Access to Nutrition Index: Progress and Plans Fall 2016

1. 1
CORE GROUP
GLOBAL HEALTH PRACTITIONER
CONFERENCE
ACCESS TO NUTRITION INDEX:
PROGRESS AND PLANS
FALL 2016

2. Agenda
2
1. Introductions
2. The Access to Nutrition Foundation: positioning and goals
3. The importance of improving nutrition globally
4. The Access to Nutrition Index methodology
5. The Access to Nutrition Index 2016: Findings and Recommendations
6. Focus on marketing of breastmilk substitutes – key findings
7. The Access to Nutrition Index 2016 impact
8. Future plans
9. Q&A

3. 1. Access to Nutrition Foundation
3
• Key product: Global Nutrition Index of F&B
companies, published every two years (first Index
2013, second Index 2016, third Index planned 2018).
• In addition: country Spotlight Indexes. Pilots have
been done in South Africa, Mexico and India. India
Spotlight Index to be published in 2016.
• Covers both forms of malnutrition: over- and
under-nutrition.
• Not-for-profit established in The Netherlands in 2013
• Independent of industry - funded by Bill & Melinda
Gates Foundation, Wellcome Trust and Children’s
Investment Fund Foundation.
• Multi-stakeholder approach.
• Rigorous and objective: Independent Advisory Panel
and Expert Group.
Mission: Improving nutrition for all
For more information see: www.accesstonutrition.org

4. 4
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
Investors
Provide context for company engagement
Media
Raise profile of industry role in malnutrition
Civil society
Facilitate effective advocacy
Policymakers
Inform regulatory and policy agenda
Academics
Stimulate 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
Accountability
tool
2. What ATNF aims to achieve – our theory of change

5. 3. We are suffering a global nutrition crisis
5 Source: 2016 Global Nutrition Report

6. 6
No Causes of deaths, 2012 Deaths
(million)
% of
deaths
Since
2000
1 Ischaemic heart disease 7.4 13.2 Up
2 Stroke 6.7 11.9 Up
3 COPD 3.1 5.6
4 Lower respiratory infections 3.1 5.5
5 Trachea, bronchus, lung cancers 1.6 2.9
6 HIV/AIDS 1.5 2.8
7 Diarrhoeal diseases 1.5 2.7
8 Diabetes mellitus 1.5 2.7 Up
9 Road injury 1.3 2.3
10 Hypertensive heart disease 1.1 2.0 Up
25.8 29.8%Diet & lifestyle related = bold
Poor nutrition kills millions annually, makes millions ill
WHO statistics
• Overweight and obesity are linked to more
deaths worldwide than underweight.
• 65% of the world's population live in a country
where overweight and obesity kills more
people than underweight. This includes all
high-income and middle-income countries.
• Globally, 44% of diabetes, 23% of ischaemic
heart disease and 7–41% of certain cancers
are attributable to overweight and obesity.
• Over 800 million people in the world still go
hungry.
• In 2014, 159 million children were affected by
stunting (low height-for-age) while 50 million
children were affected by wasting (low weight-
for-height).
• Poor nutrition continues to cause nearly half of
deaths in children under five.
• Over 2 billion people are affected by
micronutrient deficiencies, or "hidden hunger",
due to inadequate vitamins or minerals.

7. F&B industry has an important role to play …
7
Although the industry is still growing
globally, it is increasingly clear that
consumers want healthier products,
more information and more
responsible marketing from F&B
manufacturers.
Companies must be part of the
solution.
ATNI provides an ‘accountability
tool’ to investors and other
stakeholders to understand what
companies are doing and how they
are improving over time.

8. 8
• 22 of the largest global food and beverage companies were assessed and
ranked for the 2015 Global Index. 19 of the 25 companies assessed on the 2013
Global Index.
• ATNI Methodology assessed companies against international guidelines, norms
and accepted good practices.
• Companies’ commitments/ performance/ disclosure assessed, weighted. Categories
(see next slide) also weighted. Important to note the Index assesses companies’
actual performance, not just disclosure /reporting, as many other Indexes only do.
• Assessment was based on guidance from a panel of nutrition experts.
Suggestions from extensive stakeholder consultations held during 2014
substantially strengthened the methodology.
• Company assessments were conducted by the research firm Sustainalytics, and
used publicly available documents, supplemented by additional information provided
by each company via an online data platform.
• Each company is rated on a scale of 0 to 10 based on their nutrition-related
commitments, practices and disclosure across seven different Categories.
• The companies that sell baby food and where sales of baby food make up 5% of
their total retail revenues were also assessed on their marketing of breast-
milk substitutes: Danone, Heinz, FrieslandCampina and Nestlé plus two
pharmaceutical companies that are among the largest breast-milk substitute
producers globally: Mead Johnson and Abbott.
4. 2016 Global Index methodology and research
8

9. 9
Global Index methodology

10. 10
5. Overall 2016 ATNI 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.

11. Overall findings Global Index 2016
11
The world’s largest food companies must step up efforts to
address the global nutrition crisis
• 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 nutrient profiling 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; some US companies particularly must not just
focus on their home markets.
• The marketing practices of all six of the baby food manufacturers evaluated fall short of
international standards, undermining breastfeeding - the optimal form of nutrition for
infants.

