European Network on reducing marketing pressure on children

Transcription

1 European Network on reducing marketing pressure on children Report from the 7th meeting, Copenhagen, Denmark, March 2012 Norwegian Directorate of Health

2 Contents Executive summary Introduction... 4 Background... 4 The seventh network meeting Introductory session... 5 Opening and welcome... 5 Goals and objectives of the meeting Updates from Observers... 6 WHO Headquarters (WHO HQ)... 6 WHO Regional Office for Europe (WHO EURO)... 7 International Association for the Study of Obesity (IASO) International Obesity Task Force (IOTF) 8 Consumers International (CI) Update on research on food marketing National activities related to food marketing to children, including the implementation of the WHO set of recommendations Nutrient profiling Global coordination of Nutrient Profile Modeling Work on nutrient profiling in Norway Plans on nutrient profiling in Slovenia Different types of regulations Regulatory and voluntary landscape concerning food marketing in UK Self-regulation Monitoring food marketing to children Experiences with and advices on how to monitor food marketing to children, and comments on the new draft sweep protocol from the Network Status on the draft sweep protocol from the Network Food marketing restrictions in the context of preventing NCDs WHO Global Status Report on Noncommunicable Diseases The WHO European Action Plan on Noncommunicable Diseases Food marketing restrictions in the context of preventing NCDs Further plans and next steps Annex 1 - List of participants Annex 2 Programme... 26

3 Executive summary Several calls for action to reduce the marketing pressure on children of food and non-alcoholic beverages have been made over the past years, i.e. in World Health Assembly resolutions, at WHO European regional level and at national level in several countries. In 2008, the WHO Regional Office for Europe facilitated the setting up of region-wide action networks to ensure the follow-up of actions outlined in the Second WHO European Action Plan for Food and Nutrition Policy ( ). Several countries were interested in a network on marketing to children, and Norway took on the responsibility to lead and facilitate the network. The European Network on reducing marketing pressure on children consists of countries in the WHO European Region who want to work together to find ways to reduce the marketing pressure on children of high salt, energy-dense, micronutrient-poor foods and beverages. Since the network was established in 2008, six network meetings have been held; in Norway, Serbia, Slovenia, the United Kingdom, Portugal and Belgium. The 7 th network meeting was held in Copenhagen, Denmark, March In total, 29 meeting participants attended the 7 th network meeting. These included representatives from 8 network countries (Belgium, Denmark, Estonia, Israel, Norway, Portugal, Slovenia, the United Kingdom); observers from World Health Organization (WHO), Consumers International (CI), International Association for the Study of Obesity, International Obesity TaskForce (IASO IOTF); and invited speakers. The objectives for the network meeting were to discuss national follow-up and implementation of the WHO set of recommendations on the marketing of foods and non-alcoholic beverages to children, nutrient profiling, different types of regulations, food marketing restrictions in the context of preventing non-communicable diseases (NCDs), follow-up and further plans for monitoring and to discuss future plans of the network. The invited speakers covered issues like updates on research on food marketing; regulatory and voluntary landscape concerning food marketing in UK and elsewhere; self regulation in Denmark; experiences with and advices on how to monitor food marketing to children; and presentation on marketing restrictions in the context of preventing NCDs. WHO presented a framework for implementing the set of recommendations on the marketing of foods and non-alcoholic beverages to children, the global coordination of nutrient profile modeling, WHO Global Status Report on NCDs, current activities and plans related to implementation of the WHO set of recommendations in the European Region, and the WHO European Action Plan on NCDs; CI updated the network on implementation of the CI monitoring manual; and IASO-IOTF gave an update on work on food marketing in IASO-IOTF. The network member countries gave updates on national activities related to food marketing to children, including implementation of the WHO set of recommendations. Norway presented ongoing work on implementation of the WHO set of recommendations and work on nutrient profiling, and Slovenia presented plans on nutrient profiling. 3

