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UK Food Policy & Nutrition: Tracking
ProgressStrengthening accountability systems for nutrition in the UK
Foodfoundation.org.uk
Today’s speakers
@Food_Foundation
Lawrence HaddadSenior Research Fellow
IFPRI@l_haddad
Inge KauerExecutive DirectorAccess to Nutrition
@ingekauer
Boyd Swinburn - KeynoteProf. of Population,
Nutrition and Global HealthUniversity of Auckland
@BoydSwinburn
Fiona WatsonConsultant
The Food Foundation@Food_Foundation
Today’s panellists
@Food_Foundation
Lord Chris Haskins
Andrew OpieDirector of Food and Sustainability
British Retail Consortium @the_brc
Jo RallingCampaign Director
Jamie Oliver Food Foundation@FoodRev
Guy Poppy Chief Scientific Advisor Food Standards Agency
@GuyPoppy1
Corinna Hawkes - ChairProf. of Food Policy
City University London@CorinnaHawkes
www.foodfoundation.org.uk
Tracking progress on food and nutrition policies
Boyd SwinburnProfessor of Population Nutrition and Global HealthUniversity of Auckland
Co-Director, Global Obesity Centre, Deakin University
The Food Foundation SymposiumLondon, February 2016
Overview – healthy food policies
• What are the imperatives?• What are the priority policies?• How much progress is being made globally?• Strengthening accountability• INFORMAS
– International Network for Food and Obesity/NCD Research, Monitoring and Action Support
• Quasi-regulatory approaches• Importance of UK leadership
•
Lim et al Lancet 2012
Food environments
What needs to be done?
WHO’s Global NCD Monitoring Framework
Mortality & Morbidity
Cancer incidence by type of cancer per 100
000 population
Unconditional probability of dying
between ages 30 and 70 years from cardiovascular
diseases, cancer, diabetes or chronic
respiratory diseases
Salt
Fruits and Vegetables
Saturated Fat
Overweight and Obesity (2)
Physical Inactivity (2)
Blood glucose/diabetes
Blood Pressure
Total Cholesterol
Harmful use of Alcohol (3)
Risk Factors
Tobacco use (2)
Access to palliative care
National Systems Response
Policies to limit SFA and virtual elimination of PHVO
Essential NCD Medicines
HPV Vaccine
Marketing to children
Drug therapy and counseling
Cervical cancer Screening
Hepatitis B Vaccine
25 In
dica
tors
Very little in monitoring food environments and policies
• No country has turned around the epidemic• Some countries show flattening/declines in
some child populations– Young, white, high SES, girls– Increasing disparities by SES and ethnicity
• Some countries introducing food policies
World Cancer Research Fund
Why so little progress on healthy food policies?
1. Food industry actions– Direct opposition (esp Coca Cola & Pepsi on SSB taxes) – Self-regulatory pledges/codes etc
2. Lack of government leadership– Weak governance systems, conflicts of interest– Belief in education approaches and market solutions– Unwilling to battle food industry (chill effect)
3. Lack of sufficient public demand for policies– Usually high majority support for most policies
(moderate/minority support for SSB taxes)– Not translated into pressure for change
Bellagio Declaration Obes Rev 2013
• Need to shift from responsibility pledges to accountability systems– Multiple parties involved– Agreed actions– Power relationships (includes sanctions)– Independent vs mutual accountability
Accountability Framework (Kraak V et al PHN, 2014)
What evidence persuades change-agents?• Monitoring and benchmarking progress under
their jurisdiction• Case studies of successful changes
– Evidence of impact and support– Stories– Visits, networks, personal recommendations
• Evidence of impact of policies and actions– Changes in reach and uptake– Changes in environments and behaviours– Changes in obesity (often not possible)
INFORMAS (www.informas.org)
• INFORMAS is a global network of public-interest organisations and researchers that aims to monitor, benchmark and support public and private sector actions to create healthy food environments and reduce obesity, NCDs and their related inequalities
• Progress– Phase 1: (2012) frameworks & indicators
• 2013 Obesity Reviews suppl – 14 Foundation papers– Phase 2: (2013/4) protocols, pilot testing– Phase 3: (from 2015/6) available globally
• Currently 17 countries using INFORMAS modules (or have grants under review)
Objectives1. Develop a global network of public-interest and
research groups to monitor, benchmark and support efforts to create healthy food environments and reduce obesity, NCDs and their related inequalities
2. Collect, collate and analyse data on public and private sector actions, food environments, population diets, obesity, and NCDs
3. Compare and communicate the progress on improving food environments against good practice benchmarks, between countries and within countries over time
4. Use the results to strengthen public health efforts, particularly by supporting the translation of relevant evidence into public and private sector actions.
