Evaluation of Food Retail Policies Implementation in China Using the Healthy Food Environment Policy Index

Objectives: Despite the importance of food environments in shaping dietary behaviors and diet-related noncommunicable diseases, no standardized and validated method has been used to assess this policy domain in China. This study aimed to benchmark China's food retail policies against international benchmarking to identify implementation gaps and propose evidence-based strategies for improving food environments. Methods: Using the standardized and validated Healthy Food Environment Policy Index (Food-EPI), we assessed four food retail indicators: restrictive zoning for fast-food outlets (RETAIL 1), healthy food accessibility (RETAIL 2), institutional support systems (RETAIL 3), and food service promotion (RETAIL 4). A multidisciplinary expert panel (n = 13) from academia, public health, and industry conducted structured assessments using a standardized scoring tool (1-5). Scores were converted to implementation percentages and categorized into four levels. Descriptive statistics (frequencies, percentages, and mean ± SD) were summarized. Results: Sixteen food retail policies were analyzed, with 62.5% (n = 10) of provincial policies focusing on fast-food zoning and healthy food access, and 37.5% (n = 6) of national policies targeting government support and healthy food promotion. Regulations comprised 55% (n = 11), mainly addressing zoning and access, while guidelines accounted for 45% (n = 9), primarily promotional. Overall, the food retail domain was rated as low level (2.3 ± 1.1, 45.8% implementation). Among the four indicators, healthy food access in outlets (2.6 ± 1.3, 52.4%) and promotion of healthy food in services (2.5 ± 1.0, 50.8%) were at medium implementation levels. In contrast, local fast-food zoning restrictions (1.7 ± 0.6, 33.8%) and government support for healthy food (2.3 ± 1.1, 46.2%) remained at low levels. Conclusions: China's food retail policies showed inconsistent implementation levels, with strong provincial execution in accessibility and promotion but weak national coordination in zoning and support systems. To align with the WHO and China's goals, priorities are unified national frameworks, enforceable standards, equity-focused monitoring, and strengthened multi-sector collaboration.