4 1 Introduction Background The European Network on reducing marketing pressure on children was established in Oslo, Norway in January 2008 when the first meeting in the network was organised. The network was established as a response to several calls for action to reduce the marketing pressure on children of foods and non-alcoholic beverages, especially the Second WHO European Action Plan for Food and Nutrition Policy ( ) and the European Charter on Counteracting Obesity. The initiate was based on an interest in many countries in the WHO European Region to work together to respond to these calls and the WHO Regional Office for Europe facilitated the setting up of the network. The work is also responding to calls for action in the WHO Global Strategy on Diet, Physical Activity and Health and the 2007 World Health Assembly resolution on the Prevention and Control of Non-communicable Diseases: Implementation of the Global Strategy (WHA 60.23). The latter called on the Director-General of WHO to develop a set of recommendations on marketing of foods and non-alcoholic beverages to children. At the Sixty-third World Health Assembly in May 2010, the WHO Member States endorsed a set of recommendations on the marketing of foods and non-alcoholic beverages to children (resolution WHA63.14). The recommendations were developed in response to a request made by Member States in May 2007 (resolution WHA60.23) 1. The importance of action on marketing of food to children was reinforced in the Action Plan for the implementation of the European Strategy for the Prevention and Control of Noncommunicable Diseases and the declaration of the UN High-level Meeting on the NCDs in New York in September The long term goal of the network is: To protect children s health through sharing experiences and best practices in order to identify and implement specific actions which will substantially reduce the extent and impact of all marketing to children of high salt, energy-dense, micronutrient-poor foods and beverages. As of July 2012, the network consists of the following 20 countries in the WHO European Region: Belgium, Bulgaria, Cyprus, Denmark, Estonia, Finland, France, Greece, Latvia, Israel, Ireland, Montenegro, the Netherlands, Norway, Poland, Portugal, Serbia, Slovenia, Sweden and the United Kingdom. Representatives from WHO, the EC, the United Nations Standing Committee on Nutrition (SCN), the Food and Agriculture Organization of the United Nations (FAO), IASO IOTF and CI participate as observers in the network. Taking part in the network does not imply any particular policy preference with regards to regulatory approach. The network meetings have been held two times a year in the first network period from and once a year in the second network period: 2008: Oslo, Norway on January and Belgrade, Serbia on September 2009: Ljubljana, Slovenia on 9-10 February and London, the United Kingdom on 8-9 June 1 4

5 2010: Lisbon, Portugal on 8-9 March : Brussels, Belgium on 7-8 March 2011 More information about the background of the network and the reports from earlier network meetings can be found at: The seventh network meeting The 7 th network meeting was held at the WHO Regional Office for Europe on 21 and 22 March The WHO Regional Office for Europe and the Danish Veterinary and Food Administration hosted the meeting. Eight network countries (Belgium, Denmark, Estonia, Israel, Norway, Portugal, Slovenia and the United Kingdom) were able to attend the meeting. In addition to representatives from network countries, meeting participants included representatives of network observers and invited speakers; in total 29 participants 2. The report has been prepared by the network secretariat in Norway 3 and mainly follows the same structure as the meeting program 4. The majority of the summaries are based on abstracts provided by the speakers. The views expressed in this report are not necessarily the official view of the countries and observers/organizations represented, but could be the view of the professionals present. 2 Introductory session Opening and welcome The Director of the Danish Veterinary and Food Administration Esben Egede Rasmussen was thankful for the opportunity to open the meeting in The European network on reducing marketing pressure on children. He underlined that as habits from childhood very often lead to lasting habits in adulthood, the central issue is not whether we should act in relation to marketing to children, but rather how we act most effectively. Esben Egede Rasmussen applauded the WHO network as an important forum for sharing experiences and best practices in order to identify national or common actions which have the potential to reduce both the extent and impact of marketing to children of unhealthy foods. In light of the multinational character of TV and Internet marketing it was stressed, that it is essential to ensure cooperation and policy coordination over borders. This is an area where this WHO-network in particular has and will continue to have a valuable role to play. In regard to the Danish situation it was underlined that the position of the Danish government is that even though self-regulation has not yet resulted in a complete absence of marketing towards children in Denmark, it has shown some measurable results. 2 A list of participants can be found in Annex 1. 3 The report was compiled by Christina Hildonen and Britt Lande at the network secretariat, the Norwegian Directorate of Health. 4 The full programme can be found in Annex 2. 5

6 For the present, the Danish authorities will therefore continue to follow the development of marketing of unhealthy foods to children in Denmark, before any thoughts on further action, such as legislative initiatives, might be considered. Gauden Galea, Divisional Director, WHO Regional Office for Europe welcomed the participants and underlined that reduction of marketing of foods high in fat, sugar or salt to children is necessary to alleviate NCD. He presented trends in NCD mortality and data showing high prevalence of overweight and obesity among 6-9 year old children in 12 European countries. He pointed to the global policy framework for work on the prevention and control of NCD, as well as to documents and policy framework in the WHO European region giving mandate for action in this area. The Action Plan for the implementation of the European Strategy for the Prevention and Control of Noncommunicable Diseases and the political declaration of the High-level Meeting of the General Assembly on the prevention and Control of NCDs in New York in September 2011 was emphasized. The network on reducing marketing pressure on children is one of 6 action network established to facilitate implementation of the WHO European Action Plan for Food and Nutrition Policy The WHO set of recommendations on the marketing of food and non-alcoholic beverages to children, endorsed at WHA, May 2010, is important to guide efforts in designing new and/or strengthening existing policies on food marketing communications to children in order to reduce the impact of marketing. Goals and objectives of the meeting Knut-Inge Klepp, chair of the Network/ Director General of Division Public Health of the Norwegian Directorate of Health, gave a brief update on the current status of the network, and presented the goals and objectives of the network meeting, which were to discuss national follow-up and implementation of the WHO set of recommendations on the marketing of foods and non-alcoholic beverages to children, to discuss nutrient profiling, different types of regulations, food marketing restrictions in the context of preventing NCDs, follow-up and further plans for monitoring and to discuss future plans of the network, including: continued network activities, network secretariat, collaborations and the mandate for the network. 3 Updates from Observers WHO Headquarters (WHO HQ) A Framework for Implementing the WHO set of recommendations on marketing of food and nonalcoholic beverages to children By Godfrey Xuereb, WHO HQ presented by Caroline Bollars, WHO Regional Office for Europe The marketing of foods and non-alcoholic beverages to children has been around since time immemorial and cognizant of its effect on the dietary habits of children the Sixty-third World Health Assembly adopted a set of recommendations on marketing of foods and non-alcoholic beverages to children (WHA63.14). 6

