Ni Mhurchu Cliona, Rosin Magda, Shen Stephanie, Kidd Bruce, Umali Elaine, Jiang Yannan, Gerritsen Sarah, Mackay Sally, Te Morenga Lisa
Department of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand.
Centre for Translational Health Research: Informing Policy and Practice (TRANSFORM), Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
BMC Med. 2025 May 28;23(1):299. doi: 10.1186/s12916-025-04122-x.
Healthy food and drink guidelines for public sector settings can improve the healthiness of food environments. This study aimed to assess the implementation and impact of the voluntary National Healthy Food and Drink Policy (the Policy) introduced in New Zealand in 2016 to encourage provision of healthier food and drink options for staff and visitors at healthcare facilities.
A customised digital audit tool was used to collate data on foods and drinks available for sale in healthcare organisations and to systematically classify items as green ('healthy'), amber ('less healthy'), or red ('unhealthy') according to Policy criteria. On-site audits were undertaken between March 2021 and June 2022 at 19 District Health Boards (organisations responsible for providing public health services) and one central government agency. Forty-three sites were audited, encompassing 229 retail settings (serviced food outlets and vending machines). In total, 8485 foods/drinks were classified according to Policy criteria. The primary outcome was alignment with Policy guidance on the availability of green, amber, and red category food/drink items (≥ 55% green and 0% red items). Secondary outcomes were proportions of green, amber, and red category items, promotional practices, and price. Chi-square tests were used to compare results between categorical variables.
No organisation met the criteria for alignment with the Policy. Across all sites, 38.9% of food/drink items were rated red (not permitted), 39.0% were amber, and 22.1% were green. Organisations that adopted the voluntary Policy offered more healthy foods/drinks than those with their own organisational policy, but the proportion of red items remained high: 32.3% versus 47.5% (p < 0.0001). About one-fifth (21.3%) of all items were promoted, with red (24.6%) and amber (22.2%) items significantly more likely to be promoted than green items (14.0%) (p < 0.001). Green items were also significantly more costly on average (NZ$6.00) than either red (NZ$4.00) or amber (NZ$4.70) items (p < 0.0001).
Comprehensive and systematic evaluation showed that a voluntary Policy was not effective in ensuring provision of healthier food/drink options in New Zealand hospitals. The adoption of a single, mandatory Policy, accompanied by dedicated support and regular evaluations, could better support Policy implementation.
公共部门场所的健康食品和饮料指南可改善食品环境的健康程度。本研究旨在评估2016年在新西兰推出的自愿性《国家健康食品和饮料政策》（以下简称《政策》）的实施情况及其影响，该政策旨在鼓励医疗机构为员工和访客提供更健康的食品和饮料选择。
使用定制的数字审计工具收集医疗机构在售食品和饮料的数据，并根据《政策》标准将其系统分类为绿色（“健康”）、琥珀色（“较不健康”）或红色（“不健康”）。2021年3月至2022年6月期间，对19个地区卫生委员会（负责提供公共卫生服务的组织）和一个中央政府机构进行了现场审计。共审计了43个场所，包括229个零售场所（提供食品的店铺和自动售货机）。总共8485种食品/饮料根据《政策》标准进行了分类。主要结果是符合《政策》关于绿色、琥珀色和红色类别食品/饮料项目供应的指导意见（绿色项目≥55%且红色项目为0%）。次要结果是绿色、琥珀色和红色类别项目的比例、促销做法和价格。使用卡方检验比较分类变量之间的结果。
没有组织达到与《政策》相符的标准。在所有场所中，38.9%的食品/饮料项目被评为红色（不允许），39.0%为琥珀色，22.1%为绿色。采用自愿性《政策》的组织比有自身组织政策的组织提供了更多健康食品/饮料，但红色项目的比例仍然很高：分别为32.3%和47.5%（p< 0.0001）。所有项目中约五分之一（21.3%）进行了促销，红色（24.6%）和琥珀色（22.2%）项目比绿色项目（14.0%）更有可能被促销（p< 0.001）。绿色项目的平均成本（6.00新西兰元）也明显高于红色（4.00新西兰元）或琥珀色（4.70新西兰元）项目（p< 0.0001）。
全面系统的评估表明，自愿性《政策》在确保新西兰医院提供更健康的食品/饮料选择方面并不有效。采用单一的强制性政策，并提供专门支持和定期评估，可能会更好地支持政策实施。
