. 2022 Nov 16;23:100522. doi: 10.1016/j.lanepe.2022.100522

Table 4.

The top prioritized policy actions for each participating country.

No.	Priority actions	Domain
	Finland^a
1	Making the nutritional quality of a meal a requirement for a tax-subsidized lunch or food benefit.	Composition
2	Exploring the possibility of introducing a national mandatory labelling system for packaged foods on the front of the food packaging, indicating the nutritional value of the product and a mandatory national (the Heart Symbol or similar) nutrition labelling system in fast food restaurants to communicate nutritionally better meal options.	Labelling
3	Exploring the possibilities for national legislation and enforcement of such legislation and self-regulation regarding the marketing of unhealthy foods to children. Prohibiting the marketing of unhealthy foods and beverages to children by law. Investigating children's exposure to the marketing of unhealthy foods in the digital environment. Adding the use of minimum nutritional quality requirements as a procurement criterion in the supplement of the state contribution of the promotion of well-being and health used for municipalities and provinces. Monitoring children's exposure to the marketing of unhealthy foods in different operational environments.	Promotion
4	Exploring fiscal measures and other measures that would allow the price of vegetables to fall. Introducing a health-based taxation on food/foodstuff.	Prices
5	Restricting the sale and supply of unhealthy foods by legislative means in the living environment of young people and children, such as at school and in hobbies. Developing recommendations and guidelines for grocery stores to create a selection environment conducive to health-promoting choices, for example through product placement and presentation.	Retail
6	Encouraging the food industry and public / private food service operators to improve the nutritional quality of their products by adopting the use of the Heart Symbol. Exploring the possibilities of making the Heart Symbol system free of charge for users. Clarifying the legislation regarding the criteria for free school and student meals so that it would be mandatory to take nutrition recommendations into account.
	Ireland^b
1	Implement nutrition standards for all schools including tuck shops operating therein. All school-based health promotion programmes should be delivered by health professionals. An inter-school nutrition forum should be established on the promotion of healthy food choices within the school environment, with support from appropriate governing bodies.	Provision
2	Establish a committee with a cross-governmental structure to monitor and evaluate food-related income support programmes for vulnerable population groups.	Prices
3	Ringfence revenue from tax on unhealthy foods to improve public health initiatives and provide healthy food subsidies targeted at disadvantaged groups in the community.	Prices
4	Introduce zoning legislation “No Fry Zones” to prohibit the placement of unhealthy food outlets within 400m of primary and secondary schools.	Retail
5	Implement a comprehensive policy on nutrition standards for food and beverage provision in public sector. Monitoring of existing policies and guidelines for effectiveness in provision and promotion of healthy food choices should be conducted.	Provision
	Germany^a
1	Mandatory, publicly funded implementation of the nutrition standards of the German Nutrition Society in schools and kindergartens and waiving of fees for parents. The nutrition standards include specifications for the main meals offered, other food and beverages available on the school premises, characteristics of the dining rooms and the arrangement of communal meals. Furthermore, it includes the provision of sufficient financial resources (e.g., under a federal investment program), professional support, and training opportunities.	Provision
2	Reduced value-added tax rate on healthy foods and increased value-added tax rate on unhealthy foods.	Prices
3	Introduction of a tax on SSBs based on sugar content and use of the revenue for health promotion (e.g., improvement of catering for school and day-care).	Prices
4	Ban on advertisement of unhealthy foods directed at children, including all forms of advertising (television, internet, print and outdoor advertising, point-of-sale advertising, direct marketing, packaging, and advertising in kindergartens, schools, playgrounds and other sports and recreational facilities frequented by children) and based on an appropriate nutrient profile model (e.g., the model of the WHO European Regional Office).	Promotion
5	Mandatory implementation of the nutrition standards of the German Nutrition Society in public institutions, such as public offices, clinics, senior citizen facilities and universities. The nutrition standards include specifications for the main meals offered, other food and beverages available on the school premises, characteristics of the dining rooms and the arrangement of communal meals. Furthermore, it includes the provision of sufficient financial resources (e.g., under a federal investment program), professional support, and training opportunities.	Provision
	The Netherlands^b
1	Ensure that the new product improvement system, in continuation of the agreement on product composition improvement, meets at least the following requirements: • It includes more ambitious food composition targets than the current targets in the agreement on product composition improvement. • It includes annual targets to reduce the amounts of salt, saturated fat, and added sugars in all product categories which have an impact on the salt, saturated fat, and added sugars intake, where a reduction in one nutrient does not lead to an increase in another nutrient. • There is a clear timeline with annual independent monitoring including baseline measurement, with publicly accessible reporting, to make the progress visible. • It includes proven, effective incentives per product category that ensure that food producers comply with agreements.	Composition
2	Ban all forms of marketing (Article 1 of the Dutch Advertising Code) aimed at children under the age of 18 years old for foods that fall outside the Dutch healthy dietary guidelines (i.e., the Wheel of Five) (an advertisement is aimed at children when the advertisement reaches an audience consisting of 10% children under 18 or more), via: • Media channels such as TV, radio, online and social media, point of sale, packages, games, cinema, print, sponsorship, kids’ clubs, sales promotion, product placement, films, peer-to-peer etc. • Marketing methods such as the use of children's idols, cartoons, animation figures, games, puzzles etc.	Promotion
