Clinical Practices

Healthy Food and Beverage Environments Policy Contents 1.

Overview ........................................................................................................................................2

2.

Healthy Food and Beverage Environments Policy .........................................................................4

3.

Cafés ...............................................................................................................................................5

4.

Vending Machines ..........................................................................................................................6

5.

DHB Function Catering and Contracted Provider Catering ............................................................7

6.

Volunteer Food and Beverage Services for Patients and Visitors ..................................................7

7.

Staff Facilities .................................................................................................................................7

1.1 1.2 1.3 1.4 2.1 2.2 2.3 3.1 3.2 3.3 3.4 4.1 4.2 4.3 4.4 4.5 5.1 5.2 6.1 6.2 7.1 7.2 7.3

Purpose ........................................................................................................................................2 Scope ............................................................................................................................................2 Definitions ....................................................................................................................................3 Associated documents .................................................................................................................3 Healthy Food and Beverage Environments ..................................................................................4 Access to Choices .........................................................................................................................4 Promotion of Healthy Options .....................................................................................................4 Purpose ........................................................................................................................................5 Policy ............................................................................................................................................5 Opening Hours..............................................................................................................................5 Promotion of Healthy Options .....................................................................................................5 Purpose ........................................................................................................................................6 Policy ............................................................................................................................................6 Definition ......................................................................................................................................6 Approval .......................................................................................................................................6 Placement of Vending Machines ..................................................................................................6 Purpose ........................................................................................................................................7 Policy ............................................................................................................................................7 Purpose ........................................................................................................................................7 Policy ............................................................................................................................................7

Purpose ........................................................................................................................................7 Facilities for Storing Own Meals ...................................................................................................8 Drinking Water .............................................................................................................................8

Appendix 1: Healthy Food and Beverage Environments Guidelines .......................................................9 A.1 Purpose ..................................................................................................................................................9 A.2 Scope .....................................................................................................................................................9 A.3 Food and Beverage Categories ..............................................................................................................9 A.4 Food and Beverage Availability ...........................................................................................................10 A.4.1 Requirements for Vending Machines Only .......................................................................................10 A.4.2 Requirements for Retail Outlets and Catering (excluding vending machines) .................................11

Issued by Authorised by

Director Health Outcomes Director Funding

Issued Date Review Period

September 2015 12 mths

Classification Page

01002-05-004 Page 1 of 13

This information is correct at date of issue. Always check on Waitemata DHB Controlled Documents site that this is the most recent version.

Clinical Practices

Healthy Food and Beverage Environments Policy 1. Overview 1.1 Purpose The purpose of this document is to ensure that Waitemata DHB: • •

• •

provides an environment that supports healthy food and beverage options demonstrates commitment to the health and wellbeing of staff and visitors by providing healthy eating and beverage options, which support a balanced diet in accordance with the New Zealand Food & Nutrition Guidelines acts as a role model to the community by providing and promoting healthy, and safe food beverage choices within DHB settings acknowledges the needs of different cultures, religious groups and those with special dietary needs, and will accommodate these on request, where possible and practicable.

1.2 Scope This policy applies to all Waitemata District Health Board facilities/sites and the staff working on these sites. It also applies to all contractors providing services to Waitemata DHB and to healthAlliance staff. All future contracts with external food providers should refer to this policy. This policy applies to: •

All food and drink provided or able to be purchased from any retailer on Waitemata DHB premises for consumption by staff and visitors.

•

All food and drink able to be purchased from any vending facility (machine or box) on Waitemata DHB premises.

•

Any external parties contracted to provide food or catering services at any Waitemata DHB facility or function. This includes functions, meetings, special events at any Waitemata DHB facility organised by any DHB employee, contractor, visitor or student; or any offsite function organised by any DHB employee for DHB staff and/or visitors.

•

Any fundraisers organised by groups associated with the DHB where food and drinks are sold or intended for consumption on DHB premises. Fundraisers associated with groups outside of the DHB which do not meet this policy should not be promoted on DHB premises or through DHB communications.

•

All food and drink provided by volunteer services on Waitemata DHB premises.

•

Any gifts offered to guest speakers and/or formal visitors on behalf of Waitemata DHB if containing food and/or beverages should be in keeping with this policy.

•

All contracted providers who have a food and beverage environment clause in their contract with Waitemata DHB.

