharesetoutbelow.
Compileevidence,assessperformance,agreeonpriorityactions
EightstagesarefollowedtodevelopaninitialbaselineFoodEPI,whichallowstheidentificationofcritical
gapsandpriorityactions.Thesestagesaresetoutinfigure2andcanbesummarisedinthreebroadsteps.
Firstly, the evidence on all relevant policies is compiled in an evidence paper which was reviewed for
accuracyandcompletenessbygovernmentofficials.Thiscoversstages1-4.Secondly,independentexperts
arebroughttogethertoidentifycriticalgapsandprioritiseactionstofillthosegaps,equivalenttostages56. Thirdly, the actions are used to advocate to the government for changes to improve the food
environment.
Figure2:Processforassessingthepoliciesandactionsofgovernmentstocreatefoodenvironments
Compareinternationally
TheINFORMASgrouphascompiledasetofinternationalexampleswheregovernmentshavedemonstrated
leadership and taken action to improve food environments that can serve as potential ‘benchmarks’ for
othercountries.ThelistincludessomeoftheexamplesfromtheNOURISHINGframeworkadoptedbythe
World Cancer Research Fund International (see appendix 1 for selection criteria). Whilst the list is not
comprehensive and continues to be developed, it provides some level of ‘benchmark’ against which
countriescancomparethemselves(seeappendix2forthefulllistofinternationalexamples).
Trackprogress
TheFoodEPIcanbere-appliedatalaterpointintimetocomparetheprogressmadebyagovernmentin
improvingpoliciesthataffectthefoodenvironmentagainsttheinitialbaseline.Thisre-applicationcouldbe
done,forexample,immediatelybeforeanelectiontoassessanout-goinggovernment’sperformanceand
indicateareasofconcernforin-cominggovernments.
Modificationstothemethod
TheFoodEPImethodisbeingappliedinanumberofdifferentnationalcontextsandisthereforesubjectto
modifications and further development. Since the Food EPI was first conceptualised, a number of
5
modificationshavebeenmadetothedomainsandthewordingofthegoodpracticestatements.Thelistof
internationalexamplesisexpandingandisbeingcontinuallyupdated.
Howwastheevidencecompiledandvalidated?
The Food EPI is founded on evidence. An evidence paper is compiled of the policies and infrastructure
supportthatarecurrentlyinplace.Whilethisevidencepaperbecomesquicklyoutdatedasnewpoliciesare
adopted, it reflects a moment in time and serves as an evidence-based starting point pulling together
informationfromacrossthefoodenvironment.
EvidenceCompilation
The Food Foundation undertook a review of government policy documents that relate to the food
environmentinEnglandtocompiletheevidencepaper.Documentswereaccessedthroughinternetsearch.
PolicieswereincludedwheretheyappliedtoEngland,theUK(beforedevolutionin1999)andEUlegislation
thatisbeingenactedinEngland.Themainbodyofthedocumentisbasedonthelegislationandpolicies
that apply to England. Specific legislation and policies for Scotland, Wales and Northern Ireland are
describedinboxes.
TheevidencepaperisdividedintosevenpolicydomainsandsixinfrastructuredomainsfollowingtheFood
EPIconceptualframework(seefig1forthelistofdomains).Atotalof48goodpracticestatementsareset
out under the domains. INFORMAS has developed and modified the wording of 47 good practice
statements(seeappendix2)andthesewereadoptedfortheevidencepaper.Oneadditionalgoodpractice
statementwasincludedunderdomain6:FoodRetail.Thiswas:
6.5Foodhygienepoliciesarerobustenoughandarebeingenforced,whereneeded,bynationalandlocal
governmenttoprotecthumanhealthandconsumers’interestsinrelationtofood.
The logic for including this statement is that food hygiene has an impact on health and is particularly
relevant in the context of England where there have been a number of major incidents relating to food
contamination.Thishasledtopoliciesbeingputinplacetoprotectthehealthofthepopulation.
The evidence is presented for each good practice statement in turn and a summary box of evidence
included for each domain. The evidence paper was prepared in the period September 2015 to February
2016.
