Gold Coast Health: Healthier Food and Drinks Guideline July 2019

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Gold Coast Health: Healthier Food and Drinks Guideline 2019

Gold Coast Health: Healthier Food and Drinks Guideline: endorsed by GCH EMT 8 July 2019

Published by the State of Queensland (Gold Cost Health Hospital and Health Service), July 2019

This document is licensed under a Creative Commons Attribution 3.0 Australia licence. To view a copy of

this licence, visit creativecommons.org/licenses/by/3.0/au

© State of Queensland (Gold Coast Hospital and Health Service) 2019

You are free to copy, communicate and adapt the work, as long as you attribute the State of Queensland

(Gold Coast and Metro North Hospital and Health Services).

For more information contact: Gold Coast Public Health, Gold Coast Hospital and Health Service, 45 Chisholm Road Carrara 4211, email gcphu-hp@health.qld.gov.au ph: (07) 5667 3200 (Health Promotion).

Disclaimer:

The content presented in this publication is distributed by the Queensland Government as an information source only. The State of Queensland

makes no statements, representations or warranties about the accuracy, completeness or reliability of any information contained in this

publication. The State of Queensland disclaims all responsibility and all liability (including without limitation for liability in negligence) for all

expenses, losses, damages and costs you might incur as a result of the information being inaccurate or incomplete in any way, and for any

reason reliance was placed on such information.

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Gold Coast Health: Healthier Food and Drinks Guideline 2019

Contents Summary ...................................................................................................................................... 4

Background .................................................................................................................................. 4 Alignment with GCH Strategic Plan 2016-2020 ................................................................................. 5 Progress to 2018 within Gold Coast Health facilities and services .................................................... 5 Out of scope ..................................................................................................................................... 6 Where do the guidelines apply? ........................................................................................................ 8

Food and drink outlets ............................................................................................................. 8 Catering provided at functions, meetings and special events ................................................... 8 Fundraising activities, events and prizes ................................................................................. 8 Out of scope ............................................................................................................................ 9

Governance ............................................................................................................................... 10 Stages ................................................................................................................................... 10 Sponsor ................................................................................................................................. 10 Implementation group ............................................................................................................ 10 Communication tools ............................................................................................................. 10

Appendices and Figures Appendix 1: Healthier Food and Drink Guideline - Audits ....................................................................... 11 Appendix 2: Healthier Food and Drinks guideline summary table ........................................................... 12

Key Supporting Documents

ABC https://qheps.health.qld.gov.au/abetterchoice

HSD https://www.health.qld.gov.au/__data/assets/pdf_file/0033/837915/qh-hsd-049.pdf

Catering Guidelines https://www.health.qld.gov.au/__data/assets/pdf_file/0019/443053/catering-guidelines-functions.pdf or https://www.worksafe.qld.gov.au/__data/assets/pdf_file/0007/82951/healthy-choice-info-sheet.pdf

Drinks classification guide https://www.health.qld.gov.au/__data/assets/pdf_file/0038/837929/abc-drink-classification-guide.pdf

Acknowledgements

This guideline is based on the extensive work undertaken by the Metro North Hospital and Health Service and their enabling A Better Choice Guideline. Many elements have been reproduced or amended for application locally.

Consultation via the Queensland Health ‘Healthier Drinks State-wide Working Group’ informed these guidelines and continues to provide useful guidance for the implementation of the Healthier Food and Drinks guideline.

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Gold Coast Health: Healthier Food and Drinks Guideline 2019

Summary Gold Coast Health is leading by example by serving food of high nutritional value to staff and visitors at all of our facilities. We have developed a Healthier Food and Drinks Guideline to create an environment that supports patients, staff and visitors in making choices that promote their health and wellbeing.

The Guideline outlines how GCH will work towards delivering on the Healthier Drinks in Healthcare Facilities Health Service Directive (QH-HSD-466:2019) which directs Hospital and Health Services to ensure that any drinks sold, provided, promoted and advertised at their facilities are only healthier drinks.

This will be achieved by: improving the range, availability and accessibility of healthier drinks and food; and providing information on, and promotion of, these foods and drinks.

The Gold Coast Health: Healthier Food and Drinks Guideline (guideline) provides the information and tools to assist with the implementation of the recommendations.

