Healthier food and drinks at healthcare facilities

Directive number: QH-HSD-049

Effective date: 6 November 2023

Review date: 6 November 2026

Supersedes: Version 3

On this page:

Preamble

Health and Wellbeing Queensland was established on 1 July 2019, as an independent statutory body within the health portfolio in the Queensland Government to improve the health and wellbeing of all Queenslanders and reduce health inequities.

Under this remit, Health and Wellbeing Queensland is leading Queensland Government efforts to improve food environments so Queenslanders have access to healthy food and healthy drink options in places outside the home. This includes developing, supporting and reporting on policies related to healthy food and healthy drinks, including A Better Choice Food and Drink Supply Strategy for Queensland Healthcare Facilities which assists implementation of this Health Service Directive.

Purpose

This Health Service Directive (Directive) directs Hospital and Health Services (HHSs) to ensure that healthy food and healthy drinks are sold, provided, promoted and advertised at healthcare facilities. The Directive will establish HHSs as places where staff and visitors are supported to make choices that promote health and wellbeing.

Scope

This Directive applies to all HHSs and all retail outlets and vending machines in HHS facilities. This includes private businesses leasing space within a HHS facility.

This Directive does not apply to:

  • in-patient, residential and aged-care meals, but implementation of this Directive is encouraged in these facilities
  • food and drinks that staff and visitors bring from outside the Healthcare facility for their own personal consumption and
  • existing HHS legal arrangements that do not address or align with this Directive.

A HHS that believes part or all of their HHS is, or should be, exempt from the obligation to comply with this Directive, must:

  • provide documentary evidence of an existing exemption or
  • submit documents supporting a new request for an exemption—

to PSB_Corro@health.qld.gov.au to enable the Directive Custodian to consider, make a decision and respond.

Principles

  • Leadership – healthcare providers have a responsibility to lead the way in modelling environments that support healthier choices.
  • Quality – to support the delivery of health services that promote health and wellbeing.
  • Consistency – in the sale, provision, promotion, and advertising of healthy food and healthy drinks for staff and visitors across HHSs.
  • Alignment – with the Australian Dietary Guidelines, that recommend consumption of food and drink from the five food groups, drinking plenty of water, and limiting intake of food and drinks containing added sugars, fats (including saturated fat), salt and/or alcohol.

Outcomes

Hospital and Health Services included in the scope of this directive shall achieve the following outcomes:

  • A consistent approach to the sale, provision, promotion, and advertising of healthy food and healthy drinks in Queensland HHSs will be adopted and maintained. This will contribute to delivering Queensland Health’s leadership role in making healthy choices easier and keeping Queenslanders healthy.

Mandatory requirements

For all Healthcare facilities selling or providing food and drinks

  • Free drinking water will be made readily available, prominently promoted or advertised and accessible, and water promoted as the drink of choice.
  • Where a Healthcare facility is required to have a Water risk management plan in place it must address drinking water.
  • Only healthy food and healthy drinks, classified as GREEN, will be promoted and advertised.

For all Retail Outlets and Vending Machines

  • HHSs will ensure achievement of performance targets in this Directive as follows:
    • No more than 20% of the total proportion of food displayed or provided is unhealthy, classified as RED.
    • There is no sale or provision of unhealthy drinks, classified as RED.
    • Alcoholic drinks will be served in accordance with a relevant liquor licence or permit, or not supplied at all.
    • Intense artificially or naturally sweetened drinks, classified as AMBER, must be no more than 20% of the total proportion of drinks displayed or provided.
    • Only healthy food and healthy drinks, classified as GREEN, will be promoted and advertised.
    • At least 50% of the proportion of drinks displayed or provided are healthy drinks, classified as GREEN.
    • For vending machines, at least 30% of the proportion of foods displayed or provided are healthy food, classified as GREEN.
    • For all other retail outlets (excluding vending machines), at least 50% of the proportion of foods displayed or provided are healthy foods, classified as GREEN.

For all Fundraising activities and all Catering activities

  • GREEN healthy food and healthy drink options will be made available and actively promoted.
  • There will be no sale, provision, promotion or advertising of unhealthy drinks, classified as RED.