Public sector policies and actions Private sector policies and actions
How much progress have (international, national, state and local) governments made towards good practice in improving
food environments and implementing obesity/NCDs prevention policies and actions?
(University of Auckland)
How are private sector organisations affecting food environments and influencing obesity/NCDs prevention
efforts?(Deakin University)PR
OCE
SSES
IMPA
CTS
OU
TCO
MES
Food composition
Foodlabelling
Food marketing
Food provision Food retail Food prices Food trade &
investment
What is the nutrient
composition of foods and non-
alcoholic beverages?(The George
Institute)
What health-related labelling
is present on foods and non-
alcoholic beverages?
(University of Oxford)
What is the exposure and
power of promotion of
unhealthy foods and non-
alcoholic beverages to
different population
groups?(University of Wollongong)
What is the nutritional
quality of foods and non-alcoholic
beverages provided in
different settings (eg.
schools, hospitals,
workplaces)?(University of
Toronto)
What is the availability of healthy and unhealthy
foods and non-alcoholic
beverages in communities
and within retail outlets?(University of
Auckland)
What is the relative price
and affordability of ‘less healthy’
compared with ‘healthy’ diets, meals & foods?
(Queensland University of Technology)
What are the impacts of trade and
investment agreements on the healthiness
of food environments?
(Australian National
University)
Population diet Physiological & metabolic risk factors Health outcomes
What is the quality of the diet of different population groups?
(University of Sao Paulo)
What are the burdens of obesity and other risk factors?
(WHO)
What are burdens of NCD morbidity and mortality?
(WHO)
INFORMAS module structure
ORG
ANIS
ATIO
NS
FOO
D EN
VIRO
NM
ENTS
POPU
LATI
ON
S
NZ Food-EPI • Positives:
international standard in 6
• Stronger infrastructure than specific policies
• Major gaps in implementation– Marketing to
children– Fiscal policies– Comprehensive
plans & funding
Top priorities (out of 34 actions)1. Comprehensive
plan2. Targets
– Childhood obesity– Population intakes
Na, SFA, sugar– Food composition
3. Funding (to $70m/y)4. Restrict marketing
to children
5. Healthy food policies – Schools– Early childhood settings
6. Health Star Rating food labelling
7. 20% excise tax on sugary drinks
Quasi-regulatory systems• Strengthens voluntary initiatives
– More accountable, credible, feasible, transparent, effective (for public health goals)
• Involvement of government– Including: set policy objectives, manage process,
determine the parameters, monitoring, communications, advocacy, threat of regulation etc
• Involvement of civil society– Including: advocacy for public health, independent
monitoring (process and impacts)• Example: Health Star Rating system
Importance of UK leadership• Strong public health traditions, culture, capacity
& expertise• Strong track record of public actions for healthier
food environments– Government– Academia– NGOs– Private sector– Individual champions
• World leading National Child Measurement Program
England’s National Child Measurement Program
0%
2%
4%
6%
8%
10%
12%
14%
Least deprived
Most deprived
Obe
sity
prev
alen
ce
Index of Multiple Deprivation (IMD 2010) decile
2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13
0%
5%
10%
15%
20%
25%
30%
Least deprived
Most deprived
Obe
sity
prev
alen
ce
Index of Multiple Deprivation (IMD 2010) decile
2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13
4-5 year oldsBy year & deprivation decile
10-11 year oldsBy year & deprivation decile
Future directions
Aims: 1. Monitoring progress for accountability 2. Underlying systems causes and solutions
www.lancetobesity.info
Conclusions• Current burden of unhealthy diets is very high
and future threats from climate change and population growth– Demands a robust food strategy and policies
• Accountability systems also needed to speed up progress– INFORMAS platform for creating the data for
monitoring, benchmarking, evaluating, and modelling• Excellent opportunities to build on UK expertise
– Regulatory, quasi-regulatory, programmatic, community systems-based approaches
Acknowledgements
• INFORMAS collaborators internationally and the coordination team at University of Auckland
• www.informas.org• Twitter: @_INFORMAS #INFORMAS • Funders:
How does the UK compare with other high income countries on key nutrition
indicators?
