INITIATIVES ARE NOT ENOUGH)
Voluntary agreements with the food industry may lose effectiveness over time (MacGregor et al., 2015). Some countries, such as Argentina, are moving from voluntary to mandatory sodium-reduction targets, while others, such as South Africa, are regulating nutritional content from the outset (Peters et al., 2017; Charlton et al., 2014).
WHO’s REPLACE action package has also acknowledged the need for legislation to move forward on the elimination of industrially produced trans fats (WHO, 2018). Food marketing evidence has shown that self-regulation is not effective (Kunkel et al., 2015).
Despite the positive results of voluntary sodium-reduction targets in Brazil, the companies that have signed up to the national agreements only account for around 80 percent of the country’s food market, so the whole market has not been reached. Regulations establishing mandatory reductions are gaining support from consumer protection groups and academia. Mandatory targets for all foods that take part in the national agreements could avert or postpone up to 3 900 deaths annually, potentially saving a total of USD 2.5 million dollars a year to the Brazilian health system.
CONCLUSION
Nutrition is currently at the forefront of the international agenda and this is a crucial window of opportunity to strengthen multi-sector and multi-stakeholder commitments to support and expand nutrition-sensitive food value chains.
Food reformulation can be approached through voluntary and/or regulatory initiatives. Brazil’s experience highlights the potential of voluntary sodium targets to reduce the consumption of excessive salt. Evidence gathered as the voluntary process evolves will determine the next steps in terms of the country’s sodium-reduction policy.
It is important to stress that reducing the intake of ingredients such as sodium, fats and sugars requires multiple strategies, so dietary counselling, health-education campaigns, school interventions and regulatory policies – such as the mandatory labelling of sodium, sugars, total, saturated and trans fats, front-of-pack labels (Vyth et al., 2010) and the taxation of unhealthy foods and beverages (Zhong et al., 2018) (Grogger, 2017; Berardi et al., 2016; Kanter et al., 2017) – play important roles (Hyseni et al., 2017).
Public policies must be strengthened and national government must assume a leadership role in pinpointing potential partners and carefully managing possible conflicts of interest, shaping the food environment in order to facilitate healthy dietary choices, strengthening evidence-based policies in all fields and engaging with partners in academia, civil society and the private sector. Lastly, the participation of private sector, especially the food industry, can be helpful, but must be accompanied by clear commitments to health transparency and management of conflicts of interest so as to avoid unintended consequences and to prioritize the interests of public health (Burlandy et al., 2016).
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The 2019 edition of UNSCN Nutrition focuses on “food environments to enable healthy and nutritious diets”.
The food environment has been broadly defined as “the physical, economic, political and socio-cultural context in which consumers engage with the food system to make their decisions about acquiring, preparing and consuming food” (High Level Panel of Experts, 2017: 28). Following on from my comments in Speakers’ Corner in UNSCN News 43 in 2018 (Kent, 2018a), I wish to highlight the importance of human relations in determining who will have nutritious and healthy diets. The quality of the community affects the quality of the diet.
When dealing with health issues, the unit of analysis usually is individuals. However, we can also speak about the health of communities. The community can be viewed as a whole, as if it were a living thing, in line with those who view the Earth from a Gaia perspective, that “humanity constitutes a living system within the larger system of our Earth” (Sahtouris, 1998; Lovelock, 1995).
From a Gaia perspective, “understanding that the health of soil, water, and ecosystems is inseparable from our own health, reason no longer urges their pillage” (Eisenstein, 2018).