EvidenceValidation
A consultation draft of the evidence paper was circulated to officials within government departments,
arms-length departmental bodies, non-departmental public bodies, and self-regulatory organisations for
validation in March 2016. Officials were asked to identify inaccuracies and/or absence of relevant
information.Thepolicyexpertiseofindividuals,ratherthanformalendorsementbyeachorganisation,was
sought.TheevidencepaperwasreviewedbystaffwithinFoodStandardsAgencyEngland,FoodStandards
Scotland,FoodStandardsWales,PublicHealthEngland,DepartmentofHealth,HMTreasury,Department
forEducation,DepartmentforCommunitiesandLocalGovernment,theCommitteeofAdvertisingPractice,
and multiple teams within the Scottish and Welsh governments. Detailed comments were received and
correctionsandamendmentsweresubsequentlymadetotheevidencepaper.
NoresponsewasreceivedfromtheDepartmentforEnvironment,FoodandRuralAffairsorFoodStandards
Northern Ireland. This means that sections 7.1 and 7.2, which relate to food trade and investment,were
notreviewedbyarelevantexpertwithinthepolicycommunity.Likewise,thepaperhasnotbeenreviewed
byofficialsintheNorthernIrelandgovernment.Thevalidatedevidencepapercanbefoundinappendix3.
6
Howdidexpertsratepolicies?
BringingindependentexpertstogetherisanimportantpartoftheFoodEPIprocess.Theseexpertsidentify
thecriticalgapsinpolicyimplementationandprioritisetheactionstofillthosegaps.Theprocessinvolvesa
ratingworkshopfollowedbyanEmailconsultation.
SteeringGroupandExpertPanel
AsmallSteeringGroupwasformedtooverseetheratingofpoliciesandsubsequentstagesoftheFoodEPI
method.Representativesfromcivilsocietyorganisationsandacademia(UKHealthForum,WorldObesity
Federation,FoodResearchCollaboration,FoodFoundationandINFORMAS)wereincluded.
An Expert Panel was identified by the Steering Group to rate government policies in England and to
prioritiseasetofactions.ThecriteriausedtoselecttheExpertPanelwere:(1)individualswithexpertisein
one or more domain areas; and (2) individuals from organisations independent of the government. Over
100peopleintotalwereinvitedtojointheExpertPanelfromarangeoforganisationsincludingacademic
institutions, professional bodies, and civil society. Whilst the majority of people were from England,
individualsfromWales,ScotlandandNorthernIrelandwerealsoincluded.
RatingMethods
TheratingofgovernmentpoliciesinEnglandwascarriedoutbyasub-groupoftheExpertPanel,whowere
availabletoattendanall-dayratingworkshop.Theworkshoptookplacein May2016attheUniversityof
WestminsterinLondon.Thevenueisa‘neutral’environmentnotlinkedtogovernment.
Participants
AllmembersoftheExpertPanelwereinvitedtoparticipateintheratingworkshop.Atotalof59individuals
participated in the workshop: 51 independent experts from the Expert Panel plus an additional 8
governmentofficialswhocameasobservers.
Materials
Materialswerepreparedinadvanceoftheworkshopandsenttoconfirmedparticipants.Theseincluded:
•
•
•
•
•
Evidencepaper(seeappendix3)
Methodspaper(seeappendix4)
MethodsFAQ(seeappendix5)
Glossaryofterms(seeappendix6)
Setofpower-points(seeappendix7)
Participantswererequestedtoreadthroughthedocuments,inparticulartheevidencepaper,inorderto
bepreparedforaproductivediscussionattheworkshop.
Approach
The rating workshop was divided into two sections. In the morning, the Expert Panel rated government
policiesandinfrastructuresupport.Theafternoonwasdevotedtodiscussionofactionsneededtoaddress
criticalimplementationgapsidentifiedthroughtheratingprocess.Theagendaisincludedinthemethods
paper(seeappendix4).
Whodidtherating?
Only the non-government members of the Expert Panel took part in the rating. Some independent
participantschosenottotakepartintheratingprocesseitherbecausetheywerenotpresentthroughout
thewholedayorpreferredtoobservetheprocess.Atotalof41participantscompletedtherating.Thelist
oforganisationsofthosewhotookpartintheratingcanbefoundinappendix8.Consenttoincludethese
detailswasobtainedfromparticipantsduringtheworkshop.
7
Whatdidtheyrate?
Aratingwasrequiredforeachofthe48goodpracticestatements.Inadvanceofeachrating,twopowerpoint presentation slides were shown for each good practice statement: the first presented evidence of
measurestakenbythegovernmentinEnglandtopartiallyorfullyadoptpoliciesrelatedtothatarea;the
second slide presented examples from other countries of measures taken by governments to partially or
fullyadoptrelevantpolicies.Theseinternationalexamplesweretakenfromthosecontainedinappendix2.