Lawrence HaddadInternational Food Policy Research Institute
10 February 2016
Outline
Nutrition Status Drivers Policy and Legislation Missing Data Conclusions
GreeceSp
ain USA Italy UK
Belgium
German
yFra
nce
Netherlands
Australi
a
Canad
a
New Zeala
nd
Denmark
Norway
Irelan
d
Sweden
10
8 87 7 7 7 7 6 6 6 6 5 5 5
5
Low Birth Weight (%)
Source: UNICEF 2015
Greece Italy
France
Netherlands
Spain
Belgium
Denmark
German
y
Sweden
Australi
a
Norway
Irelan
d
Canad
a
New Zeala
nd UKUSA
20 19 19 18 18 18 18 18 18 18 17 17 1715 15
12
Anaemia in women of reproductive age (%)
Source: WHO 2015Note: all data estimated for 2011
Off course On course
USA
Canad
a
Australi
a
New Zeala
nd UKSp
ainFra
nce
Greece
Irelan
dIta
ly
Norway
Belgium
Netherlands
Sweden
Denmark
German
y
67 64 64 64 63 61 61 61 60 59 59 57 56 56 55 55
Adult overweight and obesity (%)BMI ≥ 25
Source: WHO 2015Note: all data estimated for 2014
High and increasing Low and increasing
USA
New Zeala
nd
Australi
a UK
Canad
a
Irelan
dFra
nceSp
ain
Norway
Greece Italy
Sweden
Belgium
German
y
Netherlands
Denmark
3429 29 28 28
26 24 24 23 23 21 21 20 20 20 19
Adult obesity (%)BMI ≥ 30
Source: WHO 2015Note: all data estimated for 2014.
Off course On course
English Data (not in GNR)
Overweight children 54-66 months All: 22.6% (2013-14)(Greater than or equal to the 85th BMI centile in reception class) Source: National Child Measurement Programme. England 2014-2015 school year http://www.hscic.gov.uk/catalogue/PUB16070/nati-chil-meas-prog-eng-2013-2014-rep.pdf p.17
Obese Adolescents 13-15 yearsBoys = 17% Girls = 22% (2013)(Greater than the 95th UK National BMI centile) Source: Health Survey for England 2013. http://www.hscic.gov.uk/catalogue/PUB16076/HSE2013-Ch11-Child-BMI.pdf p.18
Norway
Irelan
d
German
yIta
ly
Sweden UK
Spain
Netherlands
GreeceFra
nce
Belgium
Denmark
New Zeala
nd
Australi
aUSA
Canad
a
41 41 40 38 38 38 37 37 36 36 35 35 33 32 30 30
Raised blood pressure (%)
Source: WHO 2014.Note: all data estimated for 2008
Off course On course
German
y
Denmark UK
Irelan
d
Belgium
Italy
France
Norway
Netherlands
New Zeala
ndSp
ain
Australi
aUSA
Canad
a
Sweden
Greece
66 65 63 63 62 62 62 62 6156 56 55 54 53 52
48
Raised blood cholesterol (%)
Source: WHO 2014.Note: all data estimated for 2008
Off course On course
USA
New Zeala
ndSp
ain
Canad
a
Norway
Greece
Australi
a
German
y
Belgium
Denmark Italy
Irelan
d
Sweden UK
France
Netherlands
1110 10 10 9 9
8 8 8 7 7 7 7 76
5
Raised blood glucose (%)
Source: WHO 2014.Note: all data estimated for 2008
Off course On course
German
y
Belgium
Australi
aSp
ain
New Zeala
ndUSA
Sweden
France
Norway UK
Denmark
Irelan
d
Canad
a
Netherlands
Italy
Greece
478 515 521 557 566 576 578 586 588 602 605 621 666 673782
967
Availability of fruit and vegetables (grams per day)
Source: FAO 2014Note: Data are for 2011.
