Global overview: Labelling into national nutrition policy · Department of Nutrition for Health and...

Global overview:

Labelling into national nutrition policy

Chizuru Nishida

Coordinator, Nutrition Policy and Scientific Advice (NPU)

Department of Nutrition for Health and development (NHD)

A Global Action Network on Nutrition Labelling:

Taking action for better informed consumers’ choices

in the Decade of Action on Nutrition

Paris, France, 6 - 7 February 2019

Global overview of country actions

Work of Codex in incorporating obesity

and NCD concerns

WHO work on nutrition labelling

Outline

Global overview of country actions

2009-2010: 1st Global Nutrition Policy Review

123 countries responded

Information on nutrition governance (incl. capacities, coordination mechanisms, surveillance)

Assessment of policies and actions in 6 areas: 1) IYCN (incl SAM/MAM, nutrition & infectious diseases), 2) International Code of Marketing of BMS, 3) School-based programmes, 4) Vitamins and minerals, 5) Obesity and diet-related NCD, 6) Food security and agriculture policies

Data incorporated into WHO Global database on the Implementation of Nutrition Action (GINA) http://www.who.int/nutrition/gina/en/

Results served as background for developing CIP-MIYCN – Final report published in 2013

WHO's work on monitoring policies and actionsto promote healthy diets and nutrition

1993-2001: Monitoring implementation of 1992 ICN commitments Regular review and monitoring of country progress through regional review

meetings between 1992 - 2001

Monitoring of development, operationalization & implementation of multisectoral national plans of action on nutrition addressing the double burden of malnutrition based on 9 strategic actions

WHO Global Database on National Nutrition Policies and Programmes

2016: 2nd Global Nutrition Policy Review

177 countries responded to date (91%)

Information on nutrition governance (incl. capacities, coordination mechanisms, surveillance)

Assessment of policies and actions in 6 areas: 1) MIYCN, 2) Prevention & treatment of acute malnutrition, 3) Nutrition and infectious diseases, 4) School health & nutrition programmes, 5) Vitamin and mineral nutrition, 6) Promotion of healthy diet and prevention of overweight, obesity and diet-related NCDs

Coverage/inclusion of Global Nutrition and diet-related NCD Targets in national policies

Data will be incorporated into GINA

Results will contribute to:

• Monitoring of ICN2 FFA implementation

• Assessing baseline for the Decade of Action on Nutrition

http://www.who.int/nutrition/gina/en/

Policy measures for promoting healthy diet

in 158 countries

Source: 2nd Global Nutrition Policy Review 2016 – 2017 (WHO 2018)

76%81%

57%

43%

19%27% 30%

12%

72%

83%

0%10%20%30%40%50%60%70%80%90%

100%

Policy measures for promoting healthy diet

in 158 countries


Types of nutrition labelling being implemented

in 124 countries



Mandatory or voluntary nutrient declaration

in 74 countries


Mandatory nutrients to be declared

in 66 countries


Elements used in FOPL systems

in 37 countries

Work of Codex in incorporating

obesity and NCD concerns

Active

Codex Alimentarius Commission

Executive Committee

Vertical / Commodity

Committees

Horizontal / General

Committees

Ad-hoc Intergovernmental

Task Forces

Import and Export

Inspection and

Certification Systems

(Australia)

Food Labelling

(Canada)

General Principles

(France)

Residues of Veterinary

Drugs in Foods

(United States)

Food Additives

(China)

Pesticide Residues

(China)

Contaminants in Foods

(Netherlands)Food Hygiene

(United States)

Methods of Analysis

and Sampling

(Hungary)

Nutrition and Foods for

Special Dietary Uses

(Germany)

Adjourned sine die

Fish and Fishery

Products

(Norway)

Processed Fruits

and Vegetables

(United States)

Fats and Oils

(Malaysia)

* Sugars

(Colombia)

Meat Hygiene

(New Zealand)

Natural Mineral Waters

(Switzerland)

Vegetable Proteins

(Canada)

Fresh Fruits

and Vegetables

(Mexico)

Spices and Culinary

Herbs

(India)

* Milk and Milk Products

(New Zealand)

Cocoa Products

and Chocolate

(Switzerland)

FAO/WHO Regional Coordinating Committees

Africa

(Kenya)