7 In the resolution Member States were urged to take necessary measures to implement the recommendations and to identify the most suitable policy approach given national circumstances and develop new and/or strengthen existing policies that aim to reduce the impact on children of marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt. They were also urged to take active steps to establish intergovernmental collaboration in order to reduce the impact of cross-border marketing and to cooperate with civil society and with public and private stakeholders in implementing the set of recommendations in order to reduce the impact of that marketing, while ensuring avoidance of potential conflicts of interest. In order to assist Member States in implementing the recommendations the WHO secretariat was requested to provide the necessary technical assistance and to strengthen regional networks, while also cooperating with civil society and with public and private stakeholders in implementing the recommendations. To fulfill its mandate the WHO secretariat has worked with Durham Law School and the International Association for the Study of Obesity to develop a Framework for the implementation of the recommendations. This framework is aimed at policy-makers wanting to apply the recommendations in their individual territories and has four distinct sections dealing with: 1. What is marketing? 2. Policy development 3. Policy implementation 4. Monitoring, evaluation and research These sections can be followed consecutively as a process, or used individually to support specific areas of policy development or implementation. In the section What is marketing the framework defines marketing and how marketing works, highlighting the issues of exposure and power as the main components of the marketing message. It also discusses who is involved in marketing and the linkage between food producers and the marketing communication. In the section on policy development the framework defines four steps which need to be taken during the development process and identifies the questions to be asked and the actions to be taken such as which children need protection?, what are the communication channels and marketing techniques used?, what are the settings where children gather? and what foods should be included or excluded?. The section on policy implementation defines the roles of the different stakeholders and discusses the areas of effective enforcement and international cooperation. Finally the last section defines what needs to be monitored, evaluated and researched and gives examples of indicators that can be used for effective monitoring. WHO Regional Office for Europe (WHO EURO) Presentation by Joao Breda, WHO Regional Office for Europe The presentation started with on overview of the prevalence situation with regards to overweight and obesity among adults in the WHO European Region. Compared with the data available at the Istanbul Conference in November 2006, new data was identified for 36 countries as of 2007 and beyond. Only 16 countries, however, have measured body weight and height to estimate the prevalence among adult women and even less, 11 countries collected measured data to estimate the 7

8 prevalence among adult men. These figures show that overweight affects between one quarter to 7 out of ten individuals depending on the country and obesity affects 5 to 30% of adults in the countries of the WHO European Region. The highest overweight for men was found in Malta and in the UK the highest prevalence for women. With regards to prevalence data among school children (6-9 years), the WHO Regional Office for Europe has established a European Childhood Obesity Surveillance System (COSI) in fifteen countries in the WHO European Region. The system aims to routinely measure trends in overweight and obesity in primary school children (6-9 years), in order to understand the progress of the epidemic in this population group and to allow for comparisons between countries within the European Region. Following the situation analysis, an overview was provided of recent WHO Policy framework related to nutrition. With the endorsement of the Moscow Declaration by the World Health Assembly, the launch of the Global Status Report on NCDs in Moscow, the NCD Action Plan endorsed at the European Regional Committee, and the political declaration of the UN High-Level Meeting in the prevention and control of non-communicable diseases in September 2011, the stage is set for strong implementation. With regards to implementation, WHO Regional Office for Europe developed a range of specific tools available that also include aspects of physical activity and sports, such as the HEPA Europe Network and the Healthy Cities Network. Hereafter a detailed overview of the implementation of policy actions in the WHO European Member States linked to the WHO Second Action Plan for Food and Nutrition Policy was given. The Provision of Free or Subsidized School Fruit and Vegetable schemes was mentioned by a large majority of countries followed by the implementation the food based dietary guidelines. Measures that affect food prices were the least referred as fully implemented. An overview was given in more details for the WHO European Member States with regards to the action on marketing restricting food and beverages to children. The need to address marketing as on online tool through different communication tools was also stressed during the presentation. International Association for the Study of Obesity (IASO) International Obesity Task Force (IOTF) Current IASO-IOTF advocacy work on marketing to children By Tim Lobstein, IASO-IOTF IASO-IOTF continues to develop its work in this area. A presentation on the StanMark project was given to the Network in Brussels, March The StanMark (Standards for Marketing of food and drink for children) project was part-funded with a grant from the External Relations Services of the European Commission, and comprised a series of meetings on policy and research during 2010 and 2011, along with the development of advocacy materials and services. Although the EU funding has ceased, the advocacy work continues with the following activities: (a) Monitoring the EU Pledge: a report was prepared on the gaps and weaknesses of the voluntary Pledge, A Junk-Free Childhood, which was published in June 2011 (available at 8