Background The consumption of foods high in saturated fat and refined sugar is known to be associated with long-

term outcomes such as cardiovascular disease, type 2 diabetes and some cancers, obesity and also has

short term impacts on body functions. In 2015/16 approximately 71,600 Gold Coast adults were obese,

and over 161,000 were overweight. A similar body weight plateau can be seen in childhood obesity;

however one in four children is still overweight or obese in Queensland.

Cognitive functions such as memory, attention, speed and flexibility have all been found to be impaired

by high saturated fat intake. Additionally, evidence shows that even a short-term uptake of a diet high in

both saturated fat and added sugar has an impact on the hippocampus, and in turn, memory, learning

and ingestive control.

Eating behaviours are also often influenced by ease of access, in that food that is in close proximity, or

merely in eyesight, can stimulate individuals to eat, therefore increasing caloric consumption. It is

therefore important to not only ensure nutrient rich foods are made available as the easy choice, but to

also minimise mindless eating throughout the day via foods and drinks in work areas.

Queensland Health initially established a healthy eating guideline (ABC policy) in 2007 which

categorised foods and drinks as GREEN, AMBER or RED based on their nutritional value. The overall

intent was to work towards increasing healthier options to at least 80 per cent of foods and drinks, whilst

restricting less healthy options to no more than 20 per cent of foods and drinks displayed.

The Healthier Drinks in Healthcare Facilities Health Service Directive sets the following mandatory requirements:

1. No sale, provision, promotion and advertising of unhealthy drinks, classified as RED Drinks

(refer to Table 1), at any outlet or through catering and fundraising activities. This includes no

drinks with added sugar, cream, ice-cream, sorbet, gelato or confectionary; or larger serving

sizes of juices, flavoured milks, milk-based drinks, hot drinks, and artificially sweetened drinks.

2. Any drinks for sale, provided, promoted and advertised at any outlet or through catering and

fundraising activities must be healthier drinks.

3. Artificially sweetened drinks do not comprise more than 20% of drinks displayed for sale at any

outlet.

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Gold Coast Health: Healthier Food and Drinks Guideline 2019

4. Free drinking water is readily available, promoted and accessible in healthcare facilities,

wherever drinks are sold or provided.

5. Water is promoted as the drink of choice for sale at any outlet.

6. Alcoholic drinks are restricted in supply, or not supplied at all.

7. Monitoring of compliance of these requirements is undertaken at least annually, as at 1 December, and

reported to the Department of Health by 31 December each year.

Alignment with GCH Strategic Plan 2016-2020

These guidelines align with the Gold Coast Health Strategic Plan 2016 – 2020 under objective 3: Support a healthy Gold Coast community and enables us to align with state priorities. The guidelines also contribute to delivery against the Gold Coast Active and Healthy City Strategy 2018-2022 by:

• Organisations working to reduce sugar drinks availability

• Restrict food advertising and other forms of commercial promotion of foods and drinks that are high in fat and/or sugar and low in nutritional value.

The Gold Coast Hospital and Health Service Board and Executive (to be affirmed) a commitment to support

the wellbeing of staff and visitors to Gold Coast Health and to this end advocate increasing the availability

of healthier food and drink options within all access points within its facilities and services.

Progress to 2018 within Gold Coast Health facilities and services

As per the original ABC Strategy, GCH worked with vending supplier in 2018 to change all vending machines to the following:

• healthier options (GREEN,) minimum 40 per cent

• reducing (AMBER) where possible

• restricting less healthy options (RED) to no more than 20 per cent

More detailed information can be found in Appendix 2: Healthier Food and Drinks guideline summary table

Green food and drinks Amber food and drinks Red food and drinks

Why food/drinks are in this category

• Excellent sources of key nutrients for good health and wellbeing

• Low in saturated fat and/or added sugar and/or salt

• Lower energy density; help avoid excess energy intake

• Some nutritional value

• Can have moderate amounts of saturated fat and/or added sugar and/or salt

• Can, in large serve sizes, contribute to excess energy

• Nutrient-poor and lack nutritional value

• Energy dense and can contribute to an excess energy intake

• High in added fats, saturated fat, and/or sugar and/or salt

40% or more

40% or less

20%

Green

Amber

Red

Figure 4: Proportion of each food category

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Gold Coast Health: Healthier Food and Drinks Guideline 2019

Canteens, kiosks, cafes; Vending machines

GREEN choices should:

• Always be available

• Be displayed prominently

• Be actively promoted and encouraged at all times

AMBER options should:

• NOT be promoted

• NOT be displayed prominently

• NOT dominate menu choices

• <20% artificially sweetened

• Be avoided in large sizes

RED choices should:

• NOT be promoted/advertised

• NOT be displayed

• Be limited to no more than 20% (0% vending)

Catering provided at functions, meetings, etc.

