PHE’s replacement must take “bold and robust” action on nutrition, urge experts

07 Jan 2021 --- Experts are calling for the replacement of soon-to-be scrapped Public Health England (PHE) to take bolder and robust action on improving the nutritional content of foods. One proposal detailed in an editorial published in the British Medical Journal is establishing a robust independent regulatory system. There are also renewed calls for mandatory legislation within the nutrition space to move away from “failed self-regulation.”

“It’s hard to say what is going to happen with the successor to PHE,” Dr. Anthony Laverty, editorial co-author and lecturer in public health at Imperial College London, tells NutritionInsight.

“At the minute, there is no clear idea as to what is going to happen to its health improvement functions, which include these issues around food targets and reformulation. PHE’s scrapping adds to the uncertainty about what the future is going to look like, which is bad news for both consumers and industry.”

Laverty continues that this is the time to think seriously about having a robust independent regime and a focus within food on preventing disease. “This would be to the benefit of us all.” 

The editorial argues that PHE’s successor must have the freedom to take a more robust approach with the food industry and makes pointed remarks about the current voluntary-led initiatives within the nutrition space.

“It must abandon the failed experiment of self-regulation. Without mandatory measures, the food industry will continue to prioritize profit over health and drive unsustainable increases in diet-related diseases.”

“It’s imperative that whoever is responsible for tackling the biggest cause of premature death and disability in the UK when PHE is dissolved, prevents disease and not just treats it,” adds Katharine Jenner, campaign director of Action on Sugar and Action on Salt, which are not affiliated with the editorial. The UK’s mandatory soft drink industry levy has seen sugar levels drop by nearly a third.

Building on sugar tax’s success
Laverty emphasizes that the details of the organization will be important. This includes how independent it is, how much funding and stability it will have, and how receptive ministers will be to findings and recommendations. 

Some inspiration can be taken from prior examples, such as the mandatory soft drink industry levy (SDIL), which saw sugar levels drop by nearly a third after coming into force in April 2018.

“The soft drink industry levy showed that it can be done, and with careful thought, it can be made to work well,” says Laverty.

He continues that there are lots of reasons why a sturdy and independent regime is currently not in place.

“The UK used to have a world-leading regime, for example, to reduce the amount of salt in food, with food manufacturers working to reduce this and associated harm. There is some political and other resistance to these ideas, but the SDIL shows that such systems can be good for consumers, good for the economy and good for business.”

He proposes that SDIL could be extended to more foods. Alternatively, other fiscal incentives could be used to drive people away from unhealthy food and toward healthier alternatives. 

Multi-pronged approach
Another facet that PHE’s replacement could address is food labeling. Laverty notes that some of the types of front-of-pack labeling (FoPL) used in Chile and Peru have been successful. These involve a warning label on foods high in energy, sugar, salt and saturated fats. 

The Latin American approach has been especially effective when it is combined with policies to restrict marketing. 

“Proposals to ban all online adverts for unhealthy food are ambitious and welcome, although evidence from bans on television advertising indicates the effects will depend on how both advertising and food industries respond,” details the editorial. 

It notes that while the UK’s prime minister renewed a government commitment to reduce obesity after contracting COVID-19, policy is still framed in the language of individual choice. This means it is based on an underlying assumption that with more information, consumers will make healthier dietary decisions.

PHE’s replacement has been urged to address front-of-pack nutrition labeling.

Complexities around ultra-processed foods
The editorial also states that the steady accumulation of evidence on the human and environmental harms of ultra-processed foods suggests that these should be a target for further action.

However, this is a complicated issue as ultra-processed reformulated foods are often promoted as healthier options. According to Laverty, this is especially risky in low- and middle-income countries, where consumption of ultra-processed foods is growing rapidly and reformulation can legitimize their introduction into local markets.

In September, the UK government urged industry to reduce excessive calories in everyday foods by up to 20 percent by 2024 to help tackle obesity.

Meanwhile, European regulators are gearing up to make FoPL mandatory by the end of 2022. In response to this, Bunge Loders Croklaan is ramping up its reformulation solutions to give food manufacturers a “competitive edge.”

By Katherine Durrell