NOURISHING nutrition policy index

The NOURISHING policy index rates the “policy status” of nutrition policy in different countries. It combines a large amount of information in a single assessment of each policy area of the NOURISHING framework. Results are displayed by country and policy area, allowing comparisons between countries.

The index:

• Gives a value for the strength of policy design in the 10 areas of the NOURISHING framework for each country.
• Looks at the interplay between the policies under each area, rather than individual policies.
• Offers an at-a-glance assessment of how well national governments are enabling healthy diets.
• Identifies gaps and opportunities for action in each country and across Europe.

The index was produced by benchmarking nutrition policy actions against aspirational standards in 30 European countries. The tools were applied on complete datasets of nutrition policy actions taken by a national government. Datasets were collected through a comprehensive scan methodology for 30 European countries and are available in our NOURISHING database.

> Read more about the NOURISHING benchmarking tool

The index scores were calculated in two stages:

• Benchmark scores (0–100) = Policy action presence (“no” = 0, “yes” = 50) + Average of design attributes scores (0–50)
• Policy area scores (0–100) = Calculated average (mean) of benchmark scores for each policy area

We benchmarked 30 European countries which have data available from the Health Behaviour in School-aged Children (HBSC) Study. The countries are: Austria, Belgium, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Malta, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden and UK (England, Northern Ireland, Scotland and Wales).

The focus on data on health-related behaviours in adolescents is in line with the focus of the CO-CREATE project: an innovative EU-funded project that aims to reduce childhood obesity by working with young people to create policy actions promoting healthier environments. It aims to reduce childhood obesity and associated co-morbidities in Europe and the rest of the world by providing knowledge and infrastructure on policies to support making the healthiest choices the preferred ones.

> Read more about our selection criteria

The number of actions benchmarked varied as every country has implemented a different number of nutrition policies. Only policies that fitted our inclusion criteria were benchmarked.

> Read more about our inclusion criteria

The index has been developed to support young people, policymakers, civil society and researchers in engaging with policies that affect them, specifically policies that promote healthy diets. In line with the focus of the CO-CREATE project, the findings are presented in an easy-to-understand format to make it as accessible as possible, including to young people and adolescents. A youth-friendly overview of the NOURISHING index and country snapshots was prepared for the Healthy Voices website.

Young people can:

• learn how well or poorly their country is doing in nutrition.
• see the policy status in Europe and compare their country with other European countries.
• identify weaknesses in the policy status that can inform advocacy efforts to improve the policy environments, either in their country or across Europe.

The results are reflective of the nutrition policy status as of May 2023. The index provides an overview of the status of policies at a certain time and would have to be repeated to assess if there are changes in policy and/or new policies available.

The index allows people to explore relevant European and national policies, and the benchmarking tool assesses the overall level of government action in nutrition. Our NOURISHING tools cannot indicate causality between any observed trends in obesity rates and related behaviours across countries and policy actions, but it can generate hypothesis to be explored with further robust studies.

These results present a quality assessment of current action at national government level. As such, they cannot draw a causal link between the quality of policy design and any changes in the prevalence of overweight and obesity in the absence of repeat benchmarking. Further, they do not consider extent of implementation, or any action taken by regional, provincial or local governments. When used in context, these findings need to be judged carefully against a situational assessment in each country.

Some suggested questions to contextualise findings:

• Are countries that have taken action across all areas of the NOURISHING framework doing so in response to a lack of enabling conditions for healthy behaviours?
• Conversely, will countries with an existing enabling environment for healthy behaviours be likely to take less action?
• Do findings focused on the national level miss action at provincial, regional or local levels?

We reviewed the literature, followed by rigorous expert consultation, to develop the NOURISHING benchmarking tool. Any benchmarking tool has an element of subjectivity. To balance this, the process of putting together the tool drew heavily on existing evidence, not only expert opinion. Further, World Cancer Research Fund International and CO-CREATE researchers carried out the policy scan and assessments independently from national governments.

> Read more about the NOURISHING benchmarking tool

The validity of the index is discussed on our paper in Obesity Reviews.

We shared results with in-country government experts who verified the policy actions identified during the scan. Experts were given an opportunity to feed back on the results before publication.

As no gold standards exist on benchmarking national nutrition policy, there is an opportunity in the future to cross-validate findings with other tools.