An example from England (where it existed) was always included on the second slide to reinforce the
existence of policies already being implemented in England. The entire set of power-point presentation
slidescanbefoundinappendix7.
Participantswereaskedtoratethecurrentdegreeofimplementationofpoliciesandinfrastructuresupport
inEngland,onascalefrom1to5(1=lessthan20%implementation,2=20-40%implementation,3=40-60%
implementation, 4=60-80% implementation, 5=80-100% implementation). Raters were asked to consider
thepreviouslypresentedevidence,andtheirowninformedjudgement,whenrating.Anoptionof‘cannot
rate’=6wasincludedforthosewhofelttheylackedsufficientevidencetocometoadecision.
Twoformsofratingwereconducted.Firstly,policieswereratedagainsttheinternationalexamples(How
well is England doing compared to other countries?). Secondly, policies were rated against the ‘gold
standard’assetoutinthegoodpracticestatement(IsEnglanddoingaswellasitshould?).
Howdidtheyrecordtheirratings?
Each participant involved in the rating was provided with a paper rating sheet (see appendix 9) and
assignedahand-held‘TurningPoint’clicker.Thepaperratingsheetwasusedtoratepoliciesbothagainst
international examples and good practice statements. Space was made available on the rating sheet for
comments.
Participants rated only the good practice statements using the clicker which was integrated into the
powerpoint slides. Participants rated at the end of the presentation of each domain and anonymised
resultswerevisuallydisplayedonscreenfollowingeachrating.TheTurningPointsystemtrackedresponses
toindividualclickers,whichallowedinter-raterreliabilitytobeanalysed.
Howweretheratingresultsanalysed?
Theratingsfromthe‘TurningPoint’clickerwereautomaticallytransferredontoanExcelsheet.Thesewere
checkedagainstpaperrecordsandadditionaldatafromtheratingsheetsenteredmanuallybymembersof
theSteeringGroup.Allratingsof‘6’(insufficientinformationtorate)wereexcludedfromtheanalysis.
RatingResults
Averageratings
The rating of government policies could range from 1 (less than 20% implementation) to 5 (80-100%
implementation).Onaverage,theparticipantsratedpoliciesrelatingtothefoodenvironmentinEnglandas
mid-waybetweentheseextremesbothagainstinternationalexamplesandgoodpracticestatements(see
table1),thoughthescoresforwhencomparingpoliciesinEnglandwithinternationalexamplestendedto
be higher. This means that participants judged that England was, in general, doing averagely in relative
terms(comparedtoothercountries)andinabsoluteterms(comparedtoa‘goldstandard’).Onepossible
factorthatmayhavecontributedtotheratingswasthecollectivenatureoftheratingexercisethatledtoa
negative‘herdmentality’(seesectiononConstraintsofthemethodformoredetails).
8
Table1:ResultsofratingagainstInternationalExamplesandGoodPracticeStatements
Averagerating
Rangeofaveragerating
Inter-raterreliability
#ratedas‘6’
Internationalexamples
2.5
1.3–4.1
0.61
(95%CI=0.55-0.66)
171/1968
Goodpracticestatements
2.0
1.2–3.9
0.76
(95%CI=0.70-0.85)
95/1968
Inter-raterreliability
Inter-rater reliability was ascertained using the Gwet AC2 inter-rater reliability coefficient and was
relatively high. The level of agreement between raters was higher when rating against good practice
statements (0.76 95%CI=0.70-0.85) compared to rating against international examples (0.61 95%CI=0.550.66). Participants expressed some concerns with regard to the international examples (see section on
Constraints of the method for more details), which may have made it more difficult for them to make
judgementsagainstinternationalexamplesinaconsistentfashion.
Inabilitytorate
Participants were given an option of ‘cannot rate’= 6 where they felt there was insufficient evidence to
cometoadecision.Thesedatawerenotincludedintheanalysis.Asfigure3shows,moreparticipantsgave
a ‘6’ rating in relation to the international examples (blue bars) compared the good practice statements
(orange bars). The domains which caused the greatest numbers of people to rate ‘6’ were Domain 13:
Health in All Policies; Domain 11: Funding and Resources; Domain 7: Food Trade & Investment. Evidence
waslimitedinthesedomainsbothintermsofpolicyimplementationinEnglandandintherestoftheworld
(seesectiononConstraintsofthemethodformoredetails).
