By Modi Mwatsama
In May 2013, the World Health Assembly adopted the Omnibus Resolution on non-communicable diseases (NCDs). This landmark publication includes the global NCD action plan, goals and monitoring framework. It follows 20 months of negotiations by governments and global stakeholders after the United Nations High Level Meeting on NCDs, in 2011. Actions are included for each of the NCD risk factors and countries will be measured by their trans fat policies as one of the indicators of progress on diets. However, as NCDs are a new challenge in low- and middle-income countries, policy makers face a number of hurdles. These include few resources and not much evidence on what works in these settings.
The timely qualitative study by Colon-Ramos et al. contributes to the NCD evidence base by documenting and drawing lessons from the food policy experiences of low- and middle-income governments. Eating trans fats is a risk factor for NCDs. This study examines efforts to eliminate trans fats from the food supply in 13 countries across Latin America and the Caribbean. The countries report a variety of policy approaches, such as regulating trans fat levels in food, on food labels and in nutrient claims, and consumer education. However, the paper uncovers a number of challenges, from which I draw four important lessons for implementing policies in low- and middle-income countries:
- Global WHO initiatives stimulate country action: an important reminder for NCD advocates is the fact that global WHO and PAHO led initiatives are identified as key drivers of government action.
- Robust monitoring and surveillance is vital: the study exposes an absence of country-wide data on trans fat levels in food and on population intake levels. This makes it difficult to measure progress and policy effectiveness. It highlights a key role for academics. Colon-Ramos’s research in the Americas has found high levels of trans fats in selected foods and raised intakes in some groups. These studies also reveal discrepancies such as higher actual trans fat levels in foods than declared on the labels.
- Coordination and consistency are essential for progress: the countries have different definitions of trans fats (for example, whether or not they include both industrially produced and naturally occurring trans-fats). Other criteria also vary, such as for ‘trans-free’ labels. This makes it difficult to coordinate action across countries and benefit from economies of scale in areas like standardising food labels and monitoring progress.
- Civil society must hold stakeholders to account: countries identify inter-sectoral collaborations between government, industry and academia as essential components of the trans fat programmes. But a major gap is involving civil society actors. Civil society is known to have an important role in championing the public interest. This is done through awareness raising, advocacy, monitoring the activities of stakeholders and holding them to account. So their absence may be a further barrier to effective action.
The findings will be relevant to progress on dietary components that require similar approaches such as salt, saturated fats and sugars.
Modi Mwatsama is a Registered Nutritionist and Director of Global Health at the UK Health Forum.