Efficiency - Information

Introduction

Promoting health

Promoting sustainability

Introduction

In the next few sections, we identify strategies to move us in a new direction, starting from the current dominant regulatory instruments for informing consumers: definition of food terms, product labels, Point of Purchase (POP) information, and advertising. Clearly, other consumer education vehicles are available and promoted, but these are not currently regulated as significantly by the state (see Goal 3). As well, traditional instruments related to information do not represent the most profound interventions that the state can muster (Howlett, 2005), but in the current political environment, it is unlikely that Canadian governments will engage in more direct and forceful regulatory action. Our focus is on currently regulated measures that could advance population health and sustainability in the food system. Our presumption is that the state will need to proactively intervene, sometimes with the help of other policy actors, to create regulatory change to optimise the value of the emerging “citizen-consumer” phenomenon. This is admittedly challenging, as the state does not typically respond to emerging phenomena in this way. A more common response is to wait until a significant mass of consumers (and some NGOs and businesses) are demanding changes before moving incrementally towards these demands or, when the scientific evidence is so overwhelming that action can not be delayed any further. Such response tracks are currently being followed by the federal government as it holds consultations on its Healthy Eating Strategy.

Promoting health

Modifying healthy eating guidelines, product labels, shelf talkers and advertising

Healthy eating guidelines

The guidelines have been at the centre of Canada's nutrition promotion approach since arguably the 1930s. But they have been controversial, largely because of the influence of Canada's agrifood sector on health recommendations. In other words, it is clear from the historical record (Fowke, 1946; Ostry, 2006) that the animal industries have had significant influence on dietary recommendations relative to the health evidence. Revisions since the 2000s, however, have in part been designed to counter this influence. Health Canada is again revising the current guidelines that have been in place since 2007. They believe that the health evidence has not changed very significantly, but that some modest updating to the guidelines is required, particularly related to saturated fat and sugars. The main focus appears to be on the communication side of the guidelines, looking for ways to make them easier to apply. New guidelines and related information were released in 2018 and 2019 associated with the new national food policy (see blog posts). They're also in consultation with First Nations, Inuit, and Metis peoples about healthy eating tools specific to their needs and hope to release these tools in 2019. Although the new guidelines are thought to be more affordable for low-income people under certain circumstances, there remain questions about affordability (cf. Charlebois, 2019).

Product labels

The citizen consumer concept is predicated on the idea that eaters have purposes beyond self-maximizing consumption. Canada’s consumer information system has historically been rooted in fraud prevention and the assumption that self-maximizing information makes markets work efficiently. Capitalist markets presume that individual self-maximizing behaviour is also optimal for social welfare, however, this is not always the case in food markets. But self-maximizing behaviour can have larger public benefits. Individuals closely following nutrition labels may improve their health, reduce morbidity and mortality and contribute to reductions in public health care costs. However, our interest here is more in how food information can progressively contribute more directly to public maximizing activities. We devote most of our remaining analysis to these limitations in the current system, rather than a more detailed critique of the self-maximizing challenges of current information rules.

In Canada, product labels usually provide information on the company, the name of the product, nutrition information, a list of ingredients, sometimes the product grade, its origin (and sometimes Canadian status), and occasionally (only a limited number are permitted) claims about the health value and nutrient function of the food. As discussed above, consumers rely extensively on product labels for information, but although there have been recent improvements in several of these areas, others remain sub-optimal. As well, little information on the food production process ­and possible contaminants is provided.

A recent global meta-analysis of food labeling impacts found reductions in consumption of nutrients of concern and changes in firm behaviour to provide better information (Shangguan et al., 2019). Yet, such evidence still appears to be insufficient to provoke more profound regulatory interventions that would drive desirable manufacturing changes.

