Policy implementation and priorities to create healthy food environments using the Healthy Food Environment Policy Index (Food-EPI): A pooled level analysis across eleven European countries

Elisa Pineda, Maartje P. Poelman, Anu Aaspõllu, Margarida Bica, Cristina Bouzas, Elena Carrano, Pilar De Miguel-Etayo, Sanne Djojosoeparto, Mojca Gabrijelčič Blenkuš, Pedro Graca, Karin Geffert, Antje Hebestreit, Anni Helldan, Sigrun Henjum, Camilla Sanne Huseby, Maria João Gregório, Carlijn Kamphuis, Tiina Laatikainen, Anne Lene Løvhaug, Clarissa LeydonAleksandra Luszczynska, Päivi Mäki, J. Alfredo Martínez, Susanna Raulio, Piotr Romaniuk, Gun Roos, Clara Salvador, Franco Sassi, Marco Silano, Ingrid Sotlar, Maria Lucia Specchia, Miguel Telo de Arriaga, Laura Terragni, Liv Elin Torheim, Josep A. Tur, Peter von Philipsborn, Janas M. Harrington, Stefanie Vandevijvere*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Food environments have been recognised as highly influential on population diets. Government policies have great potential to create healthy food environments to promote healthy diets. This study aimed to evaluate food environment policy implementation in European countries and identify priority actions for governments to create healthy food environments. Methods: The Healthy Food Environment Policy Index (Food-EPI) was used to evaluate the level of food environment policy and infrastructure support implementation in Estonia, Finland, Germany, Ireland, Italy, the Netherlands, Norway, Poland, Portugal, Slovenia, and Spain in 2019–2021. Evidence of implementation of food environment policies was compiled in each country and validated by government officials. National experts evaluated the implementation of policies and identified priority recommendations. Findings: Finland had the highest proportion (32%, n = 7/22) of policies shaping food environments with a “high” level of implementation. Slovenia and Poland had the highest proportion of policies rated at very low implementation (42%, n = 10/24 and 36%, n = 9/25 respectively). Policies regarding food provision, promotion, retail, funding, monitoring, and health in all policies were identified as the most important gaps across the European countries. Experts recommended immediate action on setting standards for nutrients of concern in processed foods, improvement of school food environments, fruit and vegetable subsidies, unhealthy food and beverage taxation, and restrictions on unhealthy food marketing to children. Interpretation: Immediate implementation of policies and infrastructure support that prioritize action towards healthy food environments is urgently required to tackle the burden of obesity and diet-related non-communicable diseases in Europe. Funding: This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 774548 and from the Joint Programming Initiative “A Healthy Diet for a Healthy Life”.

Original languageEnglish
Article number100522
JournalThe Lancet Regional Health - Europe
Publication statusPublished - Dec 2022


  • Europe
  • Food environments
  • Healthy food environment policy index (Food-EPI)
  • Non-communicable diseases (NCDs)
  • Obesity
  • Public health policies


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