Source: Euromonitor 2014, (US $ fixed exchange rates)
Norway
Australia
New ZealandIta
lyFrance
Canada UKSpain
BelgiumGreece
Sweden
Denmark
Germany
Netherlands
Ireland
USA
740 722 720650 618
538 532 526 526 509 503 495444 424 414
332
Consumer expenditure on fruits & vegetables(US$/cap/year)
New Zealand
Greece
Denmark
BelgiumSp
ain
Ireland
Netherlands
Norway
USA
Canada
Sweden
Australia Ita
ly
Germany
France UK
391 381
334 318 306 296275
254 247 242 236 226 218 200 196 181
Fresh food purchased (kg per Cap)
Source: Euromonitor 2014
Belgium
Irelan
dIta
ly
Australi
a
DenmarkFra
nce
German
y
Netherlands UK
Canad
a
New Zeala
nd
Norway
Spain
Sweden
Greece USA
Availability and stage of implementation of guidelines, protocols, and standards for the
management of hypertension
Not available
Available, not implemented
Available, partially implemented
Available, fully implemented
Source: WHO 2014
Not available
Available, not implemented
Available, partially implemented
Available, fully implemented
Source: WHO 2014
Australi
a
DenmarkFra
nce
German
y
Irelan
dIta
ly UK
Belgium
Canad
a
Netherlands
New Zeala
nd
Norway
Spain
Sweden
Greece USA
Availability and stage of implementation of guide-lines, protocols, and standards for the management
of diabetes
No action Few provisions law Many provisions lawVoluntary Law
Source: UNICEF 2014
Implementation of the International Code of Marketing of Breast milk Substitutes
Breast feeding in England• % of babies breastfed at birth 81% in 2010• % of infants 0–5 months old, exclusively breastfed 1% in 2010
Infant Feeding Survey – UK 2010, http://www.hscic.gov.uk/catalogue/PUB08694
New Zeala
nd
Australi
a
Irelan
d
Denmark
Canad
aUSA
Netherlands
France
Norway
Spain
Greece
German
y
Belgium
Sweden UK
Italy
8572 8513
4155
1691 16671147 1072 1050 939 754 742 707 700 699 691 507
Total Emissions (CO2eq) from Agriculture/cap (kg)
Source: FAO 2011
Summary of UK performance relative to comparators
Outcomes Poor: Overweight, obesity, raised blood cholesterol Middling: LBW, raised blood pressure Good: anemia, raised blood sugar
Determinants Poor: exclusive breastfeeding, fresh food purchases Middling: availability of fruits and vegetables; purchase of fruits and
vegetables
Policy and Legislation Middling: BMS Code, Hypertension and Diabetes Protocol Implementation Good: CO2 emissions from agriculture
USA
Germany
Netherlands
Norway
France
Spain UK
Denmark
Sweden
BelgiumIre
land
Australia
Greece Italy
Canada
New Zealand
1419
25 25 26 26 26 27 27 30 30 30 33 34 34 36
% Missing Indicators in GNR Nutrition Country Profiles
Conclusions
UK food system nutritionally weak compared to other high income countries e.g. fresh food purchases, obesity and overweight rates
Even when good or middling compared to other countries, still poor in terms of absolute levels
Significant scope to improve implementation of protocols and code application
Plenty of missing UK data when reporting on global goals SDG reporting will require every country to provide U5
stunting, wasting and overweight
Thank You
What is the food environment?The collective physical, economic, policy and sociocultural surroundings, opportunities and conditions that influence people’s food and beverage choices and nutritional status.