Nutrition labels are the most direct information linking consumer health and product purchasing. In earlier periods, nutrition labeling was not mandatory in Canada, except in cases where a specific nutritional claim was being made. Where labeling was provided, it was often incomplete, and/or difficult for the consumer to read and interpret. Regulations introduced in 2003 made nutrition labels mandatory in Canada for all prepackaged foods (with some exceptions) in Dec. 2007 (Health Canada, 2008). For large manufacturers (those with more than $1 million in sales/year) an earlier deadline was imposed, Dec. 2005 (CBC, 2007).

Health Canada estimated at the time that this new nutrition labeling could help save as much as $5 billion in tax dollars over the next 20 years through a reduction in rates of diet-related diseases such as cancer, diabetes, and heart disease because of dietary improvements among the population (CBC, 2007). Analysis by Jeffery (2019a) suggests, however, that this is a serious underestimate of the savings that can result from improved nutrition labeling.

The new labels contained a Nutrition Facts Table with a standard format that listed information on calories and 13 ingredients (fat, saturated fat, trans fat, cholesterol, sodium, carbohydrate, fibre, sugars, protein, vitamin A, vitamin C, calcium and iron) in standard units [16]. The table also listed the % Daily Value of these ingredients, which is the proportion of the daily recommended intake of the ingredients (as determined by Health Canada) that exists in the food. The Nutrition Facts Table has recently been updated, with a 5-year phase in for industry starting in 2017 (regulatory amendments to the Food and Drugs Act were published in December 2016). Some of the changes improve readability, others provide additional nutritional information and attempt to make serving sizes more realistic and consistent. And trans fat labelling will not be required after Sept 15, 2018 as Health Canada has announced a ban on transfats associated with processing. Unfortunately, no changes have been made to daily values for sodium, which according to significant scientific opinion are 50% too high (Sodium Working Group, 2010). Health Canada is, however, running a consultation on sodium reduction in the food service industry. Sugar also remains excessively high according to the World Health Organization and the labels do not distinguish added sugars (see Goal 4, Reducing consumption of nutrients of concern).

The new regulations also control the nutrient content (e.g. fat-free) and disease risk reduction claims (e.g. A diet rich in vegetables and fruit reduces the risk of some types of cancer) and therapeutic health claims that can be made. Nutrient content claims can only be made in cases where the amount of the ingredient in question meets a regulated standard. Diet-related health claims are only allowed, with stipulations, in relation to 16 combinations of foods and their proven health benefits.

The 2007 label changes were a notable improvement on the previous ones. As Health Canada stated, “Prior to these regulations, nutrition labeling was optional with a few exceptions. The format of the table (the way it looked) was not consistent, and if nutrition labeling was provided, information was given on only a few nutrients. Not all nutrient content claims were regulated and the criteria for some of the existing claims did not reflect the latest science. Diet-related health claims were not allowed in Canada, before these regulations” [Health Canada, 2003].

There remain, however, some exceptions that limit the utility of the labels in certain food categories. Nutrition information is not usually provided for fresh meat, poultry, seafood, fruits, and vegetables. There are exceptions in the fat and cholesterol labeling regulations which means that not all foods are required to display their contents in a Nutrition Facts Table. Foods which are not required to display the Table include (but are not limited to) (CFIA Guide to food labeling):

• A variety of cow and goat milk products sold in refillable glass containers
• Raw meat and poultry (unless it’s ground)
• Raw fish and seafood
• Food sold only in the retail establishment where it is prepared and processed from its ingredients
• Individual servings of foods that are sold for immediate consumption (e.g. sandwiches or ready-made salads)
• Clerk-served foods which are packaged at the time of sale (these are exempt from having any label at all since they are not considered “prepackaged”).

The last three exceptions are important ones since they mean that nutrition information is not available for fast foods (donuts, french fries, hamburgers), one of the greatest sources of calories, saturated and trans fats in the Canadian diet. Certain provinces (BC, MB, ON) have enacted legislation requiring some nutrition information be displayed in the restaurant. And some firms have voluntarily decided to provide nutrition information to those who request it and the CFIA provides guidance on what information to provide (CFIA). The first three in the above list are also of concern since animal products are often high in fat.