Asia

(India)

Europe

(Kazakhstan)

Latin America and

the Caribbean

(Chile)

North America and

South West Pacific

(Vanuatu)

Near East

(Iran)

Animal Feeding

(Switzerland)

Fruit Juices

(Brazil)

Foods Derived from

Biotechnology

(Japan)

Processing and Handling

of Quick Frozen Foods

(Thailand)

Dissolved

* Cereals, Pulses and

Legumes

(United States)

* Working by correspondence

Active

Antimicrobial

Resistance

(Republic of Korea)

Nutrition-related issues considered in recent years

include:

Infant formula

Follow-up formula

Complementary foods

RUTF

Fortification – Biofortificattion

Nutrition labelling

Updated dietary goals (TRS 916) serving as

scientific basis for policy actions (DPAS)

" 4. REQUESTS the Codex Alimentarius Commission to continue to give full

consideration, within the framework of its operational mandate, to evidence-based action it

might take to improve the health standards of foods, consistent with the aims and objectives

of the Strategy"

Paragraph 59 of the Global Strategy states:

Public health efforts may be strengthened by the use of international norms and standards

particularly those drawn up by the Codex Alimentarius Commission.

Areas for further development could include:

labelling to allow consumers to be better informed about the benefits and content of foods

measures to minimize the impact of marketing on unhealthy dietary patterns

Provision of information about healthy consumption patterns including steps to increase the

consumption of fruits and vegetables

Improving production and processing standards regarding the nutritional quality and safety of

products

endorsed by 57th

WHA in 2004

(WHA 57.17)

Areas of actions proposed to implement DPAS through Codex

CCFL CCNFSDU

1. Nutrition Labelling

2. Nutrition Claims

3. Quantitative Declaration of

Ingredients

4. Modification of Standardized

Foods

1. Nutrition Labelling

2. Nutrition Claims

3. Production and Processing

Standards regarding the

Nutritional Quality and Safety

of Foods

Revising Codex Guidelines on Nutrition Labelling

According to Codex, Nutrition labelling comprises 2 components:

Nutrient declarations• a standardized listing of the nutrient content of a food or beverage and is

usually positioned on the back or the side of the package

Supplementary nutrition information• it is provided to supplement rather than replace nutrient declarations

• Only where target populations have a high illiteracy rate should supplementary

nutrition information be used in the absence of nutrient declarations

• it is intended to increase people’s understanding of the nutritional value of a

food and to assist in interpreting the nutrient declaration

• Codex does not define or outline principles for this type of labelling at present

and recognizes that the presentation of supplementary nutrition information

varies

Another component: Nutrition and health claims

refer to any representation that states, suggests or implies that a food has

particular nutritional properties, or that a relationship exists between a

food or food constituent and health

In October 2017, 44th CCFL agreed to start new work to

develop guidelines on FOPL: Prompted by the fact that currently there is no specific Codex

guideline or guidance on front-of-pack labelling as such

In July 2018, 41st CAC approved the new work.

Codex work in developing FOPL guidelines includes:

Reviewing existing guidelines

Considering key aspects, purpose and scope, definition of

FOPL, etc

Taking into consideration WHO’s work on guiding principles for

FOPL systems and evidence reviews on nutrition labelling that

are being developed as part of the guideline development for

promoting healthy diets

WHO work on nutrition labelling

Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition(endorsed together with the 6 Global Nutrition target 2025 by the 65th WHA in May 2012)

Under Action 3:

As part of the action to stimulate development policies and programmes outside the health sector that recognize and include nutrition, it stated that “Trade measures, taxes and subsidies are an important means of guaranteeing access and enabling healthy dietary choices. They can be powerful tools when associated with adequate information for consumers through nutrition labelling and responsible food marketing, and with social marketing and promotion of healthy diets and healthy lifestyles.”

Nutrition LabellingA policy measure for promoting healthy diet

Global Action Plan for the Prevention and

Control of Noncommunicable Diseases

2013-2020 (adopted by the 66th WHA in May 2013

together with 9 voluntary NCD Global Targets 2025)

Under Objective 3:

One of the policy options for Member

States is to "Promote nutrition labelling,

according to but not limited to,

international standards, in particular the

Codex Alimentarius, for all pre-packaged

foods including those for which nutrition or

health claims are made."