1. Analyse context
2. Collect relevant
info.
3. Evidence ground policies
and actions
4. Validate evidence with govt officials
5. Rate govt
policies and actions
6. Weight, sum &
calculate Food-EPI scores
7. Qualify, comment
& recommen
d
8. Translate results for
govt & stake-
holders
Methods
DomainsPOLICY
3. Promotion
2. Labelling 9. Governance
4. Prices
6. Retail
5. Provision
8. Leadership
INFRASTRUTURE1. Composition
7. Trade & Investment
12. Platforms for Interaction
11. Funding & Resources
10. Monitoring & Intelligence
13. Health in All Policies
1. FOOD COMPOSITION: There are government systems implemented to ensure that, where practicable, processed foods minimise the energy density and the nutrients of concern.
1.1 Food composition targets/standards have been established by the government for the content of unhealthy nutrients of concern in certain foods or food groups if they are major contributors to population intakes of these nutrients.
Good Practice Statements
Food Epi in the UK•Approach of current government:
- Dependence on individual choice - Voluntary control of the companies- Transfer of responsibility to local authorities
RESULT = http://www.legislation.gov.uk/
Katie in the UK
Minsŏ in South Korea Fatemeh in Iran
Some restrictions on advertising HFSS food and
drink on TV since 2008.
Advertising
Ban on soft drinks advertised on TV
since 2004.
Restrictions on advertising specific categories of food
during children’s TV, radio and internet
since 2010.
Katie in the UK
Daniela in Ecuador
Voluntary ‘Traffic light’ labelling on FOP lables
since 2010.
Labelling
Mandatory ‘traffic light’ labelling on packaged
food for fat, sugar and salt since 2014.
Victoria in AustraliaRestaurant chains required to display calorie content of food products on
their menu boards.
Katie in the UK
Crystal in Barbados
No sugar tax (yet)
Tax
Excise tax (10%) on sugary drinks introduced in August 2015
Esztera in HungaryTax (varying rates) adopted in
2012 on ready-to-eat HFSS foods
Katie in the UK
Frida in Denmark
School food regulations implemented. Milk, and fruit & veg for young
children.
School food
Fruit & veg daily for school children introduced in 2009.
Sigrid in EstoniaRestrictions on HFSS, sweet
treats and soft drinks in schools since 2008.
Brazil
Governance
• Multi-sectoral coordination
• Personal ownership and leadership from
President• Strong participation from
civil society• Private sector
engagement
Food Standards Agency
Dept. of
Health
DEFRA
Food Standards Agency
Dept. of Local
Communities
TreasuryHMRC
DEFRA
Local Authorities England
1. Analyse context
2. Collect relevant
info.
3. Evidence ground policies
and actions
4. Validate evidence with govt officials
5. Rate govt
policies and actions
6. Weight, sum &
calculate Food-EPI scores
7. Qualify, comment
& recommen
d
8. Translate results for
govt & stake-
holders
Next Steps for Food Epi in the UK
We are here• Partners?
• Devolved areas?
• Food environment or food system?
2016 GLOBAL ACCESS TO NUTRITION INDEX
FOOD FOUNDATION
LONDON, 10 FEBRUARY 2016
#ATNI2016
@ATNIndex
65
Encourage improvements in companies’ policies, practices and performance to result in:• Greater consumer access to more nutritious foods and beverages• An environment facilitating the consumption of healthier foods and beverages
InvestorsProvide context for company engagementMediaRaise profile of industry role in malnutrition
Civil societyFacilitate effective advocacy
PolicymakersInform regulatory and policy agenda
AcademicsStimulate research on best practices
Provide companies a tool for benchmarking their nutrition
practices
Serve as an impartial source of information for interested
stakeholders
Stimulate dialogue
and action
Given its size and reach, the private sector can make a significant contribution to addressing obesity and undernutrition.
ATNI seeks to
Tool for accountabilit
y
What ATNF aims to achieve – our theory of change
The private sector can play a powerful role….