Serving size information has been confusing, but the new phased-in rules will have regulated reference serving sizes. This will bring Canada more in line with some other jurisdictions that impose more stringent rules upon the food industry.  There are also calls to provide comparable "number of standard drinks" labelling on all alcohol containers, yet to be enacted.

Ultimately, in terms of population health objectives, Canadian product regulations make it difficult for consumers to understand how to relate individual nutrient levels to overall diet requirements that optimize health. The link between, for example, nutrition labels and Canada’s Healthy Eating Guidelines is not direct except in some specific cases. However, Health Canada has finally adopted Front of Pack labels for sugar, salt, and saturated fat that industry must implement by 2026. Government-sponsored Front of Pack programs have been implemented in at least 12 countries, including the United Kingdom, Chile, Ecuador, and Australia (Hobin et al., 2017)

The proposals have largely been embraced by health groups and NGOs, but heavily contested by the food industry. The debate revolves around the clarity of the labels, with health groups favouring a stop sign approach for when ingredients surpass designated levels and industry looking for a less aggressive label. Jeffery (2019b), however, argues that the focus on three nutrients of concern is too limiting for FOP labels and calls for an algorithm that integrates the best scientific evidence across a range of ingredients and nutrients that are both protective and harmful of health.

Efficiency stage changes required:

1. Remove nutrition labeling exemptions so that product or shelf labels are required for currently exempt fresh foods and for many fast food items.

2. All provinces should enact restaurant labelling schemes that comply with the voluntary guidelines of the CFIA.  Ontario will have to expand its requirements to meet the guidelines (see Goal 4, Nutrients of Concern), BC and Manitoba will also have to expand and shift from a voluntary program to a mandatory one

3. The Front of Pack labels needs to be revised to a green - yellow - red symbolism for saturated fat, salt, and sugars.

4. Continue to improve sugar information by reducing daily target value and  distinguishing added sugars from the total (see Goal 4, Nutrients of Concern)

5. Change the Daily Target Value for sodium to 1500 mg (see Goal 4, Nutrients of Concern).

Ingredients listings - food additives, processing and storage products

Product ingredients have received some attention from consumers over the years, in part because of media reports about health problems associated with specific ingredients, particularly preserving agents, food dyes, flavour enhancers, and fat and sugar substitutes.

Current ingredient list rules specify that ingredients be “ingredients must be listed in descending order of proportion by weight, as determined before they are combined to make the food. The exceptions are spices, seasonings, and herbs (except salt), natural and artificial flavours, flavour enhancers, food additives, and vitamin and mineral nutrients and their derivatives or salts, which may be shown at the end of the ingredient list in any order.” [CFIA food labelling for industry]. In other words, the way in which these components are listed is not consistent with other components.  Unfortunately, in contrast to many other jurisdictions, Canada does not require Quantitative Ingredient Declarations (QUID).

Other exceptions of importance include:

• not all prepackaged multi-ingredient foods require an ingredient list, including those packed from bulk at retail “(exception: mixed nuts, and meat products packed by a retailer which contain phosphate salts and/or water)” [CFIA food labelling for industry];
• prepackaged individual portions served with meals or snacks by a restaurant or airline or servings prepared by commissaries and sold in canteens or vending machines; and prepackaged meat or poultry products or by-products barbequed, roasted or broiled on the retail premises.
• certain foods and classes of foods may be listed by class names (rather than specific names) including vegetable oil,  flavour and artificial flavour, spices, and milk ingredients.
• many foods when used as ingredients of other foods are exempt from a declaration of their components including many fats, sweeteners, jams, and flours unless the components belong to a determined list of allergenic ingredients (such as MSG, aspartame, peanut oil)” added [CFIA  food labelling for industry].
• certain food preparations and mixtures, including flavours and seasonings, are exempt from a declaration of most of their components.

