University of Auckland, School of Population Health, Auckland, New Zealand.
BMJ Open. 2015 Jan 9;5(1):e006194. doi: 10.1136/bmjopen-2014-006194.
Effective government policies are essential to increase the healthiness of food environments. The International Network for Food and Obesity/non-communicable diseases (NCDs) Research, Monitoring and Action Support (INFORMAS) has developed a monitoring tool (the Healthy Food Environment Policy Index (Food-EPI)) and process to rate government policies to create healthy food environments against international best practice. The aims of this study were to pilot test the Food-EPI, and revise the tool and process for international implementation.
New Zealand.
Thirty-nine informed, independent public health experts and non-governmental organisation (NGO) representatives.
Evidence on the extent of government implementation of different policies on food environments and infrastructure support was collected in New Zealand and validated with government officials. Two whole-day workshops were convened of public health experts and NGO representatives who rated performance of their government for seven policy and seven infrastructure support domains against international best practice. In addition, the raters evaluated the level of difficulty of rating, and appropriateness and completeness of the evidence presented for each indicator.
Inter-rater reliability was 0.85 (95% CI 0.81 to 0.88; Gwet's AC2) using quadratic weights, and increased to 0.89 (95% CI 0.85 to 0.92) after deletion of the problematic indicators. Based on raters' assessments and comments, major changes to the Food-EPI tool include strengthening the leadership domain, removing the workforce development domain, a stronger focus on equity, and adding community-based programmes and government funding for research on obesity and diet-related NCD prevention, as good practice indicators.
The resulting tool and process will be promoted and offered to countries of varying size and income globally. International benchmarking of the extent of government policy implementation on food environments has the potential to catalyse greater government action to reduce obesity and NCDs, and increase civil society's capacity to advocate for healthy food environments.
有效的政府政策对于改善食品环境的健康状况至关重要。国际食品与肥胖/非传染性疾病（NCD）研究、监测和行动支持网络（INFORMAS）开发了一种监测工具（健康食品环境政策指数（Food-EPI））和流程，以根据国际最佳实践对政府政策进行评级，以创建健康的食品环境。本研究的目的是对 Food-EPI 进行试点测试，并对该工具和流程进行修订，以在国际上实施。
新西兰。
39 名知识渊博、独立的公共卫生专家和非政府组织（NGO）代表。
在新西兰收集了有关政府实施不同食品环境政策和基础设施支持的程度的证据，并与政府官员进行了验证。召集了两次为期一天的研讨会，由公共卫生专家和 NGO 代表参加，他们根据国际最佳实践，对其政府在七个政策和七个基础设施支持领域的表现进行了评估。此外，评估人员评估了评分的难度级别、以及每个指标所提供证据的适当性和完整性。
使用二次权重，评分者之间的可靠性为 0.85（95%置信区间 0.81 至 0.88；Gwet 的 AC2），在删除有问题的指标后增加到 0.89（95%置信区间 0.85 至 0.92）。根据评分者的评估和意见，对 Food-EPI 工具的主要更改包括加强领导力领域、删除劳动力发展领域、更加关注公平、并添加基于社区的计划和政府为肥胖和与饮食相关的 NCD 预防研究提供的资金，作为良好实践指标。
由此产生的工具和流程将在全球不同规模和收入的国家中得到推广和提供。对政府在食品环境政策实施程度方面的国际基准测试有可能促进政府采取更多行动来减少肥胖和 NCD，并增强民间社会倡导健康食品环境的能力。
