Cafés, kiosks, canteens and vending machines within hospitals and health services provide food to a large number of health workers and visitors every day. Hospitals and health services have the opportunity to model healthy food environments to the broader community through the healthiness of their facilities. Most state/territory governments have developed a policy or framework to support the provision and promotion of healthy options within hospitals and health services. Monitoring the healthiness of food and drinks offered and promoted in hospitals and health services, and compliance with government policy is vital.
Western Australiaˆ
| Indicator | Result | Assessment* | What was measured? | Source |
|---|---|---|---|---|
Food availability |
||||
Proportion of food and drinks in outlets classified as ‘healthy’** |
44% |
State-wide audit of 25 WA health services and facilities, including 52 cafés/kiosks/canteens (2018-19). Target ≥ 50% |
||
Proportion of food and drinks in outlets classified as ‘least healthy’** |
32% |
State-wide audit of 25 WA health services and facilities, including 52 cafés/kiosks/canteens (2018-19). Target ≤ 20% |
||
Proportion of food and drinks in vending machines classified as ‘healthy’** |
40% |
State-wide audit of 25 WA health services and facilities, including 158 vending machines (2018-19). Target ≥ 50% |
||
Proportion of food and drinks in vending machines classified as ‘least healthy’** |
27% |
State-wide audit of 25 WA health services and facilities, including 158 vending machines (2018-19). Target ≤ 20% |
||
Food promotion |
||||
Proportion of outlets compliant with promotion requirements*** |
83% |
State-wide audit of 25 WA health services and facilities, including 52 cafés/kiosks/canteens (2018-19). |
||
Proportion of vending machines compliant with promotion requirements*** |
96% |
State-wide audit of 25 WA health services and facilities, including 158 vending machines (2018-19). |
||
Healthy food policy |
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Proportion of outlets that met all policy requirements** |
29% |
State-wide audit of 25 WA health services and facilities, including 52 cafés/kiosks/canteens (2018-19) |
||
Proportion of vending machines that met all policy requirements** |
60% |
State-wide audit of 25 WA health services and facilities, including 158 vending machines (2018-19) |
* Green = ‘Promotes health’; Amber = ‘Needs further improvement to promote health’; Red = ‘Unhealthy’. Refer to Indicator Assessment Criteria at the bottom of the page.
** The Healthy Options WA: Food and Nutrition Policy for WA Health Services and Facilities applies a ‘traffic light’ system (‘green’, ‘amber’ and ‘red’) to classify food and drinks from healthiest through to least healthy, respectively. The policy states products on offer and on display must be at least 50% ‘green’, no more than 20% ‘red’ and the remainder classified as ‘amber’. Only ‘green’ food and drinks may be promoted and the use of ‘red’ food and drinks for fundraising initiatives, events and prizes is not permitted.
*** ‘Promotion’ of food and drinks included promotion and advertising at point of sale, on counters, cabinets, fridges, vending machines, menus and staff notice boards, in lifts and via promotional stands and product displays, banners and signs inside and outside the outlet and on furniture. Only ‘green’ food and drinks may be promoted, and the use of ‘red’ food and drinks for fundraising initiatives, events and prizes is not permitted.
ˆ Each state/territory has different criteria in their healthy food policies and so direct comparison between jurisdictions is not recommended
New South Walesˆ
| Indicator | Result | Assessment* | What was measured? | Source |
|---|---|---|---|---|
Proportion of food outlets that removed sugar-sweetened drinks** |
93% |
State-wide audit of all food outlets including cafes, kiosks, and vending machines in all Local Health Districts and Specialty Health Networks (n=908, 2020) |
NSW Health (2020) |
|
Proportion of food outlets that met ‘availability’ practices** |
65% |
State-wide audit of all food outlets including cafes, kiosks, and vending machines in all Local Health Districts and Specialty Health Networks (n=908, 2020) |
NSW Health (2020) |
|
Proportion of food outlets that met ‘quality’ practices** |
93% |
State-wide audit of all food outlets including cafes, kiosks, and vending machines in all Local Health Districts and Specialty Health Networks (n=908, 2020) |
NSW Health (2020) |
|
Proportion of food outlets that met ‘product size’ practices** |
91% |
State-wide audit of all food outlets including cafes, kiosks, and vending machines in all Local Health Districts and Specialty Health Networks (n=908, 2020) |
NSW Health (2020) |
|
Proportion of food outlets that met ‘marketing’ practices** |
83% |
State-wide audit of all food outlets including cafes, kiosks, and vending machines in all Local Health Districts and Specialty Health Networks (n=908, 2020) |
NSW Health (2020) |
* Green = ‘Promotes health’; Amber = ‘Needs further improvement to promote health’; Red = ‘Unhealthy’. Refer to Indicator Assessment Criteria at the bottom of the page.