Many of these exemptions appear to be for the convenience of the manufacturer.

Changes required:

6. Remove ingredient listing exemptions and add the functions that non-nutritive ingredients play in the food product (e.g., preservative, emulsifier, etc).

7. Implement QUID on all packaged goods (as of 2013, less than 3% of packaged goods had QUID, Franco-Arellano et al., 2019).

 Point of Purchase

POP materials have been used in-store for years by manufacturers for a number of purposes:

• to bring consumer attention to a new product;
• to encourage brand switching by offering a cents off coupon for purchase; to encourage trial of a partner product (may include a coupon);
• to promote a family of brands through a consumer contest;
• to encourage increased product purchase through coupon ad pads (often requiring multiple purchases or for next-time purchase);
• to encourage increased usage through alternative product uses (e.g. baking soda for cleaning carpets);
• to improve shelf presence in a brand category where there are many competitors;
• to promote a new product benefit.
• to advertize to children (e.g., animal and cartoon displays and toy giveaways) resulting in increased consumption of problematic foods (Minaker, 2023)

Using POP to deliver nutrition and health messages has been a much rarer phenomenon. The dominant views of POP marketing constrain the development of nutrition messages. According to this view, the consumer’s attention in a store is only retained for a few seconds, so the message on any promotional/educational material needs to be short, with a small number of very legible words to communicate the message (e.g., ad pads). The store is not the best place for educating, but it can be used to remind people of something or to direct people somewhere else for more information.  To be effective, the material needs to stand out from the products it will be placed beside and “grab” people as they walk by.

Delivering health messages is not the same as product promotion. But the traditional POP experience suggests that design and placement of promotional materials will be critical to their success. Some rethinking of traditional approaches will be necessary as these have been less successful at changing purchasing behaviour [39]. Where there have been some successes in changing actual purchasing patterns, shelf labels have been involved, with the following characteristics:

• bold, easy-to-see graphics
• writing at a grade 6/7 level
• shelf price labels with nutrient information right on it
• choose more often/choose less often categories

Retailers are unlikely to be willing to pay for such materials, given how POP has traditionally generated additional profits. Manufacturers are unlikely to pay, as health messages will not be product specific, and would likely focus more on less processed foods.

On the positive side, many retailers and manufacturers will see participation in a health program as part of being good corporate citizens. They may recognize that generic promotion of fruits, vegetables, complex carbohydrates and dairy products will be positive for store and product reputations. Well respected health organizations (Canadian Cancer Society, Canadian Heart and Stroke Foundation) have subsequently participated in third-party endorsement programmes. The regulations pertaining to third party endorsements of retail food products are outlined in CFIA’s Food Labeling for Industry, “Pictures, Vignettes, Logos and Trademarks”. These regulations were created for organizations that provide health and nutrition information for a single food item or brand, but not to groups or classes of food.  The food label must clearly explain the reason for the third party's name, statement, and logo. However, the policy was not designed for environmental claims, but could presumably be applied as long as it wasn’t confusing to consumers (Louden and MacRae, 2010).

Some private shelf-talking systems, such as Guiding Stars, that echo dimensions of the FOP approach, are being used voluntarily by retailers and manufacturers. There is some evidence that these systems, limited as they are compared to a full FOP set of initiatives, have still produced modest reductions in consumption of nutrients of concern and more fibre and polyunsaturates (Hobin et al., 2017).

Changes required:

8. Use more shelf talkers/ad pads in supermarkets as health promotion vehicles. Ad pads can work well when used to remind consumers of a campaign that they would already be familiar with through another medium (e.g. television, direct mail or outdoor advertising), when the pads are placed next to the product of the campaign and when the message contained on the ad pad (and its “look”) is consistent with that of the familiar campaign. Once FOP is implemented, POP materials should echo FOP information.