9 A follow-up report is being prepared for June (b) Monitoring news items on advertising of food and beverages to children: IASO assembles a weekly summary of recent media stories and other items relevant to marketing to children, which may interest Network members. It is distributed by at no charge, as part of IASO s weekly Obesity in the News service. To be included in the ing, please contact rleach@iaso.org. An archive of material from previous weeks is available on the IASO website, at (c) Maintaining a map of national actions: a searchable database is available at the IASO website but it depends on receiving information on new policies and actions by national authorities. Contributors should send details to rleach@iaso.org (d) Links to relevant policy documents: IASO maintains a library of publications and links to publications, including policy documents on marketing to children produced by national authorities, commercial bodies, NGOs and health-related organisations. See the library here (e) Monitoring recent scientific evidence: IASO maintains a listing of abstracts of published research on marketing food and beverages to children. The list of abstracts can be accessed here: Besides these activities, IASO continues to advocate for action by national and international authorities. It has contributed to the forthcoming WHO document A Framework for Implementing the Set of Recommendations on the marketing of foods and non-alcoholic beverages to children and is also contributing to a WHO European Region briefing paper giving an update on the situation in the region. This includes a review of the rapid rise in new technology and new media opportunities for marketing and the rise in children s exposure through these new media. Lastly, IASO is assisting in the establishment of a global network of researchers and advocacy organisations focusing on the monitoring of food and beverage industry activities. The network, to be called INFORMAA, is intended to support and enhance the work of WHO and Member States and will be launched before the end of Consumers International (CI) Status on implementation of the CI monitoring manual By Anna Glayzer, CI This year long project was funded by the Nuffield Foundation and commenced in September It was developed in consultation with a panel of international experts. The rationale came from the WHO Recommendations in May 2010, particularly Recommendation 12: Member states are encouraged to identify existing information on the extent, nature and effects of food marketing to children in their country. They are also encouraged to support further research focused on implementation and evaluation of policies. 9

10 The aim of the CI monitoring manual was to assist governments and civil society in the development of clear evidence of the exposure and power of marketing of foods to children, particularly in countries where little previous research has been done. Objectives were to provide guidance on suitable research designs for monitoring food marketing via different channels; to provide a framework for assessing marketing content and techniques that are appealing to children; and to give guidance on the type of resources required. The finished manual was published in September 2011 and distributed to CI members and beyond. Designed to be easily accessible, the manual set out to include core, expanded and desirable monitoring guidance to suit available resources, and country specific contextual factors. The manual could be used to help design systematic, comparative research in different countries, or to support more basic research. The manual is divided into two parts. Part 1 is a step-by-step guide to the theory and practice of monitoring, whilst Part 2 provides detailed consideration for monitoring specific channels: Television, print, food company websites, outdoor advertising, product packaging, and marketing in schools. Template coding forms were also developed and made available to download from the CI website. Six months after publication, a survey showed that 16 CI members are using, or planning to use the manual in the next year, with a further 10 likely to in the future. Current, recent or planned member activity was indicated in a number of countries including: UK, Netherlands, Germany, Malaysia, Fiji, India, Chinese Taipei, South Africa and Mexico. In the Netherlands in September 2011, CI member Consumentenbond published a major monitoring study of television, internet, magazines, product packaging, and leaflets and supermarket magazines. In Germany in Vzbv did a survey of toys in packages; or stickers; coupons and websites. Following strong lobbying from the Consumer Council of Fiji, the government is currently drafting legislations to limit food advertising to children. Work by El Poder del Consumidor (Mexico) includes a public denouncement of Coca-Cola, over a television advert featured children dressed as superheroes, arguing that the ad breaches Coca-Cola s own pledge not to target the under 12s. CI continues to encourage use of the manual, to collect and share work between its members and to highlight company doublestandards. CI is pushing for greater national government commitment to monitoring, and to implementation of the WHO recommendations, but emphasises that the lead must come from governments. 4 Update on research on food marketing By Jason Halford, University of Liverpool, the United Kingdom It has been established that the presence of logos and generic cartoon characters on food product packaging influences choice and intake. Recent data (Hebden et al., 2010) demonstrated that the nutritional profiles of products using promotional (brand equity) characters attractive to children on their packaging were significantly worse than those featuring sportspersons, celebrities or licensed characters (including movie tie-ins). With regard to licensed characters, recent experimental data suggest that their inclusion on packaging improves children s ratings of the product taste (Roberto et al., 2010; Lapierre et al., 2011). However this effect was weaker for carrots than for sweet or savoury 10