Contracts and Leasing

  • HHSs will act on opportunities to include this Directive in:
    • variations including extensions for existing agreements and leases, and
    • new agreements and leases with suppliers and lessees, to achieve the performance targets in this Directive.
  • For outlets where the Directive is not included in an existing agreement or lease, reasonable efforts should be made to provide and promote healthier food and drinks.

Monitoring and reporting of compliance

  • HHSs will monitor compliance with the requirements of this Directive, and report Data to Health and Wellbeing Queensland by 31 January for the previous calendar year.
  • Health and Wellbeing Queensland will:
    • collate and analyse the Data collected by HHSs
    • provide feedback on compliance and work together with HHSs on performance improvement plans, if required
    • submit a compliance report to the Director-General and Directive Custodian by 30 April each year, and
    • provide visibility of HHS level compliance to the Queensland public for the purpose of promoting transparency, tracking progress, and supporting adoption of the A Better Choice Food and Drink Supply Strategy for Queensland Healthcare Facilities.
  • Hospital and Health Boards Act 2011 (Qld)
  • Human Rights Act 2019 (Qld)
  • Healthy food and drink choices in public sector healthcare settings for staff and visitors – Goals, principles and minimum national nutritional standards, COAG Health Council 2018
  • Health and Wellbeing Queensland Act 2019

Supporting documents

Business area contact

  • Strategy Policy and Reform Division – for enquiries regarding development and review of this Directive: PSB_Policy@health.qld.gov.au
  • Health and Wellbeing Queensland – for enquires regarding the implementation of and compliance with this Directive and A Better Choice Food and Drink Supply Strategy for Queensland Healthcare Facilities: abetterchoice@hw.qld.gov.au

Review

This Directive will be reviewed at least every three years but may be reviewed earlier in light of emerging evidence based on this Directive or nutrition guidelines. In the event that this Directive is reviewed early, further consultation with HHSs will occur.

Approval and implementation

Directive Custodian

Executive Director, Prevention Strategy Branch, Strategy, Policy and Reform Division

The Directive Custodian is a delegate for the Director-General under an Instrument of Delegation and is responsible for ensuring compliance with delegable powers under Part 3 Division 2 of the Hospital and Health Boards Act 2011 (Chief executive may issue health service directives).

The Directive Custodian will consult with Health and Wellbeing Queensland and HHSs in the development and review of this Directive.

To remove any doubt, the Directive Custodian may arrange for Queensland Health personnel or a separate legal entity such as Health and Wellbeing Queensland, to be engaged to perform services relating to this Directive, including collecting Data from HHSs, collating Data and reporting it to the Director-General and Directive Custodian.

Approval by Chief Executive

Michael Walsh
Director-General, Queensland Health

Approval date: 1/11/2023

Issued under section 47 of the Hospital and Health Boards Act 2011.

Human rights

Human rights are not engaged by this directive.

Definitions of terms used in this directive

Term

Definition / Explanation / Details

Source

A Better Choice Food and Drink Supply Strategy for Queensland Healthcare Facilities (ABC)

A Queensland Government strategy, through Health and Wellbeing Queensland that is based on the Australian Dietary Guidelines and applies a traffic light system to classify food and drinks:

  • GREEN – best nutritional value
  • AMBER – some nutritional value and
  • RED – limited or no nutritional value.

A Better Choice Food and Drink Supply Strategy for Queensland Healthcare Facilities

Added sugar

Includes addition of sucrose (commonly called sugar), fructose, glucose, honey, fruit juice concentrate, fruit sugar syrup and deionised fruit juice.

 

Alcoholic drinks

Any beverage labelled as containing alcohol.

 

Australian Dietary Guidelines

The Australian Dietary Guidelines are a framework for healthy eating among the general population. There are 5 principal recommendations in the Australian Dietary Guidelines. The guidelines are intended for all healthy Australians, not the frail elderly or those who need special dietary advice for a medical condition.

