Implement mandatory targets for the public and private sectors for sodium, free sugar, and saturated fat in packaged, food service and restaurant foods and integrate FOP style labeling in restaurants and food service
Modify FDA regulations regarding fat content of animal products
Add polyunsaturated fat to the Nutrition Facts table
Extend the current Nutrition Facts table requirements to centrally prepared take away foods, baked goods and pastries, packaged sandwiches and salads, meat products, baby foods (in-store and internet sales)
Tax sugary drinks at manufacturing level (including caffeinated energy drinks)
Take-away healthy foods that meet a threshold are exempt from HST/GST
Grain and legume milling protocols to retain fibre
Implement mandatory targets for the public and private sectors for sodium, free sugar, and saturated fat in packaged, food service and restaurant foods and integrate FOP style labeling in restaurants and food service
Under the Food and Drugs Regulations, there are already composition targets for some packaged foods for infants and youth (Food-EPI Canada, 2017). The regulatory framework is in place to expand compositional targets. Following implementation of efficiency stage interventions, there should be less industry opposition to such targets and additional evidence to support the intervention. Compositional targets usually mean products have to be reformulated.
Targets and FOP-style labeling in restaurants and food service is more challenging to implement. Amendments would be required to provincial legislation comparable to the updated version of the Healthy Menu Choices Act of Ontario, discussed under Efficiency. The amendments would need to mirror the FDR changes, and to be consistent with Health Canada's Front of Pack requirements. For restaurants and food service the FOP equivalent information would have to be visible on menu boards, or counters, or on takeout packaging.
The inspection and enforcement process could be tied to municipal restaurant inspections, in some jurisdictions, but in most would be part of provincial responsibilities. In Ontario, restaurant inspections are carried out at the regional and local public health levels. Toronto has the DineSafe program, based on the provincial Food Premises Regulations which deal primarily with food safety matters, and additional municipal regulation. The regulations would need amendment to include inspection of signage. Alternately, the amendments could be part of the Healthy Menu Choices Act, although currently the legislation says inspectors can be appointed but doesn't explicitly link inspection to regional municipalities. In BC, regional health authorities are responsible. Vancouver Coastal Health has restaurant inspection reports online. Montreal carries out its own restaurant inspections, but the rest of the province is covered at the provincial level. For most other provinces and territories, restaurant inspection is provincial / territorial (for a breakdown, see this CFIA web site on restaurant inspection).
It makes sense to follow current practice around restaurant monitoring and inspection, so these changes would have to be implemented at both provincial and municipal levels in most provinces.
Modify FDA regulations regarding fat content of animal products
Many foods under the Food and Drug Regulations (FDR) are defined in part by their fat content. For many foods, maximum or minimum fat contents are named and if the food does not comply with those thresholds, enforcement action is warranted. It's clear that this is a residue of the anti-fraud orientation of earlier versions of the Food and Drugs Act (FDA).
By this stage, it should be feasible to make the FDR more coherent with the health promotion efforts of Health Canada's Healthy Eating Strategy. As highlighted elsewhere, there are issues of jurisdiction as governments move beyond relying on the criminal power for authority to intervene, but by this stage there should be sufficient precedence to warrant a focus on population health. Once Front of Pack labeling comes into force (see Goal 1, Consumer Information), and given the first Substitution proposal above, these FDA regulations should be revisited to better align with efforts to reduce nutrients of concern. As an example, ground beef can contain up to 30% fat by weight (FDR B.14.015C) and if set around that level will be close to, if not beyond, the FOP threshold for saturated fat (beyond the proposed 30% over DV for prepackaged meat). Sausage does not have an animal fat minimum or maximum in the regulations, but given that regular sausage is often in the 40% total fat range, it would normally exceed the FOP threshold for saturated fat and would have a warning label.
At the efficiency stage, FOP labeling will encourage firms to reformulate to avoid a FOP warning. But this approach is rooted in an individual responsibility framework for both firms and individual consumers. At the substitution stage, a more structural approach should be implemented, with fat maximum / minimums in the FDR set to prevent problematic levels of nutrients of concern to be in the food supply. Obviously, certain high fat foods have deeply cultural significance, and some exemptions might be required, but equally, food culture is a product of particular conditions and the conditions have changed, so more aggressive interventions are warranted. One of the criticisms of food capitalism is that it can't respect environmental and health boundaries (see, for example, Albritton, 2009), so its inability to self-regulate warrants these kinds of regulatory actions.
And with the proposed saturated fat threshold at 30% DV for prepackaged meat (double the threshold in other categories), at this stage it will be time to reduce the threshold progressively to 15%.
Add polyunsaturated fat to the Nutrition Facts table
Jeffery (2019a) argues that, given the health significance of polyunsaturated fat, it should be explicitly identified in the Nutrition Facts Table. A reduction in saturated fat intake is complemented by an increase in polyunsaturate consumption, more so than an increase in monounsaturates. Working from Global Burden of Disease data, he concludes that diets low in polyunsaturates have 5% of the attributable risk for diet related illness and death.