11 snack foods (Roberto et al, 2010), and was absent when the product (a novel breakfast cereal) was labelled as healthy, rather than sugary (Lapierre et al., 2011). Recent analysis of food industry websites has shown that advergames feature prominently. In a US study, Culp et al. (2010) conducted a website analysis focusing particularly on advergames. The websites selected were those featured on television adverts from popular children s channels including Nickelodeon and Cartoon Network. Links to websites were prevalent on adverts observed on both channels but far greater on Cartoon Network, a channel targeted at younger children. On the websites studied, online games were very prominent although contests and downloads were also commonly observed. Play-again options, access to higher levels, posting of high scores and opportunities to win free prizes were all used to keep children on individual sites for longer, to encourage repeat visits and to potentially get children to engage their friends with the material. In a similar Canadian website analysis (Brady et al, 2010), 24 previously sampled websites were examined and most were found to target children below the age of twelve. In addition to replicating findings of the US study, they noted half of these sites had a mechanism for children to recommend them to a friend. Brand and product imagery permeated all of these sites, with spokes-characters (brand equity) being by far the most common device. Brand logos appeared and were used to link to games, as game pieces, scenery and as game buttons. This is of some concern as recent data coming from the UK and Indonesia suggest this age group lack the ability to recognise advertising content on the internet compared to relative abilities with broadcast media. It is not necessary for children to be able to identify advertising/marketing for them to be influenced by it (Blades et al., 2009). A Swedish study employing state-of-the-art eye tracking (Sandberg et al., 2011) has recently demonstrated that while surfing the internet, food and beverage advertising had a relatively greater impact on attention than other forms of promotion. In this sample of adolescents, they were aware of the purpose of the advertising but could not recall their exposure to those adverts in the preceding eyetracking phase. Data from the UK shows children s use of broadcast media is near universal, although it is often being used alongside other forms of media also containing marketing content. The average television viewing time per week has increased from 2005 and is particularly high in the 4-9 age range (OFCOM, 2011). Data from the ongoing University of Liverpool analysis of broadcast media suggests that in 2010 (when full regulation was implemented) compared to 2008 (during which when partial regulation began) there has been a small reduction in overall food and beverage advertising. This is reflected in a reduction in the advertising of both core (healthy) and non-core (unhealthy) foods. However, the proportion of core versus non-core foods advertised remained constant, with an imbalance of the diet promoted weighted heavily towards foods with poorer nutritional profiles. Examining children-specific programming, there has been a clear fall in food advertising BUT during children s peak viewing time no reduction in food and beverage advertising has been seen. This may suggest that some advertising has moved to family viewing. In certain categories there may have been an actual rise in advertising during children s viewing (e.g., fast food restaurants). These have also increased during children s peak viewing time. A similar prevalence of fast food marketing has recently been reported in an analysis of Swiss children- specific programming (Keller & Schultz, 2011). In the US a rise in fast food advertising has also been seen during children s viewing (Powell et al., 2011). 11

12 With regards to parental influence, recent data from South Korea (Hyunjae, 2011) suggests that the more time parents spent viewing television with their children and the greater control they exerted over viewing, the more negative children s attitudes were towards advertising. However, in the absence of parental control, children whose parents expressed greater food and health concerns were far more likely to overeat when exposed to unhealthy food adverts (Anschutz et al., 2010). In conclusion, promotional characters appear particularly likely to feature on the packaging of unhealthy products. Licensed spokes-characters featuring on packets have also been shown to increase taste rating of an unhealthy cereal, vegetables, and sweet and savoury snack foods. Brandbased websites are commonly promoted during food adverts on children s channels, and on these sites advergames feature prominently. These are designed to increase children s interaction with the brand. With regard to broadcast media, this is still used extensively to promote unhealthy foods particularly during child and family friendly viewing. Parental viewing may negate the influence of food adverts but parental concerns may not be protective in the absence of the parent. Conflict of interest: The laboratory receives support from the BBSRC, MRC/NRPI, and EU Frame Work 7. These grants are focused on appetite control and weight management and funding within such schemes is dependent on the involvement of various Universities, SMEs and Industry Partners. The laboratory is a functional nutritional research facility and as such receives direct funding from the pharmaceutical, weight management, ingredients, and food industries for appetite research. Current research funders include the California Prune Board & National Starch. Companies engage the University in Consultancies related to weight management. The lab has recently ( ) advised Danone, Coca-Cola EU, and GlaxoSmithKline on health claims (substantiating claims on appetite control). No academic in the Laboratory takes any personal consultancy. All work engaged in on behalf of the University has to meet necessary institutional codes and standards. All research projects receive full independent review. 5 National activities related to food marketing to children, including the implementation of the WHO set of recommendations Denmark By Else Molander, the Danish Veterinary and Food Administration The assessment of the situation regarding marketing towards children in Denmark is that there is no marketing to children in schools and daycare centers and only very limited marketing to children on TV. The challenges are therefore mainly the continued marketing to children in cinemas and on new media (advergames, mobil phones etc.). The position of the Danish government on marketing towards children is that marketing of unhealthy foods to children should be eliminated, preferably through self-regulation if this is possible. However Denmark will support EU-regulation if selfregulation initiatives do not yield satisfactory results. Self-regulation in Denmark is driven by the private, self-regulatory initiative Forum of responsible food marketing communication (Forum for Fødevarereklamer) which includes a group of industry partners. The initiative was launched in 12