The Australian Dietary Guidelines | Australian Government Department of Health and Aged Care

Catering

Catering refers to occasions where any food or drinks are provided at meetings, events, conferences, exhibitions, symposiums, workshops, training, and any other functions, within HHSs. It includes ‘free’ meals prepared or paid for by the HHS or external agencies, companies and businesses.

 

Data

Data means data that Health and Wellbeing Queensland receives from HHSs, collates and reports to the Directive Custodian in accordance with this Directive.

 

Directive Custodian (Health Service Directive Custodian)

Has the same meaning as in the Queensland Health, Department of Health – Health Service Directive Management Standard – QH-IMP-366-1:

Officer responsible to lead development of a health service directive and/or oversight implementation and review of an approved health service directive.

Health service directive custodians are a position, not an individual and will at minimum be a Senior Officer (SO) or equivalent.

Health Service Directive Management

Food Environments

Food environments encompass the different settings where people purchase and consume food outside the home, including Healthcare facilities, schools, sport and recreation centres, workplaces and restaurants.

 

Fundraising activities

Fundraising activities includes promotional activities and sponsorships, staff social clubs, gifts, raffles, bake sales, third party fundraisers, static displays, fundraising including BBQ’s, breakfasts or morning teas, special interest events such as awareness weeks and competitions.

These include food and drinks provided by the HHSs or through private selling within the workplace.

 

Health and Wellbeing Queensland

The statutory body corporate representing the State of Queensland, established under the Health and Wellbeing Queensland Act 2019 and exercising the powers and functions granted under that Act.

Health and Wellbeing Queensland - Making healthy happen (hw.qld.gov.au)

Healthcare facility

A geographic site where one or more healthcare services are located on HHS land, including but not limited to:

  • hospitals
  • community health centres
  • primary health care centres
  • laboratories and
  • office buildings operated by HHSs.
 

Healthy drinks

Healthy drinks are classified as GREEN.

They have no added sugar and/or contain important nutritional value.

Further details can be found in the A Better Choice Food and Drink Supply Strategy for Queensland Healthcare Facilities.

A Better Choice Food and Drink Supply Strategy for Queensland Healthcare Facilities

Healthy food

Healthy foods are classified as GREEN.

They are good sources of vitamins, minerals and fibre, lower in saturated fat, added sugar and/or salt, lower in energy and help ensure optimal nutrient intake.

Further details can be found in A Better Choice Food and Drink Supply Strategy for Queensland Healthcare Facilities.

A Better Choice Food and Drink Supply Strategy for Queensland Healthcare Facilities

Hospital and Health Service (HHS)

The HHSs are statutory bodies established under the Hospital and Health Boards Act 2011 and are the principal providers of public sector health services.

Hospital and Health Boards Act 2011

In-patient, residential and aged-care meals

Includes any meals provided to patients admitted to a Healthcare facility e.g. for day-surgery, or a ward.

These meals are specifically designed to ensure clinical needs are met and to prevent malnutrition, particularly for long-stay patients. They must comply with the Queensland Health Nutrition Standards for Meals and Menus and the Aged Care Quality Standards.

Queensland Health Nutrition Standards for Meals and Menus and the Aged Care Quality Standards.

Intense artificially or naturally sweetened drinks

Artificially or naturally intense sweetened drinks are classified as AMBER.

Artificially or naturally intense sweetened drinks include any drinks (except milk-based drinks) which have added non-nutritive intense sweeteners from artificial or natural sources. Some examples include (but not limited to):

  • artificial   sweeteners – acesulphame potassium, aspartame, cyclamate, saccharin, sucralose and
  • natural sweeteners – stevia, erythritol, and allulose.

A Better Choice Food and Drink Supply Strategy for Queensland Healthcare Facilities

Liquor Licence or Permit

Different liquor licences are outlined in the Liquor Act 1992. The Commissioner’s liquor guidelines outline obligations under relevant legislation in Queensland.

Liquor Act 1992

Liquor guidelines | Business Queensland

Promotion and advertising

Includes product placement in prominent areas, static display of marketing materials or panels, special meal-deal promotion, digital marketing, or master-branding (i.e. billboards, store umbrellas, flags, straw holders, counter signs, and drink fridges or vending machine decals).

