Globally, there is increasing interest in monitoring actions to create healthy, equitable and environmentally sustainable food environments. Currently, there is a lack of detailed tools for monitoring and benchmarking university food environments. This study aimed to develop the University Food Environment Assessment (Uni-Food) tool and process to benchmark the healthiness, equity, and environmental sustainability of food environments in tertiary education settings, and pilot test its implementation in three Australian universities in 2021. The Uni-Food tool development was informed by a review of the literature and input from an expert advisory panel. It comprises three components: (1) university systems and governance, (2) campus facilities and environments, and (3) food retail outlets. The process for implementing the tool is designed for universities to self-assess the extent to which they have implemented recommended practice in 68 indicators, across 16 domains, weighted based on their relative importance. The pilot implementation of the tool identified moderate diversity in food environments across universities and highlighted several opportunities for improvements at each institution. The assessment process was found to be reliable, with assessors rating the tool as easy to use, requiring minimal resources. Broad application of the tool has the potential to increase accountability and guide best practice in tertiary education and other complex institutional settings.
Background: Private regulation, such as contracts, can be an effective lever to implement and manage health-enabling food retail environments. However, guidance for the effective use of contracts in food retail settings is limited. The use of contracts to create healthy food vending environments is one area where policy attention has been focussed. We applied a public health regulatory framework to publicly available guidance documents on healthy vending to develop best practice recommendations for using contracts to create healthy food vending environments. Methods: Document analysis involved i) snowball sampling to identify eligible publicly available healthy vending guidance documents from an identified seed paper; ii) application of a public health regulatory framework to extract data across three domains of form, substance and governance of healthy vending initiatives; and iii) synthesis of data to form best practice recommendations. Eligible documents were those aimed at implementing healthier vending; published from 2000 onwards; accessible online; and included recommendations beyond nutrition standards alone, including a reference to at least one regulatory governance process (administration, implementation, monitoring, enforcement or review). Results: Twelve of 92 documents identified were eligible and all were from the United States (US). All noted that products need to comply with nutrition standards. Other aspects of regulatory substance (i.e., pricing, promotion, placement, labelling and contract length) were less well considered as were elements of regulatory governance (regulatory rules, administration, implementation, monitoring, enforcement and review). Our adapted framework covers three regulatory domains with nine components, and a further 20 recommendations for best practice application in healthy vending. Conclusions: To be effective, contracts used to manage healthy food vending should include more than the nutrition standards for healthy food and drinks. Clearly stating the regulatory objectives, operative terms and conditions, and defining responsibilities for monitoring, review and enforcement within the contract, in addition to the nutrition standards, will assist practitioners in creating effective and sustained contract-based initiatives aimed at improving the healthiness of vending, or other food retail environments.
Australia's largest university, Monash, is a complex food system, with >70 000 students, 17000 staff, 50 food outlets, a supermarket and >100 vending machines. Analysis of this food system in 2016 identified poor availability of healthy food and prompted the university to implement a local healthy eating framework, the Victorian Government's Healthy Choices Guidelines (HCGs). Australians consume a diet low in plant foods and high in discretionary foods: 67% of adults are overweight or obese. Our food environment is large, complex and competitive and akin to a shopping mall or small town and our findings are broadly applicable to these settings. In 2016 Monash commenced implementation of HCGs which classify foods using a traffic light system: Green (best choice), Amber (choose carefully) and Red (limit). To create health enabling environments, the guidelines recommend ≥50% Green and <20% Red foods. Three key strategies are explored: 1) Retail food healthiness assessments, 2) Vending changes and 3) Retail food healthiness labelling. Multiple implementation challenges arose in food retail. In 2016, we conducted retail food healthiness assessments using HCGs. These assessments indicated the Monash food retail environment was 19% Green, 26% Amber and 55% Red. HCG vending was successfully implemented in 2017 using a commercial tender process. Healthy retail labelling was implemented with 32 retailers in 2018; the cost and complexities associated with menu assessments, retailer education and labelling fidelity present enormous challenges. Local frameworks do not scale up in large, complex, competitive retail systems. Success with vending contracts indicates change to food retail may occur with contract clauses. Implementing change in established food retail is problematic. Implementation challenges in large, complex, competitive retail settings require further exploration. Contract clauses show promise for implementing and sustaining change in complex food systems. Key messages Large, complex, competitive retail settings present challenges for food system change. Leasing clauses show promise for changes to large, complex, competitive, retail food systems.
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