** The following food outlet practices are assessed as part of NSW Health’s annual audit of the Healthy food and drink in NSW health facilities for staff and visitors Framework:
ˆ Each state/territory has different criteria in their healthy food policies and so direct comparison between jurisdictions is not recommended
Key Findings
Most states/territories in Australia do not monitor or report the healthiness of hospital and health services food environments in their jurisdiction. Western Australia and New South Wales are notable exceptions.
- Western Australia Department of Health monitors the healthiness of foods available in health facilities and compliance with their policy framework. Some significant improvements have been made between 2016 and 2018-19:
- In cafés, kiosks and canteens, the average proportion of ‘green’ items on offer and on display increased by 16%, while ‘red’ items decreased by 14%.
- In vending machines, ‘green’ items increased by 21% and ‘red’ items decreased by 25%.
- Overall, 36% of outlets increased the promotion of ‘green’ foods and drinks, and 18% of outlets decreased the promotion of ‘red’ items.
- New South Wales Health monitors the implementation of the Healthy food and drink in NSW health facilities for staff and visitors Framework in food outlets in all Local Health Districts and Specialty Health Networks.
- The goals of the framework include:
- Sugar-sweetened drinks are not sold in NSW Health facilities
- To promote and increase the availability of healthy food options for staff and visitors in NSW Health facilities
- To decrease the availability of unhealthy food and drink options for staff and visitors in NSW Health facilities
- Monitoring in NSW has shown strong compliance with the framework, with some areas (such as availability of unhealthy foods) still needing improvement.
- The goals of the framework include:
A 2021 study (Law et al. Nutrients) examining hospital food retailers’ experiences of implementing the mandatory WA policy found that food retailers required extensive support to effectively bring about change. Executive-level engagement, dedicated support from a trusted technical expert, and quality improvement processes were found to be essential to assist food retailers to overcome several contextual barriers to policy compliance.
Key Recommendations
- All health services should provide a nutritious food environment and model healthy eating to the community.
- Hospitals and other health facilities should:
- Develop policies and procedures aligned to national/state/territory government food and nutrition frameworks to support healthy food environments.
- Support and monitor food and drink service providers that operate within their facilities to ensure adherence to policies. This may include clear governance structures, implementation and monitoring plans, and adequate resourcing of staff with nutrition expertise.
- State/territory governments should:
- Ensure policies and frameworks in healthcare environments support nutritious and healthy eating options for staff, patients, visitors and the community.
- Build system-wide capacity for implementation, monitoring and enforcement mechanisms, to reduce duplication of efforts. This should include:
- Regular monitoring of the availability and promotion of healthy and unhealthy food and drinks within public and private health services and facilities. Recent audits have been conducted by NSW and WA state governments only. All other states and territories should regularly audit hospitals and other healthcare facilities, ideally using a common audit tool.
- Provision of resources and support (including incentives) to health services and facilities, and the food outlets that operate within them. This could include health promotion staff, guides and case studies to help facilities implement policies.
- Thorough and transparent evaluation of policy outcomes.
- Work towards a universally accepted food nutrition classification system to promote consistency and allow for comparison of food environments across jurisdictions.
- Accompany food and nutrition policies with ‘wrap-around’ initiatives to increase public awareness and support for the provision of healthy food and drinks in health services and facilities.
For more information
Websites:
Visit the Obesity Evidence Hub for key evidence on obesity trends, impacts, prevention & treatment in Australia. Access evidence related to settings based approaches in healthcare settings.
Journal Articles:
- Rosewarne, E., Hoek, A.C., Sacks, G., Wolfenden, L., Wu, J., Reimers, J., Corben, K., Moore, M., Mhurchu, C.N. and Webster, J. (2020) A comprehensive overview and qualitative analysis of government-led nutrition policies in Australian institutions. BMC Public Health, 20(1), pp.1-15.
- Law, K. K., Pulker, C. E., Healy, J. D., and Pollard, C. M. (2021). “Just So You Know, It Has Been Hard”: Food Retailers’ Perspectives of Implementing a Food and Nutrition Policy in Public Healthcare Settings. Nutrients, 13(6), 2053.
Reports:
- Western Australia Department of Health (2020): Healthy Options WA Policy Statewide Audit of Policy Implementation Report 2018-19
| Indicator Assessment Criteria | |||
|---|---|---|---|
| Metric | |||
Proportion of food and drinks in outlets or vending machines classified as ‘healthy’ or ‘least healthy’ |
Meeting or exceeding government target |
Within 10 percentage points of meeting government target |
>10 percentage points away from meeting government target |
Proportion of outlets or vending machines compliant with specific policy requirements (e.g. promotion, product quality) |
≥ 80% |
40-79% |
< 40% |
Proportion of outlets or vending machines that met all policy requirements |
≥ 80% |
40-79% |
< 40% |