Dutch policy measures for a healthy food environment lag behind other European countries. Most countries are doing more than the Netherlands to create a healthier range in schools, supermarkets and on the street. This has emerged from a comparison of eleven countries by researchers from Wageningen University and Utrecht University. The study was published this month in The Lancet Regional Health – Europe.
The Netherlands, Spain and Germany dangle at the bottom of the so-called Healthy Food Environment Policy Index (Food-EPI), an index that looks at government policies and measures directly aimed at creating a healthy food environment.
For this comparison, the researchers first made an overview of the policy in eleven European countries. Health experts in those countries then compared the policy in their own country with a list of ‘best practices’ (good examples) from the rest of the world, such as a sugar tax or a healthy school meal policy. On a scale of 1 to 5, they rated how good the implementation was in their country.
The Netherlands scores low on aspects such as the implementation of laws and regulations for food supply, labeling and marketing. Almost all the countries studied score ‘weak’ when it comes to measures for a healthier food environment. Only Finland, Norway and Portugal stand out. For example, Finland subsidizes healthy meals for students, Portugal bans marketing aimed at children under the age of 16, and Norway has more rules for making products healthier than other countries. Finland also scores high on governance, monitoring and financing.
Prevention agreement
This first European comparison shows that although there is a policy everywhere to make the food environment healthier, legislation and regulations are lagging behind. In the Netherlands, for example, there is a ‘National Prevention Agreement’ and obesity is tracked, but consumers pay VAT on fruit and vegetables, there is no tax (yet) on sugary drinks and municipalities have no instruments to ban fast-food restaurants.
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“Most striking is that in Europe every country does something different,” says Maartje Poelman, one of the authors. “There are European rules for health claims, for example, but laws and regulations that directly affect the food environment, such as a sugar tax, are not there for the entire European Union.” Poelman is an associate professor of Consumption and Healthy Lifestyle in Wageningen. She herself did not complete any questionnaires as an expert.
Obesity rates
Countries that score better on the Food EPI do not always have less obesity. Finland is with 59 percent in the highest regions. Poelman: “As a result, there may be a stronger sense of urgency to intervene.” It cannot therefore be concluded from higher obesity figures that measures have no effect.
Making the food environment healthier – think of shops, schools, catering establishments, et cetera – is important, say the researchers, because it has a major influence on eating behaviour. A heavier population leads to more type 2 diabetes, cardiovascular disease and cancer. Healthcare costs due to obesity are estimated at more than 300 billion euros per year in the EU.
The researchers acknowledge that the opinion of the experts consulted is subjective. With these types of studies, the background of experts can play a role, they write. Laws and rules in the countries have been established objectively, but experts in the Netherlands may have been more critical than elsewhere.
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Self-regulation
Joline Beulens, nutritionist and epidemiologist (Amsterdam UMC) and not involved in the research, speaks of “a beautiful study that provides a complete picture.” It also confirms what previous research showed: the policy to combat obesity and chronic diseases is being implemented to a minimum. “There is too much self-regulation and too little hard regulation. To keep healthcare affordable, a broad package of measures is needed for the prevention of chronic diseases, including the food environment.”
Poelman emphasizes the importance of follow-up research, so that it becomes clear in the long term whether obesity and other chronic diseases decrease with a healthier food environment. “The effect of individual interventions is difficult to prove.” She also says: “You have to tackle the entire system for a healthier population. Different measures reinforce each other.”
The experts in most countries believe that a tax on unhealthy food, healthier food in schools and a ban on marketing to children should be given priority. ‘Lifestyle and prevention’ will be on the agenda next week in the House of Representatives. State Secretary Maarten van Ooijen (VWS, ChristenUnie) wants, among other things, that municipalities can more easily refuse new providers of fast food.