Table 1.
Policy and infrastructure-support indicators of the Ghana Food-EPI tool.
| Policy Domain Indicators |
|---|
| Food Composition |
| COMP 1: Food composition targets/standards have been established for processed foods by the government for the content of the nutrients of concern in certain foods or food groups if they are major contributors to population intakes of these nutrients of concern (trans fats and added sugars in processed foods, salt in bread salt in snacks etc.)) |
| COMP 2: Food composition targets/standards have been established by the government for out-of-home meals in food service outlets (such as fast food joints, food kiosks, check-check joints, restaurants, and other local food vendors) for the content of the nutrients of concern in certain foods or food groups if they are major contributors to population intakes of these nutrients of concern (e.g. trans fats, added sugars, salt, saturated fat, saturated fat in commercial frying fats/oils) |
| Food Labelling |
| LABEL1: Ingredient lists and nutrient declarations in line with Codex recommendations are present on the labels of packaged foods |
| LABEL2: Robust, evidence-based regulatory systems are in place for approving/reviewing claims on foods, so that consumers are protected against unsubstantiated and misleading nutrition and health claims |
| LABEL3: A single, consistent, interpretive, evidence-informed front-of-pack supplementary nutrition information system, which readily allows consumers to assess a product’s healthiness, is applied to packaged foods |
| LABEL4: A consistent, single, simple, clearly-visible system of labelling the menu boards of quick service restaurants (i.e. fast food chains) is applied by the government, which allows consumers to interpret the nutrient quality and energy content of foods and meals on sale |
| Food Promotion |
| PROMO1: Effective policies are implemented by the government to restrict exposure and power of promotion of unhealthy foods to or for children through broadcast media (TV, radio) |
| PROMO2: Effective policies are implemented by the government to restrict exposure and power of promotion of unhealthy foods to or for children through non-broadcast media (e.g. Internet, social media, food packaging, sponsorship, religious events, outdoor advertising including around schools) |
| PROMO3: Effective policies are implemented by the government to ensure that unhealthy foods are not commercially promoted to or for children in settings where children gather (e.g. preschools, schools, sport and cultural events) |
| PROMO4: Effective policies are implemented by the government to restrict the marketing of breastmilk substitutes |
| PRICES1: Taxes or levies on healthy foods are minimised to encourage healthy food choices where possible (e.g. low or no sales tax, excise, value-added or import duties on fruit and vegetables) |
| Food Prices |
| PRICES2: Taxes or levies on unhealthy foods (e.g. sugar-sweetened beverages, foods high in nutrients of concern) are in place and increase the retail prices of these foods by at least 10% to discourage unhealthy food choices where possible, and these taxes are reinvested to improve population health |
| PRICES3: The intent of existing subsidies on foods, including infrastructure funding support (e.g. research and development, supporting markets or transport systems), is to favour healthy rather than unhealthy foods |
| PRICES4: The government ensures that food-related income support programs are for healthy foods |
| Food Provision |
| PROV1: The government ensures that there are clear, consistent policies (including nutrition standards) implemented in schools and early childhood education services for food service activities (canteens, food at events, fundraising, promotions, vending machines etc.) to provide and promote healthy food choices |
| PROV2: The government ensures that there are clear, consistent policies in other public sector settings for food service activities (canteens, hospitals, clinics, food at events, fundraising, promotions, vending machines, public procurement standards etc.) to provide and promote healthy food choices. |
| PROV3: The Government ensures that there are good support and training systems to help schools and other public sector organisations and their caterers meet the healthy food service policies and guidelines |
| Food in Retail |
| RETAIL1: Zoning laws and policies are robust enough and are being used, where needed, by local governments to place limits on the density or placement of quick serve restaurants or other outlets selling mainly unhealthy foods in communities, and to encourage the availability of outlets selling healthy options such as fresh fruit and vegetables |
| RETAIL2: The Government ensures existing support systems are in place to encourage food stores and food service outlets to promote the availability of healthy foods and to limit the promotion and availability of unhealthy foods |