Note: Any future leased space selling food or beverages on Waitemata DHB premises will need to adhere to this policy. This policy excludes: • Inpatient meal services - However, Waitemata DHB supports the use of fresh produce as a healthy component of patient diets, and encourages collaboration of food services with local growers of fresh produce. Issued by Authorised by

Director Health Outcomes Director Funding

Issued Date Review Period

September 2015 12 mths

Classification Page

01002-05-004 Page 2 of 13

This information is correct at date of issue. Always check on Waitemata DHB Controlled Documents site that this is the most recent version.

Clinical Practices

Healthy Food and Beverage Environments Policy •

Food and beverages brought to work by staff for their own consumption.

•

Food and beverages provided by clients/patients for their own use.

•

Self-catered staff shared meals and treats for staff, e.g. birthday cakes and food brought for special occasions.

•

Gifts from families /whānau of patients to staff.

However staff, clients/patients and families are encouraged to provide healthy food and beverage options.

1.3 Definitions Alcohol means any beverage that contains 1.15% or more ethanol by weight in a form that can be assimilated by people, and thus includes ethyl alcohol, including but is not limited to beer, wine and spirits. Beverage means any liquid drink that does not contain alcohol. Healthy Food and Beverage Environments means environments where all indoor and outdoor areas a person sees, enters, is near to, or uses support healthy eating and drinking as a social norm, and as the easiest choice through a number of means including, but not limited to: • Providing and promoting healthy food and beverage choices, displaying predominantly healthy foods and beverages, role modelling healthy food and beverage choices • Not advertising, selling, providing or promoting unhealthy food and beverage options; • Not utilising the name, logos, symbols or associated materials of, or sponsorship from, a business associated with unhealthy food or beverages. Sugar sweetened beverages means any beverage that has had calorific sweetener, usually sugar, added prior to sale. The main categories of sugary drinks include soft drinks/fizzy drinks, sachet mixes, fruit drinks, cordials, flavoured milks, cold teas/coffees and energy/sports drinks.

1.4 Associated documents Type DHBNZ Policy MOH Strategy Memorandum of Agreement MOH Guidelines NZBGP Policy National Inpatient Meals Standards

Issued by Authorised by

Description District Health Boards Nutrition Policy, May 2004. Healthy Eating – Healthy Action: Oranga Kai – Oranga Pumau. Background, Strategy and Implementation documents. Waitemata DHB – Auckland district schools Memorandum of Agreement to remove all sugar-sweetened carbonated drinks from vending machines in schools. Ministry of Health NZ Food and Nutrition Guidelines for adults and children New Zealand Beverage Guidance Panel Policy Brief: Options to Reduce Sugar Sweetened Beverage (SSB) Consumption in New Zealand National Nutrition Standards for Meals and Menus for Adult and Paediatric Patients in New Zealand Public Hospitals.

Director Health Outcomes Director Funding

Issued Date Review Period

September 2015 12 mths

Classification Page

01002-05-004 Page 3 of 13

This information is correct at date of issue. Always check on Waitemata DHB Controlled Documents site that this is the most recent version.

Clinical Practices

Healthy Food and Beverage Environments Policy 2. Healthy Food and Beverage Environments Policy 2.1 Healthy Food and Beverage Environments The intent of this policy is to ensure that Waitemata DHB and contracted providers with a healthy food and beverage contract clause role model an environment that consistently supports healthy food and beverage options. This policy is supported by the appended Healthy Food and Beverage Guidelines. Consistent with the Ministry of Health New Zealand Food and Nutrition Guidelines for adults and children, messages and practices relating to food and beverages in the DHB environment will reflect the following principles: 1. The food and beverages available are:  Dominated by fresh vegetables and fruit - preferably locally sourced - and wholegrains,  Prepared with minimal fat, salt and sugar, and  Beverage options always include water, and the range of beverages is dominated by water and plain milk. 2. Portion sizes of baked snack food (muffins, cakes, scones, biscuits, pastry based food, slices) are small. 3. No sugar sweetened beverages, but allowance for no added sugar fruit juice up to 250ml and drinks sweetened with non-nutritive sweeteners up to 355ml. 4. No deep fried foods provided. 5. Packaged snack foods contain less than 800 kilojoules per packet and there are limited confectionary and fried snack foods.