 

Readily available

Available and easy to access at places where foods and/or drinks are sold/provided.

 

Retail outlets, including vending machines

Any point of sale for food and drinks, including but not limited to:

  • vending machines
  • retail outlets – restaurants, cafes, kiosks, canteens, coffee carts, tea trolleys, food trucks and
  • other retail outlets that sell food and drinks—convenience stores, newsagents, post offices, florists, gift stores and pharmacies.
 

Unhealthy drinks

Unhealthy drinks are classified as RED.

These drinks are nutrient-poor and lack nutritional value, can be energy dense, and can contribute to excess energy intake (kilojoules). When frequently consumed unhealthy drinks can increase the risk of unhealthy weight and dental decay.

Further details can be found in the A Better Choice Food and Drink Supply Strategy for Queensland Healthcare Facilities.

A Better Choice Food and Drink Supply Strategy for Queensland Healthcare Facilities

Unhealthy food

Unhealthy foods are classified as RED.

These foods provide limited nutrition, can be energy dense and can contribute to excess energy intake (kilojoules). When frequently consumed unhealthy food can increase the risk of unhealthy weight and chronic diseases.

Further details can be found in the A Better Choice Food and Drink Supply Strategy for Queensland Healthcare Facilities.

A Better Choice Food and Drink Supply Strategy for Queensland Healthcare Facilities

Water risk management plan

A Water risk management plan describes how a facility, prescribed under Chapter 2A of the Public Health Act 2005 (Qld), will prevent or minimise the risks to health associated with the water supply of the prescribed facility.

Public Health Act 2005 (Qld)

Version control

Version

Date

Prepared by

Comments

V1

13/03/2019

Prevention Division

Initial version Health Service Directive Healthier Drinks at Healthcare Facilities

V2

03/09/2019

Prevention Division

Minor amendments as approved by the Director-General on 01/09/2019 and Health Service Chief Executives on 12/08/2019:

  • Amendment 1 – remove three words ‘or added juice’ from the ‘Flavoured water and Mineral water’ category on page 3
  • Amendment 2 – remove three words ‘or added juice’   from the ‘Cordials and Iced teas’ category on page 3

Amendment 3 – replace ‘Director-General’ with ‘Health Service Chief Executive’ on page 5 and remove reference to Department of Health Standard QH-IMP-291-1.2015 on page 6

V3

24/01/2020

Prevention Division

Major amendments to include requirements for foods.

V4

6/11/2023

Strategy Policy and Reform Division in consultation with Health and Wellbeing Queensland

  • Minor amendments to wording throughout to ensure   consistency with current version ABC (2022).
  • Addition of a preamble outlining Health and   Wellbeing Queensland’s role as the owner of the ABC.
  • Amendment to ‘Scope’ to provide clarity for in-scope outlets, and the   requirement to provide evidence of exemption.
  • Amendment to ‘Mandatory Requirements for all 'Retail Outlets’ to remove the interim dates and performance targets referenced   for 2020 and 2021.
  • Addition of new requirement for Hospital and Health Services to include ABC requirements in new and renewed agreements   with suppliers and lessee, and for lessees that do not have the Directive   written into existing contracts to make reasonable efforts to promote healthier food and drink
  • Amendment to wording under Monitoring and Compliance.
  • Addition of new requirement to provide visibility of data to the Queensland public for the purpose of promoting transparency, tracking progress and supporting adoption of ABC.
  • Directive Custodian updated in accordance with Department of Health organisational restructure.
  • Addition of definition of terms ‘Data’, ‘Directive Custodian’ (Health Service Directive Custodian), ‘Health and   Wellbeing Queensland’, Hospital and Health Service’, ‘Water risk management plan’ and ‘Food Environments’ ‘Liquor Licence or permit’ for clarity.
  • Clarified definition of terms for ‘Alcoholic Drinks’ and ‘Australian Dietary Guidelines’.

Last updated: 20 November 2023