Andrene Chung | A roadblock to making healthy choices

The role of consumption of ultra-processed products (UPPs) and sugar-sweetened beverages (SSBs) in the development of non-communicable diseases (NCDs) is well documented. Health education campaigns by various entities, including the Heart Foundation of Jamaica (HFJ), and led by the Ministry of Health and Wellness, have increased awareness about the risks for developing NCDs and the role of unhealthy nutrition in this regard.

However, when it comes to packaged food and beverages, these efforts are stymied by the fact that it is not always clear to the consumers whether the products they are purchasing are healthy. In fact, sometimes, consumers think they are purchasing healthy products when that may not be the case. For the most part, consumers have no idea how much sugar, sodium, trans fat and/or saturated fat is in a product. As the HFJ conducts island wide health education programmes, we are regularly greeted with shock when we show the exact sugar content of a product; or highlight salt levels in commonly eaten foods; products that the consumers thought were healthy, based on the marketing of the products.

The marketing of some UPPs and SSBs belies the fact that the content of unhealthy nutrients is high. Jamaicans need the information and the tools with which to make healthy choices. They have a RIGHT to know, and that information needs to be clearly and simply communicated. And this is where the front-of-package warning labels (FOPWL) play a major role. Front-of-package labelling is not new. Several major countries within Latin America and the Caribbean region, such as Mexico, Chile, and more recently, Argentina, have successfully implemented effective FOPWL schemes.

TESTED LABELS

A local study done by PAHO/MOHW/UTECH in 2021 tested several different types of labels. The black octagonal warning label was overwhelmingly the most easily understood. The results of this study were published in the British Medical Journal in April 2023 and showed that octagonal warning labels (OWL) performed best at improving the ability of adult shoppers in Jamaica to understand the nutrition information and at encouraging them to purchase the least harmful option more often. Furthermore, the OWL also resulted in the highest odds for correctly identifying a product with excessive amounts of sugars, sodium, and/or saturated fats and for deciding to purchase the least harmful option or none of the options. Similar studies have been done internationally and have shown the same results. It would therefore seem to be a ‘no-brainer’ that this is the label that Jamaica should adopt. But that is not the case.

While there was initial agreement to use the black octagonal FOPWL via consensus at the Bureau of Standards National Mirror Committee Meeting (NMC), this decision was reversed in an irregular meeting at a later date in a process that was biased and lacked transparency.

The matter of the FOPWL was then referred to the Cabinet, which ultimately did not support the original vote at the Bureau of Standards NMC level, which was in support of the black octagonal warning label.

BLACK OCTAGON WARNING LABEL

It is interesting to note that the Octagonal Warning Label is the system included in the Caribbean Community Regional Organization for Standards and Quality (CROSQ) proposal to be adopted by CARICOM Member States. It has been developed to indicate when food and drink products are high in sodium/salt, sugar, fats, saturated fats, and trans fats.

Some elements of the food and beverage industry have rejected the label, which the public selected as the most easily understood. They contend that they have no objection to front-of-package labels but “just not that model”. They want multiple models. This, of course, would only serve to confuse the public further and would not achieve the objective of the FOPWL. An optimal FOPWL system should not require from the consumer an advanced knowledge of nutrition and high cognitive effort for interpretation. Besides, it should be easy to use it in real life, when consumers must choose from a wide variety of products in a short time.

It is important to note that not all products will have warning labels; only those that have levels above the recommended amount of the particular nutrients of concern.

If the intent of front-of-package labels (FOPL) is to provide the consumer with factual information that is quickly and easily understood and to empower them to make informed decisions about products they wish to purchase, then what is the point of Jamaica adopting a label which evidence shows will not have this effect? There is no benefit to the Jamaican public in having an FOPL model that will not work. There should be no compromise in instituting an effective warning label. If an ineffective label were instituted, then Jamaican consumers would be no better informed than they are now, and any chance of getting an effective label in the future would be delayed, likely for years, if ever.

NOT IN THE INTEREST

Those with vested interests would then say that there is already an FOPL in place, so there is no need to change – a most effective strategy on their part. That scenario is not in the interest of the Jamaican consumer. Jamaicans have a RIGHT to know.

It is not surprising that some of those with vested interest would oppose an effective FOPWL. The Government of Jamaica should put the health of the nation first by instituting a mandatory regulation framework to promote a simplified FOPWL model that is in keeping with the evidence. FOPWL may also encourage food manufacturers and processors to reformulate, which could help the industry move towards offering healthier products. However, product reformulation should be seen as an opportunity to improve the overall nutritional value of their products and not only the nutrients of concern.

The risk factors for NCDs have been shown to be increasing with successive national surveys. I shudder to think what the next survey will show. Overweight and obesity was 45.7 per cent in 2001, and in 2017 it had increased to 53.9 per cent. High blood pressure was 20.9 per cent in 2001 and was 31.5 per cent in 2017. Where will this end?

An effective FOPWL is one of the tools that can assist in halting and ultimately reversing this epidemic. The time to act is now.

Dr Andrene Chung is chair of The Heart Foundation of Jamaica and a consultant cardiologist. Send feedback to ghapjm@gmail.com.