9
Figure3:Inabilitytorate
#of'cannotrate'selections
Domain
0
1
2
3
4
5
6
1,1
1,2
2,1
2,2
2,3
2,4
3,1
3,2
3,3
4,1
4,2
4,3
4,4
5,1
5,2
5,3
5,4
6,1
6,2
6,3
6,4
6,5
7,1
7,2
8,1
8,2
8,3
8,4
8,5
9,1
9,2
9,3
9,4
10,1
10,2
10,3
10,4
10,5
10,6
11,1
11,2
11,3
12,1
12,2
12,3
12,4
13,1
13,2
7
8
9
10
Ratingagainst
international
examples
Ratingagainst
GoodPractice
Statements
10
Ratingsofpoliciesandinfrastructuresupport
Figures4and5illustratetheaverageratingscoreforallparticipantsforall48goodpracticestatement.A
lowratingindicatesthatparticipantsjudgedthattherehadbeenlimitedadoptionofpoliciesinrelationto
the relevant good practice statement, while a high rating indicates that participants judged that policies
hadbeenwelladopted.Ashort-handformofthegoodpracticestatementsisusedinthelistsbelowand
graphs.Seeappendix2forafulllistofgoodpracticestatementsandinternationalexamples.
Thereisvariationinratingsofpoliciesagainstinternationalexamplesandgoodpracticestatementsforall
ofthedomainsTherewasn’talotofconsistencywithinadomainbutingeneral,thepoliciesthatreceived
the highest scores (most implementation) were in the domains of food labelling (domain 2), leadership
(domain8)andmonitoring&intelligence(domain10).
TheExpertPanelgavethehighestscores(i.e.goodimplementationofpolicies)tothefollowingtenpolicy
areaswhenratedagainstinternationalexamples(startingwiththehighestscore)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Monitoringofoverweight,obesity
MonitoringofNCDriskfactors
Labellingwithregardtonutrientdeclarations
Accesstoinformationandkeygovernmentdocumentsrelatingtothefoodenvironment
Dietaryguidelinesestablished
Schoolfoodstandards
Populationintaketargetsestablished
LabellingwithregardtoFOP
Monitoringofnutritionstatus
Foodcompositionstandardsestablished
Thesamepolicyareasreceivedthehighestscoreswhenratedagainstgoodpracticestatementswiththe
additionineighthplaceofexistenceofahealthpromotionagencywithdedicatedfunding.
TheExpertPanelgavethelowestscores(i.e.poorimplementationofpolicies)tothefollowingtenpolicy
areaswhenratedagainstinternationalexamples(startingwiththelowestscore):
1. Platformsbetweencivilsocietyandgovernment
2. Subsidiesinfavourofhealthierfoods
3. Investment management and non-food policy development that takes account of public
healthnutrition
4. Planningpoliciesthatfavourhealthierfoods
5. Systemsbasedapproachtoimprovingfoodenvironments
6. Advertisinginchildsettings
7. Coordinationmechanismsacrossdifferentgovernmentdepartments
8. Workplacefoodprovision
9. Advertisingthroughnon-broadcastmedia
10. Comprehensiveimplementationplantoimprovefoodenvironments.
Theabovepolicieswerealsoscoredlowestwhenratedagainstgoodpracticestatementswiththeaddition
ofprocessestoassesstheimpactofpoliciesonhealth(sixthlowest)andrestrictionofcommercialinterests
ingovernmentpolicydevelopment(tenthlowest).
11
Figure4:Ratingagainstinternationalexamples
12.3:Platformswithcivilsociety
4.3:Subsidiesonfoods
7.2:Investmentmanagement
6.2:Planningpoliciestoencouragefruit&veg.
