Creating healthy food environments in public institutions and other settings

Healthy food environments can be created in public institutions (e.g. schools, workplaces and hospitals) and other settings (e.g. cafes and restaurants) though nutrition standards for the purchase, provision, preparation, and sale of foods and meals.

Why it matters

Creating healthy food environments can lead to improvements in population diets though food supply changes and facilitating individual healthy food choices.

Public institutions are an opportunity for creating healthy food environments. They provide access to large proportions of the population for extended periods of time and have existing infrastructure to deliver nutrition interventions. In many countries, governments are one of the leading food procurers. Governments can develop and implement nutrition policies and programs in public institutions and set an example of healthy food environments. 

Healthy food environments can also be created in other settings. The out-of-home food sector e.g. cafes, restaurants, food outlets and street food, is a substantial contributor to salt intake in many countries. Working with retailers to create healthy food environments is a key area for future work. 

How to do it

Nutrition policies and programs can be implemented across a wide variety of settings including schools, workplaces, hospitals, aged-care facilities, prisons, cafes, restaurants and food outlets. There are three main initiatives that can be implemented: 

  • Nutrition standards for the purchase, provision, preparation, and sale of foods and meals (including salt criteria) (may also be known as food procurement policies) 
  • Labelling and marketing to illustrate healthier (less salty) choices to consumers 
  • Education programs to improve consumer knowledge and behaviours relating to healthy eating and salt

Released in January 2021, the WHO has developed an Action framework for developing and implementing public food procurement and service policies for a healthy diet (Resource 1). The framework consists of four domains: (1) Policy Preparation (2) Policy Development (3) Policy Implementation (4) Monitoring, Enforcement and Evaluation.

Tools for implementing healthy retail practices are available from Australia’s Nourish Network (Resource 2). This work was funded by The Australian Prevention Partnership Centre and carried out by Dr Tara Boelsen-Robinson. 

A comprehensive list of resources for public procurement policies from the LINKS community can be found in Resource 3.

Other Resources

Surveillance, monitoring and evaluation

Collecting data is important to inform the intervention, to monitor the extent to which it is being implemented effectively and having the intended effect, and to evaluate the impact of the intervention. It is important to do surveillance before (plan & design), during (monitoring & adaptation) and after (evaluation) program implementation. The figure below shows how the findings from surveillance and monitoring can be used at each stage of a program.

Industry and Reformulation

In most high-income countries, and increasingly in low and middle-income countries, 70-80% of salt consumed comes from processed foods and meals (including meals eaten out of the home and takeaway foods)

Developing Strategies

Salt reduction strategies are much more likely to be effective and sustainable if time and effort is put into developing a strategic approach and ensuring stakeholder commitment. If you are clear about what you are trying to

Consumer Awareness and Behaviour Change

Targeted and sustained communication and behaviour change strategies can be used to empower people to improve their salt intake and diet, create consumer demand for lower salt food products, and improve uptake of