Currently, polyunsaturates, including omega-6 and omega-3 polyunsaturates, can be voluntarily included in the NFT, as can monounsaturates. It's important to note, however, that additional nutrition information beyond mandatory requirements is rarely used on Canadian foods, only 1.2% of products in 2013 (Franco-Arellano et al., 2019), so given such low uptake, this provision should be mandatory.
Extend the current Nutrition Facts table requirements to centrally prepared take away foods, baked goods and pastries, packaged sandwiches and salads, meat products, baby foods (in-store and internet sales)
A challenge for these food categories is the reduced level of uniformity in the preparation, when compared with most pre-packaged and processed foods. There also needs to be some precision about what qualifies as centrally prepared. However, many small to medium enterprises would be exempt because the food is prepared on site, not in a central commissary. Many of those would, however, at this stage be covered by menu labeling requirements.
Guidance would need to be provided on a reference batch from which Nutrition Facts would be derived. A higher degree of variability would need to be tolerated by regulators, since the products would vary somewhat batch by batch depending on cook and available ingredients. A warning phrase to that effect would also be important.
Tax sugary drinks at manufacturing level (including caffeinated energy drinks)
In combination with other measures, taxes on foods with high levels of added sugars (see Instruments, Taxes) have reduced consumption and provoked product reformulation, with over 50 jurisdictions worldwide implementing measures (Chalifour and Collin, 2019; Le Bodo et al., 2022). A core reason for taxing sugary drinks, compare to other so-called fat taxes, is that they are not nutritionally valuable, compared to basic items such as meat, eggs and dairy. In addition to compositional standards, the federal government would impose an excise tax on manufacturers unless added sugars are below a specified level. Canada has a long history of setting such taxes, including for beer, wine, spirits and tobacco. The primary targets for this initiative are candy, baked goods and sweetened beverages. Given some elasticity of demand for such products, the manufacturers will not be able to fully pass on the cost of the tax to retailers, food service providers and eaters, so the effects will be felt in many parts of the supply chain. Setting the level is critical, not so high as to cause immediate hardships for consumers, but high enough to encourage product reformulation. Other jurisdictions have set the tax at a wide range of rates. Heart and Stroke recommended 5 cents / 100 ml for beverages. Simulation modeling suggests a 20% tax would generate revenue of $1.7 billion/year and save $11.5 billion in health care costs over 25 years (Chalifour and Collin, 2019). This level is consistent with a range of international studies that have found taxes at this level and above reduce consumption significantly (Wright et al., 2017). A 2020 US modelling study of a one cent / ounce tax found the intervention to be highly cost effective for both government and society and over a lifetime to prevent 22,075 new cancer cases and 13,524 deaths (Du et al., 2020). A related modeling study of tax impacts on heart disease and diabetes also found major reductions in disease incidence, significant cost savings and cost effectiveness for governments (Lee et al., 2020).
As with the current federal carbon tax, the federal government could pursue a model whereby provinces impose their own tax and if they do not, a federal tax applies. Revenues raised federally could be earmarked for a mix of federal and provincial income support programs (see Goal 1) and provincial revenue could be allocated within the province as a way to address equity concerns about the tax. Newfoundland and Labrador, the province with the highest consumption of sugary beverages / capita and with the lowest consumption of water, is the first province to implement a wholesale tax at 20 cents / litre. Revenue, projected at $9 million / year, will go to physical activity, pre-natal nutrition and school food programs.
Take-away healthy foods that meet a threshold are exempt from HST/GST
In the spirit of reducing taxes on healthy foods, some adjustments are needed to the HST/GST policy. Currently, prepared meals sold in retail establishments are generally excluded from zero rating. But those that meet health targets as defined by algorithms (see Goal 1, Consumer information) should have a zero rating. Such a change might also encourage product reformulation to have more prepared meals qualify for a zero rating.
Grain and legume milling protocols to retain fibre
Under the Safe Food for Canadians Regulations, Organic, the organic standards, including processing, are referenced. The standards specify permitted processing techniques and aids. A similar approach can be taken to improve fibre retention in non-organic goods. For government procurement, procurement officers would preference products certified to meet these protocols. With the pressure of a shift in government procurement policy, industry associations would need to establish the protocols and authentication procedures for their members in order to meet the requirements. This builds on some current voluntary health association certification schemes that identify foods higher in fibre. The reduced processing will also result in higher retention of other nutrients, although it can also alter digestibility. The effects of various milling and related techniques on nutritional parameters is relatively well characterized (cf. Oghbaei and Prakash, 2016), so the challenging is constructing protocols that meet multiple nutritional objectives. There are also taste, preparation and shelf-life implications, so combining this with other measures as discussed under Efficiency will be important.
