A new framework for international healthy-diet policies.
Interview with World Cancer Research Fund International – Corinna Hawkes
In this interview we discuss international healthy food policy with Dr Corinna Hawkes of World Cancer Research Fund International and explore the global challenges of shifting to sustainable diets.
Dr Corinna Hawkes is Head of Policy and Public Affairs at World Cancer Research Fund International. Her work involves developing and influencing policies on the prevention of cancer and other non-communicable diseases worldwide. She is a specialist in food policy who has worked for the World Health Organisation, and is an Honorary Fellow at the Centre for Food Policy, City University, London.
World Cancer Research Fund International is an umbrella organisation which leads and unifies a network of international cancer prevention charities. The World Cancer Research Fund network champions the most authoritative scientific research from around the world on cancer prevention and survival through diet, weight and physical activity, to help people make informed choices to reduce their cancer risk. The organisation aims to influence policy at the highest level and is a trusted advisor in the cancer prevention arena.
World Cancer Research Fund International recently launched a new framework called NOURISHING, to assist policymakers, civil society organisations and researchers in implementing improved healthy-eating policies. Corinna discusses the purpose of the framework, the political and structural difficulties of implementing healthy food policies, examples of effective government action, consumer awareness, labelling schemes, as well as the potential links between healthy eating and environmental sustainability.
1. How does World Cancer Research Fund International engage with global food policy and healthy diets? What advice does the organisation offer on healthy eating?
Corinna: World Cancer Research Fund International has a set of Recommendations for what people should consume and the activity they should take to reduce their risk of cancer. They are also applicable to obesity and other non-communicable diseases. We want these recommendations to be implemented more widely – ie. across populations around the world - which is why we are working to influence policymakers internationally using our new framework, called NOURISHING.
2. What are the aims of your international food policy framework for healthy diets -NOURISHING?
Corinna: We developed the NOURISHING framework in order to help countries around the world meet the World Health Organization’s voluntary global target of reducing premature death from non-communicable diseases. There was much discussion about the actions that needed to be taken, but globally there was no real, formal and comprehensive resource which categorised the range of policies needed to improve the healthiness of food environments. Now that we have the NOURISHING framework, people can monitor and benchmark food environments. And these international benchmarks of best practice will be used to assess the progress of government policy actions.
The framework does not assume that there is one single policy action that "works." Instead, policy actions should be tailored to populations and contexts. We also designed it so that it is divided into three different areas - Food Environment, Food System, Behaviour Change Communication - to emphasise the importance of taking action in all three areas.
Two additional aims behind the development of NOURISHING were to establish a framework through which civil society organisations and researchers could report, categorise and monitor policy actions and hold governments to account; and second to ensure that there was a way of systematically categorising, updating, interpreting and communicating policy evidence.
3. Who are the intended users?
Corinna: Policy makers, researchers, civil society. We hope that these groups will be able to use the framework in the following ways:
- POLICYMAKERS can use the NOURISHING framework to identify where action is needed to promote healthy diets, select and tailor options suitable for their populations and assess if their approach is sufficiently comprehensive. Use our up-to-date policy resource to see what other countries are doing. In the future, they will also be able to use NOURISHING to access the latest updated evidence for policies in each area.
- CIVIL SOCIETY ORGANISATIONS can use NOURISHING to monitor what governments are doing around the world, benchmark progress, and hold them to account.
- RESEARCHERS can use NOURISHING to identify the evidence available for different policies, identify research gaps, and as a resource for policy monitoring and evaluation.
4. Is there an interest in developing healthy eating policies within government? What are the obstacles?
Corinna: The NOURISHING project has collated the actions governments are taking around the world to encourage healthy eating - and is continuously updated. But there are lots of barriers to progress. For example:
- Even though many Ministries of Health want to take policy action, government policy more broadly tends not to prioritise healthy eating policies. This is particularly the case in lower income countries where the overall burden of non-communicable diseases and obesity is still not sufficiently recognised.
- Even when governments are willing to take action, many of them don’t know what to do.
- And in cases where they do know what they can do, they think there is not enough evidence to act. This is one reason why we we’ve ensured that our NOURISHING framework also provides details of the research evidence underpinning each policy.