12.4:Systems-basedapproach
3.3:Advertisinginchildsettings
12.1:Coordinationmechanismsacrossgovernment
5.4:Workplacefoodprovision
3.2:Non-broadcastadvertising
8.4:Comprehensiveimplementationplan
13.1:Processestoreduceinequalities
5.3:Trainingforschoolsandpublicsectorsettings
13.2:Processestoassesshealthimpacts
8.1:Politicalsupport(Cabinetlevel)
9.1:Restrictionofcommercialinfluences
2.4:Menuboardlabelling
6.4:Foodservicepromotionofhealthyfoods
8.5:Inequalitiesreduced
5.2:Publicsectorsettingfoodstandards
4.1:Taxesorleviesonhealthyfoods
1.2:Out-of-homemealcomposition
4.2:Taxesorleviesonunhealthyfoods
6.3:In-storeavailabilityofhealthyfoods
10.1:Monitoringoffoodenvironments
6.1:Planningpoliciestolimittake-aways
11.1:Fundingforpopulationnutrition
7.1:Riskimpactassessmentsinnegotiation
11.2:Fundingforresearch
10.5:Evaluationsofmajorprogrammesandpolicies
9.3:Transparencyinpolicies
6.5Foodhygienepolicies
3.1:Broadcastadvertising
10.6:Monitoringofinequalities
12.2:Platformswithcommercialsector
2.2:Healthandnutrientclaimsonlabels
11.3:Healthpromotionagencywithsecurefunding
4.4:Food-relatedincomesupportprogrammes
9.2:Evidence-basedpolicies
1.1:Processedfoodcomposition
10.2:Monitoringofnutritionstatusandpopulationintakes
2.3:Front-of-packlabels
8.2:Populationintaketargetsestablished
5.1:Schoolfoodstandards
8.3:Dietaryguidelinesestablished
9.4:Accesstoinformationandkeydocuments
2.1:Nutrientdeclarationsonlabels
10.4:MonitoringofNCDriskfactors
10.3:Monitoringofoverweightandobesity
1
1.5
12
2
2.5
3
3.5
4
4.5
5
Figure5:Ratingagainstgoodpracticestatements
7.2:Investmentmanagement
4.3:Subsidiesonfoods
12.4:Systems-basedapproach
6.2:Planningpoliciestoencouragefruit&veg.
1.2:Out-of-homemealcomposition
13.2:Processestoassesshealthimpacts
12.1:Coordinationmechanismsacrossgovernment
3.2:Non-broadcastadvertising
12.3:Platformswithcivilsociety
9.1:Restrictionofcommercialinfluences
3.3:Advertisinginchildsettings
5.4:Workplacefoodprovision
13.1:Processestoreduceinequalities
2.4:Menuboardlabelling
6.4:Foodservicepromotionofhealthyfoods
6.1:Planningpoliciestolimittake-aways
6.3:In-storeavailabilityofhealthyfoods
8.4:Comprehensiveimplementationplan
4.1:Taxesorleviesonhealthyfoods
4.2:Taxesorleviesonunhealthyfoods
11.1:Fundingforpopulationnutrition
8.1:Politicalsupport(Cabinetlevel)
7.1:Riskimpactassessmentsinnegotiation
5.3:Trainingforschoolsandpublicsectorsettings
10.1:Monitoringoffoodenvironments
5.2:Publicsectorsettingfoodstandards
8.5:Inequalitiesreduced
10.5:Evaluationsofmajorprogrammesandpolicies
11.2:Fundingforresearch
1.1:Processedfoodcomposition
4.4:Food-relatedincomesupportprogrammes
3.1:Broadcastadvertising
9.3:Transparencyinpolicies
10.6:Monitoringofinequalities
2.2:Healthandnutrientclaimsonlabels
6.5Foodhygienepolicies
12.2:Platformswithcommercialsector
9.2:Evidence-basedpolicies
5.1:Schoolfoodstandards
2.3:Front-of-packlabels
11.3:Healthpromotionagencywithsecurefunding
8.2:Populationintaketargetsestablished
8.3:Dietaryguidelinesestablished
9.4:Accesstoinformationandkeydocuments
10.2:Monitoringofnutritionstatusandpopulation…
2.1:Nutrientdeclarationsonlabels
10.4:MonitoringofNCDriskfactors
10.3:Monitoringofoverweightandobesity
1
1.5
13
2
2.5
3
3.5
4
4.5
5
Howweretheactionsprioritised?
PrioritisationMethods
Developingtheactions
Step6intheFoodEPIprocessinvolvesprioritisingasetofactions.Theseactionsarerecommendationsfor
policiesthatthegovernmentcouldputinplacetoimprovethefoodenvironment.Thepurposeistoreach
consensusonasetofpriorityrecommendationsthatcanbeusedbydifferentorganisationsandgroupsto
advocate for implementation of policies that will positively impact the food environment and in turn
improvedietsandhealthoutcomes.
