Do NZ Health Sector Organisations Have Their ‘Act Together’ Regarding Food and Nutrition Policies and Practices?

Background: Improving diet related behaviours through public health approaches is key to tackling the obesity epidemic in New Zealand (NZ). Relative inaction over the last decade has resulted in a ten-percent increase in obesity rates. Experts and the World Health Organisation (WHO) recommend population-level approaches based on altering the food environment. Focus is increasing on the workplace as an influential food environment. NZ advocates argue that health sector workplaces should demonstrate leadership through their own food and nutrition policies. Currently, hospital workplaces are at the forefront of attention while non-District Health Board Health Sector Organisations (non-DHB HSO) are being overlooked. However, these workplaces are pivotal for the credibility of the whole health sector. To date, the food and nutrition policies and practices in non-DHB HSO are unknown. Objective: This study aims to examine the current food and nutrition policies and practices in NZ non-DHB HSO, and explore attitudes regarding policy implementation and role modelling health behaviours. Design: A single case design study was used to investigate non-DHB HSO food and nutrition policies and practices. Data collected by three methods were compared. Semi-structured, in-depth face-to-face interviews were carried out with a key informant from each of the nine non-DHB HSOs. An observational audit of the physical workplace food environment was conducted, to assess its healthfulness. Finally, a policy document analysis determined the quality of policy in relation to best practice. Results: Results show that best practice stand-alone food and nutrition policies are absent in NZ non-DHB HSO, while food and nutrition practices are widespread. In general these practices reflected a wide range of best practice policy scopes. However, their impact on employee health behaviours remains unknown as no practices were evaluated. A range of factors influenced the implementation of policies and practices. Lack of government-level pressure was the major barrier to policy development and implementation; meaning reliance was on internal influencers, particularly organisation-level management or champions. Furthermore, ‘perceived’ sector norms appeared to hinder organisations from positively altering their workplace food environment. Common perceptions are that removing unhealthy choices is an intrusion on employee autonomy, and providing fruit is fiscally irresponsible. However, some non-DHB HSO have the capacity to overcome sector norms that contradict their organisational values. Furthermore, most non-DHB HSO believed the whole health sector should be role models, although some did not believe their organisation needed to do so. The audit tool results revealed that tearoom facilities and equipment met accepted standards and therefore promoted use by staff. However, the content of vending machines in all organisations requires considerable improvement. Conclusion: District Health Boards (DHB) have made a commitment to implement a food and nutrition policy by January 2016. The credibility of the health sector as a role model is now dependent on non-DHB HSO following suit. Leadership by the Ministry of Health (MoH) is needed for non-DHB HSO to implement an effective food and nutrition policy. Only then can the whole health sector show integrity when advocating health promoting nutrition behaviours to wider government and society