- Governments may believe the policy action is too intrusive (or that consumers may think it's too intrusive and then not vote for them). In some countries this perception of risk is exacerbated and perpetuated by the media.
- Critically, in many places, the private sector lobbies government very heavily against taking action, claiming it is unfair on consumers, restricts choice, and doesn’t work.
- There may also be genuine ‘push back’ from consumers. This is not helped by the fact that there is often an inadequate social movement in support of policy action.
- Governments may also worry about the cost of implementing policy actions.
- Implementing these policies requires quite complex governance because actions are often needed in other government departments and/or in other sectors outside of health.
5. What policy actions have been taken on nutrition labelling and nutrition and health claims? How are different countries approaching this issue?
Corinna: Countries are taking different types of actions, which mainly fall into one of the following:
a) Mandatory nutrient lists on packaged foods; b) Clearly visible "interpretative" labels; c) On-shelf labelling; d) Calorie labelling on menus and displays in out-of-home venues; e) Warning labels; f) Rules on nutrient claims (i.e. nutrient content and nutrient comparative claims); g) Rules on health claims.
Nutrient labelling has historically been an action countries have taken to prevent false claims –to prevent deception. This remains the dominant approach in most countries around the world; most rules on nutrition labelling are about preventing misleading information rather than promoting healthy diets. But nutrition labelling policy now forms a central pillar of healthy eating policy in some countries where they ensure that products have clearly visible labels, interpretative labels, calorie labels and warning labels. But there is a big debate, especially with industry, about which approach is most effective.
6. How would you summarize the major difficulties to formulate and implement healthy food policies, based on the experiences of the countries you have analysed?
Corinna: There is a lot of evidence out there which provides insights into how policy actions might work. It indicates that policies need to be carefully tailored to specific population groups if they are going to work. For some population groups, for example, nutrition labelling simply won’t work. For others, it could be effective. For those who it could be effective for, it needs to be tailored to have that effect. There are a lot of smart people in government, but they may not have the technical expertise needed to understand all of this, even if they are politically savvy. In the research community, academics get very wedded to what their own research shows, which may indicate that one approach is more effective than another, but which may not apply for the population that needs to change. And civil society can get very focused on calling for very top line policies rather the detail and accepting that certain actions may not work for everyone. So all in all, what is needed to get the design of policies right is more capacity, more subtlety, more nuancing, more care and more investment.
7. How do you feel all this fits in with environmental sustainability?
Corinna: Healthy eating is often good for the environment too, but it is quite a complex picture and there’s a lot of debate out there. Basically, it needs to be made more concrete for policymakers to understand how healthy eating and sustainability fit together. What I would like to see is more focus on exactly how the policy options merge. There are three main ways to do this looked at through the lens of NOURISHING:
- What implications are there for sustainability of each policy area in NOURISHING? Are there any environmental benefits to food taxes, for example? If so, what are they?
- How could the policy actions in NOURISHING be used to meet sustainability goals? For example, what actions could be taken in each area to reduce the consumption of red and processed meat?
I think these kinds of exercises can make much more concrete how these two agendas fit together in policy terms.
8. Finally, what sort of collaboration with other organisations might you welcome?
Corinna: We want to work with organisations who want to benchmark what their own government is doing compared with what governments are doing elsewhere. This kind of exercise could create a sense of global community among organisations working in these areas. This is one reason why we are interested in engaging with initiatives like www.informas.org
More broadly, we are focused on building more of a global voice for nutrition, obesity, cancer and non-communicable diseases, and working with other civil society organisations focused on these issues. This also involves making sure we are present in the post-2015 development agenda, which is where we need to be more aware of the messages of colleagues working on sustainability. For our work on physical activity, we would like to be more supportive of others working in this area, so that we can create alliances there too.
If you would like to get in touch with Corinna, see her FCRN member profile page here.
You can also e-mail her here and connect with her and WCRF on Twitter @corinnahawkes and @wcrfint.Third, it would be good to see how policy options being recommended for a more sustainable food system fit into NOURISHING framework itself. Are there labelling interventions for example (e.g. for carbon)? Are there fiscal interventions (eg. carbon taxes)?