3	Increase the prices of unhealthy foods such as sugar-sweetened beverages, for example via a proven effective VAT-increase or excise tax.	Prices
4	Formulate clear rules and regulations for caterers, quick service restaurants, supermarkets, and shops to increase the relative availability of healthy foods (with sufficient fibre, vitamins, and/or minerals) compared to the total food product availability.	Retail
5	Decrease the prices of healthy foods such as fruit and vegetables, for example by reducing the VAT to 0% (when this is possible with the new European legislation).	Prices
6	Finance food-related income support, for example by providing vouchers to people below a certain income level to purchase healthy foods free of charge (such as fruits and vegetables, such as the Healthy Start programme in the UK).	Prices
	Norway^b
1	Actively use fiscal policies to shift consumption from unhealthy to healthy foods. This includes to: • Introduce a differentiated sugar tax aiming at reducing consumption of sugary foods and drinks. • Investigate the possibility of introducing taxes to reflect climate/ environmental footprint.	Prices
2	Step up efforts to create healthy food environments and make healthy choices easy in public settings. This includes to: • Impose requirements on municipalities for healthy food environments in kindergartens and schools, based on available evidence. The requirement must include that municipalities develop an implementation plan for the use and compliance with national guidelines for food and meals in schools and kindergartens, including school canteens and kiosks. • Set requirements for the food offered in public contexts to follow the national dietary guidelines. • Set nutritional requirements for the contents of vending machines in public areas.	Provision
3	Order all municipalities to offered a simple school meal (which at least consists of free school fruit), with room for local adaptation and with state part-financing.	Provision
4	Demand clearer results in the ongoing public-private partnership (Letter of Intent with the food sector) to achieve the goals set in the agreement and make food stores healthier. This includes to: • Push to set standards for the reduction of saturated fat and sugar in the Letter of Intent. • Consider introducing and publishing a "ranking" of the best and worst actors in the food sector when it comes to nutrient composition in foods, especially regarding salt, sugar, and saturated fats.	Retail
5	Introduce a legal regulation of the marketing of unhealthy food and drink targeting children. Or alternatively, put pressure on the industry so that the guidelines in the Food Industry Professional Committee (MFU) become stricter than today and are, to a greater extent, in accordance with WHO recommendations. The latter will involve a re-assessment of the exceptions in the MFU guidelines regarding packaging, placement in supermarkets, and sponsorship.	Promotion
	Poland^a
1	Introduce a clear and simple labelling system for food products, including information on salt/sugar/trans fats.	Labelling
2	Prepare the emission of information campaigns that are thoroughly prepared from the sociological and psychological point of view, preceding the introduction of food policy regulations.	Promotion
3	Modify the Ordinance of the Minister of Health on groups of foodstuffs intended for sale to children and adolescents in education system units and the requirements to be met by foodstuffs used as part of mass nutrition of children and adolescents in these units, in a way that specifies requirements consistent with nutritional requirements and recommendations.	Provision
4	Modify school curricula by adding a subject or at least a compulsory thematic block “nutritional education”.	Provision
5	Change the VAT matrix in a way that unequivocally promotes low-processed foods and healthy food choices.	Prices
	Estonia^a
1	Training client servants on nutrition.	Provision
2	Support and incentivise businesses to improve availability, placement, and prominence of healthy foods in stores and services.	Retail
3	Restricting the advertising of products high in saturated fat, sugar, and energy content through different media and settings.	Promotion
4	Promote the advertising of healthy food options, in particular raw materials like fresh fruit and vegetables.	Promotion
5	Provide campaigns, practical guidelines, tools, training, and instructions to support healthy food choices by the general public.	Funding
	Slovenia^a
1	Maintaining and upgrading school nutrition.	Provision
2	Improving the situation on student nutrition (new guidelines, vouchers).	Provision
3	Employment, training, and education of staff in public institutions in the field of nutrition.	Provision
	Spain^a
1	Current standards require improvement. According to the WHO criteria should be more ambitious and be aligned to products that are most consumed and available in Spain, and according to their nutritional information. Monitoring of the progress in the establishment of these standards should be carried out.	Composition
2	To implement a clear mandatory front of pack labelling system.	Labelling
3	To implement plain packaging policies and ban the use of cartoons or celebrities as well as food endorsement for unhealthy foods.	Promotion
	Italy^a
1	Upgrading school menu.	Provision
2	Reformulation of food products.	Composition
	Portugal^b
1	Extend the plan in force in Portugal regarding the food products reformulation, involving the food service outlets. This plan should encompass the definition of short and medium-term priorities and objectives.	Composition
2	Reduce taxes on healthy foods (pulses, fruit, and vegetables).	Prices
3	Define a nutrient profile model which will work as the foundation for the implementation of measures to promote healthy eating environments (food products reformulation, taxation of unhealthy foods, among others).	Composition
4	Ensure the effective implementation of the existing guidelines for food provision in schools by defining a model to monitor the compliance with the standards/guidelines in place.	Provision
5	Propose an amendment to the Value Added Tax (VAT) to include other criteria for assigning VAT rates. Besides the criteria of essentiality, it is proposed to consider the food products’ nutrient profile and/or their inclusion in a healthy dietary pattern.	Prices

Prioritization based on importance and achievability.

Prioritization based on importance, achievability, and equity.