Ten years on: a review and strengthening of a mandatory healthy food and drink policy in healthcare settings in Western Australia

Food environments in healthcare settings have been identified as a priority for obesity prevention policy.⁽¹⁾ In 2008, the Western Australian (WA) government mandated the Healthy Options WA Food and Nutrition Policy (the Policy) for publicly owned or managed healthcare facilities.⁽²⁾ The Policy uses a traffic light system to classify retail food and drinks as healthy (Green), moderately healthy (Amber), or least healthy (Red) and limits the display, offer, and promotion of less healthy items. An audit in 2018 found variable but generally low policy compliance, and an in-depth review to strengthen the Policy was undertaken in 2019. This paper describes the review of the Policy, and lessons learnt for future work. The review was undertaken by tertiary-qualified nutritionists at the Department of Health, WA. The review included an analysis of evaluation data from previous audits of policy compliance, a cross-jurisdictional review of equivalent policies, and stakeholder consultation. Recommended national nutritional standards for public sector healthcare settings endorsed by the Council of Australian Governments (COAG) Health Ministers was also considered. The review found the scope of the Policy was ambiguous and did not capture all retail outlets selling food and/or drink items in public healthcare settings (e.g. pharmacies, florists), affiliated research/education facilities situated onsite, or joint public/private hospitals. Restrictions on the display and promotion of less healthy items were weak compared with other jurisdictions’ policies and the national standards. Restrictions on the provision of less healthy items for fundraising activities and business catering were limited and/or conflicted with other jurisdictions’ policies. Resources to support policy implementation (e.g. monitoring tools and promotional materials) required improvement. Most stakeholders (60%) supported banning or restricting the sale of Red (e.g. sugar sweetened) and Amber (e.g. artificially sweetened) drinks. The revised Policy removed the sale of sugar sweetened drinks and introduced stronger restrictions on the display, offer and promotion of unhealthy items including new requirements on product placement. The review identified ways to strengthen the Policy to better align with current evidence as well as opportunities for quality improvement, including feasibility considerations and implementation support. The COAG national nutrition standards provided critical policy benchmarks. These findings may be used to inform the development, implementation or review of future healthy food and drink policies in healthcare and other settings.