13 December The Forum has developed a code on food advertisements targeted at children: Code of responsible food marketing communication. The Danish government believes the self-regulatory code Forum of responsible food marketing communication has shown some measurable results, and thus for the present, specific actions are limited to following the development of marketing of unhealthy foods to children in Denmark. The future challenges in Denmark regarding marketing towards children are the following: Limiting marketing initiatives among companies/business that are not among the stakeholders in the relevant self-regulation initiatives. Expanding the scope of self-regulation initiatives to all relevant media including cinemas. Deciding which criteria should define which foods and beverages are deemed unhealthy. Norway By Joachim Nilsen, the Norwegian Ministry of Health and Care Services In March 2011, the Norwegian Government gave an interagency working group a mandate to consider the possible introduction of new restrictions on the marketing of food and beverages to children and young people. The working group includes the Ministry of Health and Care Services, the Ministry of Children, Equality and Social Inclusion, the Norwegian Directorate of Health, the Consumer Ombudsman and the Food Safety Authority. Some of the key issues to be investigated by the working group are: The extent of marketing of unhealthy foods to children and young people in Norway today Is there a need for new specific legal measures to protect children and young people from marketing of unhealthy foods in Norway? How to design possible new legal measures, including: o Which food products should not be marketed to children and young people? o How to define marketing directed at children and young people? o How to develop an appropriate system for surveillance and enforcement? The working group aims to present its recommendations to the Norwegian Government during spring The preliminary recommendations of the working group were presented at a meeting with Norwegian stakeholders at the end of February It must be stressed that these are just the recommendations of the working group and that they have not yet been approved by the Government. They include i.a.: A nutrient profiling model developed by the working group in order to serve as a basis to decide which food products should not be marketed to children and young people Regulations designed to define marketing directed at children and young people A description of the extent of marketing of unhealthy foods to children and young people in Norway today 13

14 Considerations of whether there is a need for new specific legal measures to protect children and young people from marketing of unhealthy foods and beverages in Norway Points 1 to 3 on the above list were explained to the network meeting by the Norwegian Directorate of Health and by the Consumer Ombudsman in separate presentations. The Ministry of Health and Care Services presented the considerations of the working group as concerns the question of whether there is a need for new specific legal measures to protect children and young people from marketing of unhealthy foods in Norway. On this issue, the recommendations of the working group are based on considerations related to: Public health The content of existing regulations and voluntary industry guidelines in Norway Industry support for the voluntary guidelines Surveillance and enforcement of the voluntary guidelines Implementation of WHO recommendations in Norway. As regards public health, the working group emphasizes that marketing of unhealthy foods takes place in Norway and that exposure to such marketing has an impact on the behaviour of children and young people. This is unfortunate in view of the facts that a significant weight increase has taken place among young Norwegians during the last 30 years, and that an unhealthy diet and overweight is a significant risk factor for a number of non-communicable diseases. Specific new regulations on the marketing of unhealthy foods are one measure among several which could contribute to counteract such diseases. In Norway, there are voluntary industry guidelines on the marketing of unhealthy foods to children. There also is legislation that covers some aspects of such marketing activities. In the view of the working group, neither legislation nor voluntary industry guidelines protect children and young people adequately against such marketing. The working group holds the opinion that industry support for the voluntary industry guidelines is unsatisfactory. Also, there is no system for surveillance and enforcement of the voluntary industry guidelines. As concerns the implementation of WHO recommendations in Norway, in theory this could be achieved both by a pertinent revision of the existing industry guidelines and by the introduction of new legal measures. The question is which approach would be most suitable in order to ensure appropriate implementation of the recommendations. The working group is skeptical to the possibility of significantly strengthening the voluntary industry guidelines. It holds the opinion that the introduction of new legal measures will be more expedient. The working group holds the opinion that these considerations indicate that there is a need to introduce new legal measures on the marketing of unhealthy foods to children and young people in Norway. 14

