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      Policies to Create Healthier Food Environments in Canada: Experts’ Evaluation and Prioritized Actions Using the Healthy Food Environment Policy Index (Food-EPI)

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          Abstract

          Food environment policies play a critical role in shaping food choices, diets, and health outcomes. This study endeavored to characterize and evaluate the current food environment policies in Canada using the Healthy Food Environment Policy Index (Food-EPI) to compare policies in place or under development in Canada as of 1 January 2017 to the most promising practices internationally. Evidence of policy implementation from the federal, provincial, and territorial governments was collated and verified by government stakeholders for 47 good practice indicators across 13 policy and infrastructure support domains. Canadian policies were rated by 71 experts from across Canada, and an aggregate score of national and subnational policies was created. Potential policy actions were identified and prioritized. Canadian governments scored ‘high’ compared to best practices for 3 indicators, ‘moderate’ for 14 indicators, ‘low’ for 25 indicators, and ‘very little or none’ for 4 indicators. Six policy and eight infrastructure support actions were prioritized as the most important and achievable. The Food-EPI identified some progress and considerable gaps in policy implementation in Canada, and highlights a particular need for greater attention to prioritized policies that can help to shift to a health-promoting food environment.

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          Strengthening of accountability systems to create healthy food environments and reduce global obesity.

          To achieve WHO's target to halt the rise in obesity and diabetes, dramatic actions are needed to improve the healthiness of food environments. Substantial debate surrounds who is responsible for delivering effective actions and what, specifically, these actions should entail. Arguments are often reduced to a debate between individual and collective responsibilities, and between hard regulatory or fiscal interventions and soft voluntary, education-based approaches. Genuine progress lies beyond the impasse of these entrenched dichotomies. We argue for a strengthening of accountability systems across all actors to substantially improve performance on obesity reduction. In view of the industry opposition and government reluctance to regulate for healthier food environments, quasiregulatory approaches might achieve progress. A four step accountability framework (take the account, share the account, hold to account, and respond to the account) is proposed. The framework identifies multiple levers for change, including quasiregulatory and other approaches that involve government-specified and government-monitored progress of private sector performance, government procurement mechanisms, improved transparency, monitoring of actions, and management of conflicts of interest. Strengthened accountability systems would support government leadership and stewardship, constrain the influence of private sector actors with major conflicts of interest on public policy development, and reinforce the engagement of civil society in creating demand for healthy food environments and in monitoring progress towards obesity action objectives.
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            Global benchmarking of children's exposure to television advertising of unhealthy foods and beverages across 22 countries

            Summary Restricting children's exposures to marketing of unhealthy foods and beverages is a global obesity prevention priority. Monitoring marketing exposures supports informed policymaking. This study presents a global overview of children's television advertising exposure to healthy and unhealthy products. Twenty‐two countries contributed data, captured between 2008 and 2017. Advertisements were coded for the nature of foods and beverages, using the 2015 World Health Organization (WHO) Europe Nutrient Profile Model (should be permitted/not‐permitted to be advertised). Peak viewing times were defined as the top five hour timeslots for children. On average, there were four times more advertisements for foods/beverages that should not be permitted than for permitted foods/beverages. The frequency of food/beverages advertisements that should not be permitted per hour was higher during peak viewing times compared with other times (P < 0.001). During peak viewing times, food and beverage advertisements that should not be permitted were higher in countries with industry self‐regulatory programmes for responsible advertising compared with countries with no policies. Globally, children are exposed to a large volume of television advertisements for unhealthy foods and beverages, despite the implementation of food industry programmes. Governments should enact regulation to protect children from television advertising of unhealthy products that undermine their health.
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              Diet quality in Canada.

              In addition to recommendations about the consumption of specific foods and nutriens, a measure of overall diet quality is useful. Over the years, a number of countries, but not Canada, have developed indexes to evaluate diet quality. The American Healthy Eating Index was adapted to conform to recommendations in Canada's Food Guide. Data from 33,664 respondents to the 2004 Canadian Community Health Survey-Nutrition were used. Usual index scores were calculated with the Software for Intake Distribution Estimation program. Multiple linear regression models were used to examine associations between index scores and various characteristics, particularly the frequency of vegetable and fruit consumption. For the population aged 2 or older, the average score on the Canadian adaptation of the Healthy Eating Index in 2004 was 58.8 out of a possible 100 points. Children aged 2 to 8 had the highest average scores (65 or more). Average scores tended to fall into early adolescence, stabiilizing around 55 at ages 14 to 30. A gradual upturn thereafter brought the average score to around 60 at age 71 or older. At all ages, women's scores exceeded those of men. The frequency of vegetable and fruit consumption was linked to index scores. The American Healthy Eating Index can be adapted to Canadian food intake recommendations. Canadian Community Health Survey questions about the frequency of vegetable and fruit consumption can be used as an approximation of diet quality.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                14 November 2019
                November 2019
                : 16
                : 22
                : 4473
                Affiliations
                [1 ]Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada; sahar.goorang@ 123456utoronto.ca (S.G.); kimiya.karbasy@ 123456utoronto.ca (K.K.); mary.labbe@ 123456utoronto.ca (M.R.L.)
                [2 ]School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada
                [3 ]School of Population Health, The University of Auckland, Auckland 1142, New Zealand; Stefanie.Vandevijvere@ 123456sciensano.be
                [4 ]Department of Epidemiology and Public Health, Sciensano (Scientific Institute of Public Health), 1050 Brussels, Belgium
                Author notes
                Author information
                https://orcid.org/0000-0001-5384-1821
                Article
                ijerph-16-04473
                10.3390/ijerph16224473
                6888279
                31739397
                92582076-b2ed-47be-acff-07b2ff3e2f6e
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 16 October 2019
                : 11 November 2019
                Categories
                Article

                Public health
                food environment,food policy,health policy,nutrition
                Public health
                food environment, food policy, health policy, nutrition

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