A long list of actions was drafted by the Steering Committee in advance of the rating workshop. Actions
werepreparedthatrelatedtoeachofthegoodpracticestatements.Theproposedactionswerebasedon
existing recommendations for action from civil society groups active in England (Obesity Health Alliance,
JamieOliverFoodFoundation,FabianSociety)andgovernmentbodies(PublicHealthEngland).
Further refinement of the actions took place during group discussion sessions at the workshop which
resultedinalistof60potentialactions.
Ashortlistof20actionswasidentifiedbyenlistingthesupportofindividualsfromtheExpertPanelwho
have specific knowledge and expertise in a particular domain (see appendix 10 for list of names). These
expertswereaskedto(1)RefinethewordingoftheactionstoensurethattheywereasSMARTaspossible;
(2)Prioritisetheactions(high,medium,low)basedonimportanceandfeasibility.Theshort-listofactions
wascomprisedoftherewordedactionsallocatedhighprioritybytheexperts.Expertswerenotavailableto
provideinputtodomains1,7,10,12and13.TheSteeringGroupthereforerefinedandprioritisedthese
actionsonthebasisofnotesfromtheRatingWorkshopgroupdiscussions.
Prioritisingtheactions
The entire Expert Panel was invited to prioritise the short list of actions. Each Expert Panel member was
askedtocompleteanexcelsheetprioritisationform(seeappendix11),whichwassentbyEmail.Thefirst
sheet contained instructions. The second sheet allowed Expert Panel members to prioritise 12 actions
relating to policy. The third sheet allowed Expert Panel members to prioritise 8 actions relating to
infrastructuresupport.
Prioritisation was done separately for policy actions and infrastructure actions using two criteria: (1)
Importance (need, impact, equity, other positive effects, other negative effects); (2) Achievability
(feasibility,acceptability,affordability,efficiency).Thecriteriaareexplainedintable2(below).
14
Table2:Explanationofprioritisationcriteria
The 12 policy actions had a total of 60 points which could be allocated across the statements for
importance (equivalent to an equal weighting of 5 x 12 policy actions) and a further 60 points for
achievability.Themorepointsallocated,thehigherthepriority.Actionscouldbeallocatednopointsand
onlywholenumberscouldbeused.
In addition, Expert Panel members were informed that the two scores (for importance and achievability)
would be combined to result in one score for each action. They were asked whether they thought the
importance and achievability criteria should be weighted the same or not. They were able to change the
weightingfrom50%:50%iftheythoughtthatthiswaswarranted.
Asimilarexercisewasundertakenforthe8infrastructuresupportactionsthoughinthiscaseatotalof40
points(equivalenttoanequalweightingof5x8infrastructureactions)couldbeallocatedforimportance
andafurther40pointsforachievability.
TheprioritisationofactionsexercisetookplacebetweenJulyandSeptember2016.
PrioritisationResults
The excel sheets were sent out to a total of 107 Expert Panel members. A total of 34 responses were
received though in several cases, this represented an organisation response, rather than an individual
response.
Prioritypolicyactions
Asfigure7shows,theorderofpolicyactionswasthesamewhetherforunweightedandweightedscores.
Thescoresandfulltextofeachpolicyactionarecontainedinappendix12.