Fresh healthy food and beverage options should dominate displays, be readily available, in sufficient quantities and displayed prominently in all environments (retail and catered) that offer food and beverages. Healthy food and beverage choices appropriate to a wide variety of people should be available, with consideration given to cultural preferences and religious beliefs. Vegetarian options should be available, taking into account that not all vegetarians eat eggs and dairy products. Breastfeeding is supported in all Waitemata DHB settings as the optimum nutrition for infants.

2.2 Access to Choices All staff, out-patients and visitors should have access to healthy food and beverage options when on Waitemata DHB sites at all times.

2.3 Promotion of Healthy Options It is important that Waitemata DHB and its staff are role models for the community in obesity prevention and advocate for healthy nutrition in the workplace and other appropriate areas. Issued by Authorised by

Director Health Outcomes Director Funding

Issued Date Review Period

September 2015 12 mths

Classification Page

01002-05-004 Page 4 of 13

This information is correct at date of issue. Always check on Waitemata DHB Controlled Documents site that this is the most recent version.

Clinical Practices

Healthy Food and Beverage Environments Policy Waitemata DHB will actively promote healthy food and beverage options with patients, visitors, staff and volunteers. Healthy options should be the most prominent options displayed by retailers, and should be readily available, competitively priced and promoted to encourage selection of these options, and to make it easier to select healthy options. Waitemata DHB will ensure all DHB associated environments do not advertise, sell, provide or promote unhealthy food and beverage options or utilise in any manner or for any purpose the name, logos, symbols or associated materials of, or sponsorship from, a business associated with unhealthy foods or beverages.

3. Cafés 3.1 Purpose Food and beverages available to out-patients, staff and visitors must promote health and wellbeing. Cafés on DHB premises must align with Waitemata DHB in supporting community health and wellbeing, including role modeling an environment of healthy nutrition.

3.2 Policy •

• •

The café food services on the Waitemata DHB sites are to provide a variety of healthy and nutritious food and beverage options. All meals, snacks and beverages must follow the five Healthy Food and Beverage Environments Policy principles, and meet the appended Healthy Food and the Beverage Environments Guidelines. Waitemata DHB cafés must provide predominantly healthy food and beverage options - ‘Green’ category foods - that satisfy the customer at reasonable prices. Beverages and foods categorised as ‘Red’ will not be sold on Waitemata DHB sites.

3.3 Opening Hours •

Where there is a staff café on site the hours of opening are to coincide with the majority of staff meal breaks.

3.4 Promotion of Healthy Options Healthy food and beverage options must be the predominant options in cafés, and must be promoted. Healthy food and beverage options should be promoted by such methods as: • • • • • •

Placing these options at child and adult eye level. Subsidising healthier options by increasing the price of less healthy items. Highlighting the healthier options. Making available external merchandising which promotes the healthier options and explains why these products are healthier. Constantly sourcing new healthier food options as available. Regularly monitoring sales volumes of the healthier ranges and making this information available to the Waitemata DHB Food Services Manager as required.

Issued by Authorised by

Director Health Outcomes Director Funding

Issued Date Review Period

September 2015 12 mths

Classification Page

01002-05-004 Page 5 of 13

This information is correct at date of issue. Always check on Waitemata DHB Controlled Documents site that this is the most recent version.

Clinical Practices

Healthy Food and Beverage Environments Policy In addition, all pre-packaged snack foods must meet the vending machine guidance provided in the appended Healthy Food and Beverage Environments Guidelines. Auckland welcomes innovations by café management to increase the range and availability of healthier food choices, for example: •

•

Offering vegetables or salad with all hot meals. Offering free / subsidized fresh fruit with main meal combinations.

4. Vending Machines 4.1 Purpose Food and beverages available to patients, outpatients, staff and visitors must promote health and wellbeing. Vending machines on DHB premises must align with Waitemata DHB’s role in supporting community health and wellbeing, by role modeling an environment of healthy nutrition.

4.2 Policy • •

Healthy food and beverage options must be the predominant options in vending machines. All vending machines must comply at all times with the five Healthy Food and Beverage Environments Policy principles, and the appended Healthy Food and the Beverage Environments Guidelines.