ICN2 Declaration - 10 Commitments (November 2014)

1. Eradicate hunger and prevent all forms of malnutrition

2. Increase investments

3. Enhance sustainable food systems

4. Raise the profile of nutrition

5. Strengthen human and institutional capacities

6. Strengthen and facilitate, contributions and action by all stakeholders

7. Ensure healthy diets throughout the life course

8. Create enabling environment for making informed choices

9. Implement the commitments through the Framework for Action

10. Integrate vison and commitments into the post-2015 agenda

Recommended actions for sustainable food systems promoting healthy diets

Recommendation 15: Explore regulatory and voluntary instruments – such as marketing, publicity

and labelling policies, economic incentives or disincentives in accordance with Codex Alimentarius

and World Trade Organization rules – to promote healthy diets.

Recommended actions for nutrition education and information

Recommendation 19: Implement nutrition education and information interventions based on

national dietary guidelines and coherent policies related to food and diets, through improved school

curricula, nutrition education in the health, agriculture and social protection services, community

interventions and point-of-sale information, including labelling.

ICN2 Framework for Action

Report of the Commission on Ending Childhood Obesity

(WHO Director-General to transmit to the 69th WHA in May 2016)

Recommendation 1: Implement comprehensive programmes that promote

the intake of healthy foods and reduce the intake of unhealthy foods and

sugar-sweetened beverages by children and adolescents

1.6 Implement a standardized global nutrient labelling system

1.7 Implement interpretive front-of-pack labelling, supported by public

education of both adults and children for nutrition literacy.

Nutrition LabellingA policy measure and guideline implementation tool for promoting healthy diet

First introduced in late 1980s by NGO and government agencies – endorsement

systems

Starting around 2004, in response to growing consumer interest in nutrition and

demand for healthier products, food industry started to develop FOPL systems to

give products competitive advantage

Starting around 2006, governments and government agencies made

recommendations to food manufacturers and retailers for FOPL systems that would

support consumers to make healthier food choices (e.g. UK, Australia/NZ etc)

Today, more and more proliferation of FOPL systems and symbols

Front-of-pack labelling (FOPL)

25

American Heart

Association’s Heart

Check symbol (1987)

Swedish National Food

Administration’s Green

Keyhole symbol (1989)

Objectives of the meeting were to:

1. review the types of front-of-pack labelling systems that are currently being

implemented/proposed and identify their benefits and limitations

2. review and assess the evidence on the effectiveness of different types of

front-of-pack labelling systems

3. review case studies of countries with experience in implementing front-of-

pack labelling

4. identify issues and considerations for the design and implementation of

front-of-pack labelling systems in order to develop guiding principles and a

guidance framework for implementing front-of-pack labelling

WHO Technical Meeting on

Nutrition Labelling for Promoting Healthy DietLisbon, Portugal, 9 – 11 December 2015

Country experiences reviewed:

─ Chile ─ Mongolia ─ Switzerland ─ USA

─ Ecuador ─ Netherland ─ Thailand

─ Finland ─ New Zealand ─ Tunisia

─ France ─ Portugal ─ UK

Refers to nutrition labelling systems that:

are presented on the front of food packages (in the principal

field of vision) and can be applied across the packaged retail

food supply

comprise an underpinning nutrient profile model that considers

the overall nutrition quality of the product or the nutrients of

concern for NCDs (or both)

present simple, often graphic information on the nutrient

content or nutritional quality of products, to complement the

more detailed nutrient declarations usually provided on the

back of food packages

Front-of-pack labelling (FOPL)

Guiding principles A policy measure and guideline implementation tool for promoting healthy diet

Field-test in countries in 2018-19

Regional meetings:• AMRO/PAHO – November 2017

• SEARO / WPRO – April 2018

• AMRO/PAHO – May 2018

• EMRO – September 2018

15 guiding principles for FOPL system

Overarching principles (5)

Principle 1: The FOPL system should be aligned with national public health and

nutrition policies and food regulations as well as with relevant WHO guidance and

Codex guidelines.

Principle 2: A single system should be developed to improve the impact of the FOPL

system.