Thesixmostimportantpolicyactions(outofatotalof12actions)are,inorderofprioritisation:
1. Control advertising of HFSS foods to children: Government to significantly reduce the exposure of
children under the age of 16 years to the promotion of HFSS food and drink by removing such
promotionfrom:a)broadcastmediabefore9pm;b)allnon-broadcastmedia(includingdigital)which
have an above average child audience;and c) the sponsorship of cultural and sporting events which
appealtochildren.(Averagenon-weightedscore=515,range2-30)
2. Implement the levy on sugary drinks: Government to implement the levy on sugary drinks by April
2018 and redesign the levy as a sales tax to ensure that the intervention provides a clear price
differential at point of sale to promote a reduction in consumption of sugary drinks. (Average nonweightedscore=472,range1-20)
15
3. Introduce composition standards for processed foods: Government to introduce composition
standardsforprocessedfoodsanddishessoldthroughfoodserviceinrelationtofreesugar,saturated
fatandsalt.(Averagenon-weightedscore=462,range4-20)
4. Monitor school and nursery food standards: The Department of Education to work with Ofsted, the
Care Quality Commission and Food Standards Agency to set out a new framework and independent
body for inspection and monitoring of school and nursery food standards in England. (Average nonweightedscore=382,range2-10)
5. Introducemandatorybuyingstandardsforallpublicsectorinstitutions:GovernmenttomakeBuying
StandardsandapplicationofthebalancedscorecardforFoodandCateringServicesmandatoryforall
publicsectorinstitutionsby2020.(Averagenon-weightedscore=348,range0-11)
6. Strengthen planning laws to discourage less healthy food offers: Government to support local
authoritiestodevelopsupplementaryplanningguidanceandprovidethemwithsufficientpowersfora
simplified mechanism of planning laws to enable them to both promote healthier food options and
discouragelesshealthyoffers.(Averagenon-weightedscore=340,range1-10)
16
Figure7:PriorityPolicyActions
600
Weighted
Non-weighted
515
500
472
462
400
382
348
340
Score
322
300
294
284
267
264.4
229.4
224
236
188.3
200
171
165.5
171.2
169.4
137.6
155.9
132.1
111
100
85.8
0
17
Priorityinfrastructureactions
Therewasalsonodifferenceintheorderofscoresforinfrastructureactionswhethertheywereweighted
and unweighted scores for infrastructure (see figure 8). The scores and full text of each infrastructure
actionarecontainedinappendix12.
Thefour(outofatotalofeight)mostimportantinfrastructureactionsare,inorderofprioritisation:
1. Prioritise health and the environment in the 25-year Food and Farming Plan: Prioritise sustainable
healthandenvironmentprincipleswithinthegovernment’s25-yearFoodandFarmingPlan.(Average
non-weightedscore=376,range2-11)
2. Adopt National Food Action Plan: Parliament to adopt a National Food and Nutrition Action Plan, to
ensure healthy and sustainable food supplies affordable to all. (Average non-weighted score = 366,
range3-10)
3. Monitor the food environment: Government to identify a suite of indicators to monitor the food
environmenttobeincludedinthepublichealthoutcomesframework.(Averagenon-weightedscore=
358,range2-10)
4. Implementindependentevaluationsofmajorprogrammes:Governmenttooutlineaplantoevaluate
policies related to the food environment and commission independent evaluations of major
programmesandpolicies.(Averagenon-weightedscore=337,range2-10)
18
Figure8:PriorityInfrastructureSupportActions
400
Weighted
376
366
Non-weighted
358
350
337
333
325
321
302
300
Score
250
200
190.6
185.3
174.8
161.8
170
168
159.2
153.7
150
100
50
0
Prioritise
Adopt
Excludefood Monitorfood Implement
Establish
Establish Assessimpact
sustainable NationalFood industryfrom environment independent independent coordination ofpolicieson
healthwith andNutrition government
evaluationsof nutrition
mechanisms nutritionand
foodand
ActionPlan committees
major
promotion
across
health
farming
programmes
agency
departments
framework
19
WhatarethestrengthsandlimitationsofFoodEPI?
Strengths
ThereareseveraladvantagestoapplyingtheFoodEPIinEngland.Anestablishedmethodhasbeenusedto
compile evidence, bring together independent experts and prioritise policy actions with the aim of
improving the food environment. Furthermore, use of the same method in a large number of countries
allowsinter-countrycomparisons.WhiledetailsofthemethodweremodifiedforthecontextofEngland,
FoodEPIprovidedausefuloverallframework.TheexistenceofabaselineFoodEPImeansthatitispossible
tore-applyFoodEPIinthefuturetomeasureprogressovertime.
Theevidencepaperisusefulinbringingtogetheralargebodyofpolicies,coveringlegislationandguidance,
thatgovernthefoodenvironmentinEngland.Theevidencepaperwasgenerallywellreceivedbyarangeof
government officials from different departments who provided detailed comments on the text. This
providesausefulresourceforgovernmentandnon-governmentagencieswishingtoexaminepolicygaps
andcoherence.
TheRatingWorkshopbroughttogetheragroupofacademics,peoplefromcivilsocietyorganisationsand
governmentobserverswithaninterestinthefoodenvironment.Itwasnotonlyanopportunitytofocuson
thegapsintheimplementationofpoliciesbutalsotonetworkandlearnaboutdifferentaspectsofthefood
environment.
Most importantly, the outcome of the Food EPI process is a set of actions that can be used to bring
togetherdiversegroupsaroundacommonsetofadvocacymessages.