| RETAIL 3: Food hygiene policies are robust enough and are being enforced, where needed, by national and local government to protect human health and consumers’ interests in relation to food. |
| Food Trade and Investment |
| TRADE1: The Government undertakes risk impact assessments before and during the negotiation of trade and investment agreements, to identify, evaluate and minimize the direct and indirect negative impacts of such agreements on population nutrition and health |
| TRADE2: The government adopts measures to manage investment and protect their regulatory capacity with respect to public health nutrition |
| Infrastructure Support Domain Indicators |
| Leadership |
| LEAD1: There is strong, visible, political support (at the Head of Government / Cabinet level) for improving food environments, population nutrition, diet-related NCDs and their related inequalities |
| LEAD2: Clear population intake targets have been established by the government for the nutrients of concern to meet WHO and national recommended dietary intake levels |
| LEAD3: Clear, interpretive, evidence-informed food-based dietary guidelines have been established and implemented |
| LEAD4: There is a comprehensive, transparent, up-to-date and government-owned implementation plan, - linked to national needs and priorities -to improve food environments, reduce the intake of the nutrients of concern to meet WHO and national recommended dietary intake levels, and reduce diet-related NCDs |
| LEAD5: Government priorities have been established to reduce inequalities or protect vulnerable populations in relation to diet, nutrition, obesity and NCDs |
| Governance |
| GOVER1: There are robust procedures to restrict commercial influences on the development of policies related to food environments where they have conflicts of interest with improving population nutrition |
| GOVER2: Policies and procedures are implemented for using evidence in the development of food policies |
| GOVER3: Policies and procedures are implemented for ensuring transparency in the development of food policies |
| GOVER4: The government ensures access to comprehensive nutrition information and key documents (e.g. budget documents, annual performance reviews and health indicators) for the public |
| Monitoring and Evaluation |
| MONIT1: Monitoring systems, implemented by the government, are in place to regularly monitor food environments (especially for food composition for nutrients of concern, food promotion to children, and nutritional quality of food in schools and other public-sector settings), against codes/guidelines/standards/targets. |
| MONIT2: There is regular monitoring of adult and childhood nutrition status and population intakes against specified intake targets or recommended daily intake levels. |
| MONIT3: There is regular monitoring of adult and childhood overweight and obesity prevalence using anthropometric measurements |
| MONIT4: There is regular monitoring of the prevalence of NCD risk factors and occurrence rates (e.g. prevalence, incidence, mortality) for the main diet-related NCDs |
| MONIT5: There is sufficient evaluation of major programs and policies to assess effectiveness and contribution to achieving the goals of the nutrition and health plans |
| MONIT6: Progress towards reducing health inequalities or health impacts in vulnerable populations and societal and economic determinants of health are regularly monitored |
| Funding |
| FUND1: Funding for the promotion of healthy eating and healthy food environments, as a proportion of total health spending and/or in relation to the diet-related NCD burden is sufficient to reduce obesity and diet-related NCDs |
| FUND2: Government funded research is targeted at improving food environments, reducing obesity, NCDs and their related inequalities |
| FUND3: There is a statutory health promotion agency in place that includes an objective to improve population nutrition, with a secure funding stream |
| Platforms for Interaction |
| PLATF1: There are coordination mechanisms across departments and levels of government (national and local) to ensure policy coherence, alignment, and integration of food, obesity and diet-related NCD prevention policies across governments |
| PLATF2: There are formal platforms between government and the commercial food sector to implement healthy food policies |
| PLATF3: There are formal platforms for regular interactions between government and civil society on food policies and other strategies to improve population nutrition |
| Health in all Policies |
| HIAP1: There are processes in place to ensure that development of all government policies relating to food are sensitive to nutrition, public health, and reducing health inequalities in vulnerable populations |
Adapted from Swinburn et al. (Swinburn et al., 2013)