GCH Healthier Food and Drinks guidelines apply to all catering instances, including:

• Conferences/exhibitions/symposiums; training courses; meetings or forums; awards nights, official announcements, celebratory or fundraising meals

Food and drinks provided

• GREEN items should always be available

• AMBER and RED items may be supplied; however AMBER should not dominate, and RED food should be limited and RED drinks not to be supplied

• Category percentages do not apply here; however aim for small quantities and provide moderate serve sizes where possible

External events

The GCH Healthier Food and Drinks guideline does not apply to food and/or drinks that are purchased and provided by external agencies. However, Gold Coast Health employees are encouraged to influence these to provide healthier options.

Personal celebrations within Gold Coast Health

This policy does not apply to occasional birthday cakes and/or other celebratory food and/or drinks that Gold Coast Health employees bring in to share with colleagues. In the spirit of the policy, the inclusion of healthy options at these occasions is encouraged.

Leased premises selling food/drinks

• To align with the intent of guideline, leased premises within Gold Coast Health facilities selling food and/or drinks will also be required to comply with the recommendations over time

o All new leases undertaken will include a clause outlining guideline recommendations regarding the supply, promotion, advertising and placement of food and drinks.

o Those tenants with current leases will be required to comply with eABC as per lease agreement

Fundraising activities, events and prizes

• Food and/or drink based fundraising drives, activities and/or products should be consistent with the values, purpose and goals of Gold Coast Health and the Queensland Government.

• Fundraising, for any purpose, whether Gold Coast Health based or of a personal nature, conducted within Gold Coast Health facilities should be in line with guideline recommendations, i.e. GREEN and AMBER options may be used and RED food items limited.

• Gold Coast Health staff must not use alcohol and foods from the RED category, such as chocolates and confectionery, as gifts or fundraising prizes.

.

Out of scope

Food/ drink from outside Gold Coast Health facilities Foods and drinks brought into facilities/services by staff, visitors and the general public are not in scope.

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Gold Coast Health: Healthier Food and Drinks Guideline 2019

Inpatient meals

Food and drinks served to facility inpatients are determined by the Queensland Health Nutrition Standards for Meals and Menus 20151 which are specifically designed to prevent malnutrition and ensure specific clinical needs are met, particularly for long-stay patients.

1 Queensland Health Nutrition Standards for Meals and Menus 2015. Available at: https://www.health.qld.gov.au/__data/assets/pdf_file/0030/156288/qh-nutrition-

standards.pdf

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Gold Coast Health: Healthier Food and Drinks Guideline 2019

Where do the guidelines apply?

The recommendations within this guideline apply to all situations where food and/or drinks are supplied to or made available for purchase by staff, patients and visitors within all Gold Coast Health facilities and services.

Food and drink outlets GCH owned cafes, kiosks and other retail areas that sell food and/or drinks (excluding leased premises) The mandatory requirements for drinks as outlined in the Health Service Directive must be met for all drink supplies. Food supplies should demonstrate improvements towards more healthy options annually.

Leased cafes, kiosks and other retail areas that sell food and/or drinks To align with the intent of guideline, leased premises within Gold Coast Health facilities selling food and/or drinks will also be required to comply with the recommendations over time. All new leases undertaken from 1st January 2019 will include requirements regarding the supply, promotion, advertising and placement of food and drinks. Those tenants with current leases will be encouraged to move towards change voluntarily and required to comply with guidelines once their lease is renewed and/or renegotiated.

Vending machines For ALL drink vending machines, a >60% GREEN, <20% artificially sweetened, 0% RED supply must be achieved. Placement of GREEN drinks should be closest to eye level. Amber drinks occupy the bottom rows. For ALL food vending machines, no more than 20% RED options must be stocked, however GREEN and AMBER percentages are flexible. Achieving 60% GREEN items is challenging with the snack items currently available for a non-refrigerated machine. Many items ‘branded’ healthy may not meet the healthier food requirements, when assessed against the Guideline nutrition criteria. An increase in the proportion of GREEN items being offered is required to be demonstrated on a 6 monthly basis until the desired 40% is achieved.

Catering provided at functions, meetings and special events Guideline applies to all instances where foods and/or drinks are provided and purchased by Gold Coast Health, including: conferences, exhibitions or symposiums; staff training courses; meetings or forums; and special events, e.g. awards, official announcements, celebratory or fundraising meals.