Limitations
There were, however, a number of limitations when applying the Food EPI method. Many of these
limitations were highlighted during the Rating Workshop. The rating sheets used in the workshop (see
appendix 9) had a space in which participants could make comments. Further comments were received
fromfourparticipantswhocompletedtheworkshopevaluationformthatwassentoutatthesametimeas
the action prioritisation excel sheet. The limitations set out below are a compilation of the comments
received from workshop participants. Where relevant, direct quotes from workshop participants are
includedinitalics.
Internationalexamples
•
Insufficientorweakevidenceoninternationalexamples.Thiswasparticularlytrueforsomedomains
especiallyforDomain7:FoodTrade&Investment;Domain9:Governance;andDomain11:Funding&
Resources.
•
International examples are not comprehensive. Many international examples were not included e.g.
dietaryguidelinesforCanada,France.
•
Oneparticipantsuggestedthatitwouldbeusefultoapplyaconsistentmethodtothecompiliationof
internationalexamplessothatcomparabledataareavailable.
Goodpracticestatements
•
Some good practice statements are misleading or unclear. One example is on health and nutrient
claimsonfoodlabels
“The good practice statement is misleading – should be about whether health claims are made on
unhealthyfoods.”
20
•
Wordslike‘ensure’ledsomeparticipantstoscorelowere.g.wherevoluntaryguidelineswereinplace
butthesewerenotmandatory.
“Some statements focus on effectiveness of current policies, others just whether they exist. I presume
thereisarationaleforthis,butnoteresponsesondifferentstatementsarenotnecessarilycomparable
forthisreason.”
•
Terms like ‘nutrients of concern’ were too limited as the term doesn’t include fibre, fruit & veg,
red/processedmeat.
Difficultiesinrating
•
Difficulty in rating against international examples. Quite a few participants noted that they found it
hardtorateagainstincompleteinternationalexamplesaboutwhichtheyhadincompleteknowledge.
“WherethereisnotmuchactioninUK,(andit)ismeasuredagainstnotmuchactionelsewhere,itisv.
hardtoratemeaningfully.”
“Notparticularlyeasy(torate).Dependsonour(imperfectknowledgeandappreciationoffoodpolicy
190othercountries)”
“Difficult (to rate) because I didn't necessarily know what the best international examples were, and
becauseit'sdifficulttotakeindividualpoliciesinisolation”
•
Effectiveimplementationishardtorate.Forexample,domain10:Leadershipwasespeciallydifficult
toratebecausepoliciesmaybeinplacebuttheirdegreeofeffectiveimplementationisquestionable.
•
Difficult to provide single rating when a number of areas are covered. For example, it is difficult to
ratewhenthegoodpracticestatementcoversanumberofdifferentnutrientswhichmaybesubjectto
differentpoliciese.g.infoodcomposition–muchmoresuccesswithsaltinEnglandcomparedwithfat
orsugar.
•
Betterifratinghadbeendoneasanindividualexerciseonline.Severalparticipantsnotedthatitwas
not ideal to score in a workshop setting and that they would have preferred to have carried out the
ratingon-line.
“IfIhadscoredthemathome,alone,Iwouldhavedonesowithgreatercare,moreinternalconsistency,
becauseImighthaveback-trackedandamendedsomeinordertogiveamorerealisticdistributionof
goodandnotsogoodareas,withouttheinfluenceofothersandwithoutsomuchtimeawayfromthe
department.”
Herdmentalitysetinveryquickly,exacerbatedbyfeedingbackthescoresaftereachitem.
•
Collective scoring led to lower scores. The mood of the room was to be hypercritical so, even with
anonymousvotingitwasveryhardtoscorethingshighly.
“Theclickerswerefunandkeepsusawake,butIwonderwhetherandhowseeingresponsesofothers
influencesourownresponses.”
Whatarethenextsteps?
AdvocacyPlan
ThefinalandmostimportantphaseoftheFoodEPIprocessinvolvesadvocatingtothegovernmentfora
change in policies and infrastructure support to improve the food environment. The Steering Group is
preparinganadvocacyplanincludingthepreparationofapolicybriefingpaperwhichwillbelaunchedata
ParliamentaryeventinNovember2016anddiscussedatnationallevelevents.Thetechnicalreportwillbe
madeavailableon-lineandanacademicpaperwillbeconsidered.
21
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