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Policy implementation and recommended actions to create healthy food environments using the Healthy Food Environment Policy Index (Food-EPI): a comparative analysis in South Asia

Pineda, E., Atanasova, P., Wellappuli, N. T. , Kusuma, D. ORCID: 0000-0002-1909-9341, Herath, H., Segal, A. B., Vandevijvere, S., Anjana, R. M., Shamim, A. A., Afzal, S., Akter, F., Aziz, F., Gupta, A., Hanif, A. A., Hasan, M., Jayatissa, R., Jha, S., Jha, V., Katulanda, P., Khawaja, K. I., Kumarendran, B., Loomba, M., Mahmood, S., Mridha, M. K., Pradeepa, R., Aarthi, G. R., Tyagi, A., Kasturiratne, A., Sassi, F. & Miraldo, M. (2024). Policy implementation and recommended actions to create healthy food environments using the Healthy Food Environment Policy Index (Food-EPI): a comparative analysis in South Asia. The Lancet Regional Health - Southeast Asia, 26, article number 100428. doi: 10.1016/j.lansea.2024.100428


The increasing prevalence of diet-related non-communicable diseases (NCDs) in South Asia is concerning, with type 2 diabetes projected to rise to 68%, compared to the global increase of 44%. Encouraging healthy diets requires stronger policies for healthier food environments.

This study reviewed and assessed food environment policies in Bangladesh, India, Pakistan, and Sri Lanka from 2020 to 2022 using the Healthy Food Environment Policy Index (Food-EPI) and compared them with global best practices. Seven policy domains and six infrastructure support domains were considered, employing 47 good practice indicators to prevent NCDs. Stakeholders from government and non-governmental sectors in South Asia (n = 148) were invited to assess policy and infrastructure support implementation using the Delphi method.

Implementation of food environment policies and infrastructure support in these countries was predominantly weak. Labelling, monitoring, and leadership policies received a moderate rating, with a focus on food safety, hygiene, and quality rather than obesity prevention. Key policy gaps prioritized for attention included front-of-pack labelling, healthy food subsidies, unhealthy food taxation, restrictions on unhealthy food promotion, and improvements in school nutrition standards to combat NCDs.

Urgent action is required to expand food policies beyond hygiene and food security measures. Comprehensive strategies targeting NCD prevention are crucial to combat the escalating burden of NCDs in the region.

Publication Type: Article
Additional Information: © 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (
Publisher Keywords: South Asia, Food policy, Policy monitoring, Food environment, Policy mapping, Public health policy, Food-EPI, Non-communicable diseases
Subjects: D History General and Old World > DS Asia
H Social Sciences > HD Industries. Land use. Labor
H Social Sciences > HN Social history and conditions. Social problems. Social reform
J Political Science
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments: School of Health & Psychological Sciences
School of Health & Psychological Sciences > Healthcare Services Research & Management
SWORD Depositor:
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