12. Companies need to do much more on undernutrition
12
Undernutrition remains largely neglected by companies | Few
have made specific commitments | Little translation into action
• The top three companies on the Index also top the undernutrition sub-ranking.
• Mars and Ajinomoto show leading practice in some areas.
• Although many companies plan to expand into emerging economies, none have
integrated a commitment to undernutrition at a strategic level; they need to do much more
strategy and market research.
• Only four companies provided evidence of initiatives to formulate products specifically for
the undernourished – through targeted micronutrient fortification – in high-priority
countries.
• Experts urge a focus on particularly high-priority countries –few companies seem to be
aware of which they are - and on two key population groups: women of childbearing age
and children under two, which few companies also state a focus on.

13. 6. Infant food and formula (BMS) marketing is a
critical nutrition issue
13
• Substantial tension between companies’ commercial
interests and infants’ health ….
• Absolutely no question that breastfeeding gives
babies the best start in life, and protects health over
their lifetime – Lancet Breastfeeding Series, January
2016.
Company FY2014
global
market
share
FY2014
baby food
revenues
($m)
Share of
company’s
FY2014
revenue
1 Nestlé SA 23.7% 13,370.6 14%
2 Group Danone 12.3% 6,913.1 26%
3 Mead Johnson Nutrition Co 10.6% 5,953.3 100%
4 Abbott Laboratories Inc 7.1% 4,012.0 18%
5 Royal FrieslandCampina 3.0% 1,686.3 10%
Source: Euromonitor
56% 31,935
Total global baby food sales in 2014: US$50 billion

14. Detailed new analysis of BMS marketing
14
Are world’s six largest baby food companies
marketing breast-milk substitutes (BMS) in
line with the 1981 WHO Code?
BMS 1: Corporate Profile
• Is the company’s BMS marketing policy aligned with The
International Code?
• Does the company have good procedures, training programs,
incentives, auditing systems etc?
• Does the company publish its policies, procedures, results of
audits etc?
BMS 2: In-country assessment (Vietnam and Indonesia) of
companies’ marketing practices using IGBM Protocol
• IGBM protocol originally developed in late 90s/early 2000s by
stakeholder group including many UK church investors.
• Seen as only credible methodology to use for such studies by
key nutrition/BMS stakeholders (UNICEF, STC, others).
• Conducted by independent global health research company,
Westat.
• Includes
• Interviews with healthcare workers and > 800 bmothers
• Evaluation of Informational posters and flyers
• Media monitoring (TV, print and online adverts)
• Analysis of in-store promotions
• Analysis of labels
• Detailed reports for each country.
Detailed separate BMS Scorecards

15. No company markets BMS in line with The International Code;
all need to make substantial improvements
15
Companies’ BMS scores incorporated into Index
score

16. 16 19-10-2016
“We are extremely pleased to receive this independent
recognition of our efforts to improve nutrition,” says Unilever
spokesperson. “We recognize more hard work is needed to
embed nutrition in our global ambition ‘to make sustainable
living commonplace.’’
Unilever, Jan 2016
“Health and nutrition are core to the evaluation of the food
industry from both a financial and non-financial
perspective. The Access to Nutrition Index provides us with an
invaluable tool with which to assess corporate strategy on
nutrition, as well as helping us to deepen our dialogue with the
companies in this critical area."
BNP Paribas, Jan 2016
“We are looking very much forward to working with the report
and the recommendations for improvements.”
Arla, Jan 2016
“You have done an amazing job at spelling out all the issues
and complexities so clearly and thoroughly. I am deeply
impressed by how you have managed this whole process and
I know we will be citing the report frequently”. (BMS)
UNICEF, Jan 2016
7. Initial response to 2016 Global Index

17. 8. Future plans
17
• First India Index: Late 2016
• First India Index due to be published towards the end of this year.
• Will include Corporate Profile (analysis of commitments, performance and disclosure, Product Profile
(analysis of the nutritional quality of products) and BMS assessment (analysis of compliance of marketing
with Indian regulations and the WHO Code).
• This can be a useful test of whether multinational companies truly apply their ‘global’ policies in an
individual country. Also enables comparison of local and multinational companies’ on nutrition, and provides
further evidence on BMS marketing compliance.
• Feasibility study: 2017
• Project to look at whether and how ATNF might develop new Indexes within the F&B sector to encompass
retailers, food service companies, fast food companies, develop further Spotlight (individual country)
Indexes, and opportunities to innovate research methods.
• NGOs will be consulted.
• Action research program initiating in 2017
• ATNF to begin collaborative research to develop guidance on how companies can improve their
performance in key areas where it is currently weak (e.g. Affordability and Accessibility of healthy products,
Undernutrition) or where progress has stalled (e.g. Marketing to Children). NGOs will be involved in
roundtables and research.
• Global Index: March 2018
• Consultations on revising the methodology will start in early 2017 – aiming to keep methodology mostly the
same, to enable easier comparison with 2016 results.
• Research will start early 2018.

18. 18
9. Discussion