4.3 Definition • •

The vending contract includes ALL payment-based, all-hours, food and beverage vending machines and honesty boxes. Note that snack boxes are not permitted in Auckland workplaces as they contravene the rights of the approved vending supplier.

4.4 Approval • • •

Vending is an optional service provided at the discretion of Service Managers. Only approved suppliers of vending machines are to be placed on Waitemata DHB sites. Approval is obtained through the General Manager of the Service AND the General Manager of Clinical Support Services after discussion with Facilities Management. All contracts and agreements with external providers must involve consultation with healthAlliance Procurement and must only be signed by the General Manager of the Service. A copy of the signed contract must be held by healthAlliance Procurement.

4.5 Placement of Vending Machines The placement or location of vending machines in Waitemata DHB facilities must be approved by the Service General Manager and Facilities Management.

Issued by Authorised by

Director Health Outcomes Director Funding

Issued Date Review Period

September 2015 12 mths

Classification Page

01002-05-004 Page 6 of 13

This information is correct at date of issue. Always check on Waitemata DHB Controlled Documents site that this is the most recent version.

Clinical Practices

Healthy Food and Beverage Environments Policy 5. DHB Function Catering and Contracted Provider Catering 5.1 Purpose Food and beverages provided to Waitemata DHB staff and visitors, and to the staff and clients of contracted providers who have a healthy food and beverage contract clause, should role model healthy nutrition, and promote health and wellbeing.

5.2 Policy •

Functions and meetings hosted on-site at Waitemata DHB premises are to provide a variety of healthy and nutritious food and beverage options. Waitemata DHB catering menus must align with the five Healthy Food and Beverage Environments Policy principles, and the appended Healthy Food and the Beverage Environments Guidelines to support staff to make healthy choices.

•

Food and beverages provided to staff and clients of contracted providers during events, functions and meetings should align with the five Healthy Food and Beverage Environments Policy principles, and the appended Healthy Food and Beverage Environments Guidelines.

6. Volunteer Food and Beverage Services for Patients and Visitors 6.1 Purpose Volunteer food and beverage services provided to patients and visitors at Waitemata DHB should role model healthy nutrition, and promote health and wellbeing.

6.2 Policy Volunteer food services provided within the hospital setting must align with the five Healthy Food and Beverage Environments Policy principles, and the appended Healthy Food and the Beverage Environments Guidelines, including: • • •

Food and beverages provided should be predominantly ‘Green’ foods. ‘Amber’ food and beverages can be a small component of food and beverages available, and must be of appropriate small size according to the guidelines. ‘Red’ category food and beverages should not be provided.

The Waitemata DHB Food Services Manager can be consulted for advice on utilising the Healthy Food and Beverage Environments Guidelines to ensure healthy food and beverages are provided.

7. Staff Facilities 7.1 Purpose Waitemata DHB places of work must provide staff with reasonable access to facilities that ensure staff are able to provide their own healthy food and beverage options. 1 Low fat milk should be available for use in beverages where tea and coffee are provided as per employment agreements.

1

Issued by Authorised by

Director Health Outcomes Director Funding

Issued Date Review Period

September 2015 12 mths

Classification Page

01002-05-004 Page 7 of 13

This information is correct at date of issue. Always check on Waitemata DHB Controlled Documents site that this is the most recent version.

Clinical Practices

Healthy Food and Beverage Environments Policy 7.2 Facilities for Storing Own Meals Waitemata DHB places of work must provide reasonable access to facilities that allow staff to bring their own meals with them to consume at work. Staff should be provided with reasonable access to storage facilities for when they bring their meal to work. This includes fridges, lockers or cupboards. Wherever possible this would also include reasonable access to a microwave oven.

7.3 Drinking Water • •

Waitemata DHB places of work must provide reasonable access to drinking water for all staff on site. Wherever possible this means water should be available in a water cooler. Each service must ensure that water coolers in their areas are cleaned and serviced on a regular basis.

Issued by Authorised by

Director Health Outcomes Director Funding

Issued Date Review Period

September 2015 12 mths

Classification Page

01002-05-004 Page 8 of 13

This information is correct at date of issue. Always check on Waitemata DHB Controlled Documents site that this is the most recent version.

