Comparative Policy Analysis of Healthcare Healthy Eating Policies in Canada

Healthy eating policies are of growing importance to the management of retail food environments in healthcare (e.g., hospital cafeterias). Several researchers have begun to analyse health promoting benchmarks within these policies. However, little is understood about the relationship between policy and continuous quality improvement (CQI) for health promotion in healthcare. Furthering our understanding of benchmarks within these policies could provide insight into how we can measure and create standards in health promotion. This policy analysis examined publicly accessible healthcare healthy eating policies in Canadian health authority jurisdictions, up until November 22, 2022.

Data was extracted using a monitoring and evaluation framework for evaluating nutrition policies in publicly funded institutions, with adaptations based on organisational CQI concepts. Policy components analysed included: policy design, nutrient profiling systems, nutrition standards, evaluation, and monitoring. A second reviewer independently extracted data and peer debriefing was completed on the extractions.

This analysis identified five healthy eating policies meeting the inclusion criteria, from Alberta, British Columbia, Newfoundland and Labrador, Nova Scotia, and Winnipeg, Manitoba. Policies included nutrient profiling, including benchmarks for selling healthy, moderately healthy, and less healthy food and beverages. Other benchmarks were mentioned but contained fewer indicators (e.g., fundraising, catering, and advertising). Policies included benchmarks about product and placement (e.g., healthier items in visible places) but less about price. The included policies promoted collaboration amongst healthcare providers but lacked details about evaluation and monitoring.

This policy analysis suggests that different healthcare settings may require different benchmarks, tailored to their contexts. Furthermore, standardisation may not be optimal if further experimentation is needed to identify benchmarks for health promotion practices, as is common in healthcare CQI. Policy implementation requires a combination of top-down and bottom-up approaches, and collaboration with multiple partners may be necessary for success. Benchmarking processes are a potential strategy for understanding improvements to other aspects of the food environment beyond nutrient standards.

CQI and retail food environments each focus on customer satisfaction and costs, thus sharing alignments. CQI benchmarking processes are a potential strategy for understanding improvements to other aspects of the food environment beyond nutrient standards. Further exploration is needed to implement and monitor benchmarks over time.