9. Banning POP displays designed to attract children to low quality foods.

Advertising (with significant contributions from Marchese and Mihaly, 2022)

Although advertising can contribute to market efficiency by providing consumers with information, it can also be part of an insidious process of misinforming and partially informing the public (Singer, 1986). Advertising promotes the feeling that happiness is associated with the purchase of goods and services. It shifts consumer focus from needs to wants by redefining basics needs as wants. It proposes consumption as a cure for anxiety and fear, and redefines serious social issues as personal problems that can be solved by buying products (Wallack and Montgomery, 1992). It often reduces food literacy by encouraging consumers to eat convenience foods, eat out, or buy in. Many ads by restaurants and home delivery companies disparage cooking or propose relief from a manufactured tedium. There are few ads for eating fresh food, cooked from scratch, at home because in general such circumstances do not make money for most food firms. The costs of such misinformation have been borne by the public, directly in product prices, and indirectly in lost government tax revenues, because advertising expenses have regularly received preferential tax treatment (McQuaig, 1987). The public and taxpayers also bear the costs of ill-health that result from consumption of many of these products. Some studies have suggested that advertising is not often cost-effective, and that it con­tributes to waste, monopoly, and higher prices (Singer, 1986). When responding to calls to restrict advertising, the advertising industry has argued that its influence is overestimated. This would appear to be a disingenuous argument. If advertising is not effective in influencing people's choices, then why would companies spend money on it? The food and media industries have opposed changes in Canada because of the financial losses they would experience, resulting in dilution of regulatory proposals (cf. Krashinsky Robertson, 2019).

Although advertising regulations exist, the focus is on preventing fraud and not on the provision of full product informa­tion. As well, Canadian regulations have been weakened over the past few decades. It used to be that food commercial scripts and preferably storyboards had to be reviewed in advance by Industry Canada and it had the authority to request modifications and even reject commercials. Advertisers could not make changes without resubmitting. A recommendation for the prevention, treatment or cure of a disease or ailment would not be permitted unless approved by Health Canada (Consumer and Corporate Affairs, 1988). In the late 1990s, responsibility shifted to the advertising industry, through Advertising Standards Canada (formerly the Canadian Advertising Foundation). Advertisers are guided by their industry Code of Ethics which states that “no commercial message containing a claim or endorsement of a food or non-alcoholic beverage to which the Food and Drugs Act and Regulations apply may be broadcast unless the script for the commercial message or endorsement has been approved by the Food and Beverage Clearance Section of Advertising Standards Canada and carries a current script clearance number” (CFIA 45). As well, there were no mandatory requirements for review of print advertising.  Labels could voluntarily be submitted to the federal government for advice. Regarding advertising to children CFIA rules only relate to breakfast cereals, whereby ads cannot present exaggerated energy or physical skill claims nor give the impression that cereal is a complete breakfast (CFIA, 2014). This fits within their general anti-fraud approach.

The motivation for these changes was clearly economic and not related to public health needs. And decision makers could not claim there was no evidence to suggest this was a poor decision as it has been known at least since the 1980s that particular forms of advertising influence dietary choices, particularly among young people (Taras et al., 1989). “Evidence shows that exposure to food advertisements significantly and directly affects consumption of fattening food by both children and adults” (Engelhard et al., 2009:41). A meta-analysis concluded that food marketing to children strongly influenced preferences for the advertised products and increased dietary intake (Sadeghirad et al. 2016; see also Prowse, 2017).