15 Norway, continued presentation By Anna Charlotte Amdal Neumayer, the Consumer Ombudsman The working group was asked in the mandate to give a description of the extent of marketing of unhealthy foods to children and young people in Norway today. The description should provide an overview of the marketing channels used, including: broadcasting, internet, magazines, in stores, at events, etc. The description should also say something about the scope of this marketing and provide specific examples. The methods chosen were observations by the working group, spot tests and small sweeps carried out in selected channels by the Consumer Ombudsman and a simple survey among a selected number of companies. The simple survey was carried out in November A questionnaire was sent to 42 large food and beverage companies suggested by industry representatives. The questionnaire was developed in dialogue with industry representatives, and consisted of questions about which marketing channels and means they had used in 2011 for which products and who was the intended target group. They were asked to describe their marketing of all food and beverages, and also to specify the intended audience for each marketing activity. Some main results from the mapping were presented. Other network countries All attending network countries gave short updates on national activities related to food marketing to children in their country. 6 Nutrient profiling Global coordination of Nutrient Profile Modeling By Nancy Aburto, WHO Headquarters The systematic 'describing' or 'categorizing' of foods based on their nutrient content has been formally practiced for over two decades. This activity has recently been defined as 'nutrient profiling'. The objectives of this presentation are to 1) introduce the concept of nutrient profiling; 2) provide background on WHO's global coordination of nutrient profiling; and 3) describe WHO's technical activities in nutrient profiling. WHO defines nutrient profiling as the science of classifying or ranking foods according to their nutritional composition for reasons related to preventing disease and promoting health. The general purpose of nutrient profiling is to generate descriptions related to the nutrient levels in foods or to the effects of consuming the food on a person's health. Nutrient profiling is a tool to describe foods based on their ability to contribute to a healthier diet, which could subsequently lead to better health. Nonetheless, one must recognize that diets are influenced by factors other than nutrient quality of food and health is influenced by factors other than diet. Additionally, nutrient profiling is concerned with nutrients and not other substances in foods such as pesticides or other potential concerns people may have about foods such as environmental sustainability and price. The 15

16 development of a nutrient profile model aspires to reach principles of efficiency, validity, transparency, and co-operativity. Nutrient profile models should have clear purpose; be evidence informed, rational, and logical; be developed systematically and with an openly available algorithm; and involve stakeholders in the development. WHO's work on nutrient profiling was initiated in WHO and international partners recognized that there was a proliferation of the ad hoc development of models resulting in numerous inconsistencies, confusion for the target audience and subsequent lost opportunity for further support for nutrient profiling. For these reasons, WHO began global efforts at harmonization of nutrient profiling through developing the guiding principles and a methodological framework for developing nutrient profile models. The goal of this work is to develop coordinated individual applications using nutrient profiling that may be integrated in coherent public health strategies. To reach this goal, WHO has developed the Guiding Principles and Framework Manual for the Development or Adaptation of Nutrient Profile Models. The manual is divided into two parts: 1) Background and guiding principles and 2) Framework manual for the development and adaptation of a nutrient profile model. Part 2 is further divided into technical modules: 1) Planning the development or adaptation of a nutrient profile model; 2) Step by step procedures for developing or adapting a nutrient profile model; 3) Validating a nutrient profile model; and 4) Implementation, monitoring and evaluation of applications involving nutrient profile models. WHO is currently undertaking field-testing workshops to put this manual into practice in Member States with the objectives of supporting nutrient profiling work in Member States and assessing the manual's relevance, understandability, and usefulness. WHO will update the manual based on feedback from the workshops with the aim of producing an effective tool for supporting Member States in developing or adapting nutrient profile models for use in public health nutrition interventions. Work on nutrient profiling in Norway By Arnhild Haga Rimestad and Britt Lande, Norwegian Directorate of Health, Norway The work on nutrient profiling (NP) is part of the ongoing work on food marketing in Norway (see chapter 5), where one of the key issues is to look into how to define foods and to propose a NP model for this purpose. The main responsible for the work on NP in the working group has been the Norwegian Directorate of Health in cooperation with the Norwegian Food Safety Authority. Several documents were explored, including national documents and reports on regulations, diet and health, the WHO set of recommendations and the draft framework for implementation, the WHO draft manual for NP models and documentation on other NP models and documents from the European Network (goal, Network Code). A part of the process was to explore existing models. Three models were selected as a starting point: 1. Nordic Keyhole - N-model 2. FSA/Ofcom model - UK-model 3. US-proposal, draft April