Clinical Practices

Healthy Food and Beverage Environments Policy Appendix 1: Healthy Food and Beverage Environments Guidelines A.1 Purpose The detail in these guidelines supports the bullet points in the Waitemata DHB Healthy Food and Beverage Environments Policy, and is applicable to all food and beverages provided for Waitemata DHB outpatients, staff and visitors and contracted provider staff and clients or able to be purchased by patients, outpatients, staff and visitors and contracted provider staff and clients.

A.2 Scope These Guidelines apply to: •

All food and drink provided or able to be purchased from any retailer on Waitemata DHB premises for consumption by staff and visitors.

•

All food and drink able to be purchased from any vending facility (machine or box) on Waitemata DHB premises.

•

Any external parties contracted to provide food or catering services at any Waitemata DHB facility or function. This includes functions, meetings, special events at any Waitemata DHB facility organised by any DHB employee, contractor, visitor or student; or any offsite function organised by any DHB employee for DHB staff and/or visitors.

•

Any fundraisers organised by groups associated with the DHB where food and drinks are sold or intended for consumption on DHB premises. Fundraisers associated with groups outside of the DHB which do not meet this policy should not be promoted on DHB premises or through DHB communications.

•

All food and drink provided by volunteer services on Waitemata DHB premises.

•

Any gifts offered to guest speakers and/or formal visitors on behalf of Waitemata DHB if containing food and/or beverages should be in keeping with this policy.

•

All contracted providers who have a food and beverage environment clause in their contract with Waitemata DHB.

Note: Any future leased space selling food or beverages on Waitemata DHB premises will need to adhere to these guidelines.

A.3 Food and Beverage Categories Foods and beverages are placed into three categories: Green Foods • These foods are the basis of a healthy diet and include fruits, vegetables, breads, cereals and grains, reduced fat dairy products, lean meat, fish, chicken, eggs and legumes. • They are lower in saturated fats, and sugar and added salt. Amber Foods

• •

Red Foods

Issued by Authorised by

• •

These foods are processed foods and drinks. They have some nutritive value but can contain saturated fats, added sugar, or added salt. They can contribute to consuming excess energy. Red foods are highly processed foods and drinks. They are of poor nutritional value and high in saturated fat, added sugar, and/or added salt and energy. They can contribute to consuming excess energy.

Director Health Outcomes Director Funding

Issued Date Review Period

September 2015 12 mths

Classification Page

01002-05-004 Page 9 of 13

This information is correct at date of issue. Always check on Waitemata DHB Controlled Documents site that this is the most recent version.

Clinical Practices

Healthy Food and Beverage Environments Policy A.4 Food and Beverage Availability Choices always need to be available so that the ratio of ‘Green’ and ‘Amber’ food choices remains constant throughout service for each food category. GREEN CATEGORY Green category items: • dominate the food and drinks available • are displayed at child and adult eye level on shelves, benches, cabinets and vending machines • are displayed at the front of cabinets or bain maries • are always available in sufficient quantities to be the predominant option • are recommended to be identified with “healthy choice” labelling AMBER CATEGORY Amber category items: • should not be large portion sizes • do not dominate the available choices at the expense of Green category items • are not prominently displayed at the expense of Green category items • are always available in sufficient quantities RED CATEGORY Red category items: • Red category items are not to be sold at DHB food and beverage outlets, offered in catering menus or provided at functions

A.4.1 Requirements for Vending Machines Only

Commercially prepared packaged snack foods

Cold beverages

GREEN CATEGORY 85% < 800kj per packet ≤ 1.5 grams saturated fat/100g ≤ 450mg of sodium/100g Excluding all confectionary. Plain water and plain milk. Beverages sweetened with nonnutritive sweeteners 3.3g/100g

All white breads/specialty breads with: • Fibre content: 3g per serve Some ice-blocks, sorbet, water- or fruit-based ice confection, smoothies and ice crushes with: • Energy content: >600kj per serve • Saturated fat content: >3g per serve

Lean meats such as chicken, turkey, beef, pork, lamb, and veal with visible fat and skin removed. All fresh and plain frozen fish. Tuna, salmon, sardines canned in spring water with no added salt. Eggs.

Processed meats with: • Serving size ≤50g • Energy content: ≤900kj/100g • Saturated fat content: ≤3g/100g • Sodium content: ≤700mg/100g

Processed meats with: • Serving size > 50g • Energy content: >900kj/100g • Saturated fat content: >3g/100g • Sodium content: