We developed the NOURISHING framework to highlight where governments need to take action to promote healthy diets and reduce overweight and obesity.
The framework is accompanied by a regularly updated database (last updated 24 October 2018), providing an extensive overview of implemented government policy actions from around the world.
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We know from the evidence that making fruit and vegetables available in schools increases consumption. There is also evidence that food standards to restrict availability have the effect of reducing consumption of the restricted food.
For these actions to be effective for all children, they need to be sustained over time and accompanied by complementary behaviour change communication techniques, such as "modelling", school gardens, and communication to all stakeholders involved in the provision and consumption of school food. Worksites and healthcare also present strong potential for improved eating among adults.
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In 1997, Bermuda implemented the mandatory Healthy Schools Nutrition Policy which contains school food standards including the provision of fruit and vegetables in food service/cafeteria menus and all school events that provide food, limits on the use of food high in salt and sugar, provision of low-fat dairy products, leaner meats, whole grains, fruits and vegetables, the use of lower-fat cooking methods, the consumption of whole fruit and vegetables as preferable to the sole consumption of fruit and vegetable juices and school lunches are required to be consistent with the recommendations of Bermuda’s Daily Dietary Guidelines EatWell Plate.
The Food Service Providers Contract, implemented in 2009 to strengthen the compliance of cafeteria, hot lunch and breakfast vendors in schools, mandates that food provided in schools must be consistent with the Healthy School Nutrition Policy. To monitor compliance, a form exists in which anyone at any school can rate various aspects of a meal provided by a food service provider (eg appropriateness of portion sizes, inclusion of four of five food groups, etc).
The Ministry of Education also has a policy in which only fruit, yoghurt, cheese, crackers and vegetables can be eaten at morning recess.
In 2006, Bermuda implemented the Healthy Schools Vending Machine and Cafeteria Policy which bans sodas and snacks from vending machines on school premises. Only plain, unsweetened water and/or 100% fruit juice is permitted.
Since 2008, Healthy Schools in Bermuda has partnered with a charity that provides healthy breakfasts to at-risk school-age children. The milk served in this programme must be low in fat.
For more information about Healthy Schools see “O – Mandatory standards for food available in schools, including restrictions on unhealthy food” (above).
In 2008, the Government Vending Machine Policy was implemented in government offices and facilities in Bermuda to ensure access to healthy snacks and beverages for staff. The policy requires that all food and beverages in vending machines on government premises meet specific criteria based on levels of total fat, saturated fat, trans fat, sodium and sugar. The criteria exclude nuts and 100% fruit juices.
Empirical estimates show that food prices influence, to a varying degree, how much food people buy. Targeted subsidies have been shown to help overcome affordability barriers to healthy food for people on low incomes. Incentives, like financial rewards or price discounts, have also been shown to encourage people to switch to healthier options.
Emerging evidence from implemented taxes, as well as modelling studies, indicate the potential for effectiveness to reduce consumption. Given food choices are influenced by a whole host of factors, especially in modern, complex food markets, taxes must be designed very carefully to maximise effectiveness.
Please note, $ refers to USD.
Added October 2018: On 1 October 2018, the Customs Tariffs Amendment (No 2) Act 2018 introduced an ad valorem tax of 50% of the value of waters, including mineral waters and aerated waters, containing added sugar or other sweetening matter or flavouring, and other non-alcoholic beverages entered into force. Syrups containing sugar or other sweetening matter are also taxed at 50%, while fruit and vegetable juices are exempt. Tariff Code 1704.909 also introduced a 50% tax on sugar confectionery not containing cocoa.
Policies within this category aim to harness the whole food system, and the sectors which influence it, to ensure coherence with healthy eating. This is because the food system, and the policies that affect it, influence our food environment.
What our food industry produces is in part a response to incentives in the supply chain. Sectors outside of health influence our ability to take policy action. Likewise, if governments implement policies contained in NOURISHING, they have repercussions upstream for the actors and activities in food systems. This wider relationship to the food supply chain presents an opportunity to support all the policies in NOURISHING with actions in the food supply chain.
Active NCD Commissions exist in eight of the 20 CARICOM member states (Antigua and Barbuda, Bahamas, Barbados, Bermuda, British Virgin Islands, Dominica, Grenada, Saint Lucia), which are all housed in their Ministries of Health, with members recommended by the Minister of Health and appointed by the Cabinet of Government for a fixed duration; all include government agencies, and, to a varying degree, civil society and the private sector.
Awareness is one precursor to eating well. The evidence suggests that public campaigns can boost awareness. To influence consumption, they need to be sustained and use multiple channels.
The Caribbean Community (CARICOM) celebrates Caribbean Wellness Day every year on 13 September to raise awareness of healthy lifestyle options, including promoting healthy food choices. The main slogan is “Love that body” and the campaign elements include posters, stickers, a logo, a jingle, a website and public service announcements.