Table 1.
Policy options and examples to reduce population-level sugar intake: the NOURISHING Framework
| Policy area | Potential policies and examples | |
|---|---|---|
| N | Nutrition label standards and regulations on the use of claims and implied claims on foods | Clearly visible ‘interpretative’ labels |
| • E.g. The UK’s voluntary ‘traffic light’ labelling for use on front of pre-packaged products. The label uses green, amber and red to identify whether products contain low, medium or high levels of energy, fat, saturated fat, salt and sugar | ||
| O | Offer healthy foods and set standards in public institutions and other specific settings | Mandatory standards for food available in schools, including restrictions on unhealthy foods |
| • E.g. US Healthy, Hunger-Free Kids Act of 2010 sets nutrition standards in the National School Lunch and School Breakfast Programs. Standards include limits on the amount of fat, saturated fat, salt and added sugars permitted in foods. Beverages are also restricted to water, low-fat or non-fat milk | ||
| U | Use economic tools to address food affordability and purchase incentives | Health-related food taxes |
| • E.g. Mexico has a sugary drinks tax: an excise duty of 1 peso ($US 0·80) per litre is applied to sugary drinks – about a 10 % price increase – at point of production (simplifies implementation) | ||
| R | Restrict food advertising and other forms of commercial promotion | Mandatory regulation of food advertising to children |
| • E.g. South Korea prohibits television advertising for specific categories of food that do not meet set nutritional standards (including maximum levels for energy, sugar, saturated fat, sodium and minimum levels of protein per serving) before, during and after programmes shown between 17.00 and 19.00 hours and during other children’s programmes | ||
| I | Improve the quality of the whole food supply | Voluntary reformulation of food products |
| • E.g. As part of the French National Programme for Nutrition and Health, the Ministry of Health has established a Charter of Engagement with the food industry (2007). One area of action is improvement of the nutritional composition of food products by reducing the amount of salt, free sugars total and saturated fats. To date, thirty-four companies have made commitments. The voluntary commitments are reviewed and validated by a committee to ensure they are ‘significant’ | ||
| S | Set incentives and rules to create a healthy retail environment | Initiatives to increase the availability of healthier foods |
| • E.g. New York City’s Shop Healthy NYC is an initiative in which the Department of Health works with communities to increase access to healthy foods. It targets both supply and demand by helping retailers stock and promote healthy foods, and by collaborating with distributors and suppliers to facilitate wholesale purchases. For example, Shop Healthy NYC works with shop owners to sell more low-fat milk, low-salt and no-sugar-added canned goods and to improve the quantity, quality and display of fresh foods | ||
| H | Harness the food supply chain and actions across sectors to ensure coherence with health | Healthier retail procurement |
| • E.g. As part of the Healthier Hawker Food Programme launched in Singapore in 2011, street food vendors are encouraged to use healthier ingredients such as oils with reduced fat content, fibre-enriched noodles, brown rice, low-fat milk, salt with reduced sodium content and drinks with lower sugar content. The government absorbs part of the cost associated with the use of healthier ingredients. Vendors providing healthier options can display certified labels such as ‘I will use LESS SUGAR/SYRUP if you ASK’ on their stalls | ||
| I | Inform people about food and nutrition through public awareness | Public awareness campaigns concerning specific unhealthy foods and drinks |
| • E.g. New York City’s Pouring on the Pounds, 2009 advertising campaign urges subway and bus riders: ‘Don’t drink yourself fat. Cut back on soda and other sugary beverages. Go with water, seltzer or low-fat milk instead’. In November 2013, a new obesity prevention campaign was launched in New York City with the tagline ‘Your kids could be drinking themselves sick’. The adverts encourage consumers to swap sugary drinks for water, fat-free milk and fresh fruit, and appear on television and on the subway | ||
| N | Nutrition advice and counselling in health care settings | Nutrition in primary care |
| • E.g. Brazil has a system of Family Health Support Nuclei. These are multi professional teams, including nutritionists, which support the Programa Saúde da Família (Family Health Program – one of the main means of delivering primary care in Brazil). | ||
| G | Give nutrition education and skills | Nutrition education in schools |
| • E.g. Slovenia’s national nutrition policy requires nutrition education to be included in school curricula. Nutrition education in primary schools is delivered mainly through science subjects, but also in home economics, and is designed to aid both knowledge and skills acquisition (e.g. understanding healthy eating guidelines, classifying foods according to nutritional content (including sugar), interpreting food labelling, understanding energy values of food and cooking skills) |
Source: Derived from information in the World Cancer Research Fund International NOURISHING framework( 15 ).