Catering at functions, meetings or special events should follow the Guideline for GREEN, AMBER and RED food and drink options. Therefore, GREEN items should always be available, AMBER choices should not dominate, and RED options be <20%.

Fundraising activities, events and prizes Food and/or drink based fundraising drives, activities and/or products should be consistent with the values, purpose and goals of Gold Coast Health and the Queensland Government. Gold Coast Health staff should consider fundraising drives, gifts, prizes, activities and/or products that promote health and wellbeing. Therefore fundraising (for any purpose, whether Gold Coast Health based or from a personal point of view) conducted within Gold Coast Health facilities and services should follow the Guideline, .ie. GREEN and AMBER options may be used and RED items limited. Gold Coast Health staff must not use alcohol and discretionary foods from the RED category, such as chocolates and confectionery, as gifts or fundraising activities.

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Gold Coast Health: Healthier Food and Drinks Guideline 2019

Out of scope External events The guideline does not apply to food and drinks purchased and provided by external agencies such as an external: dinner or function at a private venue; fundraising events or activities; or conference or meeting. Gold Coast Health employees are encouraged to influence external agencies to provide nutritious, healthier options and promote responsible alcohol drinking practices where possible.

Personal celebrations within Gold Coast Health facilities/services This policy does not apply to birthday cakes and/or other celebratory food and/or drinks that Gold Coast Health employees bring in to share with colleagues on an irregular basis. However, in the spirit of the policy in assisting staff and visitors to adopt and model healthy eating behaviours, the inclusion of healthy food and drink choices at these occasions is encouraged. As demonstrated here the morning tea consists of one RED item (the cake); AMBER savoury muffins (smaller serve sizes); and all other items are GREEN.

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Governance Implementing the guideline will be a staged process working in collaboration with service providers, staff and community.

Stages Stages of change:

• Executive endorsement of Healthier Food and Drink Guideline by EMT

• Vending machine contain 0% Red drinks and <20% artificially sweetened drinks by 1 July 2019

• Reduce 3P’s [promotion, position and proportion (<20%)] of red drinks in all retail outlets

• Make lowest Price option in all vending a green product.

• Increase the proportion of Green foods offered and promoted in retail outlets

• Reduce the promotion and visibility of Red foods in retail outlets

• Catering guideline communicated to all approved catering suppliers 2019

• Catering suggestions to be provided to supply reps who provide foods during product demonstrations 2020

• Monitoring and evaluation [baseline April 2019; yr 1 Dec 2019; yr 2 Dec 2020; yr 3 Dec 2021].

Sponsor The sponsor for the guideline is the Food and Nutrition Steering Group.

Implementation group

Group responsible for coordinating the implementation of guideline is: Healthier Food and Drinks working group.

The Group’s role is to oversee the implementation of guideline across all situations where food and drink are supplied to staff and visitors at the facility/service.

Key tasks may include:

• Advice to contracting team when new contractors are engaged

• Coordination of audits

• Advice to contractors on supply to meet guidelines

• Support to retailers to trial implementation strategies as guideline is rolled out

• Inform communication strategies for guideline to staff and visitors

• Report to the Executive on HSD and guideline implementation

• Encourage communication between different groups regarding implementation of guideline.

Communication tools A number of communication tools will be made available to assist with:

• Presentations and screensavers: outlining why a healthier food and drink supply is important, the rationale for guideline, and the requirements of the program.

• Webpage to host key information re guideline – what, where, when, how, etc.

• Catering guide for orders

• Food and Drink category information

• Promotional material: aimed at both staff and visitors, including posters printable in various sizes, food and drink images, infographic-type icons, water wayfinders etc.

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Gold Coast Health: Healthier Food and Drinks Guideline 2019

Appendix 1: Healthier Food and Drink Guideline - Audits

Carrying out audits to assess level of compliance at beginning and following implementation will help to

highlight the changes necessary, and to indicate successes (or losses) after the implementation of

alterations. Ongoing audits, for example annually, can avoid ‘red creep’ occurring.

Initial Audit

1: Determining food and drink access points

• Define all the food and drink access points in the facility or service: canteens, cafes, vending machines; retail outlets

• Conduct baseline audit of each access point

2: Establish food and drinks available

• Take photos of each section within the location; e.g. drinks fridges, ice-cream freezers; cold food cabinets; hot food cabinets; snack item areas (shelving, containers, etc.), etc.

