title: Pilot test of the Healthy Food Environment Policy Index (Food-EPI) to increase government actions for creating healthy food environments.
abstract: OBJECTIVE
  Effective government policies are essential to increase the healthiness of food environments. The International Network for Food and Obesity/non-communicable diseases (NCDs) Research, Monitoring and Action Support (INFORMAS) has developed a monitoring tool (the Healthy Food Environment Policy Index (Food-EPI)) and process to rate government policies to create healthy food environments against international best practice. The aims of this study were to pilot test the Food-EPI, and revise the tool and process for international implementation.
  
  
  METHODS
  New Zealand.
  
  
  METHODS
  Thirty-nine informed, independent public health experts and non-governmental organisation (NGO) representatives.
  
  
  METHODS
  Evidence on the extent of government implementation of different policies on food environments and infrastructure support was collected in New Zealand and validated with government officials. Two whole-day workshops were convened of public health experts and NGO representatives who rated performance of their government for seven policy and seven infrastructure support domains against international best practice. In addition, the raters evaluated the level of difficulty of rating, and appropriateness and completeness of the evidence presented for each indicator.
  
  
  RESULTS
  Inter-rater reliability was 0.85 (95% CI 0.81 to 0.88; Gwet's AC2) using quadratic weights, and increased to 0.89 (95% CI 0.85 to 0.92) after deletion of the problematic indicators. Based on raters' assessments and comments, major changes to the Food-EPI tool include strengthening the leadership domain, removing the workforce development domain, a stronger focus on equity, and adding community-based programmes and government funding for research on obesity and diet-related NCD prevention, as good practice indicators.
  
  
  CONCLUSIONS
  The resulting tool and process will be promoted and offered to countries of varying size and income globally. International benchmarking of the extent of government policy implementation on food environments has the potential to catalyse greater government action to reduce obesity and NCDs, and increase civil society's capacity to advocate for healthy food environments.
authors.affiliation: University of Auckland, School of Population Health, Auckland, New Zealand.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Vandevijvere
authors.affiliation: University of Auckland, School of Population Health, Auckland, New Zealand.
authors.forename: Boyd
authors.initials: B
authors.lastname: Swinburn
mesh_terms: D019649:Food Industry; D006078:Government Programs / Q000458:organization & administration*; D006293:Health Promotion / Q000379:methods / Q000458:organization & administration*; D006801:Humans; D007391:International Cooperation; D009520:New Zealand; D018673:Nutrition Policy; D009765:Obesity / Q000517:prevention & control; D010865:Pilot Projects; D011634:Public Health / Q000331:legislation & jurisprudence*
keywords: NUTRITION & DIETETICS; PUBLIC HEALTH