Cyber claims: how do we protect public health nutrition within a rapidly changing food environment?

There exists an historically unprecedented number of food products available in the marketplace. And the pace of change is relentless. According to Nestle, 116 000 packaged foods and beverages have been introduced into the USA since 1990. (1) The concept of 'health' is a key factor stimulating this rapidly changing food environment and ongoing food innovation. It is unclear how much of this change is being driven by food manufacturers' supply and how much by consumers' demands. Either way, the core currency in this supply and demand environment is nutrition, health and related claims. Consumers are becoming increasingly reliant upon such food claims to inform their food selection. For food manufacturers, food claims are the oxygen for food innovation--if manufacturers could not make claims about their products, would they still innovate?

Protecting public health nutrition is a central debating point associated with nutrition, health and related claims. Some stakeholders argue that such claims will protect public health nutrition by helping to prevent chronic disease and substantially reducing health-care expenditure in Australia and New Zealand. Other stakeholders argue that such claims might place public health nutrition at risk by predominantly promoting highly processed foods, creating consumer confusion and dietary imbalances and, if they are more expensive, being less accessible to people on low incomes. The challenge is how do we regulate such claims to protect public health nutrition and provide the consumer with information that is accurate and not misleading?

Food Standards Australia New Zealand (FSANZ) has sought to address public health nutrition and consumer information concerns in its development of the new food standard for nutrition, health and related claims that is anticipated for release in early 2007. The Dietitians Association of Australia and the New Zealand Dietetic Association were two of the many stakeholders who provided detailed submissions in relation to the development of this standard. In establishing a framework for approving health claims, the new food standard will provide further impetus for food product innovation in the future food environment.

The rapidly changing nature of the food environment is not restricted to the burgeoning number of food products, or the types of claims associated with foods. Also changing is the medium for communicating claims. In their lead article, Dragicevich and colleagues report findings from their monitoring research examining the use of health claims on the Internet. (2) Although they did not find significant difference in the use of health claims on the Internet relative to more conventional media, it is a timely piece of research. The Internet is predicted to have at least two social impacts that will have a bearing on food claims in the next few decades. First, it is predicted that into the future people will progressively shift from conventional media to the Internet for information and entertainment (note: how effective will current advocacy efforts to restrict television advertising of food to children be if young people spend more and more time online?). Second, it has been predicted that people will gradually shift their food shopping to online purchases rather than physically visiting shops and supermarkets (although this prediction appears now to have been overstated).

The Internet presents novel challenges for food regulators and enforcement agencies. Despite food regulators' best intentions to protect public health and safety and avoid inaccurate and misleading information being communicated to consumers within Australia's and New Zealand's borders, the food environment increasingly is global in scale and nebulous in shape. Although people may purchase food locally, they may access their food and health information from websites that have no respect for national borders. Adding to these challenges is the ephemeral nature of information on websites and in cyberspace in general (how many email spam messages attempting to sell you something have you received lately?).

Dragicevich and colleagues conclude that in the future food enforcement will need to give greater priority to monitoring claims on the Internet. In principle, this is a sensible conclusion. In practice, enforcement in a rapidly changing food environment is no easy task. In developing the new health claims standard FSANZ has been required to work within the existing legal provisions. This presents dilemmas for regulating issues associated with emerging technological innovations such as the Internet. For example, in relation to whether labelling provisions associated with health claims apply to advertising, the Food Standards Code is relatively clear when it states in clause 13 of Food Standard 1.1.1 that,

  Advertisements for food must not contain any statement, information,
  designs or representations which are prohibited by this Code from
  being included in a label for that food. (3)

This statement clearly indicates that regulatory provisions for health claims extend to advertising. The dilemma is whether the definition of advertising extends to the Internet? Consider the following definition for 'advertisement' provided in the Model Food Act,

  Any words whether written or spoken, or pictorial representation or
  design, or any other representation by any means at all used or
  apparently used to promote directly or indirectly the sale of
  food. (4)

This is a very broad definition. How would you interpret the scope of the word 'indirectly' in relation to regulating food claims on the Internet? In the future, FSANZ may be required to provide guidance for enforcement purposes, for example decision making might come down to what consumers consider to be advertising.

This example illustrates the enigma of whether the food regulatory system proactively creates the framework for leading change or reactively follows change. If regulators regulate, does this mean that they cannot innovate? In the case of the present research into health claims on the Internet, clearly the regulator is not leading this component of the changing food environment.