Not surprisingly, these changes have not been positive for children's exposure to unhealthy food ads (Marchese and Mihaly, 2022):

• children under 12 are exposed to over 25 million food and drink ads per year, 90% for processed foods and drinks high in sugar, sodium, and fat (Chai, 2017).
• industry nutritional standards are set too low, and their viewing thresholds too high (Potvin Kent et al., 2012; 2018).
• companies continue to advertise “better-for-you” products that still include unhealthy or junk foods brands.
• multiple studies have shown that this voluntary industry initiative is insufficient (Potvin Kent & Wanless, 2014; Potvin Kent et al., 2012; 2018). Children’s exposure to ads before and after the implementation of industry self-regulation actually increased in Toronto and Vancouver for snacks, yogurt, and fast food ads, but decreased in soft drinks, juices, cheese, and sweets (Potvin Kent et al., 2018).
• Potvin Kent and Wanless (2014) found that after weakening of the regulatory regime, food ads decreased on children's channels but increased on generalist stations, resulting in an overall increase in children’s exposure.
• children's social media exposure to low quality foods continues to increase despite industry claims to improved self regulation (Potvin Kent et al. 2022)

Québec has for many years banned food advertising targeted to children under 13 (Quebec Consumer Protection Act, QCPA). Viewership thresholds are set at 15%,  higher  than any industry standard in the rest of the country. The QCPA has influenced the macronutrient profile of foods advertised to children -  lower in carbohydrates and sugar, and higher in protein and fat (total and saturated) (Potvin Kent et al., 2012). Quebec also has the highest fruit and vegetable consumption levels and the lowest rates of obesity among children under 12 (Restrict food and beverage marketing to children., n.d.). Francophone young adults in Québec were 38% less likely to purchase fast food than their Ontario counterparts (Dhar & Baylis, 2011). Nonetheless, even with all these positive aspects, there are still some weaknesses that can be taken as lessons for future legislation:

• the nutritional quality of food ads are still not in line with nutritional guidelines.
• doesn’t protect against advertising on packaging or at storefronts. Potvin Kent et al. (2012) found that banning advertising directed at children has not stopped children from seeing unhealthy food and drinks. Ads directed at teens or adults even at prime child viewership times is acceptable under the QPCA as long they’re not child directed products (e.g. candy). Thus, children are still exposed to unhealthy food and drink ads even in Quebec, albeit at a much lower rate.
• the Act cannot prevent cross-border advertisements which requires federal intervention

Quebec being the exception, Canada is clearly behind on this issue. At least 50 countries now regulate television advertising aimed at children, including the UK, Norway, Chile and South Korea, and the World Health Organization has identified it as a major concern (Shelley and McPhail, 2019). 

Changes required:

10. The conclusion for many is that current advertising generally runs counter to government efforts to promote healthy eating. The federal government should implement measures such as those in place in Quebec since 1980 through their Consumer Protection Act, with improvements as proposed here. Attempts to implement national legislation that builds on the Quebec experience have so far been unsuccessful. Private member's bill C-313 proposed amendments to the Broadcasting Act. but it did not pass first reading in the 2015-19 Parliament. Senate Bill S-228, the Child Health Protection Act (CHPA), was introduced in 2016 as an amendment to the Food and Drugs Act (FDA), prohibiting food and drink advertisements directed at children under 13 years old. It successfully passed through all three readings in the Senate and successfully passed all the stages at the House of Commons, but with proposed amendments redirected to the Senate. It died on the order paper in 2019. Campbell and Green Raine (2019) attributed this result to “a few senators who used government procedures to defer a final Senate vote”.

There may be hope for the revival of this bill since Trudeau’s Mandate Letter to the Minister of Health in 2019 stated the importance of restricting ads targeting children, which could potentially open a new policy window (Mulligan et al., 2021). Bill C-252 passed second reading in Sept 2022, but Marchese and Mihaly (2022) suggest that it should have been designed more closely around Senator Greene Raine’s original proposal prohibiting all food and drinks ads directed at children under 17. Because of weaknesses in Canada's Food and Drug regulations and Canada's Food Guide, this is probably a better approach than attempting to use nutrient-based advertising restrictions which could be more readily challenged in court (cf. Jeffrey, 2017:4). It may also be more viable as a government-sponsored bill in the House.

This approach would likely survive a charter challenge (Shelley and McPhail, 2019).