Full slide pack from all speakers at the Food Foundation's tracking progress event on 10/02/16

1. UK Food Policy &
Nutrition: Tracking
Progress
Strengthening accountability systems for nutrition in the UK
Foodfoundation.org.uk

2. Today’s speakers
@Food_Foundation
Lawrence Haddad
Senior Research Fellow
IFPRI
@l_haddad
Inge Kauer
Executive Director
Access to Nutrition
@ingekauer
Boyd Swinburn - Keynote
Prof. of Population,
Nutrition and Global Health
University of Auckland
@BoydSwinburn
Fiona Watson
Consultant
The Food Foundation
@Food_Foundation

3. Today’s panellists
@Food_Foundation
Lord Chris
Haskins
Andrew Opie
Director of Food and Sustainability
British Retail Consortium
@the_brc
Jo Ralling
Campaign Director
Jamie Oliver Food Foundation
@FoodRev
Guy Poppy
Chief Scientific Advisor
Food Standards Agency
@GuyPoppy1
Corinna Hawkes - Chair
Prof. of Food Policy
City University London
@CorinnaHawkes

4. www.foodfoundation.org.uk

5. Tracking progress on food and
nutrition policies
Boyd Swinburn
Professor of Population Nutrition and Global Health
University of Auckland
Co-Director, Global Obesity Centre, Deakin University
The Food Foundation Symposium
London, February 2016

6. 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

7. Lim et al Lancet 2012

8. Food environments

9. What needs to be done?

10. 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
Very little in monitoring food environments and policies

11. • 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

12. World Cancer Research Fund

13. 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

14. • Need to shift from responsibility pledges to
accountability systems
– Multiple parties involved
– Agreed actions
– Power relationships (includes sanctions)
– Independent vs mutual accountability

15. Accountability Framework (Kraak V et al PHN, 2014)

16. 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)

17. 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)

18. Objectives
1. 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.

19. 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)
PROCESSESIMPACTSOUTCOMES
Food
composition
Food
labelling
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
ORGANISATIONSFOODENVIRONMENTSPOPULATIONS

20. 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

21. Top priorities (out of 34 actions)
1. Comprehensive
plan
2. 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

22. 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

23. 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

24. England’s National Child
Measurement Program

25. 0%
2%
4%
6%
8%
10%
12%
14%
Least
deprived
Most
deprived
Obesityprevalence
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
Obesityprevalence
Index of Multiple Deprivation (IMD 2010) decile
2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13
4-5 year olds
By year &
deprivation
decile
10-11 year olds
By year &
deprivation
decile

26. Future directions
Aims:
1. Monitoring progress for accountability
2. Underlying systems causes and solutions
www.lancetobesity.info

27. 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

29. Acknowledgements
• INFORMAS collaborators internationally and the
coordination team at University of Auckland
• www.informas.org
• Twitter: @_INFORMAS #INFORMAS
• Funders:

30. How does the UK compare with other high
income countries on key nutrition
indicators?
Lawrence Haddad
International Food Policy Research Institute
10 February 2016

31. Outline
 Nutrition Status
 Drivers
 Policy and Legislation
 Missing Data
 Conclusions

33. 10
8 8
7 7 7 7 7 6 6 6
6 5 5 5
5
Low Birth Weight (%)
Source: UNICEF 2015

34. 20
19 19 18 18 18 18 18 18 18 17 17 17
15 15
12
Anaemia in women of reproductive age (%)
Source: WHO 2015
Note: all data estimated for 2011
Off course On course

35. 67 64 64 64 63 61 61 61 60 59 59 57 56 56 55 55
Adult overweight and obesity (%)
BMI ≥ 25
Source: WHO 2015
Note: all data estimated for 2014
High and increasing Low and increasing

36. 34
29 29 28 28
26
24 24 23 23
21 21 20 20 20 19
Adult obesity (%)
BMI ≥ 30
Source: WHO 2015
Note: all data estimated for 2014.
Off course On course

37. 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 years
Boys = 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

38. 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

39. 66 65 63 63 62 62 62 62 61
56 56 55 54 53 52
48
Raised blood cholesterol (%)
Source: WHO 2014.
Note: all data estimated for 2008
Off course On course

40. 11
10 10 10
9 9
8 8 8
7 7 7 7 7
6
5
Raised blood glucose (%)
Source: WHO 2014.
Note: all data estimated for 2008
Off course On course

41. 478 515 521 557 566 576 578 586 588 602 605 621
666 673
782
967
Availability of fruit and vegetables
(grams per day)
Source: FAO 2014
Note: Data are for 2011.

42. Source: Euromonitor 2014, (US $ fixed exchange rates)
740 722 720
650
618
538 532 526 526 509 503 495
444 424 414
332
Consumer expenditure on fruits & vegetables
(US$/cap/year)

43. 391 381
334
318 306 296
275
254 247 242 236 226 218
200 196
181
Fresh food purchased (kg per Cap)
Source: Euromonitor 2014

44. 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

45. Not
available
Available, not
implemented
Available, partially
implemented
Available, fully
implemented
Source: WHO 2014
Availability and stage of implementation of
guidelines, protocols, and standards for the
management of diabetes

46. 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

47. 8572 8513
4155
1691 1667
1147 1072 1050 939 754 742 707 700 699 691 507
Total Emissions (CO2eq) from Agriculture/cap (kg)
Source: FAO 2011

48. 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

49. 14
19
25 25 26 26 26 27 27 30 30 30 33 34 34 36
% Missing Indicators in GNR Nutrition
Country Profiles

50. 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

51. Thank You

53. 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.

54. 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 &
recommend
8. Translate
results for
govt &
stake-
holders
Methods

55. Domains
POLICY
3. Promotion
2. Labelling 9. Governance
4. Prices
6. Retail
5. Provision
8. Leadership
INFRASTRUTURE
1. Composition
7. Trade &
Investment
12. Platforms
for Interaction
11. Funding &
Resources
10. Monitoring
& Intelligence
13. Health in All
Policies

56. 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

57. 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/

58. 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.

59. 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
Australia
Restaurant chains
required to display
calorie content of
food products on
their menu boards.

60. Katie in the UK
Crystal in Barbados
No sugar tax (yet)
Tax
Excise tax (10%) on sugary drinks
introduced in August 2015
Esztera in Hungary
Tax (varying rates) adopted in
2012 on ready-to-eat HFSS
foods

61. 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 Estonia
Restrictions on HFSS, sweet
treats and soft drinks in schools
since 2008.

62. 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
Treasury
HMRC
DEFRA
Local
Authorities
England

63. 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 &
recommend
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?

64. 2016 GLOBAL ACCESS TO NUTRITION
INDEX
FOOD FOUNDATION
LONDON, 10 FEBRUARY 2016
#ATNI2016@ATNIndex

65. 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
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
Tool for
accountability
What ATNF aims to achieve – our theory of change

66. The private sector can play a powerful role….
66
… and has a financial and social responsibility to act

67. 67
2016 Global Index methodology

68. 68
2016 Global Index methodology

69. 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.

70. 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. 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. 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

73. 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. 74
Discussion

75. • 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’).

76. www.foodfoundation.org.uk