Given this perspective of responding to rapid change, what should regulators do to protect public health nutrition and avoid inaccurate and misleading information being promulgated in the food environment? It is in this context that monitoring of the food environment is critical. Ongoing surveillance of food claims enables the regulator to learn what is happening and to be informed if a response is indicated.

The article of Dragicevich and colleagues draws attention to the importance for food regulators to be aware where people source their food and nutrition information and what is available. Increasingly, monitoring systems need to be flexible and adapt to the changing nature of the food environment if they are to accurately capture relevant information. In this instance, the importance of extending traditional surveillance of food labels and advertising to cyberspace is illustrated.

Monitoring and evaluation of health claims also is essential for providing the evidence base to inform specific public health nutrition policies. For example, currently the only permitted health claim in Australia and New Zealand is that communicating the relationship between folic acid intake and a reduction in the risk of neural tube defects. When this health claim was first approved as a public health nutrition policy intervention, one of its objectives was to provide an incentive to encourage food manufacturers to take advantage of voluntary folate fortification provisions and to inform consumers about this health relationship. Monitoring research has enabled this objective to be evaluated. The results indicate a very modest implementation of this health claim in 2005, raising doubts about its effectiveness as a public health nutrition intervention and suggesting modifications for its future use. (5)

From a broader public health nutrition perspective, regular surveillance will also need to address how potential health claims in general will be implemented in the marketplace. For example, which types of food products will be using health claims--is it predominantly highly processed food products or equally core foods? In this regard, it is interesting that Dragicevich and colleagues found that it was spreads that had the highest number of claims per product and energy drinks were the only food category for which an Internet claim was associated with all of that category's products. (Neither category is considered to be a core food group.) Also, it would be relevant for monitoring to assess whether foods that display health claims are more expensive than those foods that are compositionally similar but do not use health claims. If it is the more expensive foods that use health claims, the perception among consumers may be that spending more money is necessary in order to eat healthily.

With the new food standard for nutrition, health and related claims soon to be released, baseline- and then ongoing-monitoring of food claims on food labels, in advertising and in cyberspace will be core components for public health nutrition policy activities. Already there are food label surveys underway to monitor food claims on food labels by FSANZ (6) as well as collaborative research between Deakin and Wollongong universities.

In contemporary times it is axiomatic that one of the few constants in society is change. Food, being an integral component of society, is a powerful litmus paper of social change. When Australia and New Zealand harmonised their food regulations in the mid-1990s, they could not have predicted the influence within a decade of technological and global factors on the food environment. In another decade's time we can be confident that the food environment will be different from today. In terms of protecting public health nutrition in this rapidly changing food environment it will be critical that change is monitored so we know what is happening and can be informed to respond appropriately. Innovative surveillance systems will be needed to deal with innovative developments in the food environment.

ACKNOWLEDGEMENT

I acknowledge the helpful comments of Jane Allen, FSANZ, during the preparation of this Editorial.

Mark Lawrence, PhD, APD 

Senior Lecturer (Public Health Nutrition), School of Exercise and Nutrition Sciences

Deakin University, Burwood, Victoria, Australia

REFERENCES

1 Nestle M. Food Politics--How the Food Industry Influences Nutrition and Health. London: University California Press, 2002.

2 Dragicevich H, Williams P, Ridges L. Survey of health claims for Australian foods made on Internet sites. Nutr Diet 2006; 63: 139-147.

3 Food Standards Australia New Zealand. Food Standard 1.1.1, Clause 13--Application of Labelling Provisions to Advertising. Food Standards Code--Volume 2.Canberra: Information Australia, 2002.

4 Model Food Act. (Cited 28 Jun 2006.) Available from URL: http://www.foodstandards.gov.au

5 Lawrence M. Evaluation of the implementation of the folate-neural tube defect health claim Pilot and its impact on the availability of folate-fortified food in Australia. Aust N Z J Public Health 2006; 30: 363-368.

6 Food Standards Australia New Zealand. Overview on Food Label Monitoring Surveys. (Cited 30 Jun 2006.) Available from URL: http://www.foodstandards.gov.au/mediareleasespublications/publications/evaluationreportseries/foodlabelmonitoringsurvey/flmsoverviewfactshee3077.cfm