Principle 3: Mandatory nutrient declarations on food packages are a pre-requisite for

FOPL systems.

Principle 4: A monitoring and review process should be developed as part of the

overall FOPL system for continuing improvements or adjustments as required.

Principle 5: The aims, scope and principles of the FOPL system should be

transparent and easily accessible.


Principles for a collaborative approach to FOPL development (1)

Principle 6: Government should lead the multi-sectoral stakeholder engagement process

for the development of trusted systems, including nutrient profiling criteria.

Principles for FOPL system format (design and content) (4)

Design

Principle 7: The FOPL system should be interpretive, based on symbols, colours, words

and/or quantifiable elements.

Principle 8: The design of FOPL systems should be understandable to all population

sub-groups and be based on the outcome of consumer testing, evidence of system

performance and stakeholder engagement.

Content

Principle 9: Content should encompass nutritional criteria and food components that aim

to inform choice and enable interpretation of food products against risks for diet-related

NCDs and for promoting healthy diets.

Principle 10: The FOPL system should enable appropriate comparisons between food

categories, within a food category, and between foods within a specific food type.


Principles for the implementation of FOPL systems (5)

Principle 11: Uptaking of the FOPL system should be encouraged across all eligible

packaged foods, either through regulatory or voluntary approaches.

Principle 12: Early engagement of industry groups and the development of guidance

documents (i.e. style guide) are necessary in facilitating the implementation of the FOPL

system..

Principle 13: Engagement with key opinion leaders (including food and nutrition experts

and the media) and consumers are essential and should be well managed.

Principle 14: Well-resourced public education campaigns and consumer education with

special consideration of techniques to target at-risk groups are necessary for improving

nutrition literary and consumer understanding and use of the FOPL system.

Principle 15: Baseline data should be collected to support monitoring and evaluation of

the impact on consumers and reformulation of food products.

WHO Nutrition Guidance Expert Advisory Group (NUGAG)

Work of the Subgroup on Diet & Health

Guidelines updated: Sodium (2012)

Potassium (2012)

Free sugars (2015)

Draft guidelines completed (for public consultation (2018):

SFA

TFA

Draft guidelines being completed (2019): Total fat

CHO (Starch & Fibre incl. fruit & vegs)

PUFA

Non-sugar sweeteners

Systematic review under preparation: Dietary patterns

Launching of the Subgroup on Policy

Actions

Develop policy guidelines for promoting

healthy diet and nutrition and prevent

obesity and diet-related NCDs through

changing food environment

Call for experts issued in 2017

Start with priority policy measures:

• Fiscal policies, Nutrition labelling policies,

Marketing policies, Trade and investment

policies

Scoping documents prepared for 3 policy

measures

1st meeting held in December 2018

2nd meeting scheduled in December 2019

Rationale for developing guidelines on policy actions

In April 2016, the UN General Assembly (UNGA) declared:

UN Decade of Action on Nutrition (2016 – 2025)

The goal of the Decade is to:

Increase actions at the national, regional and global levels to implement

the recommended actions of the ICN2 Framework for Action

Provides a set of policy options and strategies which governments may

incorporate into their national sectoral or development/investment policies

and plans, and consider in negotiating international agreements to achieve

better nutrition for all.

Rational for developing policy guideline on

nutrition labelling policies

Despite progress in implementing nutrition labelling policies, the policy

impact varies between countries and the effectiveness of the different

components (e.g. nutrient declarations, supplementary nutrition

information) of nutrition labelling policies on specific outcomes (i.e.

consumers’ nutrition and health outcomes, food reformulation, etc) are

uncertain and have not been systematically reviewed.

Undertaking systematic evidence review and developing evidence-

informed recommendations will contribute to more consistent and

effective implementation of nutrition labelling policies as one of the

global commitments in addressing malnutrition in all its forms and

preventing diet-related NCDs.

Codex Guidelines on Nutrition Labelling

Provides guidance on the

procedures for implementing

nutrition labels, i.e.

➢ how to implement nutrient

declarations

➢ which nutrients are to be

declared

➢ what reference values are to be

used

➢ how to present nutrient contents

➢ how to present nutrition labels

(including criteria for legibility)

DO NOT provide any guidance nor

recommendations on nutrition

labelling policies

Thank you

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