66
… and has a financial and social responsibility to act
67
2016 Global Index methodology
68
2016 Global Index methodology
69
Overall ranking
• Unilever leads the Index, with a score of 6.4 out of 10
• Nestlé and Danone also remain in the top three, as in 2013
• Mars (16 to 5) & FrieslandCampina (19 to 8) have improved the most
• Eight have risen, six fallen, five stayed the same, three new entrants.
Overall findings
70
The world’s largest food companies must step up efforts to address the global nutrition crisis – investors can play a key role
• Some companies have made improvements but the industry as a whole is moving too slowly: the average score has only increased to 2.5 from 2.2 in the 2013 Index
• All companies must invest more in embedding nutrition into their global businesses– To tackle obesity, they should adopt stronger nutrition strategies and
policies and use robust systems to measure the nutritional value of all of their products and make their foods healthier, among other things
– To tackle undernutrition, they must invest within their businesses and work with governments and civil society to find innovative ways of providing affordable and accessible foods for poorer people
• Companies must take a global approach; US companies particularly must not just focus on their home markets, as they typically do
• The marketing practices of all six of the baby food manufacturers evaluated in a new element of the assessment fall short of international standards, undermining breastfeeding which is the optimal form of nutrition for infants
71
Category B - Products• Unilever leads with significant margin over Nestlé
• Higher ranking than in 2013: FrieslandCampina, Mars and Ferrero
• Lower ranking: Kellogg’s and ConAgra
• Inadequate efforts to improve products’ nutritional quality
• Nutrient Profiling system: only 13 companies report having one
• % of products that can be advertised to children• Proxy for healthiness of product portfolio• Only Danone and Unilever provided data
• Fortification of products to tackle undernutrition • Only Ajinomoto, Danone, FrieslandCampina,
Mondelez, Nestlé, Coca-Cola and Unilever have formulated a commitment
72
Category D - Marketing• Highest-scoring Category, Danone leads.
• Marketing to all consumers 7 companies without evidence of a responsible marketing policy
• Marketing to children • Most companies subscribing to self-regulatory
pledges • But significant gaps remain in pledges
• Not applied to all media• Do not cover over 12s• Audience threshold for children 35%
• Definition of marketability to children• Only Kellogg, Ferrero, Danone, Nestlé
and Unilever use a robust NPS
• GLOBAL policies on responsible marketing to children and adults, applied to all channels, particularly new media, are required.
• No data on marketing spending on healthy products
Categories C, E, F and G – average scores very low
73
Category C: Accessibility and affordability
Category E: Support for healthy and active lifestyles
• Most companies engage with nutrition stakeholders but unclear whether and how they use the results to improve policies and practice
• Very little engagement on undernutrition
• Much more transparency is needed on companies’ lobbying activities on nutrition
• Critical issue• Lowest scoring Category on the
Index, as in 2013.
• Companies expected to do much more to make healthy foods in developed and developing markets more affordable and more accessible.
• Generally a low-scoring Category• Employee wellness programs need to
be strengthened and extended• More focus needed on supporting
breastfeeding mothers at work• Companies need to move to
supporting independently designed and implemented programs to support consumers
Category F: Labelling and claims
• Back-of-pack labelling commitments reasonably good; generally not globally consistent and some key nutrients missed
• Lack of data from companies on extent of policy roll-out
• Focus needs to be on useful front-of-pack labelling and responsible use of health and nutrition claims. Category G: Engagement with
stakeholders and policymakers
74
Discussion
• Strengthen the UK country profile in the Global Nutrition Report (UK Government to make available relevant data)
• Complete the Food EPI exercise for the UK (Food Foundation to convene a workshop of experts to assess the UK Government’s level of implementation of policies and infrastructure support against international best practice for improving the healthiness of food environments)
• Conduct a Access to Nutrition Index for the UK that scores and rates the largest Food & Beverage manufacturers (ATNI to include the UK as a ‘Spotlight Country’).
www.foodfoundation.org.uk