17 The working process included to see how these models classified about 60 foods on the Norwegian market. The results for all three models were compared and a list of pros and cons were made. When comparing the models, there were match for typical unhealthy products and discrepancies for several other food groups. Some information needed was not easily available or adaptable for all foods and there were some specific challenges for the three different models. For example in the USproposal, nutrient per portion (RACC) or serving is used; the N-model only identifies healthier food items and for the UK-model there were uncertain whether all score values could be directly adapted to Norway. The conclusions were that the US-proposal was not applicable and that comprehensive adoptions would be necessary for the UK- and the N-model. At this stage in the process, Norway was asked and agreed to be a test country in connection with WHOs work on the NP manual. A workshop was held in Oslo in December 2011 and gave valuable knowledge of the process of and steps in adapting or developing a NP model. Specific results and challenges for Norway, pros and cons of different models and adaption of existing models were discussed. On the basis of knowledge from the WHO workshop, results and lessons learned from the review of existing models and the subsequent discussions, it was decided to develop a simplified new model for defining unhealthy foods and beverages for the purpose of marketing restrictions to children. The focus should be on the typical unhealthy products rather than to define both healthy and unhealthy products. This would imply that the foods that were not defined as typical unhealthy by the use of the model, not necessarily would be defined as healthy. The principles and proposals for a step-by-step process for developing a nutrient profile model described in the WHO draft manual on NP models has been an important background document. A draft proposal for a new model (not finalized) was presented at the network meeting. The draft proposal defines typical unhealthy foods, is based on dietary challenges and recommendations and defines foods and beverages with high contents of nutrients that are connected with health challenges. In the draft model, typical unhealthy foods are defined as energy dense and nutrient poor foods which have a high content of fat, sugar and/or salt. Such foods are f. ex. sweet beverages, chocolate, sweets, cakes, biscuits, snacks, some breakfast cereals and unhealthy variants of fast food. Plans on nutrient profiling in Slovenia By Mojca Gabrijelčič Blenkuš, National Institute of Public Health of the Republic of Slovenia Existing nutrient profiling in Slovenia were first presented, e.g. the»protect your heart«sign from the Slovene Heart Association and the Guidelines for healthy nutrition in schools and kindergartens. The latter are defined in the School food law, and criteria of nutrition quality of school meals are given. Next, further plans on nutrition profiling work in Slovenia were presented. Slovenia has agreed to be a test country for WHO guiding principles and framework manual for the development or adapation of nutrient profile models. For Slovenia nutrient profile models are needed for the work on restricting marketing pressure to children and for a more general approach (general model) for further use (for instance, food taxation). The adaptation of one of the existing 17

18 models has been considered, but also a specific country model has been discussed. A systematic review of the models will not be done in Slovenia, but they will use the WHO overview. Important background sources in this nutrient profiling work include e.g. household budget surveys, national representative dietary studies among Slovene adults and adolescents and an evaluation of the School fruit scheme. A working group has been establised. The WHO inputs are very much appreciated. They strongly believe that action networks, together with the European network on reducing marketing presure on children, with all the member countries and observers are very supportive for the work at the national level, and that sharing good practices and common work is essential. Slovenia hope to be able to report on the developments at a next network meeting. 7 Different types of regulations Regulatory and voluntary landscape concerning food marketing in UK By Jane Landon, National Heart Forum, the United Kingdom This presentation reports on an analysis of current controls on food marketing to children in the UK including marketing practices, regulations, policies, commitments and proposals to identify their gaps and weaknesses. Current statutory and self-regulatory regimes and codes were identified and analysed as well as voluntary pledges and best practice guidance applicable in the UK. Examples of marketing techniques used to promote food and drink were also identified using a combination of a desk-based literature review and detailed content analysis of advertiser-owned websites and associated marketing activities. A gaps analysis shows that product packaging, point-of-sale promotions and sporting and cultural sponsorship are not presently addressed by either regulation or voluntary codes. Marketing techniques of product and brand integration in digital media, formulation and presentation of products (including colours, flavours and shapes), premiums and give-aways and use of equity-brand characters also fall outside any rules or codes. There are gaps and inconsistencies within and between the various rules and codes which reduce the potential level of protection for children and make it difficult for members of the public to understand what is permissible and how to make complaints about marketing that may be in breach. International agencies recommend action by national governments. If the UK government assumed this responsibility and chose to apply sufficiently inclusive definitions about what media and marketing techniques are covered, most of the gaps identified in this study (excluding cross-border marketing) could potentially be addressed. Self-regulation Voluntary Industry Initiative Prevents Advertising for Foods High in Fats, Sugar and Salt in Children s Media in Denmark By Mette Peetz-Schou, Forum for Responsible Food Marketing Communication, Denmark In Denmark a voluntary industry led initiative has proven successful in preventing children from exposure to advertising for foods with a high content of fats, sugar and salt. Organisations representing the entire advertising chain from the advertisers, retailers, advertising and media selling 18