• Assess food and drink traffic using traffic light categories and record on audit tool

• Use A Better Choice Drinks Classification Guide for Queensland Health facilities 2019 for clarification.

3: Determining category availability (%), placement and promotion

• Using the diagrams for each section of the outlet determine the percentage of GREEN, AMBER and RED items (availability), review the position in relation to eye height (placement) and any promotion of products in and around the outlet.

• Discuss the findings for each food and drink access point (and section within):

– Priority areas that require changes and a timeline for implementation

– Additional elements that require attention i.e. product placement and advertising materials

– Potential resource requirements i.e. equipment or staff training

Recommend changes/ develop options • Determine products to be phased out or reduced

• Identify alternative(s) to be trialled

• Determine timing of changes; i.e., identify a timeframe to reduce RED, introduce and trial new menu items.

• Identify ways to promote new options to generate interest with customers.

• Seek feedback from customers

Post-guideline implementation audit Following the dissemination of recommendations/advice further reviews of changes implemented will be undertaken. This will enable acknowledgement of positive actions, to review any barriers identified and to continue to work collaboratively towards healthy food and drinks across GCH facilities.

This may be carried out by a person independent from the Group and the food/drink outlet to ensure the report on compliance is unbiased and less time consuming for retailers.

Annual audit Annual reporting on the implementation of the HSD is required in December each year.

This will be an opportunity to check in with the outlet manager/staff to see if they require any assistance with the ongoing maintenance of the guideline recommendations.

Appendix 2: Healthier Food and Drinks guideline summary table

Green food and drinks Amber food and drinks Red food and drinks

Why food/drinks are in this category

• Excellent sources of key nutrients for good health and wellbeing

• Low in saturated fat and/or added sugar and/or salt

• Lower energy density; help avoid excess energy intake

• Some nutritional value

• Can have moderate amounts of saturated fat and/or added sugar and/or salt

• Can, in large serve sizes, contribute to excess energy

• Nutrient-poor and lack nutritional value

• Energy dense and can contribute to an excess energy intake

• High in added fats, saturated fat, and/or sugar and/or salt

Canteens, kiosks, cafes; Vending machines

GREEN choices should:

• Always be available

• Be displayed prominently

• Be actively promoted and encouraged at all times

AMBER options should:

• NOT be promoted

• NOT be displayed prominently

• NOT dominate menu choices

• <20% artificially sweetened

• Be avoided in large sizes

RED choices should:

• NOT be promoted/advertised

• NOT be displayed

• Be limited to no more than 20% (0% vending)

Catering provided at functions, meetings, etc.

GCH Healthier Food and Drinks guidelines apply to all catering instances, including:

• Conferences/exhibitions/symposiums; training courses; meetings or forums; awards nights, official announcements, celebratory or fundraising meals

Food and drinks provided

• GREEN items should always be available

• AMBER and RED items may be supplied; however AMBER should not dominate, and RED food should be limited and RED drinks not to be supplied

• Category percentages do not apply here; however aim for small quantities and provide moderate serve sizes where possible

External events

The GCH Healthier Food and Drinks guideline does not apply to food and/or drinks that are purchased and provided by external agencies. However, Gold Coast Health employees are encouraged to influence these to provide healthier options.

Personal celebrations within Gold Coast Health

This policy does not apply to occasional birthday cakes and/or other celebratory food and/or drinks that Gold Coast Health employees bring in to share with colleagues. In the spirit of the policy, the inclusion of healthy options at these occasions is encouraged.

Leased premises selling food/drinks

• To align with the intent of guideline, leased premises within Gold Coast Health facilities selling food and/or drinks will also be required to comply with the recommendations over time

o All new leases undertaken will include a clause outlining guideline recommendations regarding the supply, promotion, advertising and placement of food and drinks.

o Those tenants with current leases will be required to comply with eABC as per lease agreement

Fundraising activities, events and prizes

• Food and/or drink based fundraising drives, activities and/or products should be consistent with the values, purpose and goals of Gold Coast Health and the Queensland Government.

• Fundraising, for any purpose, whether Gold Coast Health based or of a personal nature, conducted within Gold Coast Health facilities should be in line with guideline recommendations, i.e. GREEN and AMBER options may be used and RED food items limited.

• Gold Coast Health staff must not use alcohol and foods from the RED category, such as chocolates and confectionery, as gifts or fundraising prizes.